Magnetic resonance imaging in children with implants

Comparison of the different imaging modalities used to image pediatric oncology patients: A COG diagnostic imaging committee/SPR oncology committee white paper

Diagnostic imaging is essential in the diagnosis and management, including surveillance, of known or suspected cancer in children. The independent and combined roles of the various modalities, consisting of radiography, fluoroscopy, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine (NM), are both prescribed through protocols but also function in caring for complications that may occur during or subsequent to treatment such as infection, bleeding, or organ compromise. Use of a specific imaging modality may be based on situational circumstances such as a brain CT or MR for a new onset seizure, chest CT for respiratory signs or symptoms, or US for gross hematuria. However, in many situations, there are competing choices that do not easily lend themselves to a formulaic approach as options; these situations depend on the contributions of a variety of factors based on a combination of the clinical scenario and the strengths and limitations of the imaging modalities. Therefore, an improved understanding of the potential influence of the imaging decision pathways in pediatric cancer care can come from comparison among the individual diagnostic imaging modalities. The purpose of the following material to is to provide such a comparison. To do this, pediatric imaging content experts for the individual modalities of radiography and fluoroscopy, US, CT, MRI, and NM will discuss the individual modality strengths and limitations.

Perioperative Management of Nonorthopaedic Devices in the Pediatric Neuromuscular Patient Population

Pediatric patients with neuromuscular conditions often have nonorthopaedic implants that can pose a challenge for MRI acquisition and surgical planning. Treating physicians often find themselves in the position of navigating between seemingly overly risk-averse manufacturer's guidelines and an individual patient's benefits of an MRI or surgery. Most nonorthopaedic implants are compatible with MRI under specific conditions, though often require reprogramming or interrogation before and/or after the scan. For surgical procedures, the use of electrosurgical instrumentation poses a risk of electromagnetic interference and implants are thus often programmed or turned off for the procedures. Special considerations are needed for these patients to prevent device damage or malfunction, which can pose additional risk to the patient. Additional planning before surgery is necessary to ensure appropriate equipment, and staff are available to ensure patient safety.

Assessment of MRI Safety Practices in Saudi Arabia

Aim

The aim of this study is to investigate the safety practices used by MRI departments in Saudi Arabia.

Methods

A cross-sectional study across 113 private and public hospitals was conducted in Saudi Arabia. A survey questionnaire was designed and sent to 113 MRI units. The questionnaire consisted of 43 items under 14 sections for the assessment of MRI safety practices. These 14 sections are related to (i) MRI and its safety, (ii) MRI usage and its safety, and (iii) safety of the MRI technologists and reporting of adverse effects during the usage. The American College of Radiology (ACR) guidance document on MRI safety practices was used as a template for this survey. Data were analyzed using IBM SPSS Statistical software for Windows version 26.0 (IBM Corp., Armonk, NY, USA).

Results

Of the 43 items assessed, only 3 items' binary responses (Yes & No) did not differ much. A greater proportion of positive responses for 40 items (93%) regarding MRI safety practices. More than 50% of the participants claimed that their departments lacked a Magnetic Resonance Safety Officer (MRSO). Regarding regular safety training programs, less than 50% received training in MRI safety. Handheld metal detectors were found in only 39% of the MRI units.

Conclusion

The majority of MRI units in Saudi Arabia have demonstrated compliance with majority of ACR MRI safety recommendations; nonetheless, there are two main items for which the guidelines may not be attained: MRSO and regular MRI safety training programs. By taking into account the limitations of this study, it is strongly recommended to assign MRSO and implement annual MRI safety training to improve MRI safety practices for both patients and healthcare workers.

MRI Safety Practice Observations in MRI Facilities Within the Kingdom of Jordan, Compared to the 2020 Manual on MR Safety of the American College of Radiology

Purpose

The absence of ionizing radiation in MRI applications does not guarantee absolute safety. Implementing of safety guidelines can ensure high-quality practice in the clinical MRI with the minimum risk. For this purpose, this cross-section quantitative study conducted in Jordan Kingdom aimed to assess current MRI safety guidelines in comparison with those of 2020 Manual on MR Safety of the American College of Radiology (ACR).

Patients and Methods

A site observation study of 38 MRI units was undertaken in June 2021. A well-structured MRI safety questionnaire was the primary data collection method. Data were subjected to a descriptive statistics content analysis by the SPSS version 20. The results were analyzed to yield comprehensive discussions.

Results

A total of 38 MRI facilities in participated in this study with the responding rate of 44.7%. Patient screening areas and changing rooms were available in about 29% (11/38) of the MRI facilities. Most facilities (55%, 21/38) conducted verbal screening only whereas 21% implemented both written and verbal screening for their patients and companions in zone II, which was present in a percentage of 29% in the approached facilities. Meanwhile, only 13 (43.2%) of 38 facilities used handheld magnets for physical screening, 25 (65.8%) of MRI units did not use any kind of ferromagnetic metal detection systems. Three (7.9%) participating centers had MR-safe wheelchairs, ventilators, anesthesia machines, and stretchers. Most MRI facilities participating in this study (71%) had emergency preparedness plans for alternative power outages. Despite a relatively low number of participating centers having an emergency exit or code (26.3% and 10.5%, respectively), none of them performed practice drills for such scenarios.

Conclusion

Investing in new MR-safe equipment requires introducing ferromagnetic detecting systems. More research is needed to establish the degree of MRI professional’s safety-related education.

Intraoperative MR Imaging during Glioma Resection

One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.