Fully automated free-breathing cardiac magnetic resonance imaging at 3T: A prospective randomized study of image...

Automation in cardiovascular magnetic resonance (CMR) scans holds the potential to improve examination efficiency and workflow consistency. Prospective clinical evidence validating automated scan workflows in routine CMR practice remains limited.

In this prospective randomized study, consecutive patients referred for non-stress CMR were assigned to either an automated or a manual free-breathing scanning workflow. The fully automated workflow integrated automated plane prescription of multiple steps required for successful image acquisition. The primary endpoint was total examination time; secondary endpoints included plane prescription accuracy, image quality scores, scanner idle time, and technologist workload.

Of 255 screened patients, 221 were included (automated, n = 109; manual, n = 112). All examinations were diagnostically adequate. The automated and manual workflows showed a similarly low incidence of plane prescription misalignment, corresponding to 19.3% (21/109) and 17.9% (20/112) misalignment events per examination, respectively, with no significant difference between groups (0.19 vs. 0.18 events per examination, P = 0.780). No significant differences were observed across imaging planes or technologist experience levels, and image quality scores were comparable between workflows (2.74 ± 0.67 vs. 2.69 ± 0.70, P = 0.547). However, the automated scanning workflow significantly reduced total examination time (19.16 ± 2.32 vs. 21.25 ± 2.25 min, P < 0.001) and scanner idle time (7.80 ± 1.80 vs. 10.12 ± 2.03 min, P < 0.001), with consistent savings across all experience levels. Operator workload was also substantially lower with automated scanning, evidenced by fewer mouse clicks and keystrokes (both P < 0.01).

An automated CMR scanning workflow improves examination efficiency and reduces operator workload without compromising image quality or plane prescription accuracy, supporting its integration in routine clinical CMR practice.