UW Health Radiology Guidelines for MRI in Patients with Cardiac Implantable Electronic Devices (CIEDs) and Related Components

Scheduling Guidelines

• MRI available Monday-Friday, 8am-4pm; UW Health University Hospital Only.
• 1.5T preferred for abdomen, pelvis, and L-Spine exams. For Cardiac MRI, UWMR2/3 only. 
• 3T possible if device labeling allows, e.g. for fMRI, 3T-preferred cases such as prostate MRI, or for scheduling reasons.  Will possibly require MR Physics to assist with SAR management.

Required Personnel

• MRI Nursing (Workup + monitoring for most patients, with standard precautions).
• Cardiac Device Clinic Nurse (Device programming + monitoring for expanded precautions).

Recommended Personnel 

• MR Physicist (Cardiac/Thoracic/Shoulder/3T studies only).

Special MRI Protocol Considerations

Cardiac MRI ICDs: Use Cardiac ICD Protocol if generator in usual position on left side; possibly use standard protocol if on right side.

Outpatient Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has CIED and/or determined through MRI scheduling process.
2. MRI Nursing begins Conditional PM/ICD workflow.
3. Electrophysiology (EP) Device Clinic reviews patient, including chest x-ray to determine condition of device/leads, most recent pacing+therapy settings, and patient’s condition, to determine standard vs. expanded precautions.
4. Patient appointment scheduled per designated blocks, appointment time is 40 minutes prior to exam time.
5. One week prior to exam, Radiology Nursing calls patient, completes screening process, and reminds patient regarding Chest X-ray, if needed.
6. Proceed to MRI Exam Procedure.

Inpatient/ER Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has CIED.
2. MRI Nursing begins Conditional PM/ICD workflow.
3. EP Device Clinic reviews patient, including chest x-ray to determine condition of device/leads, most recent pacing+therapy settings, and patient’s condition, to determine standard vs. expanded precautions.
4. MRI Scheduler / Command Center confirms CIED presence, finds appropriate exam time in the 8am-4pm M-F window, and coordinates EP team availability and patient transport.
5. Proceed to MRI Exam Procedure

MRI Exam Procedure

1. Patient arrives in MRI area.
2. EP Device Clinic team programs CIED to appropriate settings for patient’s MRI exam.
3. MRI performed, patient’s vital signs monitored by Radiology Nursing personnel (standard) or EP personnel (enhanced precautions).
4. MRI Physics present to assist with Low SAR protocol modifications.
5. Following  MRI exam, EP Device Clinic returns CIED to appropriate programming.

Includes

• Patients with a functioning system and abandoned leads.
• Patients with a functioning system and epicardial pacing leads.
• Any other complete device system not precisely following manufacturer’s MR Conditional labeling.

Scheduling Guidelines

• MRI available Monday-Friday, 8am-4pm; UW Health University Hospital Only.
• Patient consented and consent form to be signed by Radiology Attending/Fellow/Resident.
• 1.5T Only. For Cardiac MRI, UWMR2/3 only.

Required Personnel

• MRI Nursing (Workup + monitoring patients with standard precautions).
• Cardiac Device Clinic Nurse (Device programming + monitoring for expanded precautions).
• Radiology Attending/Fellow/Resident (Patient Consent).
• MRI Physicist (Only for patients with abandoned or epicardial leads or otherwise requiring Low SAR mode).

Recommended Personnel 

• MR Physicist (Cardiac/Thoracic/Shoulder studies only).

Special MRI Protocol Considerations

MRI Physicist will likely recommend Low SAR Mode for patients with abandoned or epicardial leads, determined by specific protocol considerations.

Cardiac MRI ICDs: Use Cardiac ICD Protocol if generator in usual position on left side; possibly standard protocol if on right side.

