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MRI Safety

MR BASIC for Radiographer

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Applications Specialist MR

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Contents Outline:
1. Magnetic Field Classifications
2. Peripheral Nerve Stimulation
3. Patient Screening Procedure
4. MRI Compatible Equipment / Implants
5. Patient Monitoring
6. Ear Protection
7. Pregnancy
8. Magnet Quench / Magnetic Field Emergency
MRI: Why are we concerned?

• Static Field
? ! ?
• Gradient (time-varying) Field ?! ?!
• Radiofrequency (RF) Field ! ?
!

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An “Attractive” Force

Close to the magnet, the field increases in


N strength rapidly over a short distance.

S
The more rapidly the change over
distance, the greater the attractive force.

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Static Magnetic Field

Primary Concerns:
• Loose ferrous objects
• Electronic devices and/or implants
• Ferrous implants

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Static Magnetic Field
Dangers

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Fringe Field

Fringe fields : magnetic field outside the bore


of the magnet.
•Varies with Field Strength
•Less with Low Field & Vertical Systems

What measures does you department take to


ensure safety in the fringe field?

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Gradient Magnetic Fields
Magnetic fields vary in intensity over distance
+

-
0
Rapid switching of the gradient field can induce
current in conductor (Faraday’s Law of Induction)

Can you think of when might this be of concern?

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Gradient Terminology

Gradient Amplitude (maximum)


•The larger the number of protons in the image and
the brighter the signal will appear
•Measured in (mT/m)
gradient amplitude

gradient pulse
Slew Rate (T/m/sec)
rise time
•Measure of switching speed (acceleration)
•determine the shortest scan times achievable
•Slew rate = gradient amplitude / rise time

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Gradient Safety Concerns

• Acoustic Noise
• Increases with gradient strength
• Greater with faster imaging sequences
• Earplugs probably not necessary at 0.2 and 0.35

• Current Induction
• Peripheral Nerve Stimulation (PNS)
• Care should be taken when imaging patients with
implanted leads

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Peripheral Nerve Stimulation
What is it?
•Rapidly changing magnetic fields can, under certain conditions, cause nerves close to the skin to become
stimulated. dB/dt is the change in the B0 field divided by the change in time. The potential for PNS is a function of
the dB/dt and the gradient rise time.
•The point where 50% of the population experiences PNS is referred o as the PNS Threshold. Peripheral Nerve
Stimulation can be thought of as a light “touching” sensation on the surface of the skin.

•The potential for patients experiencing PNS is very low-- but still possible.

What to do?

If a patient complains of PNS, stop the scan if possible an change to another pulse sequence. Fill out
PNS form and send to GE.

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When might PNS occur?
Primarily EPI based pulse sequences.

EPI applications include, but are not limited to:

• Rapid brain imaging


• BOLD: Task activation
• Diffusion Imaging
• DSC (perfusion) Imaging
• Abdominal and cardiac imaging
PNS is possible with any sequence, not just EPI, but at the higher slew rates, EPI has a greater potential.

Remember, PNS is not harmful.

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Radio Frequency (B1 field)

• Oscillating magnetic field


• Responsible for heating of tissues
• Amount of RF deposition dependent on many factors which include
- Flip angle
- Field strength
- Duty cycle
• RF deposition expressed by the Specific Absorption Rate (SAR)

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SAR and RF Power

• The greater the amount of RF energy used for imaging, the greater the amount of tissue heating
• The amount of power necessary for a 90 degree RF pulse increases with field strength
• Doubling the flip angle requires a 4x increase in RF power

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Patient Padding

Patients should never be allowed to come in direct contact with the magnet
bore or with any surface coil

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Patient Screening?
• Metallic Foreign Bodies
• Biomedical Implants and Devices
• Aneurysm Clips
• Catheters (Thermodilution Swan-Ganz)
• Coils, Filters and Stents
• Heart Valves
• Pacemakers and Pacing Wires
• Intra-ocular Ferrous Foreign Body
• Personal belongings
• Pregnancy

Does your site screening form


include all of these key areas?

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Additional Screening?

Family / Visitors

Ancillary Staff Education


• Housekeeping
• Construction / Maintenance
• Nursing
Patient Support
• Emergency Response
• Security
• Fire Department

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Final Screening Tips

• DO NOT RELY ON THE SCREENING PROCEDURES FROM ANY OTHER MR FACILITY TO BE ADEQUATE
• SCREEN ALL VISITORS AS IF THEY WERE PATIENTS
• SCREENING SHOULD BE DONE MORE THAN ONCE
• SCREENING SHOULD BE PERFORMED BY TRAINED INDIVIDUALS

SAMPLE SCREENING FOR AVAILABLE AT: www.mrisafety.com

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MRI Magnet Room Environment

• Non-ferrous IV Poles, Wheelchairs, Oxygen Tanks, Crash Carts, Gurneys, etc.


