Acute neurobehavioral effects of exposure to static magnetic fields: Analyses of exposure–response relations

Radiographers' awareness level of MRI-induced vertigo and their perspectives on the post-examination care provided to patients in Saudi Arabia

INTRODUCTION

Vertigo has been reported by operators and patients during magnetic resonance imaging (MRI) examinations and found to increase in severity as the strength of the scanner magnet increases. This study examined a cohort of MRI radiographers' awareness of MRI-induced vertigo and their perspectives on post-MRI care.

METHODS

This cross-sectional study used a web-based survey distributed to 110 radiographers. The 18-item survey included questions to elicit demographic information, MRI radiographers' awareness of MRI-induced vertigo, and their perspectives on the post-MRI care that should be provided to patients. Responses were collected between June 2021 and January 2022. The collected data were analyzed using SPSS, version 27.

RESULTS

A total of 110 MRI radiographers completed the survey. Participants were predominantly male (64.5 %) and working in public practice (91.8 %). Almost all the radiographers were aware of MRI-induced vertigo. About two-thirds of participants knew patients needed assistance off the couch. Nearly all participants knew patients should be asked about their experience with MRI-induced vertigo after their procedures. There were statistically significant associations between the size of magnetic field strength used by the participants and their appreciation of the needed support for patients post-MRI examinations (p= 0.012).

CONCLUSION

This study provides the first insight into Saudi Arabian MRI radiographers' awareness and perceptions of MRI-induced vertigo. Radiographers were largely aware of MRI-induced vertigo and the supportive care they were supposed to provide their patients.

IMPLICATIONS FOR PRACTICE

The current study points to a need for training to expand awareness levels of MRI-induced vertigo among a few Saudi MRI radiographers.

Subjective Symptoms in Magnetic Resonance Imaging Personnel: A Multi-Center Study in Italy

Introduction: Magnetic Resonance Imaging (MRI) personnel have significant exposure to static and low-frequency time-varying magnetic fields. In these workers an increased prevalence of different subjective symptoms has been observed. The aim of our study was to investigate the prevalence of non-specific subjective symptoms and of "core symptoms" in a group of MRI personnel working in different centers in Italy, and of possible relationships with personal and occupational characteristics. Methods: The occurrence of 11 subjective symptoms was evaluated using a specific questionnaire with 240 subjects working in 6 different Italian hospitals and research centers, 177 MRI health care and research personnel and 63 unexposed subjects employed in the same departments. Exposure was subjectively investigated according to the type of MRI scanner (≤1.5 vs. ≥3 T) and to the number of MRI procedures attended and/or performed by the personnel, even if no information on how frequently the personnel entered the scanner room was collected. The possible associations among symptoms and estimated EMF exposure, the main characteristics of the population, and job stress perception were analyzed. Results: Eighty-six percent of the personnel reported at least one symptom; drowsiness, headache, and sleep disorders were the most frequent. The total number of symptoms did not differ between exposed persons and controls. Considering the total number of annual MRI procedures reported by the personnel, no significant associations were found nor with the total number of symptoms, nor with "core symptoms." Only subjects complaining of drowsiness also reported a significantly higher mean annual number of MRI procedures with ≤ 1.5 T scanners when compared with exposed subjects without drowsiness. In a multivariate model, subjects with a high level of perceived stress complained of more symptoms (p = 0.0002). Conclusions: Our study did not show any association between the occurrence of reversible subjective symptoms, including the more specific "core symptoms," and the occupational exposure of MRI personnel to static and low-frequency time-varying magnetic fields. On the other hand, the role played by occupational stress appears to be not negligible. In further research in this field, measurements of EMF exposure should be considered.

Occupational Exposure to Electromagnetic Fields and Health Surveillance According to the European Directive 2013/35/EU

In the European Union, health surveillance (HS) of electromagnetic fields (EMF)-exposed workers is mandatory according to the Directive 2013/35/EU, aimed at the prevention of known direct biophysical effects and indirect EMF's effects. Long-term effects are not addressed in the Directive as the evidence of a causal relationship is considered inadequate. Objectives of HS are the prevention or early detection of EMF adverse effects, but scant evidence is hitherto available on the specific procedures. A first issue is that no specific laboratory tests or medical investigations have been demonstrated as useful for exposure monitoring and/or prevention of the effects. Another problem is the existence of workers at particular risk (WPR), i.e., subjects with specific conditions inducing an increased susceptibility to the EMF-related risk (e.g., workers with active medical devices or other conditions); exposures within the occupational exposure limit values (ELVs) are usually adequately protective against EMF's effects, but lower exposures can possibly induce a health risk in WPR. Consequently, the HS of EMF-exposed workers according to the EU Directive should be aimed at the early detection and monitoring of the recognized adverse effects, as well as an early identification of WPR for the adoption of adequate preventive measures.

