Abstract

Traditionally, the expertise required to perform and interpret cardiac magnetic resonance (CMR) has created barriers to its’ use, with the majority of CMR concentrated at larger academic institutions. Some of the main challenges to incorporating CMR into busy practices include long imaging time with complex sequences, limited technologist training, and post-processing requirements. There are several strategies to overcome these barriers and expand access to CMR. In this presentation I will review the strategies our cardiovascular imaging division has employed to improve and standardize performance in our growing CMR practice.

There are several factors that contribute to the complexity of performing CMR. There are numerous sequences available in CMR, some of which require separate post-processing software for analysis and interpretation. There is a wide range of pathology affecting the heart, so it is important for radiologists and referring clinicians to understand when CMR is appropriate, and which sequences to select for each exam. Patient related challenges in CMR include variable anatomy and compensating for breathing and cardiac motion. MR technologists performing CMR especially need to be familiar with patient related challenges and how to optimize image quality without prolonging scan time. In addition, there are many additional steps in the patient preparation for CMR compared to other MR exams. Maximizing productivity of technologists performing CMR can have a significant impact on scan time and total table time.

Creating disease specific protocols reduced scan time which it not only beneficial to the patient and the technologist, but can have a dramatic effect on image quality, especially when imaging patients who have difficulty with breath holds or lying flat for extended periods of time. From an operations standpoint, decreasing the imaging time allows for shorter scheduling slots, opening up the scanners for additional exams. Our cardiovascular division worked closely with technologists and physicists to design, build and incorporate disease specific CMR protocols into our daily practice. I will discuss the design and benefits of our focused CMR protocols, talk about the challenges in making these changes, and the ongoing work we are doing to fully streamline our CMR practice.