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  • Poster presentation
  • Open Access

Remote delivery of congenital cardiac magnetic resonance imaging services, a unique telemedicine model

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Journal of Cardiovascular Magnetic Resonance201517 (Suppl 1) :P210

  • Published:


  • Congenital Heart Disease
  • Remote Control
  • Cardiac Magnetic Resonance
  • Deep Sedation
  • Patient Safety Issue


Cardiac MRI is increasingly utilized in patients with congenital heart disease; however, the expertise to perform and interpret these studies is not universally available, despite an increasing population of congenital heart survivors. This retrospective analysis describes our experience providing CMRI services on-site versus over a distance of 250 miles.


Our technique utilized the syngo Expert-i (Siemens) remote control software. Our configuration included a T3, high speed dedicated line with secure communication to achieve remote control of the scanner console without lag, immediate transfer of DICOM images, and to support secure voice and video over internet (VOIP). The remote site utilized a standard hospital-issued PC with a graphics card upgrade to install the Expert-i and VOIP software. The local site installed VOIP software on a laptop with built-in webcam. Figure 1 demonstrates the workflow for remote scan acquisition, image transfer, post-processing and completion of a study report.

Figure 1

We performed a retrospective descriptive analysis of our experience providing congenital cardiac MRI services both locally and from a remote location using the same physician providers.


Patient demographics and scan details are listed in Table 1. There were 83 "local" scans with both physician and patient on-site compared with 91 scans controlled by a physician geographically remote from the patients. The patients were well-matched for age, sex, study duration, scan type and history of prior cardiac surgery or intervention. There was no difference in use of deep sedation or diazepam for anxiolysis, or use of atropine for arrhythmia suppression. There were 2 minor events: A 23 hour observation was initiated by anesthesia in the local period after deep sedation in an infant with chronic lung disease, and a single patient experienced emesis after gadolinium administration in the remote period. There were no patient safety issues and there was satisfaction on the part of the referring physicians who were able to obtain more timely studies, as well as the remote-scanning physicians who had a workflow comparable with the local scans, but no lost travel time.
Table 1

Patient demographics and scan details.


Local Scan Period

Remote Scan Period



05/06 to 01/10

02/10 to 04/12


Number of patients




Age (years), median (25 th , 75 th percentile)

9.8 (3.5, 17.3)

10.6 (5.6, 16.8)


Patient age < 6 years, (%)

30 (36.1)

25 (27.5)


Patient age = 6years, (%)

53 (63.9)

66 (72.5)


Male, (%)

44 (53.0)

56 (61.5)


Inpatients, (%)

4 (5.2)

5 (5.7)


Anesthesia-directed sedation, (%)

39 (47.0)

30 (33.0)


Diazepam, oral, (%)

7 (8.4)

12 (13.2)


Atropine, (%)

3 (3.6)

4 (4.4)


Prior cardiac surgery or catheter intervention, (%)

57 (68.7)

54 (59.3)




Study duration (minutes), mean(SD)

58 ± 19

57 ± 19


Study duration (minutes), median(25 th , 75 th percentile)

57 (46, 73)

55 (42, 69)


Scan Type


Cardiac MRI only

5 (6.0)

3 (3.3)


MRA chest only

8 (9.6)

2 (2.2)


Cardiac MRI and MRA chest

39 (47.0)

44 (48.4)


Cardiac MRI with MDE and MRA chest

31 (37.4)

42 (46.2)


* Assessed for significance using transformed variable


This experience suggests that remote delivery of cardiac MRI services for the congenital heart population is feasible and can be done with comparable success and safety to a traditional "local" model. We also suggest the necessary configuration to provide such remote CMRI services with readily available hardware and software.

Authors’ Affiliations

Division of Pediatric Cardiology, Department of Pediatrics and The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Radiology, Arnold Palmer Hospital for Children, Orlando, FL, USA
Pediatrics, Division of Cardiology, Arnold Palmer Hospital for Children, Orlando, FL, USA
Research, Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN, USA


© Garg et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.