Employer:
Inland Imaging, LLC
Inland Imaging Associates, PS
Inland Imaging Business Associates / Policy Number: / Page:
1/1
Subject:
Cardiac Pacemakers / MRI Examination / Date Originated:
7/24/08 / Last Revision
Category:
Patient Care Policy / Approved By:
IIAPSBoard on:

PURPOSE:

To provide MRI examinations on patients with cardiac pacemakers.

DESIRED OUTCOME:

To minimize the risk of complications and / or physical deterioration in patients that has an implanted cardiac pacemaker and requires an MRI examination.

POLICIES:

1. Consideration should be given to perform these MR examinations only in the hospital setting.

1. Establish and document risk-benefit ratio for the patient.

2. A radiologist will review a recent CXR for pacemaker lead electrical conductive loops or fractured

wires to avoidburn risk of surrounding tissue.

2. Obtain written informed consent.

3. Cardiologist should decide if it is necessary to reprogram the pacemaker before and after the MRI

examination and should be in attendance for the entire study.

4. Attendance of a representative from the electro-physiology lab is highly recommended.

5. Attendance from a representative of the pacemaker manufacturer is highly recommended.

6. A person with expertise in MR physics and safety should be involved with the scan to optimally plan

the scan to minimize risk.

7. MRI examinations should be scheduled in advance and coordinated with all of the above entities.

PROCEDURE:

Pre-scanning steps outside of the MRI environment:

  1. Pretest pacemaker functions and if applicable, reprogram to “asynchronous mode.” If ICD device is present, disable “therapy and detection for tachycardia/bradycardia modes.”
  2. Appropriate personnel and a “crash cart,” including a defibrillator, must be available throughout the procedure.
  3. Instruct the patient to alert the MR system operator of any unusual sensation or problems.

Steps taken during the MRI examination:

  1. The patient’s heart rhythm and vital signs should be monitored throughout the MR examination.
  2. The MRI operator will enter the MR environment slowly to avoid deflection of the cardiac device.
  3. Maintain visual and voice contact with the patient throughout the procedure.
  4. Use only the brain transmit / receive coil to minimize gradient magnetic field risks.
  5. MRI examinations should only be performed at a maximum of 1.5 Tesla.

Post-scanning steps outside of the MRI environment:

  1. An electrophysiological expert should interrogate the pacemaker function and reprogram as needed. If patient has an ICD device, the EP expert should perform device reprogramming and defibrillation threshold testing.

SPECIAL CONSIDERATIONS:

Two technologists should be present during these examinations to maintain safety in the MRI environment should emergency intervention be required during the MRI examination.

Make and model of the pacemaker should be thoroughly examined as these devices contain metal with variable ferromagnetic qualities, as well as complex electrical systems, and additionally consist of 1 or several leads implanted into the myocardium.