Cognisance of magnetic resonance imaging-induced vertigo and supported care: A study among a cohort of MRI radiographers in a country in West Africa

INTRODUCTION

Magnetic resonance imaging (MRI) can induce vertigo in patients undergoing such examinations. The severity of the vertigo is thought to increase with higher magnetic field strengths and could cause a patient to fall. The study assessed the awareness levels on MRI-induced vertigo among a cohort of MRI radiographers and their perspectives on the care that should be administered to patients post MRI examinations.

METHODS

The study utilized a quantitative cross-sectional research design and a questionnaire. Out of a total of 40 MRI-radiographers identified nationwide, 31 participated in the study. Statistical Package for Social Sciences v.21.0 was used to analyse the data.

RESULTS

Most participants (n = 21, 67.7%) were aware of MRI-induced vertigo. Many knew that patients (able and weaker) need to be assisted off the couch (n = 28, 90.3%) and escorted to the changing rooms post MRI examinations (n = 31,100%). There were statistically significant associations between the size of magnetic field strength used by the participants and their level of awareness about MRI-induced vertigo (r = 0.691, p = 0.003), appreciation of the needed support for patients post MRI examinations (r = 0.530, p = 0.041) and the frequency of occurrence of MRI-induced vertigo among their patients (r = 0.530, p = 0.001).

CONCLUSION

The radiographers were mostly cognisant of MRI-induced vertigo and the supported care they were supposed to administer to their patients. The size of magnetic field strength used by the participants correlated with their level of awareness about MRI-induced vertigo and their appreciation of the needed support for patients post MRI examinations.

IMPLICATION FOR PRACTICE

The study highlights the need for a refresher training to expand the knowledge-base of a few of the radiographers who were not very cognisant about MRI-induced vertigo.

Effect of Static Magnetic Field of Electric Vehicles on Driving Performance and on Neuro-Psychological Cognitive Functions

Human neuropsychological reactions and brain activities when driving electric vehicles (EVs) are considered as an issue for traffic and public safety purposes; this paper examined the effect of the static magnetic field (SMF) derived from EVs. A lane change task was adopted to evaluate the driving performance; and the driving reaction time test and the reaction time test were adopted to evaluate the variation of the neuro-psychological cognitive functions. Both the sham and the real exposure conditions were performed with a 350 μT localized SMF in this study; 17 student subjects were enrolled in this single-blind experiment. Electroencephalographs (EEGs) of the subjects were adopted and recorded during the experiment as an indicator of the brain activity for the variations of the driving performance and of the cognitive functions. Results of this study have indicated that the impact of the given SMF on both the human driving performance and the cognitive functions are not considerable; and that there is a correlation between beta sub-band of the EEGs and the human reaction time in the analysis

Development of hypertension after long-term exposure to static magnetic fields among workers from a magnetic resonance imaging device manufacturing facility

OBJECTIVE

To assess the association between long-term exposure to static magnetic fields (SMF) in a magnetic resonance imaging (MRI)-manufacturing environment and hypertension.

METHODS

In an occupational cohort of male workers (n = 538) of an MRI-manufacturing facility, the first and last available blood pressure measurements from the facility's medical surveillance scheme were associated with modeled cumulative exposure to SMF. Exposure modeling was based on linkage of individual job histories from the facility's personnel records with a facility specific historical job exposure matrix. Hypertension was defined as a systolic pressure of above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg. Logistic regression models were used to associate cumulative SMF exposure to hypertension while adjusting for age, body mass index and blood pressure at time of first blood pressure measurement. Stratified analysis by exposure duration was performed similarly.

RESULTS

High cumulative exposure to SMF (≥ 7.4 K Tesla minutes) was positively associated with development of hypertension (Odds Ratio [OR] 2.32, 95% confidence interval [CI] 1.27 - 4.25, P = 0.006). Stratified analysis showed a stronger association for those with high cumulative SMF exposure within a period up to 10 years (OR 3.96, 95% CI 1.62 - 9.69, P = 0.003), but no significant association was found for (high) cumulative exposure accumulated in a period of 10 or more years. Our findings suggest SMF exposure intensity to be more important than exposure duration for the risk of developing hypertension.

