RPS 1714 - Advancements in MR: safety, patient care, and technological innovation

Author Block: J. Mcnulty¹, A. Cradock¹, A. Mcgee¹, A. De Bock², J. L. Portelli³, A. England⁴; ¹Dublin/IE, ²Brussels/BE, ³Msida/MT, ⁴Utrecht/NL
Purpose: Little has been published on the details of curricular content for radiographers in MRI safety despite the EFRS MRSO role descriptor benchmark document being published in 2021. This survey aimed to capture the current status quo in terms of MRI safety education for radiographers across Europe in terms of content, pedagogical and assessment approaches, challenges, and opportunities.
Methods or Background: An online survey of educational institutions (EIs) involved in the delivery of MRI safety education to radiographers was designed. The survey was distributed via the EFRS to all member EIs. Additionally, it was shared with all member national societies and to committee and working group members for onward distribution to EIs.
Results or Findings: Responses were received from 69 EIs. 58 EIs confirmed they deliver MRI safety education to radiographers (23 to undergraduate (UG) medical imaging (MI) students, 23 to UG combined MI and radiotherapy (RT) students, 5 to UG RT students, and 22 to Masters students. The most common MRI safety teaching methods for postgraduates (PGs) were in-person lectures (70.8%), small group discussions (61.9%), review of MRI safety scenarios (61.9%), and clinical placements (61.9%). The MRI safety contact hours for PGs averaged just 6 (range: 0-30 hours). For PGs, at the ‘advanced level’, the most infrequently taught topics were ‘Digital data safety’ (27.8%) and ‘Special MRI systems’ (33.3%). 65.2% of EIs were either ‘very satisfied’ or ‘satisfied’ with their PG MRI safety education provision.
Conclusion: Significant heterogeneity in content and levels of delivery of MRI safety education for radiographers was evident and highlights the potential for a common MRSO curriculum.
Limitations: This was a convenience sample of EIs across Europe accessed through the EFRS network and thus may not be representative of the population as a whole.
Funding for this study: The ECSO-MRI Project is co-funded by the Erasmus+ Programme of the European Union (KA220: 2022-1-BE02-KA220-HED-000085873).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Due to the nature of this study and the target population, the University College Dublin Human Research Ethics Committee – Sciences granted a formal Ethics Exemption (Reference: LS-LR-24-203-McNulty).

Author Block: E. Kjelle, I. Ø. Brandsæter, J. Porthun, B. M. Hofmann; Gjøvik/NO
Purpose: This study compares radiographers' and radiologists' vetting of justification for MRI referrals for low back pain and headaches.
Methods or Background: 360 lower back MR referrals and 353 brain MR referrals in adult patients were collected from private imaging centers in Norway. Four experienced radiologists and four experienced radiographers vetted the referrals using the Choosing Wisely recommendations for patients with low back pain and uncomplicated headaches. The assessors had three alternatives: 1)Justified, 2)Unjustified, and 3)Need more information. Data was analyzed using descriptive statistics, chi-square test to compare groups, and Gwen's AC2 for inter-rater agreement analysis. Significant level was p<0.05
Results or Findings: On average, in brain MR, the radiographers rated 52% of the referrals as justified, compared to 53% among the radiologists. The unjustified rate was 32% among radiographers and 41% among radiologists. In the category need more information, the rate was 15% for radiographers and 6% for radiologists. The difference was statistically significant, p<0.001. The interrater agreement was moderate 0.45 (95% CI:0.38-0.52) among the radiographers and good 0.71 (95% CI:0.68-0.75) among the radiologists.
In lower back MRI, the justified rate was 65% for radiographers and 59% among radiologists. The unjustified rate was lower among the radiographers (18%) than among radiologists (26%). While the need more information rate was higher among radiographers. The difference was statistically significant, p<0.001. The interrater variability was moderate in both groups, with 0.60 (95% CI:0.53-0.66) among the radiographers and 0.56 (95% CI:0.49-0.62) among the radiologists.
Conclusion: Radiographers need more referral vetting training to avoid performing unjustified imaging. In this study, radiographers often required more information or rated a referral as justified compared to radiologists.
Limitations: The general clinical practices and experience could influence the assessors' vetting; thus, these results are not necessarily generalizable.
Funding for this study: This study was funded by the Norwegian Research Council (Project number 302503).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Regional Committees for Medical and Health Research Ethics ref.no. 378396

