New medical devices are being introduced on a continuous basis, and familiarity with their imaging appearances can be challenging.
Chest radiographs are frequently used to confirm placement of devices—to that end, the radiologist plays a vital role in assessing these devices and identifying complications in a timely fashion.
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Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest
1. Radiographic Review of Current Therapeutic
and Monitoring Devices in the Chest
29/6/2018
radiographics.rsna.org
RG • Volume 38 Number 4
July-August 2018
Christopher J. G. Sigakis, MD
Susan K. Mathai, MD
Thomas D. Suby-Long, MD
Nicole L. Restauri, MD
Daniel Ocazionez, MD
Tami J. Bang, MD
Carlos S. Restrepo, MD
Peter B. Sachs, MD
Daniel Vargas, MD
ChestImaging
2. Learning Objectives
Identify the types of therapeutic and monitoring devices in the chest.
List the indication and appropriate position for new thoracic medical
devices.
Recognize the MR imaging safety features of newer devices in the
chest.
3. Introduction
New medical devices are being introduced on a continuous basis, and familiarity
with their imaging appearances can be challenging.
Chest radiographs are frequently used to confirm placement of devices—to that
end, the radiologist plays a vital role in assessing these devices and identifying
complications in a timely fashion.
This article reviews the arsenal of newer thoracic medical devices and describes
their indications, radiologic appearances, complications, and magnetic
resonance (MR) imaging safety.
This article focuses on (a) cardiac devices, (b) endovascular devices, (c)
bronchopulmonary hardware, and (d) esophageal devices.
4. Cardiac Devices
cardiac devices may be temporary or permanent and treat a variety of
cardiac disease states.
Some devices are unique in their appearance and other devices that
serve the same purpose have varying morphologies, which may cause
confusion to unfamiliar eyes.
The cardiac devices reviewed in this article include-
left ventricular assist devices (LVADs),
cardiac partitioning devices,
cardiac restraint devices,
left atrial appendage (LAA) closure devices,
atrial septal defect (ASD) occlusion devices,
transcatheter valve replacements,
sutureless cardiac valves,
percutaneous mitral regurgitation therapy devices, and
leadless pacemakers.
5. Surgically Implanted Ventricular
Support Devices
An LVAD is a type of mechanical circulatory support device that augments
cardiac output in the setting of ventricular dysfunction.
Clinical Indications- (a) a bridge to cardiac transplantation, (b) a bridge to
recovery, and (c) long-term destination therapy for nonsurgical candidates.
Devices and Radiographic Appearance—
HeartMate II- placement within a subdiaphragmatic preperitoneal pocket, its
unique bell-shaped impeller housing, and the inflow/outflow cannulas that are
partially depicted on radiographs
Heart-Mate 3 and Heart Ware HVAD System are placed within the pericardial
space and demonstrate a circular impeller unit with a centrally located inflow
cannula. In addition, the radiopaque portion of the HeartMate 3’s outflow cannula
is angled, whereas the radiopaque portion of the HeartWare HVAD System’s
outflow cannula assumes a straighter position
6. HeartMate II LVAD. (a,b) subdiaphragmatic
positioning, the bell-shaped impeller housing unit (*),
and the radiopaque inflow/outflow cannulas (arrows),
features unique to this VAD. The device driveline
(arrowheads) is also seen. (c) inflow cannula relative
to the pump body angle (open triangle) of 42.6°
(ideal angle, >55°). (d) Corresponding axial
nonenhanced CT image shows the inflow cannula
(arrowhead) angled at the interventricular septum.
7. (a) HeartMate 3 LVAD projecting over the cardiac shadow (in the pericardial space) in a
normal position. Note the circular impeller housing (*), the angled outflow cannula
(curved arrow), and the driveline (arrowheads).
(b) HeartWare HVAD System in the appropriate position. Note the circular impeller
housing (*), without an angled outflow cannula. The driveline (arrows) extends inferiorly.
8. Device-specific Complications- device malfunction and thrombosis,
hemorrhage, venous thromboembolism, right heart failure, cardiac
arrhythmias, solid organ dysfunction, and driveline infections.
MR Imaging Safety- The HeartMate II, Heart- Mate 3, and HeartWare
HVAD System are MR imaging unsafe.
9. Temporary VADs
Clinical Indications— A temporary VAD is one of a variety of short-
term mechanical circulatory support devices that assist the failing heart
in the setting of cardiogenic shock owing to myocardial infarction and
acute decompensated heart failure or in the perioperative setting.