CONCLUSIONS

Our data revealed that exposure to high levels of MRI-related SMF during MRI-manufacturing might be associated with developing hypertension.

MRI-related magnetic field exposures and risk of commuting accidents - A cross-sectional survey among Dutch imaging technicians

BACKGROUND

Imaging technicians working with magnetic resonance imaging (MRI) may experience acute effects such as vertigo or dizziness when being exposed. A previous study also reported an increased risk of accidents in MRI exposed staff.

OBJECTIVES

We aimed at evaluating commuting accident risk in Dutch imaging technicians.

METHODS

Of invited imaging technicians, 490 (29%) filled in a questionnaire pertaining to (near) accidents when driving or riding a bike, health, lifestyle and work practices. We used logistic regression to evaluate the association between exposure to MRI-related electromagnetic fields and risk of commuting (near) accidents in the year prior to the survey, adjusted for a range of potential confounders.

RESULTS

Our cross-sectional study indicated an increased risk of (near) accidents if imaging technicians had worked with MRI in the year prior to the survey (odds ratio OR 2.13, 95%CI 1.23-3.69). Risks were higher in persons who worked with MRI more often (OR 2.32, 95%CI 1.25-4.31) compared to persons who worked sometimes with MRI (OR 1.91, 95%CI 0.98-3.72), and higher in those who had likely experienced higher peak exposures to static and time-varying magnetic fields (OR 2.18, 95%CI 1.06-4.48). The effect was seen on commuting accidents that had occurred on the commute from home to work as well as accidents from work to home or elsewhere.

CONCLUSION

Imaging technicians working with MRI scanners may be at an increased risk of commuting (near) accidents. This result needs confirmation and potential risks for other groups (volunteers, patients) should be investigated.

[Physical interactions in MRI: Some rules of thumb for their reduction]

Magnetic resonance imaging (MRI) is one of the most powerful and at the same time gentlest clinical imaging techniques at the present time; however, the enormous physical complexity as well as simple inattentiveness (projectile effect) implicate a significant risk potential and place high demands on the MR operator to ensure a safe workflow. A sound knowledge of the potential MR interactions is the foundation for a safe and profitable operation for all parties.The first part of this article deals with the three most important sources of physical interaction, i.e. static magnetic field, gradient and high-frequency (HF) fields. The paper discusses the differences between each type of field with respect to the impact on human beings, the interactions with magnetic and electrically conducting objects/implants and the relevant safety standards. Each section is followed by simple rules of thumb to minimize potentially unwanted physical MRI interactions.

Magnetic resonance safety

Magnetic resonance imaging (MRI) has a superior soft-tissue contrast compared to other radiological imaging modalities and its physiological and functional applications have led to a significant increase in MRI scans worldwide. A comprehensive MRI safety training to protect patients and other healthcare workers from potential bio-effects and risks of the magnetic fields in an MRI suite is therefore essential. The knowledge of the purpose of safety zones in an MRI suite as well as MRI appropriateness criteria is important for all healthcare professionals who will work in the MRI environment or refer patients for MRI scans. The purpose of this article is to give an overview of current magnetic resonance safety guidelines and discuss the safety risks of magnetic fields in an MRI suite including forces and torque of ferromagnetic objects, tissue heating, peripheral nerve stimulation, and hearing damages. MRI safety and compatibility of implanted devices, MRI scans during pregnancy, and the potential risks of MRI contrast agents will also be discussed, and a comprehensive MRI safety training to avoid fatal accidents in an MRI suite will be presented.

Implementation of a comprehensive MR safety course for medical students

This review article proposes the design of an educational magnetic resonance (MR) safety course for instructing medical students about basic MR and patient-related safety. The MR safety course material can be implemented as a traditional didactic or interactive lecture in combination with hands-on safety demonstrations. The goal of the course is to ensure that medical students receive a basic understanding of MR principles and safety considerations. This course will prepare medical students for patient screening and safety consultations when ordering MR studies. A multiple-choice exam can be used to document the proficiency in MR safety of the medical students. The course can be used by various medical school programs and may help to ensure consistent quality of teaching materials and MR safety standards.

