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Patients with cardiac devices should not be excluded from MRI scans, say experts

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3623 (Published 22 August 2018) Cite this as: BMJ 2018;362:k3623
  1. Zosia Kmietowicz
  1. The BMJ

Patients fitted with a pacemaker or an implantable cardioverter defibrillator (ICD) are missing out on prompt diagnosis of a range of conditions because they are being prevented from having magnetic resonance imaging (MRI) scans owing to safety concerns, cardiologists and radiologists have said.

Only one in 50 patients with a cardiac device who need an MRI scan is currently given one, as pacemakers and ICDs have both traditionally been seen as contraindications.

But this assumption is no longer valid and needs to change, said a statement from the British Cardiovascular Society and the Clinical Imaging Board (the Society and College of Radiographers, the Institute of Physics and Engineering in Medicine, and the Royal College of Radiologists).1

These patients “should no longer be disadvantaged and have the same access to MRI scanning in the NHS as everyone else,” they said. The statement emphasised that it was now industry standard for implantable cardiac devices to be “MRI conditional,” meaning that over 95% of devices currently implanted are safe to scan under certain conditions.

Evidence has also shown that older “non-MRI conditional” devices can be scanned safely if predefined protocols are followed, it added.

James Moon, clinical director of imaging at Barts Heart Centre in London, said, “It’s a medical scandal that these patients do not get their scans. One problem is patients have been told they can never have an MRI—advice that is now wrong.

“Thanks to extensive research, we now know we can scan almost all—over 99%—of them safely; there are just a few we cannot. Not having an MRI scan, for example if cancer or a stroke is suspected, is highly detrimental. Now we are working on that—but change is slow.”

About 440 000 people in the UK have a pacemaker or implantable cardioverter defibrillator. An estimated 50 000 of these will need a scan each year, but currently only 1000 MRI scans a year are performed on this population.

The statement described MRI as “an unmatched diagnostic test” that is used in diagnosis, treatment planning, and monitoring in a range of specialties including cancer, neurology, and cardiovascular and musculoskeletal disorders.

The colleges said, “The consequences of not undergoing MRI when indicated include late and mis-diagnosis, the use of other more invasive tests with less robust performance, more complications and more expense. Many treatments are precluded without MRI planning including neurosurgery and Cyberknife radiotherapy, potentially resulting in worse clinical outcomes for patients.”

Charlotte Manisty, consultant cardiologist and service lead for cardiac device imaging at Barts Heart Centre, said that barriers to scanning patients with heart devices arose at many levels.

“Doctors often fail to refer patients with devices because of outdated safety concerns, and many hospitals still refuse to scan them,” she said. “Our team at Barts is addressing this both locally and with a national campaign [www.mrimypacemaker.com] to raise awareness, develop services, and change policy.

“Change, however, requires cooperation at many levels, and the joint statement from the British Cardiac Society and Royal College of Radiologists should mandate other hospitals to scan device patients, to reduce the unnecessary delays and suboptimal treatment that these patients currently often receive.”

The statement called for local champions, new working practices, and partnerships—especially between cardiology and radiology and medical physics departments—to improve access to MRI for people with heart devices. “We as a community are capable of making this happen,” it said.

The Barts Heart Centre team won Diagnostic Team of the Year at the 2018 BMJ Awards in May for their work on scanning patients who have pacemakers.2

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