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Baker C, Nugent B, Grainger D, Hewis J, Malamateniou C. Systematic review of MRI safety literature in relation to radiofrequency thermal injury prevention. J Med Radiat Sci 2024. [PMID: 38937923 DOI: 10.1002/jmrs.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is a rapidly evolving modality, generally considered safe due to lack of ionising radiation. While MRI technology and techniques are improving, many of the safety concerns remain the same as when first established. Patient thermal injuries are the most frequently reported adverse event, accounting for 59% of MRI incidents to the Food and Drug Administration (FDA). Surveys indicate many incidents remain unreported. Patient thermal injuries are preventable and various methods for their mitigation have been published. However, recommendations can be variable, fragmented and confusing. The aim of this systematic review was to synthesise the evidence on MRI safety and associated skin injuries and offer comprehensive recommendations for radiographers to prevent skin thermal injuries. METHODS Four journal databases were searched for sources published January 2010-May 2023, presenting information on MRI safety and thermal injuries. RESULTS Of 26,801 articles returned, after careful screening and based on the eligibility criteria, only 79 articles and an additional 19 grey literature sources were included (n = 98). Included studies were examined using thematic analysis to determine if holistic recommendations can be provided to assist in preventing skin burns. This resulted in three simplified recommendations: Remove any electrically conductive items Insulate the patient to prevent any conductive loops or contact with objects Communicate regularly CONCLUSION: By implementing the above recommendations, it is estimated that 97% of skin burns could be prevented. With thermal injuries continuing to impact MRI safety, strategies to prevent skin burns and heating are essential. Assessing individual risks, rather than blanket policies, will help prevent skin thermal injuries occurring, improving patient care.
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Affiliation(s)
- Cassandra Baker
- Qscan Radiology, Brisbane, Queensland, Australia
- Division of Midwifery and Radiography, Department of Radiography, City University of London School of Health & Psychological Sciences, London, UK
| | - Barbara Nugent
- Division of Midwifery and Radiography, Department of Radiography, City University of London School of Health & Psychological Sciences, London, UK
- MRI Safety Matters, Edinburgh, UK
| | - David Grainger
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Johnathan Hewis
- School of Dentistry and Medical Sciences, Charles Sturt University, Port Macquarie, New South Wales, Australia
| | - Christina Malamateniou
- Division of Midwifery and Radiography, Department of Radiography, City University of London School of Health & Psychological Sciences, London, UK
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Lichtenauer EA, Santifort KM, Bergknut N, van Soens I, Beukers M, Carrera I. Case report: Radiofrequency-induced thermal burn injury in a dog after magnetic resonance imaging. Front Vet Sci 2024; 11:1364635. [PMID: 38807939 PMCID: PMC11131380 DOI: 10.3389/fvets.2024.1364635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024] Open
Abstract
A 10-year-old male Shar-Pei was referred for lethargy and proprioceptive deficits of the left thoracic limb. An magnetic resonance imaging (MRI) examination of the cervical spinal column and the brain was performed. The MRI examination of the brain was normal. A left-sided C3-C4 intervertebral disc extrusion with spinal cord compression was diagnosed. Medical treatment was elected. Within a week after the MRI examination, the dog presented with deep partial-thickness skin burn wounds in both axillae. Since the specific absorption rate had not exceeded the safety limits during any of the scans and no other procedures or circumstances were identified that could possibly have resulted in burn injuries, the thermal burn injuries were diagnosed as radiofrequency (RF) burns. The wounds healed by secondary intent over the next month. RF burns are the most reported complication in humans undergoing MRI but have not been reported in veterinary patients. Clinicians and technicians should consider the potential risk for RF burns in veterinary patients and take precautions regarding positioning of the patient and take notice of any signs of burn injury when performing follow-up examinations.
