MRI and Patients with Non-MRI-conditional Cardiac Devices: Further Evidence of Safety

Radiographer training for screening of patients referred for Magnetic Resonance Imaging: A scoping review

INTRODUCTION

Strict safety practices are essential to ensure the safety of patients and staff in Magnetic Resonance Imaging (MRI). Training regarding the fundamentals of MRI safety is well-established and commonly agreed upon. However, more complex aspect of screening patients, such as image review or screening of unconscious patients/patients with communication difficulties is less well discussed. The current UK and USA guidelines do not suggest the use of communication training for MRI staff nor indicate any training to encourage reviewing images in the screening process. This review aims to map the current guidance regarding safety and patient screening training for MRI diagnostic and therapeutic radiographers.

METHODS

A systematic search of PubMed, Trip Medical database and Radiography journal was conducted. Studies were chosen based on the review objectives and pre-determined inclusion/exclusion criteria using the PRISMA-ScR framework.

RESULTS

Twenty-four studies were included in the review, which identified some key concepts including MRI safety training and delivery methods, screening and communication, screening of unconscious or non-ambulatory patients and the use of imaging.

CONCLUSION

Training gaps lie within the more complex elements of screening such as the inclusiveness of question phrasing, particularly to the neurodivergent population, how we teach radiographers to screen unconscious/unresponsive patients and using imaging to detect implants.

IMPLICATIONS FOR PRACTICE

The consequences of incomplete or inaccurate pre-MRI safety screening could be the introduction of unexpected implants into the scanner or forgoing MRI for a less desirable modality. The development of enhanced training programs in implant recognition using imaging and communication could complement existing training.

PET/MRI, Part 1: Establishing a PET/MRI Facility

The emergence of PET and MRI as a hybrid modality has generated widespread interest in the technology and techniques. Although adoption and use are unlikely to be as expansive as for PET and CT hybrid systems, PET/MRI is an important modality that requires broad insight for nuclear medicine professions generally and deeper insight for those engaged in PET/MRI practice. This article provides insight into the considerations and challenges associated with establishing a PET/MRI facility. Each clinical site will present unique requisites for establishing a PET/MRI facility, and indeed, each PET/MRI vendor will have specific site requirements. Nonetheless, this article provides general insight into common considerations but should not be considered exhaustive. Here, development of the facility, staffing of the facility, and implications of both radiation and MRI safety are considered from the context of facility design. Given that the nature of PET is well established among the readership of this journal, the article provides an emphasis on MRI factors. This article is the first in a 4-part integrated series sponsored by the PET/MR and Publication Committees of the Society of Nuclear Medicine and Molecular Imaging-Technologist Section. In the subsequent 3 parts, PET/MRI will be explored on the basis of technology principles (part 2), protocols and procedures (part 3), and applications and clinical cases (part 4).

Patients' knowledge, perception, and experience during magnetic resonance imaging in Ghana: A single centre study

INTRODUCTION

The Magnetic Resonance Imaging (MRI) environment has the potency of inducing anxiety, panic attacks, and claustrophobia in patients with some patients describing it as being placed in a long confining tube. Therefore, having patients that are well-informed concerning the diagnostic tests they are about to undergo can contribute to these patients experiencing reduced anxiety, greater satisfaction, and participation in their care which is key in gaining patients' cooperation and compliance during imaging procedures such as MRI. This study purposed to assess patients' knowledge, perception and experience when undergoing MRI examination.

METHODS

A prospective quantitative approach was adopted for the study and was conducted in a leading teaching hospital in the Greater Accra region of Ghana. The study involved patients who were referred to undergo MRI examination from June to December 2019. Primary data was collected using closed-ended questionnaires as the research tool. The researchers self-administered and explained the details of the questionnaire thoroughly to all the patients.