Acute vertigo in an anesthesia provider during exposure to a 3T MRI scanner

Vertigo induced by exposure to the magnetic field of a magnetic resonance imaging (MRI) scanner is a well-known phenomenon within the radiology community but is not widely appreciated by other clinical specialists. Here, we describe a case of an anesthetist experiencing acute vertigo while providing sedation to a patient undergoing a 3 Tesla MRI scan. After discussing previous reports, and the evidence surrounding MRI-induced vertigo, we review potential etiologies that include the effects of both static and time-varying magnetic fields on the vestibular apparatus. We conclude our review by discussing the occupational standards that exist for MRI exposure and methods to minimize the risks of MRI-induced vertigo for clinicians working in the MRI environment.

MRI evaluation and safety in the developing brain

Magnetic resonance imaging (MRI) evaluation of the developing brain has dramatically increased over the last decade. Faster acquisitions and the development of advanced MRI sequences, such as magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), perfusion imaging, functional MR imaging (fMRI), and susceptibility-weighted imaging (SWI), as well as the use of higher magnetic field strengths has made MRI an invaluable tool for detailed evaluation of the developing brain. This article will provide an overview of the use and challenges associated with 1.5-T and 3-T static magnetic fields for evaluation of the developing brain. This review will also summarize the advantages, clinical challenges, and safety concerns specifically related to MRI in the fetus and newborn, including the implications of increased magnetic field strength, logistics related to transporting and monitoring of neonates during scanning, and sedation considerations, and a discussion of current technologies such as MRI conditional neonatal incubators and dedicated small-foot print neonatal intensive care unit (NICU) scanners.

Sensory perceptions of individuals exposed to the static field of a 7T MRI: A controlled blinded study

PURPOSE

To determine the subjective experience of subjects undergoing 7T magnetic resonance imaging (MRI) compared to a mock scanner with no magnetic field.

METHODS AND MATERIALS

In all, 44 healthy subjects were exposed to both the B0 field of a 7T whole-body MRI and a realistic mock scanner with no magnetic field. Subjects were blinded to the actual field strength and no scanning was performed. After exposure, subjects rated their experience of potential sensory perceptions.

RESULTS

The most frequently observed side effect was vertigo while entering the gantry, which was reported by 38.6% (n = 17). Other frequent side effects were the appearance of phosphenes (18.2%, n = 8), thermal heat sensation (15.9%), unsteady gait after exposure (13.6%, n = 6), and dizziness (13.6%). All side effects were reported significantly more often after 7T exposure. Nine subjects (20.5%) did not report any sensory perceptions at all, ie, neither in the 7T scanner nor in the mock scanner.

CONCLUSION

Light, acute, and transient sensory perceptions can occur in subjects undergoing ultrahighfield MRI, of which vertigo seems to be the most frequently reported. Possible psychological effects might contribute to the emergence of such sensory perceptions, as some subjects also reported them to appear in a realistic mock scanner with no magnetic field.

Does assessment of personal exposure matter during experimental neurocognitive testing in MRI-related magnetic fields?

PURPOSE

To determine whether the use of quantitative personal exposure measurements in experimental research would result in better estimates of the associations between static and time-varying magnetic field exposure and neurocognitive test performance than when exposure categories were based solely on distance to the magnetic field source.

METHODS

In our original analysis, based on distance to the magnet of a 7 T MRI scanner, an effect of exposure to static magnetic fields was observed. We performed a sensitivity analysis of test performance on a reaction task and line bisection task with different exposure measures that were derived from personal real-time measurements.

RESULTS

The exposure measures were highly comparable, and almost all models resulted in significant associations between exposure to time-varying magnetic fields within a static magnetic field and performance on a reaction and line bisection task.

CONCLUSION

In a controlled experimental setup, distance to the bore is a good proxy for personal exposure when placing subjects at fixed positions with standardized head movements in the magnetic stray fields of a 7 T MRI. Use of a magnetic field dosimeter is, however, important for estimating quantitative exposure response associations.

Occupational exposure levels of static magnetic field during routine MRI examination in 3T MR system

Occupational exposure to the high static magnetic fields (SMFs) during magnetic resonance imaging (MRI) examinations raises concerns of adverse health effects. In this study, personal exposure monitoring of the magnetic fields during routine examinations in two 3 T MRI systems was carried out. A three-axis Hall magnetometer was attached to a subject's chest during monitoring. Data acquisition started every time the subject entered the scanner room and ended when the subject exited the room. Four radiologic technologists from two different institutes participated in this study. The maximum exposed field ranged from 0 to 1250 mT and the average peak magnetic field (B) was 428 ± 231 mT (mean ± standard deviation (SD): number of samples (N) = 103). Then, the relationship between exposure levels and work duties was analyzed. The MRI examination of the head or neck showed the highest average peak B among four work categories. These results provide information of real exposure levels for 3 T MRI system operators and can also improve the current practical training advice for preventing extra occupational field exposure.