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Affiliation(s)
- Esther A. Lichtenauer
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Koen M. Santifort
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
- IVC Evidensia Small Animal Referral Hospital Arnhem, Neurology, Arnhem, Netherlands
| | - Niklas Bergknut
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Iris van Soens
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Martijn Beukers
- IVC Evidensia Small Animal Referral Hospital Hart van Brabant, Neurology, Waalwijk, Netherlands
| | - Ines Carrera
- Vet Oracle Teleradiology, Norfolk, United Kingdom
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Mittendorff L, Young A, Lee A, Sim JH. New Zealand and Australian MRI technologists' (radiographers) MRI safety knowledge and confidence levels. Radiography (Lond) 2023; 29:697-704. [PMID: 37187067 DOI: 10.1016/j.radi.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION The MRI technologist (radiographer) is at the frontline of MRI safety decision-making and has the primary responsibility to provide high quality, efficient and safe patient care in the MRI environment. As MRI technology advances and new safety issues emerge, this study aimed to provide a snapshot of the preparedness of MRI technologists in New Zealand (NZ) and Australia to practise confidently and safely. METHOD An online questionnaire, administered via Qualtrics and covering a range of MRI safety topics, was distributed in 2018 via the New Zealand MR Users Group, the MRI Australia-NZ Group Facebook, and relevant professional bodies. RESULTS A total of 312 MRI technologists attempted the questionnaire, with 246 surveys being fully completed. Of these, 61% (n = 149) were in Australia, 36% (n = 89) in NZ, and 3% (n = 8) from other countries. Findings indicated that current MRI education is preparing MRI technologists in NZ and Australia to practise safely. However, while these technologists are confident in their MRI safety decision-making, accuracy levels within some groups need addressing. CONCLUSION To develop a consistent level of safe practice, it is proposed that a minimum level of MRI-specific education is defined and mandated to practise. Continuing professional development focussing on MRI safety must be encouraged and, if audited as part of registration, could also be mandated. Implementation of a supporting regulatory framework similar to NZ is recommended for other countries. IMPLICATIONS FOR PRACTICE All MRI technologists are responsible for the safety of their patients and staff. Employers must support and ensure MRI-specific education has been completed. Ongoing engagement in MRI safety events provided by MRI safety experts, professional bodies and/or universities is essential to remain up-to-date.
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Affiliation(s)
- L Mittendorff
- Department of Anatomy and Medical Imaging, School of Medical Sciences, The University of Auckland, 85 Park Rd, Auckland, New Zealand; Mercy Radiology, 7 Polarity Rise, Silverdale, Auckland, New Zealand.
| | - A Young
- Department of Anatomy and Medical Imaging, School of Medical Sciences, The University of Auckland, 85 Park Rd, Auckland, New Zealand
| | - A Lee
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, 28 Park Rd, Auckland, New Zealand
| | - J H Sim
- Department of Anatomy and Medical Imaging, School of Medical Sciences, The University of Auckland, 85 Park Rd, Auckland, New Zealand; Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Occupational Exposure Assessment of the Static Magnetic Field Generated by Nuclear Magnetic Resonance Spectroscopy: A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137674. [PMID: 35805332 PMCID: PMC9265854 DOI: 10.3390/ijerph19137674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 01/27/2023]
Abstract
Magnetic resonance (MR) systems are used in academic research laboratories and industrial research fields, besides representing one of the most important imaging modalities in clinical radiology. This technology does not use ionizing radiation, but it cannot be considered without risks. These risks are associated with the working principle of the technique, which mainly involves static magnetic fields that continuously increase—namely, the radiofrequency (RF) field and spatial magnetic field gradient. To prevent electromagnetic hazards, the EU and ICNIRP have defined workers’ exposure limits. Several studies that assess health risks for workers and patients of diagnostic MR are reported in the literature, but data on workers’ risk evaluation using nuclear MR (NMR) spectroscopy are very poor. Therefore, the aim of this research is the risk assessment of an NMR environment, paying particular attention to workers with active implantable medical devices (AIMDs). Our perspective study consisted of the measurement of the static magnetic field around a 300 MHz (7 T) NMR research spectrometer and the computation of the electric field induced by the movements of an operator. None of the calculated exposure parameters exceeded the threshold limits imposed by legislation for protection against short-term effects of acute occupational exposure, but our results revealed that the level of exposure exceeded the action level threshold limit for workers with AIMD during the execution of tasks requiring the closest proximity to the spectrometer. Moreover, the strong dependence of the induced electric field results from the walking speed models is shown. This case study represents a snapshot of the NMR risk assessment with the specific goal to increase the interest in the safety of NMR environments.
