Radiation protection in a cohort of healthcare workers: knowledge, attitude, practices, feelings and IR-exposure in French hospitals.

The number of healthcare workers occupationally exposed to ionizing radiation (IR) is increasing every year. As health effects from exposure to low doses IR have been reported, radiation protection (RP) in the context of occupational activities is a major concern. This study aims to assess the compliance of healthcare workers with RP policies, according to their registered cumulative dose, profession, and perception of radiation self-exposure and associated risk. Every healthcare worker from one of the participating hospitals in France with at least one dosimetric record for each year 2009, 2014, and 2019 in the SISERI registry was included and invited to complete an online questionnaire including information on the worker's occupational exposure, perception of IR-exposure risk and RP general knowledge. Hp(10) doses were provided by the SISERI system. Multivariate logistic regressions were used. Dosimeter wearing and RP practices compliance were strongly associated with 'feeling of being IR-exposed' (OR = 3.69, CI95% 2.04-6.66; OR = 4.60, CI95% 2.28-9.30, respectively). However, none of these factors was associated with RP training courses attendance. The main reason given for non-compliance is unsuitability or insufficient numbers of RP devices. This study provided useful information for RP policies. Making exposed workers aware of their own IR-exposure seems to be a key element to address in RP training courses. This type of questionnaire should be introduced into larger epidemiological studies. Dosimeter wearing and RP practices compliance are associated to feeling being IR-exposed. RP training courses should reinforce workers' awareness of their exposure to IR.

Pictorial essay: MRI evaluation of endometriosis-associated neoplasms.

Endometriosis is a frequent pathology mostly affecting women of young age. When typical aspects are present, the diagnosis can easily be made at imaging, especially at MRI. Transformation of benign endometriosis to endometriosis-associated neoplasms is rare. The physiopathology is complex and remains controversial. Endometrioid carcinoma and clear cell carcinoma are the main histological subtypes. Our goal was to review the main imaging characteristics that should point to an ovarian or extra-ovarian endometriosis-related tumor, especially at MRI, as it may be relevant prior to surgical management.Key points• Transformation of benign endometriosis to endometriosis-associated neoplasms is rare.• MRI is useful when displaying endometriosis lesions associated to an ovarian tumor.• Subtraction imaging should be used in the evaluation of complex endometriomas.

Imaging quality of an artificial intelligence denoising algorithm: validation in 68Ga PSMA-11 PET for patients with biochemical recurrence of prostate cancer.

BACKGROUND: 68 Ga-PSMA PET is the leading prostate cancer imaging technique, but the image quality remains noisy and could be further improved using an artificial intelligence-based denoising algorithm. To address this issue, we analyzed the overall quality of reprocessed images compared to standard reconstructions. We also analyzed the diagnostic performances of the different sequences and the impact of the algorithm on lesion intensity and background measures. METHODS: We retrospectively included 30 patients with biochemical recurrence of prostate cancer who had undergone 68 Ga-PSMA-11 PET-CT. We simulated images produced using only a quarter, half, three-quarters, or all of the acquired data material reprocessed using the SubtlePET® denoising algorithm. Three physicians with different levels of experience blindly analyzed every sequence and then used a 5-level Likert scale to assess the series. The binary criterion of lesion detectability was compared between series. We also compared lesion SUV, background uptake, and diagnostic performances of the series (sensitivity, specificity, accuracy). RESULTS: VPFX-derived series were classified differently but better than standard reconstructions (p < 0.001) using half the data. Q.Clear series were not classified differently using half the signal. Some series were noisy but had no significant effect on lesion detectability (p > 0.05). The SubtlePET® algorithm significantly decreased lesion SUV (p < 0.005) and increased liver background (p < 0.005) and had no substantial effect on the diagnostic performance of each reader. CONCLUSION: We show that the SubtlePET® can be used for 68 Ga-PSMA scans using half the signal with similar image quality to Q.Clear series and superior quality to VPFX series. However, it significantly modifies quantitative measurements and should not be used for comparative examinations if standard algorithm is applied during follow-up.