Retrospective assessment of exposure to static magnetic fields during production and development of magnetic resonance imaging systems

At present, the relationship between chronic exposure to static magnetic fields (SMF) and health effects is unclear. We developed a task-based deterministic model for estimating historical electromagnetic field exposure from the static B-field (B0) of magnetic resonance imaging (MRI) systems, for a cohort of employees working at an MRI systems development and production facility. Technical maps describing the spatial distribution of fringe fields of B0 surrounding different types of MRI systems of various core strengths were exploited to derive estimates of static B0 exposure as a function of distance from the bore of the MRI system. Detailed information on tasks performed per exposed job and other model determinants were acquired through face-to-face interviews and used to derive base estimates of most recent exposure (2009) for each job title. The model was partially validated with actual exposure measurements. The exposure estimates from the deterministic model were used to construct a job-exposure matrix that will enable estimation of cumulative exposures for each cohort member. The generic approach described for estimating chronic MRI-related SMF exposure makes it universally applicable in other studies investigating health effects of MRI-related SMF exposure.

Orientation within a high magnetic field determines swimming direction and laterality of c-Fos induction in mice

High-strength static magnetic fields (>7 tesla) perturb the vestibular system causing dizziness, nystagmus, and nausea in humans; and head motion, locomotor circling, conditioned taste aversion, and c-Fos induction in brain stem vestibular nuclei in rodents. To determine the role of head orientation, mice were exposed for 15 min within a 14.1-tesla magnet at six different angles (mice oriented parallel to the field with the head toward B+ at 0°; or pitched rostrally down at 45°, 90°, 90° sideways, 135°, and 180°), followed by a 2-min swimming test. Additional mice were exposed at 0°, 90°, and 180° and processed for c-Fos immunohistochemistry. Magnetic field exposure induced circular swimming that was maximal at 0° and 180° but attenuated at 45° and 135°. Mice exposed at 0° and 45° swam counterclockwise, whereas mice exposed at 135° and 180° swam clockwise. Mice exposed at 90° (with their rostral-caudal axis perpendicular to the magnetic field) did not swim differently than controls. In parallel, exposure at 0° and 180° induced c-Fos in vestibular nuclei with left-right asymmetries that were reversed at 0° vs. 180°. No significant c-Fos was induced after 90° exposure. Thus, the optimal orientation for magnetic field effects is the rostral-caudal axis parallel to the field, such that the horizontal canal and utricle are also parallel to the field. These results have mechanistic implications for modeling magnetic field interactions with the vestibular apparatus of the inner ear (e.g., the model of Roberts et al. of an induced Lorenz force causing horizontal canal cupula deflection).

Cognition and sensation in very high static magnetic fields: a randomized case-crossover study with different field strengths

PURPOSE

To establish the extent to which representative cognitive functions in subjects undergoing magnetic resonance (MR) imaging are acutely impaired by static magnetic fields of varying field strengths.

MATERIALS AND METHODS

This study was approved by the local ethics committee, and informed consent was obtained from all subjects. In this single-blind case-crossover study, 41 healthy subjects underwent an extensive neuropsychologic examination while in MR units of differing field strengths (1.5, 3.0, and 7.0 T), including a mock imager with no magnetic field as a control condition. Subjects were blinded to field strength. Tests were performed while subjects were lying still in the MR unit and while the examination table was moved. The tests covered a representative set of cognitive functions, such as memory, eye-hand coordination, attention, reaction time, and visual discrimination. Subjective sensory perceptions were also assessed. Effects were analyzed with a repeated-measures analysis of variance; the within-subject factors were field strength (0, 1.5, 3.0, and 7.0 T) and state (static, dynamic).

RESULTS

Static magnetic fields were not found to have a significant effect on cognitive function at any field strength. However, sensory perceptions did vary according to field strength. Dizziness, nystagmus, phosphenes, and head ringing were related to the strength of the static magnetic field.

CONCLUSION

Static magnetic fields as high as 7.0 T did not have a significant effect on cognition.

