MRI, oh my.

Almost as tedious

by crustyg - 2020-09-24 02:56:57

Exact same problem for a cervical spine prolapsed disc.  Took the 'safety' team TWO MONTHS to decide that my BostonSci leads+PM were acceptable in their MRI.  When the specialist physio initially said 'yes, you need an MRI' I said I bet your software won't allow you to book it at the large rural center used for most OPD MRI.'  Sure enough, as soon as she put in PM it said 'No'.  Obvious, since there's no EP-tech team there.  And, not being a real doctor, she wasn't allowed to refer me directly to the big hospital MRI for the scan.

Two issues: a) is your lead+PM setup actually safe in the intense magnetic field of the MRI - some older leads had enough iron in them to rip out if you went into the scanner, b) the powerful RF impulses that make your atoms generate the signals that are processed into images really mess up the PM's sensing of your heart activations or can trigger anti-arrhythmia actions, so your PM has to be set into a mode where it just paces you at a fixed rate, regardless of anything else.  They also have to turn off Magnet Response.   So now you're not optimally paced, hence the need for the crash cart.  And then after the MRI it all has to be reset to status quo ante.

But it's all possible with modern kit, just requires a lot more planning and prep, and the benefits of an MRI for soft tissue injury are clear.  So we patiently put up with it, and bless our little boxes for keeping us alive/active.

HTH.

Oh my indeed !!!

by Gemita - 2020-09-24 03:39:12

Hello Cyborgmike,

You are quite correct, getting an MRI with an MRI safe device and leads is not straightforward at all and they will place all sorts of obstacles in the way, This was the path they took with my husband, who is not however pacemaker dependent.

1. First and foremost, he had to attend a main centre (hospital) with experience doing MRIs on pacemaker patients.  

2. The hospital had to have a pacemaker technician available to place his single lead pacemaker in "safe mode" prior to the procedure, so that settings and data could be protected for the duration of the scan.  They also recommended doing a download of the pacemaker data prior to the procedure.  Afterwards the technician would return the pacemaker to its pre-scan settings.

3. Before and after his scan on his thoracic spine he had to have an X-Ray of the position of the pacemaker/leads to make sure they had not moved during the procedure.

4.  Since he was not pacemaker dependent, I do not believe he needed a cardiologist in attendance.

With a pacemaker safe device, certain conditions have to be met to ensure that we stay safe during our scans.  Providing these conditions are strictly adhered to, I believe MRIs are safe, but there is still a lot of ignorance out there in certain centres/hospitals.  You need to present your pacemaker ID card giving details of your device/leads beforehand for them to make sure it is MRI safe.  I am currently waiting for an MRI thoracic, cervical spine + head and am told that due to COVID-19 there is a wait, but the consultant who ordered successfully my husband's MRI knows the drill with pacemaker patients so that path should be more straightforward for me. 

For those interested, I attach a link (well two) of my manufacturer's (Medtronic) guidance for those needing an MRI. 

https://www.medtronic.com/content/dam/medtronic-com/01_crhf/surescan/uc201604719en-example-protocol-for-patient-scanning-process.pdf

https://www.medtronic.com/us-en/healthcare-professionals/mri-resources/implantable-cardiac-devices/patient-scanning-process.html

Yep

by Beattie - 2020-09-24 04:48:56

i am going through similar thing...waiting on a MRI brain...i never thought it would be so difficult after being told my device was MRI conditional 🙄....in am in Australia and not many places around that can do them! i dont know percentage i am paced but i have a Boston PM and Leads both MRI conditional. 

mri

by new to pace.... - 2020-09-24 09:02:45

I too had to go to the local public hospital for MRI of right shoulder, which i found out from reading on this site.  The only hard part i had was making sure they had a copy of my card both sides.  Was told i could have an appt. at any time as the Medtronic Tech was only an hour away. 

  I agree with everthing that Germita wrote.

new to pace

MRI

by AgentX86 - 2020-09-24 19:31:13

I had one a year ago. You CANNOT  go to an MRI-IN-A-BOX sort of place. It has to be a hospital with a cardiac unit. The process of getting an MRI is simple. Mine was on my brain (before ROBO asks, no, they didn't find anything). The whole thing took about 30 minutes  from waiting room to walking out the door. The Radiology tech knew exactly what she was doing and had the PM tech on standby when we were ready, and again after. Smooth as silk. Almost like everyone knew what they were doing.