Unlike surgically placed VADs, temporary VADs are placed
percutaneously
10. Devices and Radiographic Appearance.- The Impella Ventricular
Support Systems are VADs housed within catheters designed for
percutaneous placement and short-term (4 or 6 days or fewer,
depending on the model) mechanical circulatory support.
Four of the five Impella models (Impella 2.5, Impella CP, Impella 5.0,
and Impella LD) offer varying degrees of left heart support, whereas one
model (Impella RP) is used for right heart support.
11. Impella catheter in two patients. (a) Edge-enhanced frontal radiograph shows an Impella
catheter (arrows) in the appropriate position, with the pigtail inflow overlying the left
ventricle (arrowhead).
(b) Frontal radiograph shows a malpositioned Impella catheter, terminating proximally
over the ascending thoracic aorta (arrowhead).
13. Ventricular Partitioning
Devices
Clinical Indications.— Ventricular remodeling after myocardial
infarction is a prognostic indicator for heart failure outcomes.
Therefore, preserving normal left ventricular morphology and
preventing post injury remodeling has been a target of drug and
device therapy in this patient population.
Device and Radiographic Appearance.- The Parachute Ventricular
Partitioning Device is used in patients who develop ischemic heart
failure after experiencing myocardial infarction.
The Parachute device is placed percutaneously and consists of a
fluoropolymer membrane fitted to an umbrella-shaped nitinol frame.
14. Parachute Ventricular Partitioning Device. (a) Photograph of the Parachute
device shows the nitinol frame and fitted membrane.
(b) Illustration of the heart shows the ideal positioning of the Parachute device at
the cardiac apex.
(c) Frontal radiograph of the chest shows the device in the appropriate position,
with the footplate (arrow) seated over the left ventricular apex. The wire struts
(arrowheads) are visible
15. Device-specific Complications.—malposition, migration and device
failure. eg, strut fracture and membrane leak
MR Imaging Safety.—The Parachute device is MR imaging
conditional at 1.5 T and 3 T.
16. Cardiac Restraint Devices
Clinical Indications.- Cardiac restraint devices reduce ventricular wall
stress through passive epicardial pressure and reduced left ventricular
remodeling and improved left ventricular systolic function and
symptoms of heart failure.
Device and Radiographic Appearance.— The HeartNet device is a
ventricular elastic support device made of nitinol and covered in
silicone.
The device is placed through a left mini-thoracotomy.
The unique radiographic appearance demonstrates radiopaque mesh
conforming to the cardiac contour
17. HeartNet ventricular restraint
device. Frontal radiograph of the
chest shows the Heart- Net device
and its lace-like mesh (arrowheads)
conforming to the cardiac contour.
18. Device-specific Complications.—Device and procedural-related
complications include arrhythmia, worsening heart failure, myocardial
laceration, pericarditis, phrenic nerve injury, pneumothorax, and pleural
effusion.
MR Imaging Safety.—The HeartNet device is conditional for MR
imaging at 1.5 T and 3.0 T
19. LAA Closure Devices
Clinical Indications.—LAA closure represents an alternative to oral
anticoagulation therapy for stroke prevention in patients with atrial
fibrillation and contraindications to anticoagulation therapy.
Devices and Radiographic Appearance.— Percutaneous LAA occlusion
devices include the Watchman LAA closure device, the Amplatzer Amulet,
and the Amplatzer Cardiac Plug.
The Watchman consists of a self-expanding nitinol frame, with a
polyethylene fabric covering the proximal face of the device, giving it a
jellyfish-like appearance
The AtriClip is a self-closing implantable clip applied epicardially to the
base of the LAA by either open surgery or minimally invasive techniques.
It is readily identifiable on a radiograph as a metallic hair clip–appearing
structure, sitting over the expected location of the LAA
20. (a) Photograph of the Watchman device shows the self-
expanding nitinol frame and fabric covering the face of
the device.
(b)Watchman device (arrow) over the expected location
of the LAA. The magnified image (insert) shows a close-
up of the Watchman device.
(c) Transaxial maximum intensity projection CT image
shows proper positioning of the Watchman device within
the LAA
21. AtriClip LAA closure device in a patient who underwent mitral valve
replacement. Edge-enhanced frontal radiograph of the chest shows LAA
closure with an AtriClip (arrows).
