MRI access for people with cardiac implantable electronic devices has changed substantially. Many patients with pacemakers or implantable cardioverter defibrillators can now undergo MRI, but only after the complete system and the proposed examination have been assessed through an established safety pathway.
Start with the label—and the whole system
MR Conditional is not the same as MR Safe. A device labelled MR Conditional may be scanned only when every stated condition is met, including the conditions that apply to the scanner, field strength, body region, operating mode and device configuration.
The generator alone does not define the status of a cardiac system. Leads, adapters, abandoned components and the specific combination of parts all matter. Unknown safety status should be treated as MR Unsafe until it has been positively identified and assessed.
Information to establish before the appointment
- Confirm the device manufacturer, model and identifying details for the generator and every lead.
- Review the implant record, device card and current manufacturer MRI instructions—not memory or a generic compatibility list.
- Check whether the proposed scan can meet every condition of use, including any limits on field strength, positioning, scan duration or radiofrequency exposure.
- Identify factors that require an individual risk assessment or specialist pathway, such as incomplete documentation, non-functioning components or non-MR-conditional labelling.
- Document the determination and communicate the agreed plan to the MR and cardiac device teams.
The scan is a coordinated workflow
A safe pathway is multidisciplinary. The MR team, radiologist or MR medical director, and the cardiology or electrophysiology service each have defined responsibilities. Depending on the system and local policy, the pathway may include pre-scan device interrogation, programming to an appropriate mode, patient monitoring, emergency readiness and post-scan interrogation.
Use the current standard operating procedure for your facility. Device management should be performed by appropriately trained personnel, and the scanning team should know exactly who is responsible at every stage.
Non-MR-conditional does not mean ‘routine’
Some patients with systems that do not carry MR Conditional labelling may still be scanned at experienced centres using a formal programme and a documented risk–benefit assessment. That is a specialist clinical decision—not permission to adapt an MR Conditional checklist.
Where the device is unknown, the documentation is incomplete or the local service cannot meet the required conditions, pause the booking and escalate to the designated MR safety and cardiac device leads.
What patients can do
Patients should tell the referring doctor and MRI service about any pacemaker, ICD or other implanted device as early as possible and bring their device identification card if available.
A patient should never decide for themselves that a device is compatible based on a model name found online. The imaging and cardiac teams need to verify the complete implanted system and the conditions for the planned examination.