SCMR Mid-Year Meeting: Myocardial Perfusion CMR-Nuts and Bolts of Starting a Stress CMR Program

Video Transcription

Video Summary

This conference session focused on the practical steps needed to build and sustain a stress cardiac MRI (CMR) program. Speakers covered the business case, workflow design, staffing, drug selection, and real-world case examples.<br /><br />Dr. Ibrahim Saeed emphasized the financial side: hospitals and physicians are paid through outpatient hospital payments, physician fee schedules, RVUs, and accountable care organizations. He stressed that programs must understand payer mix, maximize coding, use appropriate order sets, and advocate for reimbursement of newer quantitative mapping codes and stress CMR services. He argued that stress CMR is cost-effective and underused compared with SPECT and stress echo.<br /><br />Dr. Kevin Steele described launching stress CMR in a non-academic community setting. He highlighted the importance of strong collaboration between cardiology, radiology, technologists, schedulers, and administrators. He recommended starting with low-risk patients, making ordering simple, tracking referral patterns, and continuously promoting the program with feedback on volume, speed, and clinical value.<br /><br />Dr. Jadranka Stojanovska discussed the radiology perspective, comparing an academic/public model with a private, high-volume workflow. She stressed patient safety, EKG monitoring, appropriate preparation, and efficient division of labor. At NYU, stress processing was separated from CMR reading to improve throughput.<br /><br />Mr. Mark Masonheimer explained how nursing-led vetting, prep, and procedure workflows reduced delays and improved patient experience, cutting prep time and wait times dramatically.<br /><br />Dr. Barbara Srichai reviewed pharmacologic stress agents—adenosine, regadenoson, dipyridamole, dobutamine, and atropine—explaining mechanisms, contraindications, safety, and how to choose based on patient and site needs.<br /><br />The session ended with detailed cases illustrating ischemia, scar, artifact, and incidental findings, reinforcing the value of careful interpretation and multidisciplinary teamwork.

Keywords

stress cardiac MRI

CMR program

business case

workflow design

staffing

reimbursement

coding

payer mix

regadenoson

adenosine

dobutamine

patient safety

EKG monitoring

multidisciplinary teamwork

ischemia