Author Block: C. C. Chilanga¹, M. Heggelund¹, E. Kjelle²; ¹Drammen/NO, ²Gjøvik/NO
Purpose: To evaluate a pilot intervention to reduce low-value Magnetic Resonance Imaging (MRI) referrals for Low Back Pain (LBP).
Methods or Background: The study evaluated MRI referrals for LBP before and after an intervention involving information campaigns and return letters to clinicians whose referrals were declined. Four radiologists and two radiographers assessed the referrals based on quality and justification. Justification was classified as justified, unjustified, or requiring more information. A point system rated quality on an 8-point scale, with scores above 5.5 marked as "good" and below 2.5 as "poor." Pre- and post-intervention variations were analysed using mixed model in Stata (Release 18). A p-value <.05 was considered significant.
Results or Findings: A total n= 300 referrals (150 pre- and post-intervention) were assessed. Post-intervention, rated justified referrals increased from 63% to 68%, while unjustified referrals decreased from 19% to 17%. Those needing more information decreased from 19% to 16%. Poor-quality referrals decreased to 4% post intervention. Mixed model analysis estimated justified referrals at 61% (95% CI: 55.8–65.5) pre-intervention and increased to 66% (95% CI: 61.5–70.9) post-intervention. Unjustified referrals fell from 20% (95% CI: 15.9–24.3) to 17% (95% CI: 13.5–21.4), Rated good quality referrals increased from 7% (95% CI: 4.6–9.0) to 8% (95% CI: 5.5–10.7), poor-quality referrals decreased from 30% (95% CI: 25.4–35.3) to 27% (95% CI: 22.3–31.7). Variations were not statistically significant.
Conclusion: The intervention is ongoing and needs further evaluation. However, providing reasons for declined referrals can serve as an educational tool for clinicians and contribute to the reduction of low value MRI for LBP in radiology departments.
Limitations: Adherence to referrers’ confidentiality during data sampling prevented confirmation of whether all post-intervention referrals originated from clinicians who received return letters; however, region-wide campaigns likely mitigated this issue.
Funding for this study: The Research council of Norway (Project number 302503)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Regional Committees for Medical and Health Research Ethics (REK) reference number 378396 and Norwegian Agency for Shared Services in Education and Research (SIKT) reference 261461.

Author Block: M. Bono¹, M. Zanardo², V. Bari², B. Cairo², A. Porta², F. Sardanelli², P. Vitali²; ¹Varese/IT, ²Milan/IT
Purpose: We assessed the burden of white matter hyperintensities (WMH), a biomarker of chronic cerebrovascular disease, and quantified ischemic lesions using diffusion-weighted magnetic resonance imaging (DW-MRI) in patients undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Our goal was to investigate whether a relationship exists between chronic cerebrovascular disease and acute ischemia in aortic valve repair patients.
Methods or Background: This prospective study involved brain MRI scans at 1.5-T performed within seven days following SAVR or TAVI. The semi-quantitative Fazekas scale was used to classify WMH severity into low, intermediate, and high categories of chronic cerebrovascular disease. WMHs and DWI-positive ischemic lesions were quantified using automatic segmentation by Quantib® ND and semi-automatic segmentation adjusted by a neuroradiologist and a trained radiographer.
Results or Findings: A total of 55 patients were included in the study, of whom 47 underwent SAVR (62±15 years) and 8 TAVI (83±3 years). The mean lesion count for SAVR patients was 2.11 ± 7.07, while the mean lesion count for TAVI patients was 7.25 ± 6.88(p = 0.081).An analysis of WMH using the Fazekas scale indicated that SAVR group had mean Fazekas score of 1.30 ± 0.69, while TAVI group 2.25 ± 0.71 (p = 0.053).
Conclusion: While TAVI patients tended to have a higher burden of chronic cerebrovascular disease as indicated by the Fazekas score, the lack of significant differences in ischemic lesion counts between SAVR and TAVI suggests that both procedures pose similar acute ischemic risks.
The WMH burden may enable risk-stratification of patients who undergo TAVI/SAVR and identify those that would benefit most from the adoption of neuroprotective devices.
Limitations: Low number of TAVI patients enrolled.
Funding for this study: Ricerca Finalizzata Code: RF-2016-02361069.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee Lombardia