The month before that wasn't so easy. As much as the MRI staff knew what they were doing, noone else could find their a$$ with two hands. Clearly noone wanted to be bothered with anything just a little out of the ordinary. As I've said here before, radiologists are the MOST risk adverse group in the hospital. Anesthesiologists aren't anywhere close.

Bottom line: It can be done. It is done. Noone seems to WANT to do it.

My slightly worrying experience

by IAN MC - 2020-09-25 12:34:43

 About 4 months ago , I needed an MRI scan for a back problem.

Getting their agreement to do it was not easy , mainly because , at PM implant time I was given a card which clearly stated  " LEADS NOT MRI SAFE "

Eventually , using all my powers of persuasion, I had an MRI scan with a PM tech in attendance to switch the PM into safe mode. All went well and I survived BUT , during the scan I was aware of the leads gradually heating up.  It was all over before I fried to death but it was slightly worrying. There was a very definite increasing warmth in my chest.

Has anyone else experienced this  ( and lived to tell the tale ) ?

Ian

Ian

by Gemita - 2020-09-26 06:25:07

Oh you are worrying me now.  All I can say is that even before my pacemaker implant, I experienced a "heating up" in my chest during a previous MRI scan.  What made you think it was the leads "specifically" heating up and not the "device".  I have to say a CT scan was immediately offered but consultant felt an MRI would give more information

Gemita

by IAN MC - 2020-09-26 11:40:20

I was very interested to read that your MRI scan pre-pacemaker caused " heating up in the chest " . That is something I have never read before so maybe I was wrongly attributing it to the pacemaker leads.

It was the location of the warmth ( spreading from the collar bone towards the heart region ) which made me think that the leads were involved .  Don't worry ........we are both still alive !

Ian

A heart warming story

by AgentX86 - 2020-09-26 20:47:57

Yes, that's one of the issues with an MRI.  An MRI is a huge fixed superconducting magnet with a large RF transmitter that "pings" the the body.  The magnet aligns all the water molecules (the hydrogen atoms specifically) and the RF ping throws them off their axis.  When the RF transmitter is turned off, the water molecules re-align with the magnet causeing radio waves to be emitted.  This re-radiation is then captued by antennas all over the machine and a computer crunches all the information from the antennas to produce the image. 

The RF field can induce a current in the leads causing heating, much like a microwave oven.  Having an MRI on a foot isn't likely to cause a problem because the PM isn't in the RF field.  The field can be focused so only part of the body is affected but in this case it's the back.  The PM nor leads can be separated from an image of the back.

Interesting video: <https://www.youtube.com/watch?v=1R7KsfosV-o>

Thank you AgentX86

by Gemita - 2020-09-27 06:58:23

Not really so confident anymore !  Might ask for CT with contrast which was first offered and risk radiation instead but will speak to my team and move forward cautiously 

Agent

by IAN MC - 2020-09-27 07:32:06

Thanks for the video link ....... I enjoyed seeing the exploding MRI machine . I assume they use that on really annoying patients !

Ian

Bye bye MRI

by CyborgMike - 2020-09-27 14:06:50

To book end this thread.... I saw the orthopedic doc on Friday and he was shocked that my PCP wanted an MRI. He did a quick x-ray in his office and could see everything he needed to diagnose and treat the injury. I'll save my first "MRI experience" for something more serious and I'll be smarter the next time a doc recommends one. 

Not so confident

by AgentX86 - 2020-09-27 20:56:56

If your PM is MRI "conditional", and yours, without much doubt is, there shouldn't be any problem  The leads and generator are designed to keep this from happening.  As posted elsewhere, the hard part of an MRI is getting past paranlod radiologists.  At least here, they want signoff from the pope before they'll do it.  They obiously do it often, though.  Their staff knows exactly what to do.

Bye bye: Amazing.  Your PCP was going to do something before you saw the ortho?  Did he know you had an appointment? An MRI is a pretty costly procedure and not done unless there is something to be learned that can't be done otherwise.