The good news is that intensive international research, including work by German radiological bodies, has significantly improved the situation for pacemaker and ICD patients over recent years: people with conventional pacemakers or ICDs can now be examined using "off-label" procedures, subject to certain safety precautions. And we now have MRI-safe pacemakers and ICDs that are certified and authorized for use under specific conditions.

That sounds like a positive development. But what's the catch?

The problem is that it is still very difficult for most pacemaker and ICD patients to get an MRI scan -- even for those fitted with the new devices that are conditionally MRI-safe. This is partly because referrers, cardiologists, and radiologists don't know enough about this new and complex subject, and also because no clear procedures and responsibilities have been defined for radiologists and cardiologists working together.

We do have publications by individual associations: the 2013 European Society for Cardiology (ESC) guidelines and the DRG's 2015 position paper. Where does the DGK and DRG consensus paper fit in?

I have great respect for cardiology guidelines. However, the relevant chapter of the ESC publication deals with the whole subject in just two pages of highly simplified recommendations that don't reflect the complexity of the issue. For example, it leaves out key safety aspects such as pulse oximetry monitoring of patients, and nearly all the controllable risk management aspects of MRI technology. These include the ability to reduce high-frequency energy input by modifying MRI sequence parameters.

And what was the purpose of the DRG's 2015 paper?

The DRG's 2015 position paper was a response to the ESC publication and provided a detailed description of the radiology and physics of MRI in pacemaker patients. It reinforced, expanded, and in some cases, corrected, the ESC paper.

The new DGK and DRG consensus paper is the logical next step after these publications, setting out the two associations' objectives and ratified by both bodies. It clearly defines the interfaces between radiology and cardiology, provides harmonized and jointly ratified risk assessment and patient monitoring procedures, and presents specific reprogramming options for pacemaker and ICD systems that have been optimized for patient safety and clinical practicability.

What was it like working with your cardiology colleagues?

There were some tensions and political turf wars at first, and we exchanged a few strongly worded emails. But later on, as we discussed the issues involved and shared our specialist expertise in cardiology, electrophysiology, MRI physics, and radiology, we developed a very good, fruitful, and professional relationship.

As the authors, we're delighted the consensus paper has been brought to a successful conclusion. It's taken two years of work and five approval bodies, but there has been no significant friction or editing cuts!