Table 3 Equipment “shopping list” to start an iCMR program
From: Interventional cardiovascular magnetic resonance: state-of-the-art
Necessary | Desirable | |
|---|---|---|
MRI scanner | ▪ 1.5 T high performance MRI system | ▪ Low-field MRI system (high performance 0.55 T iCMR system currently in development) |
MRI scanner interface | ▪ Real-time CMR and interactive user interface (available from most MRI system vendors) | |
Communication | ▪ MRI system patient headset for the in-room operator to wear to communicate with MRI technologist in the control room | ▪ Noise cancelling, multi-channel staff communications system for safe operation despite the extreme acoustic noise around the scanner (representative example: Optoacoustics, Yehuda, Israel) [8, 20] |
Video displays | ▪ In-room shielded video projector or monitor to display at a minimum real-time images and hemodynamics for in-room operators | ▪ Multiple monitors/projectors or single monitor with multiple image inputs to display real-time CMR images, invasive pressure waveforms, ECG, pulse oximetry ideally at both head and foot of the patient bed |
Hemodynamic monitoring | ▪ Hemodynamic monitoring system (low-fidelity, existing anesthesia MRI patient monitor) | ▪ Hemodynamic recording system (high-fidelity, X-Ray catheterization lab equivalent) |
▪ A system to connect electrocardiogram and invasive blood pressure signals during MRI into a high-fidelity hemodynamic recording system, for example PRiME (Physiological Recording in MRI Environment) [24] | ||
Anesthesia equipment | ▪ Not required for procedures in adults using local anesthesia/moderate sedation | ▪ For pediatric iCMR procedures, MRI-conditional ventilator/anesthesia cart for general anesthesia is often required [13] |
Catheters | ▪ Non-metallic balloon wedge end-hole catheters for diagnostic iCMR catheterization (Fig. 4) | ▪ MRI-conditional electrophysiology recording and ablation system |
Guidewires | ▪ Fully insulated nitinol-core guidewires may be used under low-SAR imaging or in low-field MRI system ▪ Non-metallic MRI-conditional guidewire (0.035" EmeryGlide, B. Braun, Bethlehem, PA) ▪ “Active” antenna-guidewires | |
General supplies | ▪ General procedural supplies are similar to in an X-Ray environment: for example, patient sterile draping [98], syringes, fluid-filled tubing and pressure transducers, etc.… | |
Emergency bail out/defibrillation | ▪ Defibrillator in a room outside the MRI suite to which the patient can be evacuated in an emergency | |
▪ Standard operating procedures and regular evacuation drills can optimize safety and efficiency [12, 13] |