MRI-related static magnetic stray fields and postural body sway: a double-blind randomized crossover study

We assessed postural body sway performance after exposure to movement induced time-varying magnetic fields in the static magnetic stray field in front of a 7 Tesla (T) magnetic resonance imaging scanner. Using a double blind randomized crossover design, 30 healthy volunteers performed two balance tasks (i.e., standing with eyes closed and feet in parallel and then in tandem position) after standardized head movements in a sham, low exposure (on average 0.24 T static magnetic stray field and 0.49 T·s(-1) time-varying magnetic field) and high exposure condition (0.37 T and 0.70 T·s(-1)). Personal exposure to static magnetic stray fields and time-varying magnetic fields was measured with a personal dosimeter. Postural body sway was expressed in sway path, area, and velocity. Mixed-effects model regression analysis showed that postural body sway in the parallel task was negatively affected (P < 0.05) by exposure on all three measures. The tandem task revealed the same trend, but did not reach statistical significance. Further studies are needed to investigate the possibility of independent or synergetic effects of static magnetic stray field and time-varying magnetic field exposure. In addition, practical safety implications of these findings, e.g., for surgeons and others working near magnetic resonance imaging scanners need to be investigated.

A systematic review of the utility of 1.5 versus 3 Tesla magnetic resonance brain imaging in clinical practice and research

OBJECTIVE

MRI at 3 T is said to be more accurate than 1.5 T MR, but costs and other practical differences mean that it is unclear which to use.

METHODS

We systematically reviewed studies comparing diagnostic accuracy at 3 T with 1.5 T. We searched MEDLINE, EMBASE and other sources from 1 January 2000 to 22 October 2010 for studies comparing diagnostic accuracy at 1.5 and 3 T in human neuroimaging. We extracted data on methodology, quality criteria, technical factors, subjects, signal-to-noise, diagnostic accuracy and errors according to QUADAS and STARD criteria.

RESULTS

Amongst 150 studies (4,500 subjects), most were tiny, compared old 1.5 T with new 3 T technology, and only 22 (15 %) described diagnostic accuracy. The 3 T images were often described as "crisper", but we found little evidence of improved diagnosis. Improvements were limited to research applications [functional MRI (fMRI), spectroscopy, automated lesion detection]. Theoretical doubling of the signal-to-noise ratio was not confirmed, mostly being 25 %. Artefacts were worse and acquisitions took slightly longer at 3 T.

CONCLUSION

Objective evidence to guide MRI purchasing decisions and routine diagnostic use is lacking. Rigorous evaluation accuracy and practicalities of diagnostic imaging technologies should be the routine, as for pharmacological interventions, to improve effectiveness of healthcare.

KEY POINTS

• Higher field strength MRI may improve image quality and diagnostic accuracy. • There are few direct comparisons of 1.5 and 3 T MRI. • Theoretical doubling of the signal-to-noise ratio in practice was only 25 %. • Objective evidence of improved routine clinical diagnosis is lacking. • Other aspects of technology improved images more than field strength.

Exposure classification of MRI workers in epidemiological studies

We estimate that there are about 100,000 workers from different disciplines, such as radiographers, nurses, anesthetists, technicians, engineers, etc., who can be exposed to substantial electromagnetic fields (compared to normal background levels) around magnetic resonance imaging (MRI) scanners. There is a need for well-designed epidemiological studies of MRI workers but since the exposure from MRI equipment is a very complex mixture of static magnetic fields, switched gradient magnetic fields, and radiofrequency electromagnetic fields (RF EMF), it is necessary to discuss how to assess the exposure in epidemiological studies. As an alternative to the use of job title as a proxy of exposure, we propose an exposure categorization for the different professions working with MRI equipment. Specifically, we propose defining exposure in three categories, depending on whether people are exposed to only the static field, to the static plus switched gradient fields or to the static plus switched gradient plus RF fields, as a basis for exposure assessment in epidemiological studies.

