MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model

Abstract

BackgroundPatients with cardiac pacemakers and defibrillators are disadvantaged because of poor access to MRI scans, leading to late and misdiagnosis particularly for cancer and neurological disease. New technology allied to tested protocols now allows safe MRI scanning of such patients; however, logistical barriers persist.AimTo deliver a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs).MethodsPatients requested a ‘one-stop’ service for MRI, whereby devices could be reprogrammed and scans acquired at a single location and visit. To provide this ‘one-stop’ service, we trained a team including administrators, physicians, cardiac physiologists and radiographers. A standard protocol was used to prevent unnecessary request refusals and delays to scheduling. Service volume, waiting time and safety were analysed 6 months before and 2 years after service redesign. Waiting times for internal and external inpatient referrals plus time to treatment for patients on a cancer pathway were analysed.Results215 MRI scans were performed over 2 years. After service redesign, MRI provision increased six-fold to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events. Departmental throughput was maintained. 85 (40%) referrals were external. 41 (19%) inpatients were scanned, reducing bed-stay by 3 days for internal referrals. 24 (11%) scans were for suspected cancer, 83% allowed treatment within the national standard of 62 days. There was no preintervention service for either inpatients or suspected cancer investigation.ConclusionImplementation of a ‘one-stop’ service model to provide MRI for patients with CIEDs is safe, streamlined, scalable and has reduced delays making economic and clinical sense. Protocols and checklists are available at mrimypacemaker.com.

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

“…US data suggests that patients with CIEDs are between 40 and 50 times less likely to be referred for MRI than they should be, and refusal rates for non-clinical reasons (logistical/financial/ access) remain high [24,25]. Similar experience has been reported in Ireland, Italy, and the UK, with 73% reporting delays in receiving appointments [26][27][28][29]. In an Italian prospective questionnaire study, 39% of patients with CIEDs were denied MRI scans.…”

“…The impact on decision-making is remarkably high [33,37], but is limited to the experience of a few centers [26]. The consequences of not performing these scans can be devastating, particularly for cancer, half of transient ischemic attacks or spinal cord compression-where delayed diagnosis and travelling great distances for an MRI scan are particularly unwarranted [29]. Change must therefore be implemented rapidly.…”

“…MRI scans for patients with CIEDs have also been redesigned into dedicated lists, whereby all necessary staff are present. This however involves reaching across standard silos of practice in a hospital, but facilitates easy decisionmaking and improving confidence (particularly at the early stages of setting up a service) [29].…”

MRI in patients with cardiac implantable electronic devices: A comprehensive review

“…If no such records exist, there are a few radiological markers which may help in the identification of MRI conditional system 130 . Industry or FDA published lists of MRI‐conditional components may be useful to be present in the evaluation room where these patients are evaluated 131 . Recently a new neural network‐based system of identification of cardiac rhythm devices has undergone validation, which accurately identified the manufacturer in 99.6% of the cases and model in 96.4% of the cases 132 .…”

“…There have been several recent publications suggesting different safety protocols for carrying out an MRI in patients with CIED 11,12,94,123,130,131,134–136 . The overall idea of the protocol is as summarized in Figure 3.…”