Redefining roadmap imaging in interventional radiology: A roadmap acquisition mode (RAM)/mask recall mode (MRM)...

Roadmap imaging is a cornerstone of interventional radiology, providing real-time navigation through contrast-enhanced vascular overlays. However, the terminology and implementation of this technology, particularly regarding the distinction between real-time Roadmap Acquisition Mode (RAM) and retrospective Mask Recall Mode (MRM), vary inconsistently across vendors. This can hinder training, limit reproducibility, and reduce the optimal use of roadmap imaging in high-stakes procedures.

Eight expert radiographers conducted a narrative review using a triangulated approach that combined literature analysis, vendor manual review, and hands-on evaluation of five state-of-the-art angiography systems. They developed a vendor-neutral RAM vs. MRM classification across seven technical domains, supported by expert-consensus evaluation.

The analysis revealed significant variability in roadmap terminology, system behaviour, and user interface design. Despite system-level differences, the systems could be consistently categorised according to their functional characteristics rather than their proprietary labels. RAM was defined by real-time acquisition with motion-adaptive overlays, while MRM referred to static, retrospectively acquired image masks. To help radiographers select the optimal modality for a given situation while taking into account anatomical dynamics, dose management, and procedural phase, a decision-making flowchart and practical guide were developed.

RAM and MRM are fundamentally distinct modalities that require different application timings and levels of operator expertise. A clear, standardized classification can support safer, more effective use of the roadmap, as well as streamline the procedure.

This framework positions radiographers as active procedural leaders rather than technical executors. Standardizing roadmap terminology can promote cross-platform skills, improve communication within hybrid teams, and reinforce the interventional radiographer's role in providing dose-conscious, high-efficiency interventional care.