Head tilt in rats during exposure to a high magnetic field

During exposure to high strength static magnetic fields, humans report vestibular symptoms such as vertigo, apparent motion, and nausea. Rodents also show signs of vestibular perturbation after magnetic field exposure at 7 tesla (T) and above, such as locomotor circling, activation of vestibular nuclei, and acquisition of conditioned taste aversions. We hypothesized that the acute effects of the magnetic field might be seen as changes in head position during exposure within the magnet. Using a yoked restraint tube that allowed movement of the head and neck, we found that rats showed an immediate and persistent deviation of the head during exposure to a static 14.1 T magnetic field. The direction of the head tilt was dependent on the orientation of the rat in the magnetic field (B), such that rats oriented head-up (snout towards B+) showed a rightward tilt of the head, while rats oriented head-down (snout towards B-) showed a leftward tilt of the head. The tilt of the head during magnet exposure was opposite to the direction of locomotor circling immediately after exposure observed previously. Rats exposed in the yoked restraint tube showed significantly more locomotor circling compared to rats exposed with the head restrained. There was little difference in CTA magnitude or extinction rate, however. The deviation of the head was seen when the rats were motionless within the homogenous static field; movement through the field or exposure to the steep gradients of the field was not necessary to elicit the apparent vestibulo-collic reflex.

Physiologic and dosimetric considerations for limiting electric fields induced in the body by movement in a static magnetic field

Movement in a strong static magnetic field induces electric fields in a human body, which may result in various sensory perceptions such as vertigo, nausea, magnetic phosphenes, and a metallic taste in the mouth. These sensory perceptions have been observed by patients and medical staff in the vicinity of modern diagnostic magnetic resonance (MR) equipment and may be distracting if they were to affect the balance and eye-hand coordination of, for example, a physician carrying out a medical operation during MR scanning. The stimulation of peripheral nerve tissue by a more intense induced electric field is also theoretically possible but has not been reported to result from such movement. The main objective of this study is to consider generic criteria for limiting the slowly varying broadband (<10 Hz) electric fields induced by the motion of the body in the static magnetic field. In order to find a link between the static magnetic flux density and the time-varying induced electric field, the static magnetic field is converted to the homogeneous equivalent transient and sinusoidal magnetic fields exposing a stationary body. Two cases are considered: a human head moving in a non-uniform magnetic field and a head rotating in a homogeneous magnetic field. Then the electric field is derived from the magnetic flux rate (dB/dt) of the equivalent field by using computational dosimetric data published in the literature for various models of the human body. This conversion allows the plotting of the threshold electric field as a function of frequency for vertigo, phosphenes, and stimulation of peripheral nerves. The main conclusions of the study are: The basic restrictions for limiting exposure to extremely low frequency magnetic fields recommended by the International Commission on Non-Ionizing Radiation Protection ICNIRP in 1998 will prevent most cases of vertigo and other sensory perceptions that result from induced electric fields above 1 Hz, while limiting the static magnetic field below 2 T, as recently recommended by ICNIRP, provides sufficient protection below 1 Hz. People can experience vertigo when moving in static magnetic fields of between 2 and 8 T, but this may be controlled to some extent by slowing down head and/or body movement. In addition, limiting the static magnetic field below 8 T provides good protection against peripheral nerve stimulation.

Exposure to high-field MRI does not affect cognitive function

PURPOSE

To assess potential cognitive deficits under the influence of static magnetic fields at various field strengths some studies already exist. These studies were not focused on attention as the most vulnerable cognitive function. Additionally, mostly no magnetic resonance imaging (MRI) sequences were performed.

MATERIALS AND METHODS

In all, 25 right-handed men were enrolled in this study. All subjects underwent one MRI examination of 63 minutes at 1.5 T and one at 7 T within an interval of 10 to 30 days. The order of the examinations was randomized. Subjects were referred to six standardized neuropsychological tests strictly focused on attention immediately before and after each MRI examination. Differences in neuropsychological variables between the timepoints before and after each MRI examination were assessed and P-values were calculated

RESULTS

Only six subtests revealed significant differences between pre- and post-MRI. In these tests the subjects achieved better results in post-MRI testing than in pre-MRI testing (P = 0.013-0.032). The other tests revealed no significant results.

CONCLUSION

The improvement in post-MRI testing is only explicable as a result of learning effects. MRI examinations, even in ultrahigh-field scanners, do not seem to have any persisting influence on the attention networks of human cognition immediately after exposure.

Biological effects and safety in magnetic resonance imaging: a review

Since the introduction of Magnetic Resonance Imaging (MRI) as a diagnostic technique, the number of people exposed to electromagnetic fields (EMF) has increased dramatically. In this review, based on the results of a pioneer study showing in vitro and in vivo genotoxic effects of MRI scans, we report an updated survey about the effects of non-ionizing EMF employed in MRI, relevant for patients' and workers' safety. While the whole data does not confirm a risk hypothesis, it suggests a need for further studies and prudent use in order to avoid unnecessary examinations, according to the precautionary principle.

