1356594 - A Radiographer’s Evaluation of a Rapid Stress Perfusion CMR Protocol.

Friday, January 27, 2023

8:35 AM – 8:42 AM

Location: Shorebreak

Presenting Author(s)

Kim Le, BSc

Superintendent Radiographer
Chenies Mews Imaging Centre
London, England, United Kingdom

Primary Author(s)

Kim Le, BSc

Superintendent Radiographer
Chenies Mews Imaging Centre
London, England, United Kingdom

Co-Author(s)

JA

Jessica Artico, MD

Clinical Research Fellow
St Bartholomew's Hospital, England, United Kingdom
CM

Carol McGann, BSc

Deputy Superintendent
Chenies Mews Imaging Centre, United Kingdom
KB

Kirsty Bland, BSc

Senior MRI Radiographer
Chenies Mews Imaging Centre, England, United Kingdom
re

ryan-james evans, BSc

Senior MRI Radiographer
Chenies Mews Imaging Centre, England, United Kingdom
SP

Shane Palmer, BSc

Senior MRI Radiographer
Chenies Mews Imaging Centre, England, United Kingdom
GJ

George Joy, MBBS

Research Fellow
University College London, United Kingdom
GT

George D. Thornton, MBBS

Clinical Research Fellow
University College London, United Kingdom
IP

Iain Pierce, PhD

Scientist
Barts Heart Centre at St Bartholomew's Hospital, United Kingdom
James C. Moon, MD

Clinical Director, Imaging
Barts Heart Centre and UCL
London, England, United Kingdom
PK

Peter Kellman, PhD

Senior Scientist
National Institutes of Health, Maryland, United States

Background:

Stress Perfusion CMR is a key non-invasive technique for ischemia detection and is performed without the use of ionizing radiation. Demand is outstripping supply resulting in increased waiting times and delays in patient care.

Protocols vary, but effort is currently underway to standardize sequences as well as accelerate protocols, which is helpful for patient groups where scanning may be difficult (claustrophobia, poor breath-holding, intolerance of lying still for usual scan durations).

We report on a rapid stress perfusion CMR protocol with sequence optimisation tested at our centre, aiming to decrease overall scan examination times.

Methods:

Protocol: A rapid CMR protocol was developed and initially tested at our partner site (Barts). This consisted of focused anatomical imaging (one stack only), quatitative stress perfusion mapping with no rest sequence, long axis and short axis cines with inline AI analysis, and motion corrected late PSIR late gadolinium enhancememt.

Patients: New referrals vetted for RAPID perfusion CMR protocol, as part of service quality improvement. This included around 1/3 of referrals where the indication was focused (eg ischemia not) with no requirement for T1/T2 mapping, valve, mass or shun t assessment.

Collected data included: scan start time, adenosine start time, minutes to adenosine stress, time scan ended, overall scan time and comments for any deviations from protocol (such as additional sequences performed, or notable patient considerations which may have caused increased scan time).

Analysis: Over 2 months, 20 RAPID Perfusion CMR studies were performed. Comparison made with additional 20 studies with the same indications but where RAPID CMR was not performed.

Results: Of the 20 RAPID patients, additional radiographer support was required for 2 (communication difficulties), 2 (claustrophobia), 2 (arrhythmia) and 6 required some repeated or additional sequences. (mapping/flows/black blood imaging). Despite this, the median total scan time for RAPID was 30.8min (range 21–40) compared to 43.85min (range 31–56) minutes for conventional. For those with no additional input required, the median scan time for these patients were 27.6 minutes (see Figure A).

Conclusion: RAPID perfusion protocols are feasible – at least for ~1/3 of referrals. Around half such patients still require specific additional expert radiographer interventions, but the protocols are typically 30% faster (37% if no deviations or patient specific interventions).