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Song C, Yu B, Wang J, Zhu Y, Zhang X. Effects of Moderate to High Static Magnetic Fields on Reproduction. Bioelectromagnetics 2022; 43:278-291. [PMID: 35485707 DOI: 10.1002/bem.22404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/09/2022] [Accepted: 04/09/2022] [Indexed: 11/08/2022]
Abstract
With the wide application of magnetic resonance imaging in hospitals and permanent magnets in household items, people have increased exposure to various types of static magnetic fields (SMFs) with moderate and high intensities, which has caused a considerable amount of public concern. Studies have shown that some aspects of gametogenesis and early embryonic development can be significantly affected by SMFs, while others have shown no effects. This review summarizes the experimental results of moderate to high-intensity SMFs (1 mT-16.7 T) on the reproductive development of different model animals, and we find that the effects of SMFs are variable depending on experimental conditions. In general, the effects of inhomogeneous SMFs seem to be more significant compared to that of homogeneous SMFs, which is likely due to magnetic forces generated by the magnetic field gradient. Moreover, some electromagnetic fields may have induced bioeffects because of nonnegligible gradient and heat effect, which are much reduced in superconducting magnets. We hope this review can provide a starting point for more in-depth analysis of various SMFs on reproduction, which is indispensable for evaluating the safety and potential applications of SMFs on living organisms in the future. © 2022 Bioelectromagnetics Society.
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Affiliation(s)
- Chao Song
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,University of Science and Technology of China, Hefei, China
| | - Biao Yu
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,University of Science and Technology of China, Hefei, China
| | - Junjun Wang
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China
| | - Yiming Zhu
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,Institutes of Physical Science and Information Technology, Anhui University, Hefei, China
| | - Xin Zhang
- High Magnetic Field Laboratory, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, China.,University of Science and Technology of China, Hefei, China.,Institutes of Physical Science and Information Technology, Anhui University, Hefei, China.,International Magnetobiology Frontier Research Center (iMFRC), Science Island, Hefei, China
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6
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Tang M, Yamamoto T. Progress in Understanding Radiofrequency Heating and Burn Injuries for Safer MR Imaging. Magn Reson Med Sci 2022; 22:7-25. [PMID: 35228437 PMCID: PMC9849420 DOI: 10.2463/mrms.rev.2021-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
RF electromagnetic wave exposure during MRI scans induces heat and occasionally causes burn injuries to patients. Among all the types of physical injuries that have occurred during MRI examinations, RF burn injuries are the most common ones. The number of RF burn injuries increases as the static magnetic field of MRI systems increases because higher RFs lead to higher heating. The commonly believed mechanisms of RF burn injuries are the formation of a conductive loop by the patient's posture or cables, such as an electrocardiogram lead; however, the mechanisms of RF burn injuries that occur at the contact points, such as the bore wall and the elbow, remain unclear. A comprehensive understanding of RF heating is needed to address effective countermeasures against all RF burn injuries for safe MRI examinations. In this review, we summarize the occurrence of RF burn injury cases by categorizing RF burn injuries reported worldwide in recent decades. Safety standards and regulations governing RF heating that occurs during MRI examinations are presented, along with their theoretical and physiological backgrounds. The experimental assessment techniques for RF heating are then reviewed, and the development of numerical simulation techniques is explained. In addition, a comprehensive theoretical interpretation of RF burn injuries is presented. By including the results of recent experimental and numerical simulation studies on RF heating, this review describes the progress achieved in understanding RF heating from the standpoint of MRI burn injury prevention.
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Affiliation(s)
- Minghui Tang
- Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toru Yamamoto
- Division of Biomedical Engineering and Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan,Corresponding author: Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0812, Japan. Phone: +81-11-706-3412, Fax: +81-11-706-4916, E-mail:
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7
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Bernard FC, Kaiser J, Raval SK, Nepiyushchikh ZV, Doan TN, Willett NJ, Dixon JB. Multichromatic near-infrared imaging to assess interstitial lymphatic and venous uptake in vivo. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210078R. [PMID: 34881527 PMCID: PMC8654485 DOI: 10.1117/1.jbo.26.12.126001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/21/2021] [Indexed: 05/12/2023]
Abstract
SIGNIFICANCE Changes in interstitial fluid clearance are implicated in many diseases. Using near-infrared (NIR) imaging with properly sized tracers could enhance our understanding of how venous and lymphatic drainage are involved in disease progression or enhance drug delivery strategies. AIM We investigated multichromatic NIR imaging with multiple tracers to assess in vivo microvascular clearance kinetics and pathways in different tissue spaces. APPROACH We used a chemically inert IR Dye 800CW (D800) to target venous capillaries and a purified conjugate of IR dye 680RD with 40 kDa PEG (P40D680) to target lymphatic capillaries in vivo. Optical imaging settings were validated and tuned in vitro using tissue phantoms. We investigated multichromatic NIR imaging's utility in two in vivo tissue beds: the mouse tail and rat knee joint. We then tested the ability of the approach to detect interstitial fluid perturbations due to exercise. RESULTS In an in vitro simulated tissue environment, free dye and PEG mixture allowed for simultaneous detection without interference. In the mouse tail, co-injected NIR tracers cleared from the interstitial space via distinct routes, suggestive of lymphatic and venous uptake mechanisms. In the rat knee, we determined that exercise after injection transiently increased lymphatic drainage as measured by lower normalized intensity immediately after exercise, whereas exercise pre-injection exhibited a transient delay in clearance from the joint. CONCLUSIONS NIR imaging enables simultaneous imaging of lymphatic and venous-mediated fluid clearance with great sensitivity and can be used to measure temporal changes in clearance rates and pathways.