Author Block: A. Nocita¹, M. Zanardo², V. Bari², B. Cairo², P. Singh², A. Porta², F. Sardanelli², P. Vitali², M. Bono¹; ¹Varese/IT, ²Milan/IT
Purpose: This preliminary study investigates changes in white matter hyperintensities (WMH) and lesion counts in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The primary objective was to assess the differences in WMH volumes and lesion counts pre- and post-surgery, measured through brain magnetic resonance imaging (MRI) Fluid-Attenuated Inversion Recovery (FLAIR) 3D sequence.
Methods or Background: The first fifteen patients of the PASCAL study were included. Two brain MRI scans were acquired before the surgical intervention with cardiopulmonary bypass (pre), and after the surgical intervention (post) but within 10 days. Pre-operative and post-operative WMH volumes and lesion counts were evaluated using automatic segmentation by Quantib® ND and semi-automatic segmentation adjusted by a neuroradiologist and a trained radiographer. A t-test was conducted for statistical analysis, while reproducibility was evaluated using a Bland-Altman plot.
Results or Findings: The mean pre-surgical WMH volume was 0.49 cm³, which increased slightly to 0.57 cm³ post-surgery. A paired t-test showed a statistically significant difference between pre- and post-surgical volumes (p = 0.044). The lesion count analysis showed a mean pre-operative count of 13, increasing to 14 post-surgery. However, this difference was not statistically significant (p = 0.09). The Bland-Altman analysis for WMH volume demonstrated a mean difference of 0.04 cm³ with limits of agreement ranging from -0.15 to 0.23 cm³. For lesion count, the mean difference was 1 with limits of agreement from -5 to 7, indicating moderate reproducibility between the two methods.
Conclusion: The results suggest that while WMH volumes may increase after CPB surgery, the number of lesions does not significantly change, although the sample size limits the generalisability of these findings. Definitive results will be obtained once the estimated sample size is reached.
Limitations: Preliminary results.
Funding for this study: Ricerca Finalizzata Code: GR-2021-12372037.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee Lombardia 1, code: 06/INT/2023

Author Block: D. A. A. Costa, A. Grilo, E. Carolino, M. C. P. Ribeiro; Lisbon/PT
Purpose: The objective of this study was to assess which type of Magnetic Resonance (MRI) examination, the coil used and the patient position (to scan the brain or the knee), most influence patient’s anxiety levels.
Methods or Background: Hundred patients underwent MRI scan using a 1,5T Magneton Symphony by Siemens Healtineers. Fifty of them performed brain and the others knee scan. Before and after the MRI scan, the STAI Inventories Form Y-1 (state anxiety) and the Form Y-2 (trait anxiety) was applied. The physiological measurements of Blood Pressure and Heart Rate were collected at the beginning and at the end of scan.
Results or Findings: In brain studies, the initial mean anxiety levels (𝑥̅ =37.28 ± 12.446) are higher than those collected after examination (𝑥̅ =33.72 ± 13.389). In the knee examinations the initial mean anxiety values (𝑥̅ =31.96 ± 10.681) are higher compared to the final values (𝑥̅ =29.42 ± 8.094).
When comparing brain and knee studies, the first shown higher initial anxiety levels (𝑥̅ =37.28 ± 12.446) than patients who undergo knee scan (𝑥̅ =31.96 ± 10.681). The mean values of Maximum BP (𝑥̅ =130.06 ± 3.808) and Final HR (𝑥̅ =125.10 ± 1.851), collected after brain studies, are higher than the values collected in knee (𝑥̅ =88.24 ± 2.720) and (𝑥̅ =81.12 ± 1.943).
Conclusion: Through Multiple Linear Regression (Stepwise method), the examination type and the patient's assessment before MRI are predictors of anxiety, as their probability of occurrence is low. Higher and significant differences were found at the beginning of MRI scan. The appliance of different transceiver coils, reduces the surrounding space, contributing to increasing the levels of state anxiety.
Limitations: Lack information about other pathologies. Higher periods of questions and evaluation
Funding for this study: Not Applied
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approval by Ethical Commission of School of Health Technology with the reference CE-ESTeSL-Nº.107-2022

