Nurse-led, three-domain care pathway improves efficiency, experience, and safety in full free-breathing cardiac MRI: a prospective self-controlled study
Q Duan, W L Zhou, W H Dong, H Y Xing, M J LuAbstract
Background
Conventional breath-holding cardiac magnetic resonance (CMR) requires repeated breath-holds and substantial patient cooperation, often resulting in prolonged examination times, difficulty maintaining adequate breath control, and a higher likelihood of incomplete or low-quality scans. In addition, extended scan duration and repeated breath-holding may increase patient anxiety, discomfort during prolonged supine positioning, and the need for intensified safety monitoring. Full free-breathing CMR eliminates the breath-holding requirement, thereby mitigating these clinical and nursing challenges and improving overall examination tolerability and workflow efficiency.
Purpose
To develop and evaluate a nurse-led, personalized nursing pathway tailored to full free-breathing CMR and to quantify its effects on workflow efficiency, image quality, patient-reported experience, and adverse events.
Methods
In this prospective, self-controlled study, consecutive patients undergoing CMR between December 2024 and November 2025 completed two scanning workflows in sequence: (1) conventional breath-holding CMR with standard nursing (identity verification, informed instructions, and standardized breath-hold training) and (2) full free-breathing CMR supported by a three-domain, personalized nursing intervention (“psychological reassurance–comfort management–safety monitoring”). Outcomes included preparation time and total examination time, image quality assessed on a 5-point Likert scale by two experienced readers (score <3 defined as non-diagnostic), anxiety and depression (SAS/SDS), comfort and nursing satisfaction (10-point scales), and adverse events within the examination period and 15 minutes post-scan.
Results
Thirty patients completed both workflows successfully. Compared with conventional breath-holding CMR, the full free-breathing pathway significantly reduced pre-examination preparation time (2.58 ± 0.62 min) and overall examination time (median 19.3 vs 31.8 min; both P<0.001). Image quality was higher with full free-breathing CMR (median 4 [4–4] vs 4 [2.75–4.25]; P=0.029). Anxiety and depression scores were markedly lower (SAS 35.83 ± 7.48 vs 63.90 ± 11.45; SDS 35.47 ± 7.77 vs 61.33 ± 9.45; both P<0.001). Comfort and nursing satisfaction were improved (median 9 vs 7; both P<0.001). Adverse events were reduced (0% vs 10.0%; P=0.044).
Conclusion
A nurse-led, personalized three-domain care pathway enables full free-breathing CMR to be delivered more efficiently and safely while improving patient psychological status, comfort, and satisfaction and achieving diagnostic image quality. This approach provides a practical, scalable nursing model to optimize patient-centered CMR workflows, particularly for individuals who struggle with repeated breath-holding.illustration for the article