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How can we reduce patients’ radiation exposure during cardiac catheterization procedures, without compromising care? Radiologists and interventional cardiologists have long grappled with this question – and bringing MRI machines into the catheterization lab or vice versa may be the answer.
In 2017, The Heart Center at Children’s Health℠ in Dallas opened a specialized hybrid catheterization lab/MRI suite. It was the first in Texas and one of only a few in the country. Since then, we’ve performed more than 50 MRI-guided cardiac catheterization procedures – and seen first-hand how this reduces radiation exposure among patients and staff, while offering more detailed images than ever before.
The cath/MRI lab is the result of a collaboration between Children’s Health and UT Southwestern. A multidisciplinary team of UT Southwestern experts: F. Gerald Greil, M.D., Ph.D., and M. Tarique Hussain, M.D., Ph.D., from the MRI team, Suren Reddy, M.D., from the cath lab team, and Jennifer Hernandez, M.D., from the cardiac anesthesia team launched the Radiation-Free MRI-Guided Heart Catheterization Program at Children's Health.
From reduced radiation to improved imaging, here are three ways this program is reshaping care for our patients and providers:
The greatest benefit – for both patients and personnel working in the cath lab – is that MRI does not use any ionizing radiation.
A study by the American Heart Association found that routine diagnostic coronary angiography was equivalent to 350 X-rays and that an interventional catheterization could be similar to the exposure of up to 4,000 X-rays. In children, the levels could be even greater, considering that fluoroscopy times are 5 to 10 times longer than in adult procedures.
Most congenital heart defect patients will have multiple procedures over their lifetime, and cardiologists and cath lab staff may perform several produces each week. Over time, these radiation levels add up and can increase the risk of cancer, skin lesions and cataracts.
Moving from X-ray to MRI imaging dramatically reduces radiation exposure for both patients and cath lab staff.
X-ray angiography has a number of limitations beyond radiation. One of the greatest drawbacks is limited soft tissue detail and 3D anatomic information, which can be crucial in patients with complex congenital heart disease.
As transcatheter procedures become more complex, there will be a significant need for more detailed imaging. That’s where MRI can make a huge difference. MRI provides a level of detail and clarity that far exceeds x-ray.
3D imaging also helps cardiologists measure blood flow, the size and volume of heart chambers and thickness of the heart walls. Plus, differences between normal and abnormal tissue are more clearly visible.
MRI in the cath lab also displays images in real-time. Fast MRI has made visualization of moving structures possible, including anatomic details in the rapidly beating heart.
This enables interventional cardiologists to visualize the MRI-compatible catheter and wire as they are maneuvered through a patient’s beating heart. MRI-guided catheterization procedures help the team at The Heart Center obtain both pressure and tissue data at the same time, which is used to make critical decisions regarding patients’ candidacy for high risk cardiac surgeries. Performing MRI-guided cardiac catheterization has also helped the hybrid cath-MRI team to successfully start the high-risk lymphatic occlusion procedures here at Children’s Health.
Our cath/MRI lab is just the latest step in our push to bring the most effective and minimally invasive procedures to children with a range of heart issues. With nearly 13,000 outpatient clinic encounters, 750 catheterization procedures and more than 1,000 inpatient admissions each year, The Heart Center at Children’s Health has some of the nation’s highest volumes and best outcomes. Our team of expert subspecialists work together to offer the full spectrum of cardiac care, from prenatal diagnosis to heart transplants to adult congenital care.
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