Clinical Imaging Board statements

Position statements issued by the Clinical Imaging Board.

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2023

The use of ECG gating in CT imaging of the thoracic aorta

CIB Position Statement

Imaging of the thoracic aorta with CT is a common investigation performed in the elective and emergency settings. In acute and emergency care, it is used to identify or exclude potentially life-threatening conditions such as acute aortic syndromes, including aortic dissection.

The pulsatile nature of the aorta means that motion artefacts on imaging can make assessment extremely difficult. However, ECG gating is a well-established technique in cross sectional imaging and enables the moving structures in the thorax to be imaged effectively motion-free by coordinating scan acquisition with the patient’s heartbeat⁽¹⁾. Most modern CT scanners have this capability.

The Clinical Imaging Board supports the routine use of ECG gating in all patients undergoing thoracic aortic CT 24/7 , in and out of hours. While it is acknowledged that there will be a need for a programme of training in imaging departments, this is considered best practice and will help ensure optimal patient care and safety.

Vardhanabhuti V, Nicol E, Morgan-Hughes G, Roobottom CA, Roditi G, Hamilton MC, Bull RK, Pugliese F, Williams MC, Stirrup J, Padley S, Taylor A, Davies LC, Bury R, Harden S.
Recommendations for accurate CT diagnosis of suspected acute aortic syndrome (AAS)--on behalf of the British Society of Cardiovascular Imaging (BSCI)/British Society of Cardiovascular CT (BSCCT).
Br J Radiol. 2016;89(1061):20150705. doi: 10.1259/bjr.20150705. Epub 2016 Feb 26. PMID: 26916280; PMCID: PMC4985448.

2022

IPEM Magnetic Resonance Safety Expert (MRSE) Certificate of Competence

CIB Position Statement

IPEM Magnetic Resonance Safety Expert (MRSE) Certificate of Competence

Ensuring the safety of patients, staff and visitors is a critical component of an MRI service. The MHRA Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use recommends that all MRI facilities appoint one or more MR Safety Experts (MRSE).

A multi-professional working party (with representation from BAMRR, BIR, IPEM, RCR, BC-ISMRM and SCoR), in conjunction with IPEM, have established the IPEM Magnetic Resonance Safety Expert (MRSE) Certificate of Competence. This certification model is open to any MRI professional who can demonstrate they have the required knowledge and experience. Knowledge is demonstrated by successfully completing the American Board of Magnetic Resonance Safety (ABMRS) MRSE exam. The MR experience of an applicant is assessed from a structured portfolio demonstrating a broad range of MRSE activities.

The Clinical Imaging Board supports the IPEM Magnetic Resonance Safety Expert (MRSE) Certificate of Competence and recommends that all MRI facilities appoint one or more persons holding the MRSE Certificate of Competence either from within their own organisation, or as part of a service level agreement with an external organisation.

Further information is available on the IPEM website.

2021

Self-referral for MRI examination

CIB Position Statement

Self-referral for MRI examination

Any imaging study forms part of the overall diagnostic jigsaw that includes a history, examination and appropriate additional studies. It is necessary that an appropriate formal referral is generated by a registered healthcare professional following the appropriate clinical assessment. The result of the study, following its radiological interpretation, is then sent to the referring professional so the result can be interpreted in the context of the overall clinical assessment.

This is particularly important as any imaging study can give rise to unexpected findings which may be of no consequence or may have serious implications.

It should also be noted that the injection of an MR contrast agent (if required) is contraindicated in certain circumstances, and therefore requires proper clinical assessment prior to referral, vetting and undertaking such examination.

Therefore, the Clinical Imaging Board does not support the self-referral by the patient for MRI or any diagnostic imaging study.

Clinical Imaging Board
August 2021

The role of scout or localiser images obtained during CT or MRI in diagnostic radiology

CIB position statement

The role of scout or localiser images obtained during CT or MRI in diagnostic radiology

ISSUE

Whilst obtaining a CT or MR examination the radiographer will generate a scout or localiser to ensure accurate positioning of the patient for the subsequent diagnostic examination. There is a debate over whether these images should be included in the image set produced for the overall diagnostic interpretation. It is accepted that scout or localiser images may not necessarily be of diagnostic quality.

There are a few case series in the literature often associated with the retrospective diagnosis of lesions that only subsequently can be seen on the scout or localiser imaging.

POSITION

Considering this issue, the RCR, SOR and COR, and IPEM, collectively as the Clinical Imaging Board, has decided a joint position:

A clear and agreed local policy is required so that all staff in an imaging centre are aware and able to observe the policy when archiving imaging series in CT and MRI.
It is recognised that there are varying opinions on whether or not to include localiser images in PACS data sets for reporting. However, the Clinical Imaging Board position is that these images should be sent to PACS.
A scout or localiser can include evidence of abnormality, or unexpected findings such as pregnancy, that might be useful in setting the scan parameters or in other aspects of the management of the patient.
In the case of CT scanning, the radiation dose used to obtain the scout or localiser image is an additional consideration. Please refer to the current IR(ME)R guidance.
Any local policy where it is agreed to exclude scout or localiser images from the PACS data should state clearly why the policy position is justified within the service approach to quality improvement.
Where local policy indicates that the scout or localiser should be recorded as part of the diagnostic series, it should be reviewed when the report is being generated.
If for any reason the examination is aborted after the scout image(s), there must be a clear procedure that highlights the actions to be taken in the event of unexpected findings, for example pregnancy.

Clinical Imaging Board
June 2021

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