Outpatient Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has CIED and/or determined through MRI scheduling process.
2. MRI Nursing begins Legacy PM/ICD workflow.
3. Electrophysiology (EP) Device Clinic reviews patient, including chest x-ray to determine condition of device/leads, most recent pacing+therapy settings, and patient’s condition, to determine standard vs. expanded precautions.
4. MRI Nursing requests approval from Attending Radiology from the service appropriate for patient’s exam.
5. Patient appointment scheduled per designated blocks, appointment time is 40 minutes prior to exam time.
6. One week prior to exam, Radiology Nursing calls patient, completes screening process, and reminds patient regarding Chest X-ray, if needed.
7. Proceed to MRI Exam Procedure.

Inpatient/ER Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has CIED.
2. MRI Nursing begins Legacy PM/ICD workflow.
3. EP Device Clinic reviews patient, including chest x-ray to determine condition of device/leads, most recent pacing+therapy settings, and patient’s condition, to determine standard vs. expanded precautions.
4. MRI Scheduler / Command Center confirms CIED presence, finds appropriate exam time in the 8am-4pm M-F window, and coordinates EP team availability and patient transport.
5. Proceed to MRI Exam Procedure

MRI Exam Procedure

1. Patient arrives in MRI area.
2. EP Device Clinic team programs CIED to appropriate settings for patient’s MRI exam.
3. MRI performed, patient’s vital signs monitored by Radiology Nursing personnel (standard) or EP personnel (enhanced precautions).
4. MRI Physics available to assist with Low SAR protocol modifications, if needed.
5. Following MRI exam, EP Device Clinic returns CIED to appropriate programming.

Includes

• Patients with CIED systems that are abandoned and “turned off”.
• Patients with heart transplants where the generator is intact and leads are clipped.
• Follows UW MRI Safety Committee Guidelines for Legacy Devices with some differences.

Scheduling Guidelines

• MRI available Monday-Friday, 8am-4pm; UW Health University Hospital Only.
• Patient consented and consent form to be signed by Radiology Attending/Fellow/Resident.
• 1.5T Only. For Cardiac MRI, UWMR2/3 only.

Required Personnel:

• MRI Nursing (Workup + monitoring patients).
• Cardiac Device Clinic Nurse (Device check following MRI exam).
• Radiology Attending/Fellow/Resident (Patient Consent).
• MRI Physicist.

Special MRI Protocol Considerations:

MRI Physicist will likely recommend Low SAR Mode, determined by specific protocol considerations.

Cardiac MRI ICDs: Use Cardiac ICD Protocol if generator in usual position on left side; possibly standard protocol if on right side.

Outpatient Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has abandoned CIED and/or determined through MRI scheduling process.
2. MRI Nursing begins Legacy PM/ICD workflow.
3. Electrophysiology (EP) Device Clinic may review patient, including chest x-ray to determine condition of device/leads.
4. MRI Nursing confirms device is turned off in patient’s chart.
5. MRI Nursing requests approval from Attending Radiology from the service appropriate for patient’s exam.
6. Patient appointment scheduled per designated blocks, appointment time is 40 minutes prior to exam time.
7. One week prior to exam, Radiology Nursing calls patient, completes screening process, and reminds patient regarding Chest X-ray, if needed.
8. Proceed to MRI Exam Procedure.

Inpatient/ER Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has CIED.
2. MRI Nursing begins Legacy PM/ICD workflow.
3. Electrophysiology (EP) Device Clinic may review patient, including chest x-ray to determine condition of device/leads.
4. MRI Scheduler / Command Center confirms CIED presence, finds appropriate exam time in the 8am-4pm M-F window, and coordinates EP team availability and patient transport.
5. MRI Nursing confirms device is turned off in patient’s chart.
6. Proceed to MRI Exam Procedure

MRI Exam Procedure

1. Patient arrives in MRI area.
2. MRI performed, patient’s vital signs monitored by Radiology Nursing personnel.
3. MRI Physics available to assist with Low SAR protocol modifications.
4. Following  MRI exam, EP Device Clinic confirms CIED remains “turned off”.

Includes

• Patients without a generator, who have full intact pacemaker and ICD leads, or lead fragments that contact the endocardial surface.
• Includes full intact epicardial pacing leads (not including “thin, wispy” temporary surgical pacing wires, see next page).