Occupational exposure to ionizing radiation in medical staff: trends during the 2009-2019 period in a multicentric study.

OBJECTIVES: Health workers exposed to ionizing radiation account for + 50% of workers exposed to man-made radiation in France. Over the last decade, the use of radiation in medicine has increased due to the introduction of new practices. The EXposition des Professionnels de santE aux RayonnemenTs ioniSants study aims to evaluate and characterize the trends in radiation exposure of health workers in France between 2009 and 2019. METHODS: This retrospective study includes all health workers with at least one dosimetric record in the system for occupational dosimetry registration (Système d'information de la surveillance de l'exposition aux rayonnements ionisants) database for each of the years 2009, 2014, and 2019, in the hospitals included in the study. Individual external doses and socio-professional data were collected. Statistical analyses include descriptions, graphs, and logistic regressions. RESULTS: A total of 1457 workers were included (mean age: 39.8 years, 59% women). The average exposure significantly decreased between 2009 and 2019 (-0.008 mSv/year, p < 0.05). There were large discrepancies in trends according to professions, departments, hospitals, and gender. Over the 10-year study period, radiologic technologists and physicians were the most exposed (0.15 mSv (95%CI 0.14-0.16) and 0.13 mSv (0.06-0.21), respectively), but their exposure tended to decrease. Workers in nuclear medicine departments had the highest radiation exposure (0.36 mSv (0.33-0.39)), which remained stable over time. Thirty-eight percent of recorded doses were nonzero in 2009, decreasing to 20% in 2019. CONCLUSIONS: This study allowed to identify physicians and radiologic technologists in nuclear medicine departments as the most exposed medical workers in France, and to show an overall decrease trend in radiation exposure. This should be instructive for radiation monitoring and safety of exposed medical workers. KEY POINTS: • Radiation exposure of healthcare workers in most medical departments has steadily decreased between 2009 and 2019 in several French hospitals. • The number of zero doses consistently increased during the study period. • Workers in nuclear medicine departments are the most exposed, especially radiologic technologists and physicians.

Optimized radiological alert thresholds based on device-dosimetric information to predict peak skin dose between 2 and 4 Gy during vascular fluoroscopically guided intervention.

OBJECTIVES: To provide radiologists and physicists with methodological tools to improve patient management after vascular fluoroscopically guided intervention (FGI) by providing optimized thresholds (OT) values that could be used as a surrogate to the thresholds classically proposed by the National Council on Radiation Protection (NCRP) or could be useful to adapt their own substantial radiation dose levels (SRDL) values. METHODS: PSD of 2000-4000 mGy after FGI were calculated for 258 patients with dedicated software. Overall, the kerma and KAP 3D-ROC curves were used to assess the sensitivity (SEN) and specificity (SPE) of NCRP thresholds and OT for each PSD. Kiviat diagram and density curves were plotted for the best SEN/SPE pair of 3D-ROC curves and compared to the NCRP thresholds. RESULTS: OT for both kerma and KAP generating the best SEN/SPE couple for PSD of 2000-4000 mGy were obtained. The SEN/SPE couple of each OT was always better than that obtained using NCRP ones. The best OT among all those calculated providing the highest SEN/SPE values for kerma (3020.5 mGy) and KAP (741.02 Gy.cm2) were obtained when PSD was equal to 3300 mGy. CONCLUSIONS: We have calculated OT in terms of kerma and KAP based on 3D-ROC curves analysis and peak skin dose calculations that can be obtained to better predict high skin dose. The use of OT that predicted PSD greater than 3000 mGy is likely to improve patient follow-up. The methodology developed in this work could be adapted to other institutions in order to better define their own SRDL. KEY POINTS: • Optimized dose thresholds in terms of kerma and KAP based on 3D-ROC curves analysis and peak skin dose calculations between 2000 and 4000 mGy can be obtained to better predict high skin dose. • Patients receiving a peak skin dose between 2000 and 4000 mGy have their follow-up enhanced by using the optimized thresholds instead of the NCRP thresholds. • The best-optimized thresholds, corresponding to 3020.5 mGy and 741.02 Gy.cm2 for kerma and KAP respectively can be used instead of NRCP ones to trigger patient follow-up after fluoroscopically guided vascular interventions.