Safety implications of high-field MRI: actuation of endogenous magnetic iron oxides in the human body

Background

Magnetic Resonance Imaging scanners have become ubiquitous in hospitals and high-field systems (greater than 3 Tesla) are becoming increasingly common. In light of recent European Union moves to limit high-field exposure for those working with MRI scanners, we have evaluated the potential for detrimental cellular effects via nanomagnetic actuation of endogenous iron oxides in the body.

Methodology

Theoretical models and experimental data on the composition and magnetic properties of endogenous iron oxides in human tissue were used to analyze the forces on iron oxide particles.

Principal Finding and Conclusions

Results show that, even at 9.4 Tesla, forces on these particles are unlikely to disrupt normal cellular function via nanomagnetic actuation.

[Safety aspects in high-field magnetic resonance imaging]

With more and more 3 Tesla high-field magnetic resonance (MR) scanners entering clinical routine, the safety notion in MR imaging has also reached a new dimension. The first part of this paper deals with the three most important sources of physical interaction (static magnetic field, gradient and HF fields). The paper discusses the differences compared with the traditional clinical 1.5 T standard scanners, the impact on human beings, the interactions with metallic objects and the relevant safety standards. The second part of the paper examines the issue of MR safety as seen in clinical practice and tries to demonstrate optimization potentials. This includes structural optimization in information distribution and hospital organization as well as test standards and labeling guidelines.

Exposure to alternating electromagnetic fields and effects on the visual and visuomotor systems

Acute effects on the visual and visuo-motor systems by exposure to electromagnetic fields (EMFs) at a frequency and amplitude similar to those produced by MR imaging gradient coils were assessed. 40 volunteers were exposed in random order to three, time varying, magnetic field gradients (0, 20 and 10 mT m(-1)r.m.s.). The waveform was 50 cycles of a 490 Hz sinusoidal waveform repeated every second with a total duration of 10 min for each trial. The EMFs were generated using an in-house designed and built magnetic gradient coil and waveform generator. During each trial, a test battery assessing the visual sensory (FACT) and visuo-motor (Pursuit Aiming II and visual tracking) neurobehavioral domains was completed by all volunteers. The sequence of these tests was assigned at random for each volunteer. Performance in these tests was analysed using linear mixed effects models adjusted for confounding factors collected in a pre-trial questionnaire. Variability of the estimates was assessed using a delete-1 jack-knife procedure. There was a trend for visuo-motor accuracy to be reduced (p = 0.06) by 1% during high exposure, but not at medium exposure. There was a weaker trend for visual contrast sensitivity to be improved by 12% and 21% during medium and high exposure, respectively, compared with the non-exposed sessions (p = 0.08). These effects did not reach 5% statistical significance within a population of 40 volunteers, but also the magnitude of these effects did not depend on single "extreme" observations.

Cognitive effects of head-movements in stray fields generated by a 7 Tesla whole-body MRI magnet

The study investigates the impact of exposure to the stray magnetic field of a whole-body 7 T MRI scanner on neurobehavioral performance and cognition. Twenty seven volunteers completed four sessions, which exposed them to approximately 1600 mT (twice), 800 mT and negligible static field exposure. The order of exposure was assigned at random and was masked by placing volunteers in a tent to hide their position relative to the magnet bore. Volunteers completed a test battery assessing auditory working memory, eye-hand co-ordination, and visual perception. During three sessions the volunteers were instructed to complete a series of standardized head movements to generate additional time-varying fields ( approximately 300 and approximately 150 mT.s(-1) r.m.s.). In one session, volunteers were instructed to keep their heads as stable as possible. Performance on a visual tracking task was negatively influenced (P<.01) by 1.3% per 100 mT exposure. Furthermore, there was a trend for performance on two cognitive-motor tests to be decreased (P<.10). No effects were observed on working memory. Taken together with results of earlier studies, these results suggest that there are effects on visual perception and hand-eye co-ordination, but these are weak and variable between studies. The magnitude of these effects may depend on the magnitude of time-varying fields and not so much on the static field. While this study did not include exposure above 1.6 T, it suggests that use of strong magnetic fields is not a significant confounder in fMRI studies of cognitive function. Future work should further assess whether ultra-high field may impair performance of employees working in the vicinity of these magnets.