Scheduling Guidelines

• MRI available Monday-Friday, 8am-4pm; UW Health University Hospital Only.
• Patient consented and generic Radiology consent form to be signed by Radiology Attending/Fellow/Resident.
• 1.5T Only. For Cardiac MRI, UWMR2/3 only.

Required Personnel

• MRI Nursing (Workup + monitoring patients).
• Radiology Attending/Fellow/Resident (Patient Consent).
• MRI Physicist.

Special MRI Protocol Considerations

MRI Physicist will likely recommend Low SAR Mode, determined by specific protocol considerations.

Outpatient Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has abandoned leads and/or determined through MRI scheduling process.
2. MRI Nursing reviews patient’s chart, x-rays to confirm presence of abandoned leads, and may confer with MRI Physics to determine intact leads vs lead fragments (next section).
3. MRI Nursing requests approval from Attending Radiology from the service appropriate for patient’s exam.
4. Patient appointment scheduled per designated blocks, appointment time is 40 minutes prior to exam time.
5. One week prior to exam, Radiology Nursing calls patient, completes screening process, and reminds patient regarding Chest X-ray, if needed.
6. Proceed to MRI Exam Procedure.

Inpatient/ER Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has CIED.
2. MRI Scheduler / Command Center finds appropriate exam time in the 8am-4pm M-F window, and coordinates MRI Nursing availability and patient transport.
3. Proceed to MRI Exam Procedure

MRI Exam Procedure

1. MRI Physics available to assist with Low SAR protocol modifications, if needed.
2. Patient arrives in MRI area.
3. MRI performed, patient’s vital signs monitored by Radiology Nursing personnel.

Includes

• Patients without a generator, who have fragments of pacemaker or ICD lead(s) that do not contact the endocardial surface, often from lead extraction procedures with incomplete lead removal.
• Does not including “thin, wispy” temporary surgical pacing wires clipped at the skin.

Scheduling Guidelines

• MRI available Monday-Friday, 8am-4pm; UW Health University Hospital Only.
• Other times and locations possible with availability of MRI Physics.
• No patient consent or vital sign monitoring needed.
• 1.5T Only.

Required Personnel

• MRI Physicist.

Special MRI Protocol Considerations:

• MRI Physicist will likely recommend Low SAR Mode, determined by specific protocol considerations.

Patient Prep and MRI Exam Procedure

1. No special procedures or consent required for patients.
2. Presence of lead fragments determined through normal MRI screening process.
3. Patient arrives in MRI area.
4. MRI Physics available to assist with possible Low SAR protocol modifications.

• Often described as “thin, wispy”, temporary surgical pacing wires clipped at patient’s skin.
• No special considerations needed.
• 1.5T or 3.0T, SAR Normal Mode.

Includes

• Patients in the ICU with temporary “thin, wispy” surgical pacing wires, when critical care teams wish to not yet remove or clip at skin.
  • ONLY NEURO EXAMS that can use the T/R Transmit/Receive Birdcage Head coil.

Scheduling Guidelines

• MRI available Monday-Friday, 8am-4pm; UW Health University Hospital Only.
• No consent needed, only approval from Neuroradiology Attending Physician.
• 1.5T Only (UWMR2/3/4).

Required Personnel

• MRI Nursing (Workup when available during daytime hours; otherwise lead MRI technologist).
• Critical Care Team (Patient vital signs monitoring).
• Radiology Attending (Approval of MRI exam).

Recommended Personnel 

• MR Physicist.

Inpatient/ER Prep Procedure

1. Order placed for patient’s MRI, referring services notifies that patient has intact temporary surgical pacing wires.
2. MRI Scheduler / Command Center finds appropriate exam time in the 8am-4pm M-F window, and coordinates patient monitoring and patient transport.
3. MRI Nursing begins Temporary Epicardial Surgical Leads workflow.
4. Proceed to MRI Exam Procedure

MRI Exam Procedure

1. Patient arrives in MRI area.
2. Patient is prepared for exam according to Temporary Epicardial Surgical Leads workflow.
3. MRI performed, patient’s vital signs monitored by Critical Care team.