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Affiliation(s)
- Fabrice C. Bernard
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
| | - Jarred Kaiser
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
| | - Sarvgna K. Raval
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
| | - Zhanna V. Nepiyushchikh
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Atlanta, Georgia, United States
| | - Thanh N. Doan
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
| | - Nick J. Willett
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Emory University, Department of Orthopaedics, Atlanta, Georgia, United States
- Atlanta Veteran’s Affairs Medical Center, Department of Orthopaedics, Atlanta, Georgia, United States
- Georgia Institute of Technology, Parker H. Petit Institute for Bioengineering and Bioscience, Atlanta, Georgia, United States
| | - J. Brandon Dixon
- Georgia Institute of Technology and Emory University, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia, United States
- Georgia Institute of Technology, George W. Woodruff School of Mechanical Engineering, Atlanta, Georgia, United States
- Georgia Institute of Technology, Parker H. Petit Institute for Bioengineering and Bioscience, Atlanta, Georgia, United States
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8
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Mittendorff L, Young A, Sim J. A narrative review of current and emerging MRI safety issues: What every MRI technologist (radiographer) needs to know. J Med Radiat Sci 2021; 69:250-260. [PMID: 34498813 PMCID: PMC9163467 DOI: 10.1002/jmrs.546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI) has been traditionally regarded as a safe imaging modality due to the absence of ionising radiation. However, MRI is a source of potential hazards with a variety of risks including, but not limited to, those associated with the various electromagnetic fields used for imaging. All MRI technologists (radiographers) require sound knowledge of the physical principles of the MRI scanner and must understand the associated safety risks and how to avoid adverse events from occurring. MRI technologists now assume more responsibility in clinical decision‐making, and their knowledge base has consequently had to expand significantly. In addition, rapid advancements in MRI technology and other correlated areas such as medical implant technology, and the associated increase in MRI safety issues, place increasing demands on the MRI technologist to constantly keep abreast of current and future developments. This article reviews current and emerging MRI safety issues relevant to the three MRI electromagnetic fields and highlights the key information that all MRI technologists should be fully cognisant of to ensure competent and safe practice within the MRI environment.
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Affiliation(s)
- Lisa Mittendorff
- Department of Anatomy and Medical Imaging, School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Mercy Radiology, Silverdale, Auckland, New Zealand
| | - Adrienne Young
- Department of Anatomy and Medical Imaging, School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | - Jenny Sim
- Department of Anatomy and Medical Imaging, School of Medical Sciences, The University of Auckland, Auckland, New Zealand.,Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Monash University, Clayton, VIC, Australia
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Militello C, Rundo L, Vicari F, Agnello L, Borasi G, Vitabile S, Russo G. A Computational Study on Temperature Variations in MRgFUS Treatments Using PRF Thermometry Techniques and Optical Probes. J Imaging 2021; 7:63. [PMID: 34460513 PMCID: PMC8321332 DOI: 10.3390/jimaging7040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
Structural and metabolic imaging are fundamental for diagnosis, treatment and follow-up in oncology. Beyond the well-established diagnostic imaging applications, ultrasounds are currently emerging in the clinical practice as a noninvasive technology for therapy. Indeed, the sound waves can be used to increase the temperature inside the target solid tumors, leading to apoptosis or necrosis of neoplastic tissues. The Magnetic resonance-guided focused ultrasound surgery (MRgFUS) technology represents a valid application of this ultrasound property, mainly used in oncology and neurology. In this paper; patient safety during MRgFUS treatments was investigated by a series of experiments in a tissue-mimicking phantom and performing ex vivo skin samples, to promptly identify unwanted temperature rises. The acquired MR images, used to evaluate the temperature in the treated areas, were analyzed to compare classical proton resonance frequency (PRF) shift techniques and referenceless thermometry methods to accurately assess the temperature variations. We exploited radial basis function (RBF) neural networks for referenceless thermometry and compared the results against interferometric optical fiber measurements. The experimental measurements were obtained using a set of interferometric optical fibers aimed at quantifying temperature variations directly in the sonication areas. The temperature increases during the treatment were not accurately detected by MRI-based referenceless thermometry methods, and more sensitive measurement systems, such as optical fibers, would be required. In-depth studies about these aspects are needed to monitor temperature and improve safety during MRgFUS treatments.