Author Block: J. Scheurleer¹, A. V. Diepen¹, A. De Bock², H. Bijwaard¹; ¹Haarlem/NL, ²Brussels/BE
Purpose: This study aimed to assess the educational needs and preferences regarding MRI safety training among healthcare professionals working in MRI departments. Findings aimed to support the development of a standardised European MRI Safety Officer (MRSO) curriculum as part of the funded ECSO-MRI project.
Methods or Background: A survey among radiographers, radiologists, and other healthcare professionals across European MRI departments assessed educational backgrounds, MRI safety responsibilities, and training preferences, with 313 responses analysed. The study received local ethics committee approval and confirmed European data security requirements.
Results or Findings: Of the respondents, 71.6% had clinical experience in MRI, but 49.5% did not regularly update their MRI safety knowledge. Informal peer-to-peer training was the most commonly used learning method (62.9%). Hands-on training was the most preferred approach (89.5%). Additionally, 70% of respondents considered the development of Standard Operating Procedures (SoP) an advanced MRI safety topic. Furthermore, 40% highlighted the need for formal basic training for all radiographers working with MRI, while 63% indicated a need for formal advanced training for key users of MRI. Only 31% reported following local MRI safety guidelines, and 18.5% adhered to international standards, underscoring the need for more consistent safety protocols.
Conclusion: Significant gaps in MRI safety education, particularly in advanced training, were identified. The ECSO-MRI project aims to address these by developing a standardized curriculum in collaboration with European institutions.
Limitations: The reliance on self-reported data may introduce bias in assessing actual MRI safety practices and training needs.
Funding for this study: This study was funded by the European Union’s Erasmus+ program.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics Committee of University College Dublin Research Ethics
Research Ethics Reference Number is: LS-LR-24-220-McNulty

Author Block: C. Maloney, A. England, N. Moore, R. Young, G. A. Curran, M. F. Mcentee; Cork/IE
Purpose: Radiographers in magnetic resonance imaging (MRI) are at the forefront of patient safety, and patients with cardiac implantable electronic devices (CIED) have been referred for MRI imaging more frequently in recent years. A rise in MR-conditional devices has resulted in CIED patients accessing MRI, and previously patients with CIEDs were classed as absolute contraindications. However, the magnetic fields from the MRI scanner can interfere with CIEDs causing damage to the device itself and/or the patient. This study evaluates CIED specific knowledge, confidence levels and attitudes amongst radiographers in MRI towards cardiac implant patients.
Methods or Background: A quantitative, online survey was conducted amongst qualified radiographers in MRI internationally to evaluate participants MRI qualification status, what CIED specific knowledge is held by radiographers, confidence levels amongst radiographers scanning CIED patients, and determine common attitudes amongst radiographers towards implant patients who present for an MRI scan.
Results or Findings: 90 responses were recorded and overall, and 58% of participants held a postgraduate degree in MRI while 42% did not. 73% of radiographers highlighted they had opportunities to update their MRI safety in the work setting, while only 36% had opportunities to update their cardiac implant safety knowledge. Overall, radiographers concluded that their MRI and CIED safety knowledge was sufficient and possessed adequate knowledge of the CIED and magnetic field relationship. However, evident disagreement on confidence statements on explaining MR field impacts on CIED functioning, having insufficient knowledge on device workings to confidently scan and conflicting safety results indicate that this area requires addressing.
Conclusion: Inclusion of specific CIED safety training for MRI radiographers should be recommended as educational topics to equip radiographers with the knowledge, skills and confidence to competently provide safe patient care.
Limitations: Survey distribution was in English.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Medical School Social Research Ethics Committee - University College Cork