Childbirth simulation to assess cephalopelvic disproportion and chances for failed labor in a French population.

Reducing failed labor and emergency cesarean section (CS) rates is an important goal. A childbirth simulation tool (PREDIBIRTH software and SIM37 platform) that evaluates a 5-min magnetic resonance imaging (MRI) assessment performed at 37 weeks of gestation was developed to enhance the consulting obstetrician's ability to predict the optimal delivery mode. We aimed to determine the potential value of this childbirth simulation tool in facilitating the selection of an optimal delivery mode for both mother and infant. A retrospective cohort study was performed on all patients referred by their obstetricians to our level 2 maternity radiology department between December 15, 2015 and November 15, 2016, to undergo MRI pelvimetry at approximately 37 weeks of gestation. The childbirth simulation software was employed to predict the optimal delivery mode based on the assessment of cephalopelvic disproportion. The prediction was compared with the actual outcome for each case. Including childbirth simulations in the decision-making process had the potential to reduce emergency CSs, inappropriately scheduled CSs, and instrumental vaginal deliveries by up to 30.1%, 20.7%, and 20.0%, respectively. Although the use of the simulation tool might not have affected the overall CS rate, consideration of predicted birthing outcomes has the potential to improve the allocation between scheduled CS and trial of labor. The routine use of childbirth simulation software as a clinical support tool when choosing the optimal delivery mode for singleton pregnancies with a cephalic presentation could reduce the number of emergency CSs, insufficiently justified CSs, and instrumental deliveries.

Using Magnetic Resonance Imaging During Childbirth to Demonstrate Fetal Head Moldability and Brain Compression: Prospective Cohort Study.

BACKGROUND: Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. OBJECTIVE: This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. METHODS: A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. RESULTS: All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. CONCLUSIONS: This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability.

Endovascular Management of Vascular Complications in Ehlers-Danlos Syndrome Type IV.

(1) Background: The vascular type of Ehlers-Danlos syndrome (vEDS) is a rare genetic connective tissue disorder caused by pathogenic variants in the COL3A1 gene that result in arterial and organ fragility and premature death. We present five cases of vEDS that highlight the diagnosis and treatment challenges encountered by clinicians with these patients. (2) Case presentations: we present the cases of five patients with vascular complications of vEDS who were successfully managed using endovascular interventions or hybrid techniques at our institution from 2005 to 2022. (3) Conclusions: These data emphasize that a multidisciplinary approach is needed for vEDS patients and that when endovascular or hybrid treatment is performed in a timely manner by a skilled team of interventional radiologists, good results can be achieved. Our report also demonstrates that the prognosis of vEDS patients has improved over the past 20 years with a new prevention program including celiprolol therapy, physical activity adaptation and limitation, and scheduled monitoring by expert clinicians.

Endovascular Treatment with Arch Vessel Reconstruction on Patients with Kommerell Diverticulum and Aberrant Left Subclavian Artery.

No guidelines for the treatment of Kommerell diverticulum (KD) have been established. Endovascular treatment with arch vessel reconstruction of 4 patients with a right-sided aortic arch and aberrant left subclavian artery are presented herein. A 39-year-old woman and 47-year-old man experienced dyspnea and retrosternal pain. The first patient concomitantly underwent left subclavian transposition and thoracic endovascular aortic repair (TEVAR). The second patient underwent bilateral carotid-subclavian bypass grafting, followed by TEVAR and KD embolization. The 2 other patients were 72- and 75-year old men who presented with KD and type B dissection, in which these conditions were characterized by acute thoracic pain in the former patient and were noted on incidental body scan for prostatic adenocarcinoma in the latter. The third patient underwent carotid-subclavian bypass grafting, followed by TEVAR and subclavian plugs, and in the fourth patient, regular follow-up with antihypertensive therapy was scheduled. After a mean follow-up period of 12 months, all patients were alive.

