The clinical need

What is an MRI scan?

Magnetic resonance imaging (MRI) is a type of scan that uses magnetic waves to produce very detailed images of the body. It is a painless and safe procedure and helps to diagnose illnesses. This helps doctors to treat disease earlier and more effectively. It is an unparalleled test for many brain and spinal diseases, joint problems, and to make cancer diagnoses.

Why is this important for pacemaker patients?

50-75% of pacemaker patients will need an MRI in their lifetime2 and it is the fastest growing imaging technique5. Older pacemakers and cardiac defibrillators (also known as ‘legacy’ devices) were not designed to undergo MRI scanning and so this meant doctors had to find alternatives. Because this often meant more invasive tests, delayed diagnosis and missing out on the best treatments, newer devices were designed so that they could undergo MRI scanning. These are called ‘MRI-conditional’ devices (more detail here).

In the NHS,  we spend over £100 millions a year on this new technology that is MRI-conditional. Yet despite this technology, over half of hospitals do not even offer this service4, and we still need to increase provision 50 times to match demand.

This means we are not fulfilling our obligation to achieve accessible care for over 3 million people worldwide with pacemakers and defibrillators6,16.

“50-75% of  patients will need an MRI in their lifetime”

Figure1_modified.jpg
Trends in MRI and Pacemaker implantation in the UK

A growing problem

Our reliance on MRI, and people benefiting from IECDs are both rising: this need is growing by approximately 2% a year. 300 million MRIs are performed annually and it is the fastest growing imaging modality3,15. IECD implantation is rising by 5% per year and half of this group are aged over 65 with increased stroke and cancer rates4,5. Despite this, patients with IECDs are 44 times less likely to be referred for an MRI after a stroke6.

“Over half of hospitals do not offer MRI for device patients”

An early diagnosis makes clinical and economic sense

The benefit of these scans is most obvious in the acute setting, and recognised by 97% of acute NHS Trusts2. MRI is unmatched for cancer, spinal cord compression, half of transient ischaemic attacks and increasingly for trauma. Successive reports from the King’s Fund and National Audit Office have highlighted this deficiency and its clinical and financial costs7.

Cancer remains one of our most feared illnesses affecting over one in three of us and the reason behind one third of these scans8. Given the cost of a late diagnosis is £4,0009, this has potential annual savings of over £10 million for this indication alone.

Barriers to scale and what we need

Widespread adoption of new tests typically takes around ten years. We should not be delaying important diagnosis and treatment because patients have to search the country for a hospital that will perform the standard of care.

MRI departments report three main barriers to providing this service2:

  1. Lack of training
  2. Concerns around risk
  3. Cross-departmental logistics

We therefore need to adopt an approach that encourages service development, aligns with a regional and a national level. We should lead on these changing perceptions, together.