Cardiac implanted electronic devices and MRI safety in 2018—the state of play

Shulman, Ryan; Hunt, Ben

doi:10.1007/s00330-018-5396-0

Cited by 24 publications

(14 citation statements)

References 21 publications

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“…Specific conditions can be found in manufacturer device check tools. The use of SAR may be unreliable in the presence of a CIED, and so manufacturers are moving towards reporting a more precise measure of energy deposition, the root mean square value of the B1 field (B1+RMS) [32].…”

Section: Mri Scanning Conditionsmentioning

confidence: 99%

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

et al. 2019

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More than half of us will need a magnetic resonance imaging (MRI) scan in our lifetimes. MRI is an unmatched diagnostic test for an expanding range of indications including neurological and musculoskeletal disorders, cancer diagnosis, and treatment planning. Unfortunately, patients with cardiac pacemakers or defibrillators have historically been prevented from having MRI because of safety concerns. This results in delayed diagnoses, more invasive investigations, and increased cost. Major developments have addressed this-newer devices are designed to be safe in MRI machines under specific conditions, and older legacy devices can be scanned provided strict protocols are followed. This service however remains difficult to deliver sustainably worldwide: MRI provision remains grossly inadequate because patients are less likely to be referred, and face difficulties accessing services even when referred. Barriers still exist but are no longer technical. These include logistical hurdles (poor cardiology and radiology interaction at physician and technician levels), financial incentives (re-imbursement is either absent or fails to acknowledge the complexity), and education (physicians self-censor MRI requests). This article therefore highlights the recent changes in the clinical, logistical, and regulatory landscape. The aim of the article is to enable and encourage healthcare providers and local champions to build MRI services urgently for cardiac device patients, so that they may benefit from the same access to MRI as everyone else. Key Points • There is now considerable evidence that MRI can be provided safely to patients with cardiac implantable electronic devices (CIEDs). However, the volume of MRI scans delivered to patients with CIEDs is fifty times lower than that of the estimated need, and patients are approximately fifty times less likely to be referred. • Because scans for this patient group are frequently for cancer diagnosis and treatment planning, MRI services need to develop rapidly, but the barriers are no longer technical. • New services face logistical, educational, and financial hurdles which can be addressed effectively to establish a sustainable service at scale.

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Section: Mri Scanning Conditionsmentioning

confidence: 99%

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

et al. 2019

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“…The time-varying gradient magnetic field present during image acquisition may lead to peripheral nerve stimulation, cause acoustic noise, and/or affect implants. When MR safety standards are adhered to, peripheral nerve stimulation can be kept below the level of concern [8], and injury due to acoustic noise [6,9] or harmful induction of electrical currents in implants, such as pacemakers, can be prevented [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Swedish national survey on MR safety compared with CT: a false sense of security?

et al. 2019

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Objectives The objectives were to survey MR safety incidents in Sweden during a 12-month period, to assess severity scores, and to evaluate the confidence of MR personnel in incident-reporting mechanisms. Method Data were collected within a web-based questionnaire on safety in clinical MR environments with CT for comparison. Data reported MR and CT safety incidents (human injury, material damage, and close calls), incident severity, and confidence of participants in incident-reporting systems. ResultsThe study population consisted of 529 eligible participants. Participants reported 200 MR and 156 CT safety incidents. Among MR incidents, 16% were given the highest potential severity score. More MR workers (73%) than CT workers (50%) were confident in being aware of any incident occurring at their workplace. However, 69% MR workers (83% for CT) were not aware of reported incidents at their hospitals. Conclusion Safety incidents resulting in human injury, material damage, and close calls in clinical MR environments do occur. According to national risk assessment recommendations, risk level is high. Results indicated that MR personnel tend to a false sense of security, as a high proportion of staff members were sure that they would have been aware of any incident occurring in their own department, while in reality, incidents did occur without their knowledge. We conclude that false sense of security exists for MR. Key Points • Safety incidents in clinical MR environments still result in human injury and material damage.• Severity level of MR incidents-assessed using Swedish national risk assessment recommendations-is high.• Confidence of MR personnel in incident-reporting mechanisms is high, but reflects a false sense of security, as a high proportion of staff is unaware of reported incidents in the same workplace.

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“…Herein, we offer a practical standard CMR protocol for beginners designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines [1][2][3][4][5][6][7][8][9] and includes sequence terminology used by vendors, essential MR physics [10][11][12][13][14][15][16][17], imaging planes [2,18], field strength considerations [19][20][21][22][23][24][25], MRI-conditional devices [10,20,[26][27][28][29][30][31][32][33], drugs for stress tests [34], various CMR modules [16,[35][36][37][38][39][40][41][42][43][44][45]…”

Section: Introductionmentioning

confidence: 99%

Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 1: Standardized Protocol

Kim

Park

et al. 2019

Cardiovasc Imaging Asia

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Cardiac magnetic resonance (CMR) imaging is widely used in many areas of cardiovascular disease assessment. This is a practical, standard CMR protocol for beginners that is designed to be easy to follow and implement. This protocol guideline is based on previously reported CMR guidelines and includes sequence terminology used by vendors, essential MR physics, imaging planes, field strength considerations, MRI-conditional devices, drugs for stress tests, various CMR modules, and disease/symptom-based protocols based on a survey of cardiologists and various appropriate-use criteria. It will be of considerable help in planning and implementing tests. In addressing CMR usage and creating this protocol guideline, we particularly tried to include useful tips to overcome various practical issues and improve CMR imaging. We hope that this document will continue to standardize and simplify a patient-based approach to clinical CMR and contribute to the promotion of public health.

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Cardiac implanted electronic devices and MRI safety in 2018—the state of play

Cited by 24 publications

References 21 publications

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

Making MRI available for patients with cardiac implantable electronic devices: growing need and barriers to change

Swedish national survey on MR safety compared with CT: a false sense of security?

Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 1: Standardized Protocol

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