mri-pacemaker

MRI Scans, Pacemakers, and Implantable Cardioverter-Defibrillators: New Safety Evidence

Patients with pacemakers and implantable cardioverter-defibrillators (ICDs) may safely receive magnetic resonance imaging (MRI) testing according to a study from the New England Journal of Medicine. Currently, implanted devices must meet the Food and Drug Administration’s criteria to be considered MRI-conditional. The pacemakers and ICDs that do not meet these requirements are considered legacy devices, and the federal government considers them unsafe for MRI scans. However, the new study proves that, with adherence to protocols, patients with legacy devices can safely receive MRI scans.

 

The study followed over 1500 patients with implanted devices.

 

The prospective, nonrandomized study followed 875 patients with pacemakers and 634 with ICDs. All patients had implanted devices that were considered legacy devices —  that is, they did not meet the requirements of the Centers for Medicare & Medicaid Services (CMS). Researchers from the University of Pennsylvania performed MRIs on the patients only when it was deemed clinically necessary.

 

The scans were done under strict protocols with physicians on hand to monitor patients. Tachyarrhythmia functions were disabled on the machines and pacing modes were appropriately adjusted on the devices.

 

“We found MRI examinations to be safe in the setting of legacy cardiac pacemakers or ICD systems, when using a safety protocol,” lead study author and University of Pennsylvania professor Saman Nazarian told Cardiovascular Business. “The scans were safely performed even when performing thoracic or cardiac MRI and with patients that were dependent on cardiac pacing for every heartbeat.”

 

A previous study from MagnaSafe found similar results for non-thoracic scans.

 

The MagnaSafe Registry is a multi-center study attempting to determine how safe MRIs are for patients with pacemakers and ICDs. They published findings several years ago that upended the traditional view that MRIs were too dangerous for patients with legacy devices. With similar results to Nazarian’s study, MagnaSafe found that there were almost no clinically relevant problems caused by the scan.

 

This is hugely important because many people with legacy implants are denied MRI scans by Medicare and Medicaid. While doctors may then order computed tomography (CT) scans, MRIs are better at diagnosing certain diseases, particularly in the brain and spinal cord. Nazarian said that if a patient with a legacy device needs an MRI, they should contact a medical center that can safely conduct the scan.

 

“Many centers across the U.S. are capable of performing safe imaging despite your device,” Nazarian said to Cardiovascular Business. “MRI can be instrumental in providing the right data for appropriate treatment planning in the setting of many neurologic, cardiac and musculoskeletal disorders as well as malignancies.”

 

The results from the two studies offer compelling evidence that MR technology is safe for those with implanted legacy devices.

 

According to Robert Russo, a doctor in the MagnaSafe study, more than half of patients with implanted devices will eventually need an MRI. Replacement with an MRI-conditional device is not an option, as the complication risks are too high. Therefore, it’s important to determine the safety of MRI scanning for patients with these legacy devices.

 

The above studies show how MRIs pose minimal risks while bestowing life-saving advantages for those who need scans. The FDA and CMS have not changed their regulations in light of the findings, but the evidence is mounting that they should consider doing so.

 

References:

 

Getting an MRI if you have a pacemaker. Harvard Health Publishing. August 2015;Web. Available from: https://www.health.harvard.edu/heart-health/getting-an-mri-if-you-have-a-pacemaker

 

Nazarian S et. al. Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices. The New England Journal of Medicine. December 2017;377:2555-2564. doi:10.1056/NEJMoa1604267

 

Slachta A. MRIs proven safe for patients with with FDA-unapproved implantable devices. Cardiovascular Business. January 2018;Web. Available from: http://www.cardiovascularbusiness.com/topics/electrophysiology-arrhythmia/mris-proven-safe-patients-fda-unapproved-implantable-devices

 

10 MRI Technologists’ Rules for MRI Safety

5 Sep 2017 MRI ,

Technologists, radiologists, and facility staff all work hard to ensure MRI safety for every patient they treat. Still, some patients get nervous at the prospect of having their first-ever MRI scan.

 

Really, diagnostic imaging’s reputation for risk comes from X-rays, which expose patients to a minimal amount of ionizing radiation. Despite this, X-rays are generally safe — and if a doctor orders an imaging procedure, the patient should always comply. Medical professionals weigh the risk versus the benefit before ordering any intervention.

 

But X-rays are one thing. MRI scans don’t expose patients to any radiation at all. They’re extremely safe. The machinery can be intimidating — people don’t tend to relish the idea of sliding into a narrow tube that looks like something out of a Star Trek episode — but the scan itself is harmless, and the resulting images save lives every day.

 

If you or a loved one are about to get your first MRI scan, and you’re feeling nervous about it, we thought a few safety rules that your technologists and radiologists will follow will make you feel better. Health care professionals are trained to keep patients safe above all else, and they make sure to minimize the already-infinitesimal risks involved with MRI scans by observing important safety rules. Here are a few of the practices that imaging professionals will use to keep you safe and comfortable during your MRI scan:

 

  1. They will ensure that you don’t have any metal devices or implants on your person.

 

MRI scans create a strong magnetic field around the patient. That’s not dangerous in itself, but it does become important to ensure that no ferromagnetic metals enter the scanning room. Even nonmagnetic metals can interfere with the magnetic field, or heat up and cause burns. Facility staff screen patients for any type of metal, including that found in medical implants such as aneurysm clips.