Metastatic melanoma treated by immunotherapy: discovering prognostic markers from radiomics analysis of pretreatment CT with feature selection and classification.

PURPOSE: Immunotherapy has dramatically improved the prognosis of patients with metastatic melanoma (MM). Yet, there is a lack of biomarkers to predict whether a patient will benefit from immunotherapy. Our aim was to create radiomics models on pretreatment computed tomography (CT) to predict overall survival (OS) and treatment response in patients with MM treated with anti-PD-1 immunotherapy. METHODS: We performed a monocentric retrospective analysis of 503 metastatic lesions in 71 patients with 46 radiomics features extracted following lesion segmentation. Predictive accuracies for OS < 1 year versus > 1 year and treatment response versus no response was compared for five feature selection methods (sequential forward selection, recursive, Boruta, relief, random forest) and four classifiers (support vector machine (SVM), random forest, K-nearest neighbor, logistic regression (LR)) used with or without SMOTE data augmentation. A fivefold cross-validation was performed at the patient level, with a tumour-based classification. RESULTS: The highest accuracy level for OS predictions was obtained with 3D lesions (0.91) without clinical data integration when combining Boruta feature selection and the LR classifier, The highest accuracy for treatment response prediction was obtained with 3D lesions (0.88) without clinical data integration when combining Boruta feature selection, the LR classifier and SMOTE data augmentation. The accuracy was significantly higher concerning OS prediction with 3D segmentation (0.91 vs 0.86) while clinical data integration led to improved accuracy notably in 2D lesions (0.76 vs 0.87) regarding treatment response prediction. Skewness was the only feature found to be an independent predictor of OS (HR (CI 95%) 1.34, p-value 0.001). CONCLUSION: This is the first study to investigate CT texture parameter selection and classification methods for predicting MM prognosis with treatment by immunotherapy. Combining pretreatment CT radiomics features from a single tumor with data selection and classifiers may accurately predict OS and treatment response in MM treated with anti-PD-1.

Male Sex Is Associated With Cervical Artery Dissection in Patients With Fibromuscular Dysplasia.

Background Cervical artery dissection (CeAD) is a frequent manifestation of fibromuscular dysplasia (FMD). However, risk factors for CeAD are unknown. We investigated factors associated with CeAD in the ARCADIA (Assessment of Renal and Cervical Artery Dysplasia) registry. Methods and Results The ARCADIA registry includes women or men aged ≥18 years, with a diagnosis of renal, cervical, or intracranial artery FMD, who were prospectively recruited at 16 university hospitals in France and Belgium. Diagnosis of acute or past CeAD at inclusion was established on imaging according to standard diagnostic criteria. Associations between potential determinants and CeAD were assessed by logistic regression analyses. Among 469 patients (75 men) with FMD, 65 (13.9%) had CeAD. Patients with CeAD were younger, more likely to be men, have a history of migraine, and less likely to have a history of hypertension than patients without CeAD. In the multivariable analysis, male sex (odds ratio [OR], 2.66; 95% CI, 1.34-5.25), history of migraine (OR, 1.90; 95% CI, 1.06-3.39), age ≥50 years (OR, 0.41; 95% CI, 0.23-0.73), history of hypertension (OR, 0.35; 95% CI, 0.20-0.64), and involvement of ≥3 vascular beds (OR, 2.49; 95% CI, 1.15-5.40) were significantly associated with CeAD. To validate the association between CeAD and sex, we performed a systematic review. We collected additional data on sex from 2 published studies and unpublished data from the US Registry for Fibromuscular Dysplasia and the European/International FMD Registry. In the pooled analysis (289 CeAD, 1933 patients), male sex was significantly associated with CeAD (OR, 2.04; 95% CI, 1.41-2.95; I2=0%). Conclusions In patients with FMD, male sex and multisite involvement are associated with CeAD, in addition to other previously known risk factors. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02884141.

Position paper on stress cardiac magnetic resonance imaging in chronic coronary syndrome: Endorsed by the Société française de radiologie (SFR), the Société française d'imagerie cardiovasculaire (SFICV) and the Société française de cardiologie (SFC).