• Pt . Monitoring Equipment
• Infusion Equipment

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Implants

• Often a risk vs. benefit decision


• Up-to-date information is crucial
• www.mrisafety.com
• kanal.arad.upmc.edu/mrsafety.html

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Implants
Bone Growth Stimulator
• Bone growth stimulators
• Drug infusion pumps (Syncromed)
• Cochlear implants
• Dental implants

Cochlear Implant

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Aneurysm Clips

Radiologist and surgeon are ultimately responsible but you’re the first line of defense!

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Pacemakers

For General Public: working above 5 Gauss

“At this time, the presence of a cardiac pacemaker should be considered

an absolute contraindication for MR imaging.”

"Magnetic Resonance Bioeffects, Safety, and Patient Management"


Frank G. Shellock, Ph.D, Emanuel Kanal, M.D.

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Intraocular Foreign Bodies

Plain Film Radiograph or CT Scout of the Orbits

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Intraocular Foreign Bodies

Plain Film Radiograph or CT Scout of the Orbits

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Biological Effects

"There is no conclusive evidence for irreversible or


hazardous bio-effects related to acute, short-term
exposures of man to static magnetic fields up to
field strengths of 2.0 T."

"Magnetic Resonance Bioeffects, Safety, and Patient Management"


Frank G. Shellock, Ph.D, Emanuel Kanal, M.D.

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Patient Monitoring

Q. Who should be monitored?


A. All patients should be monitored
verbally and visually.

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Patient Monitoring
Question:

Who may require additional monitoring?

Answer:

 Patients who cannot communicate

 Patients with weak voices


 Patients who do not speak English

 Patients who are sedated

 Patients with diminished mental capacity


 Patients at risk for contrast reaction

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Patient Monitoring Devices

• Pulse Oximeter

• Expired CO2

• ECG (not system gating)

• Blood Pressure

Whatever is used, it must be proven to work properly

and safely in the MR environment.

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Cardiac Waveform Screen

Do not use waveforms for physiological monitoring.


Patient condition may not be reflected, resulting in
improper treatment.

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Hearing Protection

Earplugs or other patient hearing protection should always be used regardless of static field strength

F B0

Gradient Acoustic Noise

Page 31
Pregnancy
Three Primary Areas of Concerns:

• Patients
SMR Safety Committee :
• Contrast Studies
"MR Imaging may be used in pregnant women if
• Employees
other non-ionizing forms of diagnostic imaging are
inadequate or if the examination provides
important information that would otherwise require
exposure to ionizing radiation."

FDA: “The safety of MR imaging during pregnancy has not been proved.”
Page 32
Magnet Quench

A superconductive magnet uses cryogens to super-cool the electrical conductor that creates the magnetic field.
Liquid helium is used, although some systems also require liquid nitrogen. Temperatures as low as 269 C (-452°F)
are achieved! When these cyrogens escape, it’s know as a QUENCH

• Only hazardous if the venting fails


• The field strength in the center of the magnet will fall from 20 mT or 200 gauss is 2 minutes.
• Fringe field may expand slightly for several minutes
• Quenches are indicated by a loud noise, warning message, or the
tilting of an image on the image screen.

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Magnet Quench

In the unlikely event of a quench and the vent fails, a procedure needs to be in place to evacuate the patient
and all personnel from the magnet room. Failure to follow these precautions can result in serious injury
(e.g., asphyxiation, frostbite, or injuries due to panic).

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A Word About Patient Evacuation..

Typically patients can be evacuated from the scan room


in less than 30 seconds.

Patient evacuation may be preferred over allowing


emergency staff to enter the exclusion zone.
Reduces risk of accidental entry of ferrous objects into the
exclusion zone in stressful situations.

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Landmark Accident (2001

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After that … ACR MRI Safety Guidelines-2002, 2004, 2007, 2013

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Static Magnetic Field Issues: Site Access Restriction

MR site is conceptually divided into four Zones

• Zone I: freely accessible to the general public


• Zone II: interface between the publicly accessible, uncontrolled Zone I
and the strictly controlled Zones III and IV
• Zone III: physically restricted from general public access
• Zone IV: magnet room

- ACR Guidance Document on MR Safe Practices: 2013


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Safety Zone I

Zo Main
ne Corridor
I

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Safety Zone II

Reception counter
Waiting area
Changing room
Sub Waiting area
Recovery area
Zone II Zone II Nursing Station
Toilets

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Safety Zone III

Control room
Sedation room
Vestibule

Zone III

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Safety Zone IV

Magnet room

Zone IV

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Access Control
• A single Passcode access
entrance
• Direct vision
• Provision for housekeeping
and security personnel
• Magnet room lock

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Thank You

GE Healthcare Proprietary and Confidential Information

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