Researchers lead award-winning service to improve MRI scans for patients with pacemakers

A new, streamlined service set up by a hospital team including UCL researchers is transforming care for people with pacemakers and defibrillators.

The Cardiac Imaging Department at Barts Hospital set up the service to address poor access to MRI scans for patients with cardiac devices.

The team now does around 20 times as many scans as the national average, and has received 2 awards for their work, winning ‘BMJ Diagnostic Team of the Year’ in May and the HSJ Values awards for Diagnostic Imaging in June.

Fewer than 1,000 scans take place each year in the UK patients with cardiac devices, but the clinical need is around 50,000.

This lack of access leads to delays in diagnosis and treatment of conditions such as cancer and stroke. Delays impact patients’ health – and are also costly to the NHS. The cost of one late cancer diagnosis is £4,000.

440,000 people in the UK have cardiac devices, and up to 75% will need an MRI scan in their lifetime, but some hospitals have been reluctant to scan devices due to concerns scanning could interfere with them.

But newer pacemakers are now designed to be compatible with MRI scanners, and the latest guidelines say older pacemakers, known as legacy devices, can be scanned safely provided strict procedures are followed.

The team at Barts, which includes UCL researchers Dr Charlotte Manisty and Prof James Moon, developed a ‘one-stop’ service where devices could be re-programmed and scans acquired at one location on a single visit.

Previously, the process of having a scan had multiple steps, a barrier for patients which also led to longer waiting times. Alongside the increase in scans taking place, the service has led to a 4-fold decrease in waiting times, and an 8-fold increase in referrals for scans.

The team want to see other departments replicate their service. So far, the team at Barts has trained 16 other centres in the UK. Doctors have also set up a campaign website, ‘MRI my pacemaker’, to reach patients and healthcare professionals.

Dr Manisty, who is also a Consultant Cardiologist at UCLH, said she wants to see similar services across the UK:

‘We have shown that it’s possible to significantly increase access to MRI for patients with cardiac devices, but we need other hospitals to follow suit. We have seen patients from as far away as Northern Ireland, but patients shouldn’t have to travel all this way – they should be scanned at their local hospital.

‘We were able to introduce our service at minimal cost, so other hospitals should be able to replicate what we have done. The main changes are logistical, as our service brings together various teams including cardiologists, radiologists, and cardiac physiologists in order to provide a streamlined service for patients.’

Professor Moon, Professor of Cardiology at UCL and Clinical Director of Imaging at the Barts Heart Centre, said that more needs to be done to address concerns around the risk of scanning cardiac devices:

‘The evidence is clear – it is safe to scan devices, and this guidance is backed by the British Cardiovascular Society and the Royal College of Radiologists. However, there is still a perceived risk around scanning in some departments, and there is a lack of training for healthcare professionals on the correct procedures.

‘We need to train healthcare staff so they can roll out services in their own departments. We also need to let patients know that it is safe for them to be scanned – especially patients who have previously been told their pacemakers cannot be scanned – so that they can approach a service themselves.’

Alongside the creation of the service at Barts, Dr Manisty has been involved in BRC-supported work to improve the diagnostic quality of heart scans.

With Dr Peter Kellman, Visiting Professor at Institute of Cardiovascular Science, she has developed new MRI scanning techniques in order to improve the quality of images.

The pacemaker or defibrillator generators often produce noise on the MRI scan images, known as artefact, which makes image interpretation more difficult.

Dr Kellman and Dr Manisty developed imaging sequences which are designed to remove this artefact from images and make it easier for doctors to make accurate diagnoses.

More information: ‘MRI my pacemaker’ website