This paper is intended to update the former consensus between the French Societies of Radiology and Cardiology about the use of stress cardiac magnetic resonance imaging in chronic coronary syndrome, published in 2009. The Delphi method was used to build the present consensus. This expert panel consensus includes recommendations for indications, the procedure (with patient preparation), stress-inducing drugs, the acquisition protocol, interpretation and risk stratification by stress magnetic resonance imaging.

Biodosimetry in interventional radiology: cutaneous-based immunoassay for anticipating risks of dermatitis.

OBJECTIVES: Interventional radiology procedures expose individuals to ionizing radiation. However, existing dosimetry methods do not provide the dose effectively absorbed to the skin, and do not consider the patient's individual response to irradiation. To resolve this lack of dosimetry data, we developed a new external irradiation biodosimetry device, DosiKit, based on the dose-dependent relationship between irradiation dose and radiation-induced H2AX protein phosphorylation in hair follicles. This new biological method was tested in Clermont-Ferrand University Hospital to evaluate the assay performances in the medical field and to estimate DosiKit sensitivity threshold. METHODS: DosiKit was tested over 95 patients treated with neuroradiological interventions. For each intervention, lithium fluoride thermoluminescent dosimeters (TLD) were used to measure total dose received at each hair collection point (lateral and occipital skull areas), and conventional indirect dosimetry parameters were collected with a Dosimetry Archiving and Communication System (DACS). RESULTS: Quantitative measurement of radiation-induced H2AX protein phosphorylation was performed on 174 hair samples before and after the radiation exposure and 105 samples showed a notable induction of gammaH2AX protein after the radiological procedure. According to a statistical analysis, the threshold sensitivity of the DosiKit immunoassay was estimated around 700 mGy. CONCLUSIONS: With this study, we showed that DosiKit provides a useful way for mapping the actually absorbed doses, allowing to identify patients overexposed in interventional radiology procedures, and thus for anticipating risk of developing dermatitis. KEY POINTS: • DosiKit is a new external irradiation biodosimetry device, based on the dose-dependent relationship between irradiation dose and radiation-induced H2AX protein phosphorylation in hair follicles. • DosiKit was tested over 95 patients treated with neuroradiological interventions. • The threshold sensitivity of the DosiKit immunoassay was estimated around 700 mGy and DosiKit provides a useful way for mapping the actually absorbed doses.

Fluoroscopy guided electrode-array insertion for cochlear implantation with straight electrode-arrays: a valuable tool in most cases.

PURPOSE: To highlight the advantages of real time fluoroscopy guided electrode-array (EA) insertion (FGI) during cochlear implants surgery. METHODS: All surgical procedures were performed in a dedicated operating room equipped with a robotic C-arm cone beam device, allowing for intraoperative real time 2D FGI and postoperative 3D imaging. Only straight EAs were used. Patients were sorted out in three groups: ANAT, with anatomical concerns; HP, with residual hearing; NPR: patients with no particular reason for FGI. In all cases the angle of EA-insertion was measured. In the HP group pre and postoperative hearing were compared. The radiation delivered to the patient was recorded. RESULTS: Fifty-three cochlear implantation procedures were achieved under fluoroscopy in 50 patients from November 2015 to January 2020 (HP group: n = 10; ANAT group: n = 13; NPR group: n = 27). In the ANAT group, FGI proved to be helpful in 8 cases (61.5%), successfully guiding the surgeon during EA -insertion. On average, the angle of insertion was at 424° ± 55°. In the HP group, a controlled smooth EA-insertion was carried out in all cases but one. The targeted 360° angle of insertion was always reached. Hearing preservation was possible with an eventual average drop of 30 ± 1.5 dB. In the NPR group, FGI helped control the quality of insertion in all cases and appeared very informative in five (17.8%): one EA-misrouting, three stuck EAs, and one case with hidden electrodes out of the cochlea in revision surgery. Final 3D cone beam CT scan double-checked the EA position in all adults. The radiation dose was equivalent to a bit less than four digital subtract radiographs. CONCLUSION: The FGI is a very useful adjunct in cochlear implantation in all cases of expected surgical pitfalls, in patients with residual hearing, and even in case without preoperative particular reason, with low irradiation.

