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Magnetic Resonance Imaging (MRI)

MRI-Conditional Pacemaker 

After months of planning and training, Beverly Hospital became the first health institution on the North Shore to perform an MRI scan on a patient with a new MRI-Conditional pacemaker. Traditional pacemakers are banned from MRI scanners because they are metal and can be shut off or moved by the scanner's powerful magnet. "This is really a pioneering step," says Dr. Steven Defossez, the Chief Radiologist of MRI at Beverly Hospital and the Northeast Health System, "because, with the aging of the population and likely prevalence of pacemakers, this new capability will make an enormous difference to our patients on the North Shore and surrounding areas."

Beverly Hospital was able to scan the patient, which took place last week, because the MRI department had worked diligently and carefully to design and implement the necessary protocols, safety guidelines and procedures, according to Jeanne Riley, RTR, MR, the Chief MRI Technologist, who headed the planning team. No other hospitals on the North Shore have completed this process.

While MRI is an important diagnostic tool for many health issues, including cancer and stroke, having a traditional pacemaker prevents a patient from even walking near an MRI scanner. "The magnet in the scanner can shut off the device and heat up the wires or 'leads' connecting it to the heart" says Dr Defossez. MRI (magnetic resonance imaging) uses magnetic energy rather than radiation (in the case of x-rays) to scan inside the body. Pacemakers sense slow heartbeats and stimulate the heart to beat at a normal rate.

The patient, Judith James, a 72-year- old Danvers resident and former professor of Physical Therapy Assistants at North Shore Community College, needed the scan to learn if surgery was necessary for her painful knee. The previous year, she received a Revo SureScan Pacemaker by Medtronic to stabilize her heartbeat. Medtronic pacemakers are the only pacemakers made of materials that are safe during MRI testing, according to the Medtronic representative who reprogrammed the pacemaker and observed Beverly Hospital's use of its new protocols and procedures when James arrived at the MRI suite.

James was thrilled that she was able to get the scan near home and at Beverly Hospital. "I felt I was in good hands and was very confident," she says. Ironically, it was she who set the process in motion.

James had asked for the MRI-Conditional pacemaker when, following a stress test, her cardiologist told her a pacemaker was necessary. "I was about to participate in a medical study that would require me to undergo several MRI scans, and I had heard about this new pacemaker," says James. A cardiac surgeon, Dr. Jonathon Silver, agreed to implant the Medtronic device in the Cardiovascular Suite at Beverly Hospital after determining her eligibility. "The study I had volunteered for didn't happen after all," she says.

Then, last fall, after several months, her orthopedic surgeon told her that she needed an MRI to evaluate what was happening in her painful right knee. "Not knowing that Judith had this MRI-compatible pacemaker, I told her she would have to have another, less accurate and more invasive test," says Dr. John Boyle, whose practice is at the North Shore Center for Orthopedic Surgery in Danvers.

"I told him about my special pacemaker and that I wanted to have the scan close to home," she says.

When presented with James' case and her desire to get a scan locally, the Beverly MRI team sprang into action. "We also knew about these new pacemakers and were beginning to plan for them, but Judith's referral motivated us to begin immediately to prepare ourselves and the MRI suite to make it happen," says Judith Samuelman, the Outreach Liaison for the MRI department.

Over the next four months, a team, consisting of staff of the MRI and cardiovascular departments, in consultation with cardiologists and radiologists, worked tirelessly to prepare for James' arrival. "I think it was a wonderful collaborative effort. We developed policies, order sets, and a training and certification program for anyone involved in the care of patients like Judith," says Cynthia Beauregard, RN, the nurse manager of the cardiovascular suite, who was onsite during last week's procedure." "All cardiovascular staff and all the MRI staff were trained and certified before we did this first scan."

And it was a success. According to Dr. Boyle, the scans were very clear and helpful and will certainly contribute to his advice to Judith about the next step in treating her knee, which will likely include surgery.

Says James, "It sure is nice being a trend setter."

"We are always talking about 'patient centered' care. This is an example of just that," says Defossez.