EACVI Laboratory Accreditation in Cardiovascular Magnetic Resonance

Why would you benefit from receiving EACVI Laboratory Accreditation

Educational benefits:

• preference to be hosting centres for EACVI grants (prestige and reimbursement)
• preference in participation in EACVI specific educational projects (for instance, e-learning)
• preference to be hosting centres for fellowships
• preference in the selection for educational courses and meetings

Scientific benefits:

• preference in participation in EACVI specific scientific projects

Research benefits:

• strong preference for research programs

Economical benefits:

• preference to be selected for trials

The aim of the EACVI Laboratory Accreditation process is to raise quality standards of practice and equipment across Europe in a uniform manner. It is also designed to be used as an educational tool to improve the overall quality of the laboratories.

The EACVI Laboratory Accreditation process is also aimed at providing laboratories with standards against which they can benchmark themselves and may be used to reinforce a case for the purchase or upgrade of equipment and facilities to meet these standards. 

What this process does not provide is a legal framework for practice but represents a voluntary process of standards that must function within national and local regulations. It is designed to apply to all ESC Member Countries whatever their model of provision of echocardiography.

Requirements

Eligibility rules

To be eligible, CMR laboratories should meet the following requirements:

• Must be established for at least 3 years
• The application must be submitted by an ESC CMR level 3 certified physician
• The MRI service must include at least one trained cardiac MRI radiographer, and at least one appropriately trained cardiac MRI physician (level 2 or level 3) - access to a current EACVI CMR Level 3 certified physician (or equivalent) if the appropriately trained physician is only Level 2.
• There is no restriction on the type of centres (private, university laboratories etc.), all institutions can apply
• The lab must fulfill a list of criteria

Please note: Laboratories which achieve accreditation status may be selected at random for a visitation from the Committee to verify the information on their submitted documents. 

Language of submission

The application and all documentation should be submitted in English.

General rules

• The CMR laboratory accreditation and Specialist CMR laboratory accreditation for congenital heart disease modules can be standalone lab certifications.
• The CMR laboratory accreditation is mandatory in order to apply for the Specialist CMR laboratory accreditation for stress imaging module.
• To be eligible for accreditation the CMR laboratory must fulfil all listed criteria.
• The EACVI Committee Members may visit any EACVI accredited Laboratory to proceed with an on-site inspection and verification.

Applying for advanced accreditation does not guarantee being granted this grade.

Laboratory Accreditation application Fees

Application costs are €500 for the CMR laboratory and an additional €250 for each specialist laboratory (stress and/or congenital) requested at the same time.
Adding specialist laboratory accreditation can be at a later stage after the CMR laboratory accreditation is granted but the cost will be €500.

Application costs for accreditation of a standalone specialist CMR laboratory for congenital heart disease are EUR 500.

Process for applications

EACVI Laboratory accreditation applications are submitted online and can be done at any time.

What happens after laboratories have submitted their application online?

• Once submitted, an application is no longer editable. 
• The EACVI Accreditation Office is informed automatically. The application is first reviewed by the EACVI Accreditation Office for an administrative check.
  • If the application is incomplete, the laboratory will be contacted and asked to supply missing information within one month's time.
  • If the application is complete, it will be sent to reviewers nominated by the European CMR certification Board for review and recommendations. This process may take up to 2 months.
  • In case some information is missing, laboratories will be contacted by the EACVI Accreditation Office and asked to supply relevant information.
• Upon completion of the review process, CMR Laboratories will be informed by email of the results of their application by the EACVI Accreditation Office.
• An EACVI Laboratory Accreditation Diploma will be awarded to successful institutions.
• Laboratories which achieve accreditation status may be selected at random for a visit or video call from the Board to verify the information on their submitted documents.
• The accredited laboratories will be listed on the EACVI website.
• A diploma will be issued and awarded at the EuroCMR conference.

Please feel free to contact us to express your interest and request an application form.

Reaccreditation

The accreditation is valid for 5 years. The reaccreditation process will be provided in due time.