Optimized radiological alert thresholds based on device dosimetric information and peak skin dose in vascular fluoroscopically guided intervention.

OBJECTIVES: The National Council on Radiation Protection (NCRP) report no. 168 recommended that during fluoroscopically guided interventions (FGIs), each patient should be monitored when one of the following thresholds is reached: an air kerma > 5 Gy, a kerma area product (KAP) > 500 Gy.cm2, a fluoroscopy time > 60 min, or a peak skin dose (PSD) > 3 Gy. Whereas PSD is the most accurate metric regarding the prevention of radiological risks, it remains the most difficult parameter to assess. We aimed to evaluate the relevance of the other, more accessible metrics and propose new optimized threshold (OT) for improved patient follow-up. METHODS: Overall, 108 patients who underwent FGI in which at least one NCRP threshold was reached and PSD was measured were considered. The correlation between all metrics was assessed using principal component analysis (PCA). ROC curves and the sensitivity/specificity of both NCRP and OT to predict PSD > 3 Gy were evaluated. RESULTS: The PCA shows that FGI can be decomposed with two components based on time and dose variables. Only KAP and kerma were correlated with PSD. The overall sensitivity and specificity of the new OT regarding KAP (67.6/93.0), kerma (97.3/81.7), and time (62.2/62.0) were better compared with NCRP thresholds (97.3/16.9, 40.5/95.4, and 21.6/74.7). CONCLUSIONS: This study shows that fluoroscopy time is not a relevant metric when used to predict PSDs > 3 Gy. By adapting KAP and kerma thresholds to predict PSD over 3 Gy, patient follow-ups following vascular FGI can be improved. KEY POINTS: • In vascular fluoroscopically guided interventions, principal component analysis demonstrates that between fluoroscopy time, KAP, and kerma, only the two last were correlated to the peak skin dose. • Optimized thresholds replacing NRCP ones obtained with ROC curves analysis were 85,451 µGy.cm2, 2938 mGy, and 41 min for KAP, kerma, and fluoroscopy time respectively. • Improvements to trigger patient follow-up after vascular fluoroscopically guided interventions may be obtained by using the optimized thresholds.

Pneumatosis intestinalis with pneumoperitoneum: Not always a surgical emergency.

Pneumatosis intestinalis (PI) and pneumoperitoneum are commonly recognized as severe signs of gastrointestinal diseases that require emergency surgery. However, these symptoms can also be caused by benign conditions. We describe 4 cases of benign PI and pneumoperitoneum that were detected in different clinical situations (accidental discovery in bilan of aortic dissection (case #1), bilateral pulmonary embolism (case #2), overflow diarrhea due to fecal impaction (case #3), and in follow-up postbiliary digestive anastomosis surgery (case #4), which were addressed with exploratory surgery (case #1) or conservative treatment (the remaining cases), with favorable outcomes. Because PI and pneumoperitoneum can be associated with both life-threatening causes and benign conditions, treatment decisions should be based on the correspondence between clinical and paraclinical features, rather than imaging alone.

Joint Position Paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging on magnetic resonance imaging in patients with cardiac electronic implantable devices.

Magnetic resonance imaging (MRI) has become the reference imaging technique for the management of a large number of diseases. The number of MRI examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). The presence of a CEID was considered an absolute contraindication for MRI for many years. The progressive replacement of conventional pacemakers and defibrillators by "magnetic resonance (MR)-conditional" CEIDs and recent data on the safety of MRI in patients with "MR-non-conditional" CEIDs have gradually increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with MR-conditional devices, because these devices are not "MR safe". Specific programming of the device in "MR mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the French Society of Diagnostic and Interventional Cardiac and Vascular Imaging describes the effect of and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional non-guaranteed" and MR-non-conditional devices.