22. Atrial Septal Occlusion Device
Clinical Indications.—ASDs represent one of the most common forms of
congenital heart disease. While some ASDs are large and detected early in
life, others may be small and remain occult into adulthood until they
become hemodynamically significant.
Device and Radiographic Appearance.—The Amplatzer Septal Occluder
is a catheter-based ASD closure device that consists of a self-expanding
double-disk nitinol mesh that apposes both sides of the septal wall.
The device comes in multiple sizes and may also be used for muscular
ventricular septal defect (VSD) occlusion.
On radiographs, circular nitinol disks should be visible over the expected
location of the interatrial septum or over the interventricular septum in
cases of VSD closure.
23. Amplatzer Atrial Septal Occluder. (a) Photograph shows the Amplatzer Atrial Septal
Occluder device.
(b) Lateral coned-down radiograph of the chest shows the device (arrow) in the
expected position over the interatrial septum.
(c) Frontal radiograph of a different patient shows an embolized device (arrow) lodged in
the left pulmonary artery
24. Device-specific Complications.— device embolization is main
complication. Additional complications are arrhythmias, cardiac
perforations (rare), thromboembolic events, residual septal defects,
and device infections.
MR Imaging Safety.— The Amplatzer Septal Occluder is MR imaging
conditional at 1.5 T and 3T.
25. Transcatheter Pulmonary
Valve Devices
Clinical Indications.— Transcatheter pulmonary valve replacement
(TPVR) is a minimally invasive technique used to treat pulmonic
regurgitation or pulmonic stenosis, with or without right ventricular outflow
tract obstruction.
Devices and Radiographic Appearance.— TPVR devices are usually
made from bovine or porcine tissue. They come in multiple sizes
(diameters) and are combined with a self- or balloon-expandable stent.
Commercially available transcatheter pulmonary valves include the
Melody pulmonic valve and the Sapien XT transcatheter heart valve.
On chest radiographs, the metallic stent portion of both valves should be
visible in the pulmonic position.
26. Melody TPVR device. (a) Photograph shows the Melody TPVR device, which is made
from bovine jugular tissue that is attached to a balloon expandable stent. (b) Lateral
chest radiograph shows a Melody TPVR device in the pulmonic position.
(c) Coned-down sagittal chest radiograph of the same
patient shows fractures (arrows) through the stent lattice, which required another stent
placement, creating the valve-in-valve appearance
27. Device-specific Complications.— device malposition, migration,
and/or embolization. Additional potential device-related complications
include paravalvular leak, stent fracture, pulmonary artery
pseudoaneurysm, and pulmonary hemorrhage.
MR Imaging Safety.—The Melody valve and Sapien XT valve are MR
imaging conditional at 1.5 T and 3 T (34,35).
28. Transcatheter Aortic Valve
Devices
Clinical Indications.— transcatheter aortic valve replacement(TAVR) has been
validated as a suitable alternative to surgical aortic valve replacement in patients
with severe aortic stenosis who are considered nonoperable or highrisk for surgical
repair.
Devices and Radiographic Appearance.— Commerciall available TAVR systems
include the Sapien 3, Sapien XT, CoreValve, and Portico transcatheter aortic heart
valves.
The Sapien 3 valve has a similar construction to that of the Sapien XT valve,
described previously.
In contrast, the CoreValve is made from porcine cardiac tissue secured to a self-
expanding nitinol frame that is flared at the distal (supravalvular) end to help
stabilize the valve
The Portico valve is also composed of a flared self-expanding stent and contains
bovine leaflets with a porcine sealing cuff
These transcatheter valves sit in the aortic valve position on radiographs.
29. (a) Photograph shows the Sapien 3 valve. (b)Lateral radiograph shows the Sapien 3
valve (arrow) in the aortic position.
(c) Photograph shows the CoreValve. (d, e) Frontal (d) and lateral (e) radiographs of a
patient with pulmonary fibrosis after undergoing TAVR show the implanted CoreValve
device (arrow)
(f) Photograph shows the Portico valve.
30. Device-specific Complications.—The most severe complication of a
TAVR device is annular rupture. Other complications are similar to those
of TPVR devices, including para valvular leak.
MR Imaging Safety.—The Sapien 3, Sapien XT, CoreValve, and
Portico transcatheter aortic heart valves are MR imaging conditional at
1.5 T and 3 T.
31. Sutureless Valves
Clinical Indications.—Sutureless aortic valves allow for minimally
invasive aortic valve replacement by simplifying surgical implantation
and reducing operative time.