Laboratories accredited by EACVI

Please find here the current list of EACVI CMR accredited laboratories

Criteria for a CMR Laboratory

A CMR Lab requires to have been established for at least 3 years and to fulfil the following criteria:

Equipment

MRI scanner

• A fully maintained, MRI scanner (minimum 1.5 Tesla) with
  • Dedicated cardiac imaging software
  • Multi-element phased array receiver coil
  • ECG gating/triggering

Specific cardiac sequences

• Minimal requirement:
  • Cine sequences (e.g. SSFP, GRE)
  • Oedema sequences (black blood T2W TSE with/without fat saturation
  • Anatomical sequences (black blood T1W TSE with/without fat saturation
    • Single shot black blood prepared TSE sequences
  • Flow sequences (phase contrast)
  • Contrast enhanced angiography sequence (GRE)
  • Late Gadolinium Enhancement imaging (IR-GRE, SS-SSFP)
  • First pass perfusion sequences (GRE, SSFP, EPI)
• Desirable:
  • Realtime cine sequence
  • Alternative late gadolinium enhancement sequences (3D, PSIR)
  • Non contrast 3D whole heart sequence
  • 4D flow sequences
  • Other sequences (tagging, coronary sequence, cardiac iron (T2*), mapping techniques (T1/T2-mapping).

Dedicated Software for CMR analysis

• Minimal requirement:
  • Volumetric quantification of LV/RV volumes and mass
  • Quantification of flow and velocity
  • 3D angiographic visualisation
• Desirable:
  • T2* mapping analysis for iron quantification
  • Perfusion analysis tools
  • Late gadolinium enhancement quantification
  • Advanced 3D angiographic reconstruction
  • 4D flow assessment
  • Tagging analysis
  • Feature/tissue tracking analysis

Other required equipment

• Access to resuscitation facilities (including defibrillation/pacing/oxygen/suction)
• Access to an emergency trolley with specific drugs to deal with potential reactions to iv contrast media and stressors^[i]
• Access to MR conditional/detachable table or trolley for patient evacuation
• Access to monitoring equipment: non-invasive blood pressure, ECG and SpO2 monitoring device
• Access to MR conditional power injectors
• Access to infusion pumps (either MRI conditional or connectable to the patient in MRI room from control room)

 Staff, scanning and reporting procedures

Staff

Minimal team requirements to deliver a clinical cardiac MRI service:

• At least one trained cardiac MRI radiographer
• At least one appropriately trained cardiac MRI physician (level 2 or level 3)
  Access to a current ESC CMR Level 3 (or equivalent e.g. SCMR Level III) certified physician (if the appropriately trained physician is only level 2)

Scanning procedures:

• Good practice procedures should be in place and appropriately organised
  • Patient confidentiality must be maintained always
  • Established safety procedures that are known to all staff
  • The patient needs to complete and sign a MRI safety questionnaire before the test
• Scan protocols adherent to guidelines (e.g. SCMR scanning protocols)
• At least 2 staff members (either radiographer, nurse, fellow, physician) should be present during non-stress scanning
• For stress scanning at least 1 staff member should have a valid ALS or ILS qualification

Reporting procedures

All clinical CMR scans should have a report generated by a level 2 or level 3 cardiac MRI certified physician, with the following recommendations:

• If the reporter is a CMR level 2 certified physician, a CMR level 3 certified physician should be available to discuss cases when needed.
• CMR level 1 certified physicians should not sign off reports. However, they are encouraged to pre-report scans under the clear supervision of a CMR level 2 or level 3 certified physician

Audit and quality control

 Quality control processes are encouraged and include:

• Regular audit
• Regular clinical governance meetings to address safety and other issues
• Case review and discrepancy meetings

 CMR laboratory annual numbers

ESC/EACVI CMR laboratory

ESC/EACVI recommends that CMR labs perform a minimum of 500 cases per year The following types of studies should be included:

• Cardiomyopathies
• Ischaemic heart disease
• Vascular disease

Specialist CMR laboratory for stress imaging

ESC/EACVI recommends that specialist CMR labs perform a minimum of 300 stress CMR cases per year using physical or pharmacological stressors, in addition to the standard 500 cases per year.

Specialist CMR laboratory for congenital heart disease

ESC/EACVI recommends that specialist CMR labs for congenital heart disease perform a minimum of 250 cases/year of paediatric and/or adult congenital heart disease. Specialist CMR laboratory for congenital heart disease can be a standalone lab certification.