Multidisciplinary Protocol for 1.5T MRI in Adult Patients With Active Implantable Medical Devices: Safety and...

The growing population of patients with active implantable medical devices (AIMDs) presents challenges for MRI access. Safety concerns regarding device malfunction and patient risk, demand standardized management strategies.

To evaluate the safety and feasibility of a structured multidisciplinary safety protocol for 1.5T MRI in AIMD carriers.

Retrospective.

514 consecutive patients with AIMDs (cardiac implantable electronic devices (CIEDs) (n = 347), auditory implants (n = 85), neurostimulators (n = 61), and drug delivery systems (n = 21)) scheduled for clinical MRI (head (34.3%), spine (19.0%), prostate (10.5%), abdomen/pelvis (9.5%), knee (8.6%), heart (3.8%), and other sites (14.3%)) between 2019 and 2025.

MRI was performed on 1.5T scanners using predefined protocols, with automatic compliance to device-specific SAR limits through the Philips ScanWise Implant software.

The safety protocol included device verification, MRI-mode programming, compliance with manufacturer safety conditions, physiologic monitoring, and post-MRI device interrogation. MRI completion rates, exclusion frequencies, and adverse events were recorded, and exclusion proportions were compared across AIMD categories.

Descriptive statistics.

Of 514 patients, 50 (9.7%) with MR-unsafe, MR-nonconditional, or artifact-prone devices were not scanned: MR-unsafe (n = 23), MR-nonconditional (n = 22), or anticipated severe artifacts (n = 3). Four hundred and sixty-four (90.3%) patients successfully completed diagnostic MRI. Two brain examinations were terminated early due to implant-site pain. No device resets, malfunctions, or significant changes in sensing/pacing thresholds occurred. Internal magnet displacement was observed in three (3.5%) auditory implants, with two requiring surgical repositioning. Exclusion rates varied by device type, ranging from 11% to 14% for CIEDs to 29% for specific neurostimulators.

A structured, multidisciplinary protocol enables safe MRI in the majority of patients with MR-conditional AIMDs. Standardized pre-MRI screening and management support safe implementation, and improve MRI accessibility for this growing and complex patient population.

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