How to set up a Cardiac MR Examination Tsertos Fotios RT (MR) and Loris Alexandros RT (MR)

Safety Issues Patient Preparation

Safety Issues Patients should be screened for contraindications for MR Imaging Safety check-list Weight<200 kgr Waist circumference not to exceed 1.80 m

Before entering into the Magnetic field The patient should remove all metallic objects. Gold and silver jewelry is not ferromagnetic and thus need not be removed. Patient use toilet before starting the examination.

Patient Preparation Children<8 years old Children>8 years old Adolescents Adults

Children<8 years old Children's<8 require anesthesia. Last meal 8-10 hours before examination. Resuscitation equipment available. Written consent by both parents. Previous examinations: Results and clinical information.

Children>8 years old-Adolescents-Adults Claustrophobic Non Claustrophobic

Claustrophobia Screening Measures to minimize: 1)Music,2)Room ambience 3)Prism glasses,4) eyes closed,5)Alternate position. Frequent Communication is essential to decrease claustrophobia. The presence of chaperon inside the examination room.

Non claustrophobics patients : Instructions before the MR examination No need to fast before the MR examination. Patients are instructed to take all their usual medication (except diuretics) before the exam. Inform the patient regarding the loud noise from the gradient-fields Patients with dyspnea require O2 Previous examination: Results and clinical information It is preferable to have venous line before patient start the examination if IV contrast will be admitted Practice Breath-holding instructions.

Claustrophobic Patient: Instruction before MR examination PO Sedative Consent for IV sedative. Last meal 8-10 hours before examination The patient is asked to be in MR department 30min before examination Previous examinations: Results and clinical information.

Into the Magnetic Field For CMR, a phase-array (synergy) Cardiac coil is used. [Obese: Synergy body-Body coil-Synergy Flex coil-C1 coil].

Positioning of the Patient The patient lies on his/her back in the supine position. The back of the patient should be in close proximity to the coil. Comfortable positioning of the patient is very important, particularly because of the relatively long scan time.

Compromising for Cardiac and Respiratory motion Cardiac MR imaging is influenced by Cardiac and respiratory motion. To overcome motion-related artifacts images are usually acquired with ECG gating and frequently with respiratory gating.

Cardiac Triggering ECG is used to gate for the cardiac cycle. Attention! ECG-patches should be compatible with the Magnetic field. Good skin contact.

Cardiac Triggering It is very important to ensure for reliable triggering good ECG Signal quality. Good ECG affects the quality and duration of the examination. Better to spend more time upfront and have a reliable ECG signal than not to have good triggering. Sometimes the HR displayed on the console is NOT the actual HR due to erroneous QRS detection.

Cardiac Arrhythmias In patients with arrhythmias image artifacts are common and increase the examination time.

Positioning of the Cardiac coil and the Respiratory Belt Respiratory belt in order to monitor abdominal excursion.

Respiratory Triggering The signal from the respiration belt is used for:1)Respiration gated sequences ,2)To ensure adequate diaphragmatic motion. e.g. sedated individuals.3)To ascertain adequate Breath-holding.

Head-phones and Panic button Head-phones to listen music and breath-holding instructions. Panic Button.

Before final positioning Instructions for breath-holding are repeated and practiced (expiration phase) before final positioning. The patient is informed regarding the loud noise during image acquisition and advised not move his/her body inside the gantry.

Breath-holding Instructions For repeat breath-holding it is important to have consistency. Expiratory Breath-holding. Instructions should be standardized.

Other Positioning For claustrophobic patients the prone position can be used. For obese patients the arms may be raised up above the head.

Positioning Into the Magnet (Gantry) The heart should be in the magnet iso-center. Advise the patient to close his/her eyes during the table movement inside the gantry. Start the examination!

CARDIAC IMAGING Anatomy imaging: 1)BB(black blood images) Axial T1,T2,T2 SPAIR,T1+GD. 2)Late Enhasment (Viability images) Functional imaging : White Blood images 2CH,4CH,SAX –Movie. Assessment of the Cardiac wall functionality.

Anatomy Imaging T1BB,SPAIR

Functional Imaging 2CH

Functional Imaging 4CH

Functional Imaging SAX Images -Ejection fraction LV,RV -Stroke Volume -Cardiac Wall Mass

Late enhancement-Viability image Viability 4ch Viability Sax

CARDIAC PROTOCOLS Cardiomyopathy Stress Perfusion ARVD Myocarditis Tumour Thalassemia Coronary Arteries Congenital