Purpose or Case Report: Percutaneous interventions are increasingly being performed under MR-guidance due to the absence of ionizing radiation, the ability to visualize target lesion and the capability to monitor real-time treatment effect. Here we outline our experience with developing an interventional MRI (iMRI) service at a pediatric institution.
Methods & Materials: Subjects of discussion include: education, interventional use of diagnostic MR suites, coil types, MR-compatible supplies, billing and scheduling codes, MR safety training, creation and optimization of procedure specific MR protocols, building/simulation of procedural workflow, initial procedure selection, and role assignments for MR and IR personnel.
Results: Site visits to a well established interventional MR program for procedural and workflow observation informs the initial education and training. The choice of a 1.5T/3T scanner is institution specific with consideration for more needle artifact with 3T field strength. Appropriate fast imaging sequence protocols and installation of a slave monitor for in-suite visualization of procedures is required. Sequences should be tailored so that the visibility of saline, gadolinium and/or needles is optimized and artifacts are minimized. Protocols can be tested using basic gel or other phantoms.

MRI coils are tailored to the intervention, including surface, flex and shoulder coils. MR-compatible interventional equipment is required but limited in availability. Coil choice to enable needle placement and appropriate protection of coil during sterile procedures requires planning and ideally phantom testing. Billing and scheduling codes can be created with the expertise of IR specific coding personnel. Most importantly the entire interventional team needs to complete MRI safety training.

Roles assignments need to be clearly defined. In our institution this is a follows; IR technologist manages the MR-compatible supplies stocked on an MR-compatible rolling table, and assist the IR physician during the intervention; the IR nurse monitors the patient; the MR technologist controls the MR host; and the IR physician performs the intervention. It is ideal to start the program with a relatively non-complex non sedated intervention, as in our institution MRI-guided shoulder arthrography.
Conclusions: Conventional MRI suites can be adapted for interventional procedures. Collaborating with experienced institutions and thoughtful proactive planning are keys to a safe and successful iMRI program.