 

  1. If you do have implanted medical devices, they will insure that they are safe for the scan before you get anywhere near the imaging suite.

 

Medical implants are designated as MR Conditional, MR Safe, or MR Unsafe. Your health team will check the rating of any medical implants you have, compare the specs to those of the scanner they’ll be using, and determine whether the scan is safe to proceed.

 

  1. They will double-check every object that enters the scan room for MRI safety.

 

The working assumption is that anything imaging staff don’t have a record of is MR Unsafe. The screening process can be quite involved, but it’s also fairly quick.

 

  1. They will ask you to change out of your clothes and into a facility-provided, MR-safe gown.

 

Even the small amount of metal embedded in many items of clothing can heat up dangerously, or disrupt scans. The safest option is to ask patients to change into an MR-safe gown.

 

  1. They will help you lie in the MRI machine in a way that avoids skin-to-skin contact.

 

MRI scanners use blasts of electromagnetic radiofrequency waves to create images of the body. This energy is generally safe, although if patients maintain skin-to-skin contact during the scan, they could create a conducting circuit at the point of contact. Current might heat up the skin, causing burns. That’s why MRI technicians are always careful to help patients find a comfortable posture that doesn’t involve any skin-to-skin contact. They may provide insulating pads for this purpose.

 

 

  1. They will route all equipment cables straight outwards from the machine, and won’t allow them to touch each other or the patient.

 

Imaging technicians are extremely careful with all electrically conductive materials, including cables that are part of the scanning process. Cables that are too close to another conductor — including the patient’s skin — can transfer energy through capacitive coupling, so staff route cables very carefully.

 

  1. They will provide padding and blankets that are certified MRI-safe.

 

Patient comfort is second only to patient safety. Still, it’s important to ensure that everything entering the MRI suite is MR-safe. Imaging facilities stock comfortable blankets and nonconductive padding to ensure patient comfort during the scan.  

 

  1. They will always use the lowest amount of radiofrequency power sufficient to obtain a clear image — a measurement known as the Specific Absorption Rate, or SAR.

 

The SAR is a measurement of radiofrequency energy that passes through the patient’s body during an MRI scan. Higher levels can cause electrical conduction in the patient’s tissues, causing heat. If this goes on long enough, it can lead to burns. However, technologists always use the lowest possible SAR for a given scan, generally preventing dangerous warming.

 

  1. They will remain in constant communication with patients throughout the entire scan.

 

The most powerful tool to prevent injury during MRI scans is patient self-reporting. Technologists keep lines of communication open with patients throughout the entire process. That way, if a patient starts to feel uncomfortable, or feels skin heating up, they can report to the technologist, who will halt the scan until they address the situation.

 

  1. They will monitor patients during the scan with video and audio signals inside the machine’s bore.

 

Imaging staff won’t just wait for patients to tell them if they experience discomfort. They also carefully monitor their patients, watching for signs of distress. At the first sign of concern, technologists will pause the scan and make sure the patient’s safe and comfortable.

 

MRI Safety Along Every Dimension

 

These safety rules come courtesy of the U.S. Food and Drug Administration and the Section for Magnetic Resonance Technologists. This ensures that each tip has been tested, retested, and verified before being added to the list of best practices. The FDA and the SMRT both follow evidence-based science to make their recommendations.

 

Of course, there is one hazard to a diagnostic imaging procedure that neither the FDA nor SMRT can prevent: Overcharging. Hospitals often charge exorbitant fees for MRI scans.

 

Luckily, the FDA and SMRT aren’t the only ones looking out for patients. Independent imaging centers, such as those in the BestPriceMRI.com network, commit themselves to offering the highest-quality MRI scans at the lowest-possible prices. They are able to do this because they are specialists; hospitals have to create enough revenue to cover enormous facilities, multiple specialized departments, and hundreds or even thousands of employees.

 

The diagnostic imaging centers you’ll find on BestPriceMRI.com follow lean business practices to keep prices to an absolute minimum. At the same time, they only employ certified, industry-leading radiologists — the same ones hospitals use — and state-of-the-art equipment. It’s a high initial expense, but once the newest, best MRI scanner is installed in a facility, BestPriceMRI.com facilities are able to stay solvent through the steady stream of business that comes from quick, convenient appointments, doctor-preferred results, and excellent patient care.

 

Trust your technicians and radiologists to keep you safe during your next MRI scan. And trust BestPriceMRI.com to get you the lowest price you’ll find, along with a convenient location and a time of your choosing — even on evenings and weekends, if you prefer.

 

Contact BestPriceMRI.com at 888-322-7785 to make your appointment today.

 

References:

 

Magnetic Resonance Imaging (MRI) Safety.RadiologyInfo. Radiological Society of North America, Inc., 5 Apr. 2017. Web. 1 Sept. 2017.

 

Magnetic Resonance Imaging: Tips for Scanning Patients with Implants.FDA. U.S. Food and Drug Administration, Section for Magnetic Resonance Technologists, n.d. PDF. 1 Sept. 2017.

 

MRI Burn Prevention: Tips for Keeping Patients Safe.” FDA. U.S. Food and Drug Administration, Section for Magnetic Resonance Technologists, n.d. PDF. 1 Sept. 2017.

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