RESULTS

Two hundred and four (51%) out of the 400 respondents were males as compared with 196 (49%) females. The most common age group was 41-60 years with a total number of 156 (39%) participants. 120 (30%) indicated they were schooled on MRI by family and friends, 88 (22%) by their referring clinicians, and 65 (16%) indicated other health personnel as their source of knowledge. 228 (57%) indicated that MRI is not safe for pregnant women, 130 (32.5%) indicated it was whilst 42 (10.5%) were not sure. 208 (52%) of the respondents believed MRI can cause cancer, 140 (35%) responded that it does not whilst 52 (13%) were not sure. Also, 312 (78%) indicated that their doctors did not inform them about the use of the contrast medium.

CONCLUSION

The study revealed that majority of the respondents were schooled on MRI by family and friends instead of their referring clinicians. Most of these family and friends may not necessarily be qualified health personnel which accounted for more than half of the respondents having a misconception that MRI causes cancer similar to other ionizing imaging modalities. The study further revealed that some referring clinicians did not educate their patients on requested MRI examinations causing radiology staff to spend more time educating them resulting in a decrease in productivity.

IMPLICATIONS FOR PRACTICE

The study will bring to bear the gaps in patient's knowledge concerning MRI which will help referring clinicians and radiology staff adopt strategies to ensure that patients are well educated on MRI examinations they have been referred to undertake. This will in effect reduce the time spent by radiology staff in educating and gaining patients' compliance during such examinations resulting in a decrease in waiting and scanning time leading to an overall increase in workflow.

Safety and Clinical Impact of MRI in Patients with Non-MRI-conditional Cardiac Devices

Purpose

To explore the safety and clinical utility of MRI in participants with non-MRI-conditional cardiac implantable electronic devices, by establishing the Patient Registry of Magnetic Resonance Imaging in Non-Approved DEvices (PROMeNADe).

Materials and Methods

From September 2015 to June 2019, 532 participants (211 women) with a mean age of 69 years ± 14 (standard deviation) were enrolled prospectively in the PROMeNADe registry (ClinicalTrials.gov identifier: NCT03081364) and underwent a total of 608 MRI examinations (61 cardiac MRI examinations). All participants had device interrogations performed before and after each MRI. Pacemaker-dependent patients received asynchronous pacing. Patients with an implantable cardioverter defibrillator (ICD) had tachycardia therapies disabled during the MRI. An electrophysiology nurse monitored participants for any hemodynamic or rhythm abnormalities. Referring physicians were surveyed regarding the clinical utility of the MRI. Standard descriptive analyses included summary statistics with percentages and means.

Results

Cardiac devices included pacemakers (46%), ICDs (30%), cardiac resynchronization therapy (CRT) pacemakers (4%), and CRT defibrillators (17%), as well as abandoned leads (2%). Pacemaker-dependent patients comprised 27% of all MRI examinations. There were no patient- or device-related complications. Clinical utility surveys of MRI examinations were completed by 150 physicians. According to the survey responses, these MRI examinations changed the suspected diagnosis 25% of the time and changed suspected prognosis in 26% of participants, with planned medical or surgical treatment being changed 42% of the time.

Conclusion

This registry demonstrates that MRI examinations, including thoracic MRI examinations, can be performed safely in patients who have non-MRI-conditional devices, in pacemaker-dependent patients with ICDs, and in patients with abandoned leads. These MRI examinations can have a substantial impact on patient care, justifying the extensive resources used to perform them.Supplemental material is available for this article.© RSNA, 2020See also the commentary by Peshock in this issue.

MR Safety: Active Implanted Electronic Devices

New implanted medical devices continue to be made available for treatment of medical conditions. Many recipients can benefit from the diagnostic power of MR imaging. Provisions must be made to determine if these patients can be safely scanned. Metal-containing devices can be considered either MR unsafe or conditional. It is essential that all components of an implanted system are completely and accurately identified, with the most restrictive MR safety condition dictating the scanning approach. MR safety considerations for major classes of implanted devices are discussed, recognizing that there have been reports of serious device-related MR safety incidents.