Home » Resources » Scanning Info - Stress and safety equipment

Stress and safety equipment

a) SCMR official document standardized acquisition guidelines – relevant extract

1. General Techniques
   Stress equipment and safety equipment
   1. Monitoring equipment (blood pressure, electrocardiogram for monitoring of cardiac rhythm, intercom to communicate with patient)
   2. Preparation and regular practice for rapid removal of the patient from the magnet
   3. Emergency resuscitation policy in place
   4. Defibrillator
   5. Drugs for emergency treatment
   a. Immediately at hand: β-blocker (eg esmolol or metoprolol), nitroglycerin, aminophylline
   b. In the emergency cart: full set of emergency drugs
   (including drugs such as: epinephrine, beta blockers, atropine,bronchodilators, antiarrhythmic drugs)
   6. For dobutamine – on-line assessment of wall motion during image reconstruction performed immediately after image acquisition
   Stress agents
   Dobutamine typical maximum dose of 40 ug/kg/min
   Atropine 0.25 mg fractions typical (maximal dose 2 mg)
   Adenosine 140 μg/kg body weight/min
   Contraindications
   Dobutamine
   • Severe systemic arterial hypertension (≥ 220/120mmHg)
   • Unstable angina pectoris
   • Significant aortic valve stenosis (Peak aortic valve gradient > 50 mmHg or aortic valve area < 1 cm2)
   • Complex cardiac arrhythmias including uncontrolled atrial fibrillation
   • Hypertrophic obstructive cardiomyopathy
   • Myocarditis, endocarditis, pericarditis
   • Uncontrolled congestive heart failure
   Adenosine
   • Known hypersensitivity to adenosine
   • Known or suspected bronchoconstrictive or bronchospastic disease
   • 2nd or 3rd degree atrioventricular (AV) block
   • Sinus bradycardia (heart rate < 45 bpm)
   • Systemic arterial hypotension (< 90 mmHg)
   Atropine
   • Narrow-angle glaucoma
   • Myasthenia gravis
   • Obstructive uropathy
   • Obstructive gastrointestinal disorders
2. Patient preparation
   1. Obtain informed consent for the stress test
   2. To fully exert its effects patients should refrain from the following medications for at least 24 hours prior to the examination due to potential of counteraction against stress agent:
   Dobutamine: β-blockers and nitrates
   Adenosine: caffeine (coffee, tee, caffeinated beverages or foods e.g. chocolate, caffeinated medications), theophylline,dipyridamole
   3. Fasting is not usually considered mandatory, but is sometimes advised because recognized adverse effects of stress drugs include nausea and vomiting, which is problematic when lying supine in the restricted space of the magnet
   Potential adverse effects
   Dobutamine at high doses may cause chest pain, palpitations.
   More severe complications are uncommon, including:
   • infarction
   • ventricular fibrillation
   • sustained ventricular tachycardia
   Adenosine may cause flushing, chest pain, palpitations,breathlessness. More severe side effects include
   • transient heart block
   • transient hypotension
   • transient sinus tachycardia
   • bronchospasm

b) Expert opinion – ‘How we do’

"How I Do" CMR Scanning Safely (Elisabeth Burman, Royal Brompton Hospital, UK)

c) MRI safety and devices

www.mrisafety.com – No registration required now.  Run by Dr Shellock – look up all devices and MRI compatibility here
MR Safety (talk from GE, members only)

d) Relevant Online Talks

Free talks

Safety within the MRI Environment
By Roger Luechinger - Zurich, Switzerland
Recorded at EuroCMR 2009 Athens

CMR and CM safety
By Roger Luchinger
Recorded at EuroCMR 2008

Members only talks - general

Tips and Tricks: Patient confort and safety during stress
By Steven Dymarkowski - University of Leuven
Recorded at SCMR 2009 Physician preconference

Implants and Devices-The Current Safety Guidelines
By Shelton D. Caruthers - Washington University School of Medicine
Recorded at SCMR 2008: Technicians Workshop

Point/Counterpoint: Safety of PM/ICD in CMR
By Ergin Atalar - Bilkent University
Recorded at SCMR 2008: Plenary Session 2 CMR and Electrophysiology

Members only talks - cutting edge

MRI safety update 2009: high field
By Frank Shellock - University of Southern California
Recorded at SCMR 2009 High Field workshop

iCMR Intravascular Devices: Safety, High Field, Intravascular
By Paul Bottomley - Johns Hopkins University
Recorded at SCMR 2009 Interventional I - iCMR Technical

iCMR Coils: Multi-Channel MRI for Interventions and Safety
By Greig Scott - Stanford University
Recorded at SCMR 2009 Interventional I - iCMR Technical

d) Useful documents