Creating a Clinical Interventional MRI Service

Abstract

The expansive technological developments that occurred over the past decades have clearly moved the field of Interventional MRI beyond the arena of the "proof of concept" to a viable option for minimally invasive diagnosis and therapy. State-of-the-art MRI technology can currently be employed to identify an occult target pathology, confidently steer an interventional device into complex anatomy, accurately deliver a device, drug, or energy, and/or monitor the real time effect of a treatment. Implementing a full-scope interventional MRI service requires substantial physical and conceptual modifications of the traditional diagnostic MRI environment. As such, it is essential to recognize that interventional MRI does not only involve the actual MRI-guided interventional event but should rather be perceived as a whole foundation of technology, development, set-up, conceptual training, and an institutional culture that realizes the opportunities offered by and understands the challenges and limitations of MRI-guided interventions. At Emory University, we had the privilege to build a de novo interventional MRI suite and to subsequently operate a high volume clinical interventional MRI service. The Emory program was launched with the goal of establishing a destination site for a comprehensive clinical service of MRI-guided interventions. The experience gained and the lessons learned are shared with the readers in this article.

MRI-Guided Cardiac Catheterization in Congenital Heart Disease: How to Get Started

“…CMR technologists require training and practice to refine real-time protocols and switching between pre-selected views required for real-time guidance of interventional procedures [36,37]. Reaching out to other services who may wish to use an interventional MRI-suite including interventional radiology, neurosurgery and other surgical sub-specialties can help to build momentum and expand applications to benefit overall patient care [38]. The entire team should be invited to give input on design of potential iCMR facilities.…”

Guideline Implementation: Design and Maintenance of the Surgical Suite

“…The OR personnel participated in simulation activities to provide input to the members of the design team about user‐friendly work stations, lighting, and storage . A subspecialty team was created to help design the new MRI suite, including space requirements, built‐in safety structures, and specialized equipment and lighting . After multiple simulated walk‐throughs, the subspecialty team members established a semirestricted and a restricted zone for this space.…”

“…They included traffic patterns as a part of the simulation and addressed how patients will enter the MRI suite. Team members helped determine the final layout of the planned area based on the procedures that will be performed and how this space will be shared by surgical and diagnostic services …”

Real‐time device tracking under MRI using an acousto‐optic active marker

“…Minimally invasive image-guided interventional catheterization procedures have been displacing many major surgical procedures. [1][2][3][4] Interventional procedures allow accurate diagnosis and treatment thanks to precision guidance to the abnormality via real-time visualization while reducing cost, 5,6 recovery time, 7 pain, 8 and risk to patients 9,10 who would otherwise need open surgery. Recently, MRI emerged as an attractive medical imaging alternative to fluoroscopy, which is traditionally used for image guidance since MRI has superb soft tissue contrast and does not use ionizing radiation.…”

“…Minimally invasive image‐guided interventional catheterization procedures have been displacing many major surgical procedures 1‐4 . Interventional procedures allow accurate diagnosis and treatment thanks to precision guidance to the abnormality via real‐time visualization while reducing cost, 5,6 recovery time, 7 pain, 8 and risk to patients 9,10 who would otherwise need open surgery.…”