Introduction
Why Pursue iCMR for Congenital Heart Disease?
Pre-clinical
Clinical
Link | Content |
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- Real-time MRI-guided right and transeptal left heart catheterization at Children’s National Heart Institute, Washington, DC | |
- Presentations from the iCMR workshops 2015 – 2019 at the Society for Cardiovascular Magnetic Resonance Scientific Sessions | |
- Opto-acoustics IMROC IR Wireless communication with demonstration of real-time MRI-guided right heart catheterization (conference proceedings, Society for Cardiovascular Magnetic Resonance Scientific Sessions 2017) | |
- PRIME (Physiologic Recording in MRI Environment) system | |
How to Start an iCMR Program
Team Building
Cardiac catheterization team |
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- Interventional cardiologist with experience in congenital heart catheterization - Assistants (nurse practitioners, fellows, or additional physicians) - Catheterization laboratory nurses - Catheterization laboratory technologists |
Cardiac MRI team |
- Imaging specialist: CMR imaging trained pediatric cardiologist or radiologist - MRI technologists: At least one technologist to train in real-time image guidance protocols - MRI physicists - MRI nurse |
Procedural clinical and administrative support team |
- Pediatric cardiac anesthesia team with experience of patient care in the MRI-environment - MRI safety officer - Vendor representative - Cardiac catheterization and MRI administrative staff (for procedure scheduling) - Other services with potential interest in performing MRI-guided procedures (pediatric cardiac electrophysiology, interventional radiology, neurosurgery, and other surgical subspecialties) |
Starting with Limited Facilities and Resources
Where to Perform iCMR Procedures: Purpose-built Suites versus Adapting Existing MRI Rooms
Equipment/infrastructure | Examples |
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1.5 T wide-short-bore scanner optimized for cardiovascular imaging | - Vendor specific |
CMR surface coils for cardiovascular imaging | - Vendor specific |
Vendor specific real-time scanner control and visualization software | - RTHawk by GE - Monte Carlo prototype software by Siemens, - iSuite by Philips |
In-room display | |
- Shielded projector systems - LCD monitor | - Gaven Industries - Sentient |
In-suite cameras | - Gaven Industries |
Audio communication noise cancelling headsets | - IMROC by OptoAcoustics |
Patient monitoring | - Expression MRI Patient Monitoring System, Invivo Corporation |
Hemodynamic recording system augmentation | - Physiological Recording in MRI Environment [PriME] system - Wireless telemetry system, PELEX-MAX, PinMed Inc |
Nitric oxide delivery system | - INOmax, Mallinckrodt Pharmaceuticals |
Electrophysiology equipment specific to MRI-guided arrhythmia ablation | |
- Recording system and simulator | - Advantage MR EP Recorder/Simulator, Imricor Medical Systems, USA |
- Ablation catheter | - Vision MRTM ablation catheter, Imricor Medical Systems |
Sterile procedure maintenance in the MRI-room | - Large sterile drapes for MRI-scanner - Long extension tubing for infusions - MRI-compatible stand to serve as a procedure table |
Commercially available “off the shelf” standard catheterization equipment that is also MR-compatible | |
- Balloon wedge catheter and 1% dilute gadolinium solution for balloon inflation | - Arrow balloon wedge catheter, Teleflex Medical |
Purpose built MRI-conditional catheterization equipment | |
- MR-conditional guidewire | - Angled-tip Emeryglide MRWire, Nano4Imaging |