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Applications Specialist MR
Page 1
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 ! ?
!
Page 3
An “Attractive” Force
S
The more rapidly the change over
distance, the greater the attractive force.
Page 4
Static Magnetic Field
Primary Concerns:
• Loose ferrous objects
• Electronic devices and/or implants
• Ferrous implants
Page 5
Static Magnetic Field
Dangers
Page 6
Fringe Field
Page 7
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)
Page 8
Gradient Terminology
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
Page 9
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
Page 10
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.
Page 11
When might PNS occur?
Primarily EPI based pulse sequences.
Page 12
Radio Frequency (B1 field)
Page 13
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
Page 14
Patient Padding
Patients should never be allowed to come in direct contact with the magnet
bore or with any surface coil
Page 15
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
Page 16
Additional Screening?
Family / Visitors
Page 17
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
Page 18
MRI Magnet Room Environment
Page 19
Implants
Page 20
Implants
Bone Growth Stimulator
• Bone growth stimulators
• Drug infusion pumps (Syncromed)
• Cochlear implants
• Dental implants
Cochlear Implant
Page 21
Aneurysm Clips
Radiologist and surgeon are ultimately responsible but you’re the first line of defense!
Page 22
Pacemakers
Page 23
Intraocular Foreign Bodies
Page 24
Intraocular Foreign Bodies
Page 25
Biological Effects
Page 26
Patient Monitoring
Page 27
Patient Monitoring
Question:
Answer:
Page 28
Patient Monitoring Devices
• Pulse Oximeter
• Expired CO2
• Blood Pressure
Page 29
Cardiac Waveform Screen
Page 30
Hearing Protection
Earplugs or other patient hearing protection should always be used regardless of static field strength
F B0
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
Page 33
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).
Page 34
A Word About Patient Evacuation..
Page 35
Landmark Accident (2001
36
GE Title or job number
9/13/2015
After that … ACR MRI Safety Guidelines-2002, 2004, 2007, 2013
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GE Title or job number
9/13/2015
Static Magnetic Field Issues: Site Access Restriction
Zo Main
ne Corridor
I
40
GE Title or job number
9/13/2015
Safety Zone II
Reception counter
Waiting area
Changing room
Sub Waiting area
Recovery area
Zone II Zone II Nursing Station
Toilets
41
GE Title or job number
9/13/2015
Safety Zone III
Control room
Sedation room
Vestibule
Zone III
42
GE Title or job number
9/13/2015
Safety Zone IV
Magnet room
Zone IV
43
GE Title or job number
9/13/2015
Access Control
• A single Passcode access
entrance
• Direct vision
• Provision for housekeeping
and security personnel
• Magnet room lock
44
GE Title or job number
9/13/2015
Thank You