Devices and Radiographic Appearance.—The Perceval sutureless
aortic valve and the Intuity Elite valve system are two FDA approved
sutureless valves.
Both are composed of bovine pericardial bioprosthetic valves.
On a radiograph, the Intuity Elite valve’s subannular steel frame
appears as a “skirt,” sitting along the expected location of the aortic
valve and outflow tract.
32. Intuity Elite sutureless cardiac valve. (a) Photograph shows the Edwards Intuity
Elite sutureless valve with the stent portion below the valve (eg, subannular).
(b) Frontal radiograph obtained in a patient who underwent aortic valve replacement
shows an Intuity Elite aortic valve. Note the metallic frame (arrow) or “skirt” at the
base of the leaflets.
33. Device-specific Complications.—Valve-related complications include
endocarditis, thromboembolism, and paravalvular leak.
MR Imaging Safety.—The Perceval and Intuity Elite sutureless aortic
valves are MR imaging conditional at 1.5 T and 3 T.
34. Minimally Invasive Mitral Regurgitation
Therapy
Clinical Indications.—The surgical creation of a double-orifice mitral
valve is a safe and effective treatment of mitral regurgitation and is an
alternative to mitral valve replacement.
It is indicated in patients with significant symptomatic mitral regurgitation
and who are at prohibitive risk for mitral valve surgery.
Device and Radiographic Appearance.—The MitraClip is a polyester-
covered cobalt chromium clip used to treat mitral regurgitation.
A chest radiograph will typically demonstrate two adjacent metallic clips
in the mitral position
35. MitraClip. Frontal chest radiograph shows MitraClips (arrow) that are side by side
over the expected location of the mitral valve.
36. Device-specific Complications.—Device complications include partial
clip detachment and embolization, injury to the mitral valve, and mitral
stenosis. A clip position in a non mitral location on a radiograph would
suggest device migration.
MR Imaging Safety.— The MitraClip is MR imaging conditional at 1.5
T and 3 T.
37. Leadless Cardiac Pacemakers
Clinical Indications.—Electrical cardiac pacing is indicated for a variety of
cardiac arrhythmias and morphologic abnormalities. The use of newly
developed leadless pacemakers avoid lead-associated complications and
allow for reliable performance and improved safety.
Devices and Radiographic Appearance.—Current leadless pacemakers
include the Nanostim Leadless Pacemaker System and the Micra
Transcatheter Pacing System.
Both systems are delivered percutaneously to the right ventricle and are
transfixed to the myocardium at the apex.
A chest radiograph of the Micra device shows a small battery- shaped
electronic device overlying the expected location of the right ventricular
apex.
38. Micra leadless pacemaker. Frontal radiograph shows a Micra implantable
leadless pacemaker (arrow) projecting over the right ventricle, the expected
location for this device.
39. Device-specific Complications.—The complications for the Nanostim
and Micra devices include cardiac perforation and thromboembolism.
MR Imaging Safety.—The Nanostim is currently MR imaging unsafe in
the United States and MR imaging conditional at 1.5 T in Europe. The
Micra leadless pacemaker is MR imaging safe at 1.5 T and 3 T.
41. Endovascular Occlusion
Device
Clinical Indications. New minimally invasive strategies aimed at curtailing
blood loss in patients with exsanguinating hemorrhage include resuscitative
endovascular balloon occlusion of the aorta (REBOA).
Device and Radiographic Appearance.—The ER-REBOA is a flexible
catheter, consisting of an arterial line combined with an inflatable balloon
for aortic occlusion.
The catheter is inserted percutaneously through the femoral arterial
system and advanced into the aorta for balloon occlusion.
Radiopaque depth markers denote the proximal and distal edges of the
balloon, allowing for identification on a radiograph.
The position of the catheter depends on the level of arterial injury.
42. Figure 14. ER-REBOA endovascular occlusion device. Frontal chest radiograph
shows an ER-REBOA (arrowheads) over the thoracic aorta.
43. Device-specific Complications.—The complications of REBOA are
mainly related to vascular injury during placement and sequelae of
prolonged balloon inflation, including limb ischemia, embolic events, and
acute kidney injury induced by systemic ischemia associated with
REBOA.
MR Imaging Safety.—There is no information available on the MR
imaging safety of ER-REBOA.
44. Thrombolysis Catheters
Clinical Indications.—Catheter-directed thrombolysis is an accepted
treatment of massive and submassive pulmonary embolism.
