{'fraction_non_alphanumeric': 0.022916666666666665, 'fraction_numerical': 0.008630952380952382, 'mean_word_length': 5.577299412915851, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Facilitating Magnetic Resonance Imaging in Patients With a Cardiac Device.

July 30, 2019 347 Michael U. Antonucci, MD For the ≈1.8 million Americans with cardiac devices, the past few years have brought remarkable scientific and regulatory developments. Two large prospective trials, consisting of 1500 magnetic resonance imaging (MRI) examinations in the MagnaSafe registry1 and 2103 in a cohort reported by Nazarian et al,2 assessed complication rates in patients with non–MRI-conditional (legacy) implants, those not specifically designed by the manufacturer or labeled by the Food and Drug Administration to withstand MRI conditions. The results convincingly demonstrate that these patients can be imaged without significant risk, provided the MRI is performed under specific conditions, including prescan electrophysiological screening, confirming a lack of retained abandoned leads (not currently recommended for MRI), hemodynamic monitoring during imaging, and device interrogation. The results are welcome news to clinicians and patients, many of whom will develop issues subsequent to device implantation that could necessitate MRI evaluation. It is just as important to note that the results prompted the Centers for Medicare and Medicaid Services (CMS) to revise their MRI coverage determination, removing a long-held exclusion for this group. In total, these changes can improve the care of millions. However, for this to occur, it is essential for radiologists, cardiologists, and others to identify and address residual systemic obstacles to implementation. In large medical centers, such as those in the MagnaSafe Registry, the effects are already apparent. For the clinicians, radiologists, physicists, and MRI technologists in these facilities, preexisting familiarity ensures a relatively seamless translation of existing research protocols to clinical imaging. In addition, service expansion is likely facilitated by a systemic institutional perception, reinforced by accumulated safety data during trials and forward-thinking electrophysiologists, that the risk of MRIs in these patients is minimal. However, for many patients, decisions regarding diagnostic imaging will be made by those for whom the process is less familiar. Thus, radiologists and cardiologists must assume a shared goal of ensuring that the larger beneficial impact is not diminished by hesitation to alter practice patterns. Although some reluctance is to be expected, in particular, because the avoidance of MRI had long been grounded in a fundamental desire to do no harm, the impressive published safety data should now serve as an impetus against inertia. It is important that this is also an international issue, with recent British data demonstrating only 2% of patients with a cardiac device undergo clinically needed MRIs.3 Some radiologists’ awareness of this new capability may lag behind that of their cardiology colleagues. Although the American College of Radiology strongly supported expanded MRI services and CMS coverage, early awareness of the evidence and policy changes among radiologists was less widespread. For example, after Nazarian’s pivotal article,2 the next 9 months saw a paucity of relevant material in the high-impact general radiology literature (with the notable exception of a Radiol© 2019 American Heart Association, Inc. ON MY MIND