Interventional Innovation

Le Bonheur’s hybrid cath lab is the first in Tennessee and one of only a few in the country. Pictured above, the MRI suite and cath lab are directly adjoined so that patients can be moved seamlessly between the two.

“Cath labs of the future will be run out of MRI suites,” says Jason Johnson, MD, MHS, chief of Pediatric Cardiology and director of Cardiac MRI at Le Bonheur Children’s Hospital.  

It’s this foresight and ambition that brought together Le Bonheur’s radiology and cardiology teams to develop and pioneer something that only few in the country had done before – create a hybrid catheterization (cath) lab and MRI suite to provide better, safer care for kids. 

The first of its kind in Tennessee and only the eighth in the United States, this hybrid MRI and cath lab suite, located inside of Le Bonheur’s new Heart Institute expansion, will allow for smoother hybrid cases where transportation is needed between the cath lab and MRI. It will ultimately be a space for Le Bonheur experts to develop methods, devices and procedures for cardiac interventions inside of the MRI suite itself.  

“Our ultimate goal is to show reproducibility and safety, identify cases where an intervention in the magnet can occur and develop MRI cath protocols,” says Johnson. 

Prior to the hospital expansion and development of the hybrid cath lab and MRI suite, patients who needed an MRI during a cath procedure were transported from the second floor cath labs to the ground floor MRI suite. The cardiology and radiology teams knew that they needed a safer way to conduct these cases, says Crystal Thomas, Le Bonheur director of Cardiovascular Services. 

“With the Heart Institute expansion, we had an opportunity to get an MRI beside the cath lab. As we grew in knowledge, we realized we need to have them connected for safety,” says Thomas. “Now we can float the patient to the MRI side and the patient never loses position. We can then overlay images really easily to do the intervention in the cath lab.” 

The MRI suite has the very latest in MRI technology, the SIGNA Artists GE 1.5 Tesla, that can fit a vast size of patients, produce higher quality of scans and reduce scan times by 30-50%.  

“This new technology will be a gamechanger for our patients, enhancing the quality of care we’re providing and creating a more positive patient experience,” says Stevie Lee, Le Bonheur director of Radiology. “Doctors will have the capability to achieve more high-efficient, quality imaging to better make diagnoses.” 

The hybrid cath lab features the latest in MRI technology. Le Bonheur physicians are developing the devices, processes and methods to perform cath interventions within the MRI suite. 

This MRI will be used almost exclusively for cardiac patients, making care safer and quicker for patients in the CVICU located on the same floor. In addition to heart imaging, providers can use the MRI for diagnostics such as neurological exams or functional exams when cardiac issues impact other parts of the body. 

The teams will use the cath lab and MRI separately around 70% of the time, says Johnson. But the true novelty of the suite is the other 30% – the potential for cath interventions using MRI instead of fluoroscopy.  

Traditional fluoroscopy, which is continuous X-ray, can show blood flow and tissue level images, providing interventionalists with what is essentially an outline of the heart. Due to the nature of fluoroscopy, patients are exposed to radiation and contrast in order to perform the procedures. Cath procedures in the MRI suite would effectively erase both of these safety concerns and vastly improve visualization of the heart and its structures at a granular, cellular level, according to Johnson.  

“MRI allows you to know exactly where your catheter tip is and doesn’t require contrast or radiation,” says Johnson. “It’s completely changing the way that we visualize the structures that we want to see.” 

This could particularly benefit the sickest children that the Heart Institute sees, such as those with single ventricle conditions or failure of another organ other than the heart. It would also allow for the most effective biopsies for heart transplant patients – MRI could help identify the weakest tissue for sampling that would best detect heart transplant rejection. 

In order to reach these goals, Le Bonheur cardiologists and radiologists are working hand in hand with device manufacturers to develop safe devices for use in the MRI. A unique aspect of Le Bonheur’s hybrid cath lab is that it is vendor agnostic: one company supplies the cath lab equipment and another company provides MRI, which has led to a unique collaboration between competitors – all for the benefit of kids.  

“There’s no standard for this yet, all interventional procedures will be under research protocol as we test proof of concept,” says Johnson. “Right now, we are limited in what we can put in the magnet. We’re working with vendors to develop techniques and test this equipment.” 

The benefits of Le Bonheur’s hybrid cath lab and MRI suite are myriad. From a patient safety standpoint, anesthesia times will decrease because of the ease of movement between cath lab and MRI, and radiation will decrease, and possibly be eliminated, when procedures can be performed with MRI instead of fluoroscopy.  

Thanks to the new hybrid MRI/cath lab, patients can undergo cath procedures and MRI and only be sedated one time.  

Plus, with the hybrid cath lab on the same floor as the Heart Institute’s CVICU, patients have better access to critical care if required. The time savings benefits are huge, even if using just for diagnostics in the MRI and then the intervention in the cath lab.  

“We’re continuing to try to improve our ability to get high-class diagnostic and interventional services for a child in the safest way possible,” says Johnson. 

“We want to be the role model,” adds Crystal. “This suite provides optimal care and a whole new world of opportunities in the future.  

As part of that desire to be leaders in the field, the hybrid suite was designed with training in mind. Additional cameras and communications systems were added to better communicate between the MRI and cath lab during a case, but the development also included extra cameras making it easier to perform live cases and train other physicians.  

“Our cardiologists and radiologists are in constant conversation on how to maximize this technology,” says Lee. “We’re working together to create shared procedures and collaborating to coordinate the best care for kids.”