This therapy may also be used for peripheral arterial occlusion and deep
venous thrombosis.
Treatment is initiated through a multiple–side-hole infusion catheter,
fluoroscopically positioned along or adjacent to the areas of thrombosis,
through which a thrombolytic drug is infused.
More recent technology has applied the use of ultrasound to
mechanically enhance fibrinolysis and allow deeper penetration of lytic
agents, typically performed over 18–24 hours.
45. Device and Radiographic Appearance.—The EndoWave Infusion
Catheter System is the only FDA-approved ultrasound-assisted
multiple– side-hole catheter used for catheter-directed thrombolysis.
The device consists of an ultrasonic core wire and a porous micro-
infusion catheter that allows for delivery of the thrombolytic agent.
The EndoWave catheter contains multiple radiopaque markers,
denoting the treatment segment that aids in positioning the catheter
during fluoroscopy and X-ray.
46. EndoWave catheter. Edge-enhanced frontal radiograph of the chest in a patient
with massive pulmonary embolism managed with ultrasound-assisted
thrombolysis with Endowave catheters shows the device (arrowheads)
positioned in the bilateral pulmonary arteries.
47. Device-specific Complications.— hemorrhage, cardiopulmonary
arrest, and acute renal injury
MR Imaging Safety.—There is no information available on the MR
imaging safety of the EndoWave catheter.
48. Ambulatory Heart Failure
Monitoring
Clinical Indications.—Ambulatory methods of detecting early
physiologic changes of heart failure may allow for timely pharmacologic
intervention, with the goal of decreasing and preventing hospitalization.
Implantable sensors provide accurate and reliable noninvasive
measurements of pulmonary artery pressure in patients with heart
failure, which are comparable to those of pulmonary artery
catheterization and echocardiography.
49. Devices and Radiographic Appearance.— Current wireless
ambulatory monitoring devices include the CardioMEMS Heart Failure
System and OptiVol.
CardioMEMS is composed of an inductor coil and a pressure-sensitive
capacitor placed in protective housing. The device is deployed within a
distal pulmonary artery, is held in place with nitinol wire loops, and
provides a direct measurement of pulmonary artery pressure, which is
continuously transmitted to the patient’s treating health care provider.
On a radiograph, the device will appear as a small radiopaque line,
with an adjacent radiopaque dot on either end
50. CardioMEMS Heart Failure System. (a) Photograph shows the CardioMEMS
device and the nitinol wire loops at either end.
(b) Frontal radiograph of the chest shows the CardioMEMS device (arrow) over the
left lower lobe pulmonary artery. Zoomed-in area of interest (inset) shows the
device.
(c) Coneddown lateral view radiograph of the chest shows the device (arrow) in the
left lower lobe pulmonary artery
51. Device-specific Complications.—Complications related to
CardioMEMS include situ thrombosis. Otherwise, complications are
related to the implantation procedure (eg, pulmonary artery injury and
arrhythmias).
MR Imaging Safety.—The CardioMEMS and OptiVol devices are MR
imaging conditional at 1.5 T and 3 T
52. Bronchopulmonary Devices
Endobronchial therapies such as stent placement are designed to keep
airways open, newer technologies allow the pulmonologist to selectively
block airflow to specific segments of the lung to decrease hyperinflation,
often in the setting of chronic obstructive pulmonary disease.
53. Endobronchial Valves
Endobronchial valves are one-way valves used to block airflow to a given segment
of the lung.
Although they were originally designed for minimally invasive lung volume reduction
therapy for patients with severe emphysema, endobronchial valves have also been
used to treat persistent air leaks owing to bronchoalveolar and/or bronchopleural
fistulas.
On a standard chest radiograph, small radiopaque markers and struts overlying an
airway indicate the presence and location of an intrabronchial valve. Corresponding
atelectasis distal to the device is usually evident.
Complications associated with endobronchial valves include empyema, massive
hemoptysis, pneumonia distal to the implanted valves, pneumothorax or prolonged
air leak, and respiratory failure.
The Spiration Intrabronchial Valve System is MR imaging conditional at1.5 T and 3
T
54. Spiration endobronchial valves in two patients. (a) Frontal radiograph of the chest
in a patient with a right pneumothorax owing to a bronchopleural fistula shows the
endobronchial valves (arrows) within the right upper lobe bronchi. (b) Coned-down
chest radiograph shows the endobronchial valves (arrows) over the right upper lobe
segmental bronchi.
Note the adjacent upper lobe segmental atelectasis
55. Esophageal Devices
The esophagus not only allows a path to assess and treat
gastroesophageal reflux disease, but it is also a window used to
evaluate surrounding cardiovascular structures, such as the aorta, with
the use of esophageal medical devices.
Esophageal Doppler US
Esophageal pH Monitoring
Reflux Management Systems
56. Esophageal Doppler US
Clinical Indications.—Measuring cardiac output is helpful for
hemodynamic evaluation and guiding fluid therapy in the operating
room and in patients who are critically ill.
Accurately assessing intravascular volume status may sometimes be
difficult using conventional hemodynamic parameters. As a result,
alternative methods of assessing cardiac output and volume status,
such as the use of esophageal Doppler US, have been developed
57. Devices and Radiographic Appearance.— The CardioQ-ODM
esophageal Doppler US monitoring system is a flexible US probe,
containing a Doppler US transducer (4- MHz continuous wave or 5-
MHz pulsed wave) at the tip.
US probe positioning should be confirmed at radiography, with the
ideal placement of the probe tip at or just below the carina
58. Esophageal Doppler US probe. Coned-down frontal radiograph of the chest shows
an esophageal Doppler US probe (arrowhead) with proper positioning of the probe tip
at or just below the carina.
59. Device-specific Complications.—Theoretical risks associated with
this device include immediate complications such as esophageal
bleeding and perforation and delayed complications such as erosion
and stricture formation.
MR Imaging Safety.—The CardioQ-ODM transesophageal US probe
is MR imaging unsafe.
60. Esophageal pH Monitoring
Clinical Indications.— New esophageal pH assessment devices allow
catheter-free esophageal pH monitoring in the ambulatory setting.
Device and Radiographic Appearance.—The Bravo Reflux Testing
System is a catheter-freeambulatory esophageal pH monitoring system.
The capsule is placed with an endoscope and typically falls off within 5
days. The esophageal pH data are wirelessly transmitted to a recorder,
which a patient wears on either a shoulder strap or belt.
On radiographs, the device should be approximately 5–6 cm above the
gastroesophageal junction.
61. Bravo Reflux Testing System. Frontal and lateral radiographs of the chest show
a Bravo pH monitoring device (arrow)
in the appropriate location, approximately 5–6 cm above the expected location of
the gastroesophageal junction.
62. Device-specific Complications.—include misplacement, the need for
endoscopic removal or retrieval, and, although rare, esophageal
perforation during placement.
MR Imaging Safety.—The Bravo device is MR imaging unsafe
63. Reflux Management Systems
Clinical Indications.—Indications for antireflux surgery include
medication-resistant gastroesophageal reflux disease (GERD), long-
term complications of GERD (including Barrett esophagus and
strictures), extraesophageal symptoms (eg, asthma or chest pain),
patient preference, and paraesophageal hiatal hernia.
New minimally invasive techniques aimed at addressing these
indications offer an alternative to traditional surgical correction.
64. Device and Radiographic Appearance.—The Linx Reflux Management
System
The device functions as a flexible and expandable ring, consisting of a
series of interconnected titanium beads with magnetic cores. The magnetic
attraction between the beads (ie, resting state) enhances the lower
esophageal sphincter tone and helps prevent reflux of gastric contents into
the esophagus.
The Linx system is placed during conventional laparoscopy and, unlike
fundoplication, does not require anatomic alteration of gastric anatomy.
On a radiograph, the Linx system appears as a beaded ring overlying the
expected location of the gastroesophageal junction
65. Figure 20. Linx Reflux Management System. Frontal chest radiograph shows
a Linx device (arrow) in the proper position over the expected location of the
gastroesophageal junction.
66. Device-specific Complications.—a single case report of
gastroesophageal erosion othe potential complications include device
migration and dehiscence of the ring.
MR Imaging Safety.—The Linx Reflux Management System is MR
imaging conditional at both 0.7 T and 1.5 T (depending on the model
implanted) and unsafe at 3 T.
67. Conclusion
Knowledge of thoracic monitoring and therapeutic devices existence
and expected radiographic appearance is crucial to avoid errors in
interpretation of clinical studies. Importantly, other clinicians depend on
chest radiographs and the radiologist’s assessment in determining
whether these devices are placed and functioning appropriately.
Knowledge of potential device complications can have a substantial
impact on patient care.