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Affiliation(s)
- Carmelo Militello
- Institute of Molecular Bioimaging and Physiology, Italian National Research Council (IBFM-CNR), Cefalu, 90015 Palermo, Italy;
| | - Leonardo Rundo
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK;
- Cancer Research UK Cambridge Centre, Cambridge CB2 0RE, UK
| | - Fabrizio Vicari
- LAboratorio di Tecnologie Oncologiche (LATO), Cefalu, 90015 Palermo, Italy; (F.V.); (G.B.)
| | - Luca Agnello
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (L.A.); (S.V.)
| | - Giovanni Borasi
- LAboratorio di Tecnologie Oncologiche (LATO), Cefalu, 90015 Palermo, Italy; (F.V.); (G.B.)
| | - Salvatore Vitabile
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, 90127 Palermo, Italy; (L.A.); (S.V.)
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, Italian National Research Council (IBFM-CNR), Cefalu, 90015 Palermo, Italy;
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Karateev AE, Lila AM, Vertkin AL, Alekseeva LI, Gerasimenko MY, Arkov VV, Smirnova SN, Sukhareva ML, Tsykunov MB. Efficiency and safety of magnetotherapy in the treatment of osteoarthritis. Expert council (3 june 2020, Moscow). RHEUMATOLOGY SCIENCE AND PRACTICE 2021. [DOI: 10.47360/1995-4484-2020-734-742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - A. L. Vertkin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - M. Yu. Gerasimenko
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - V. V. Arkov
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine of Moscow Healthcare Department
| | - S. N. Smirnova
- Moscow Regional Research and Clinical Institute (“MONIKI”)
| | | | - M. B. Tsykunov
- N.N. Priorov Central Research Institute of Traumatology and Orthopedics; N.I. Pirogov Russian National Research Medical University
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11
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MR Imaging Safety in the Interventional Environment. Magn Reson Imaging Clin N Am 2020; 28:583-591. [PMID: 33040998 DOI: 10.1016/j.mric.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Interventional MR imaging procedures are rapidly growing in number owing to the excellent soft tissue resolution of MR imaging, lack of ionizing radiation, hardware and software advancements, and technical developments in MR imaging-compatible robots, lasers, and ultrasound equipment. The safe operation of an interventional MR imaging system is a complex undertaking, which is only possible with multidisciplinary planning, training, operations and oversight. Safety for both patients and operators is essential for successful operations. Herein, we review the safety concerns, solutions and challenges associated with the operation of a modern interventional MR imaging system.
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12
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Tagell L, Alcheikh A, Jurevics R, Nair AP. Thigh burn - A magnetic resonance imaging (MRI) related adverse event. Radiol Case Rep 2020; 15:2569-2571. [PMID: 33082900 PMCID: PMC7550826 DOI: 10.1016/j.radcr.2020.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022] Open
Abstract
Burns are an unexpected adverse event of magnetic resonance imaging (MRI). We present an interesting case of a patient who underwent an MRI and suffered a second degree burn to their inner thighs thought to be caused by the creation of a “tissue-loop.” It is important that clinicians and technicians are aware of this adverse event to help prevent further occurrences in this commonly used imaging modality.
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Affiliation(s)
- Laura Tagell
- Albury Wodonga Health, 201 Borella Road, East Albury 2640 NSW, Australia
| | - Ahmad Alcheikh
- Border Cancer Hospital, 201 Borella Road, East Albury 2640 NSW, Australia
| | - Richard Jurevics
- Albury Wodonga Health, 201 Borella Road, East Albury 2640 NSW, Australia
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13
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Blankholm A, Hansson B. Incident reporting and level of MR safety education: A Danish national study. Radiography (Lond) 2020; 26:147-153. [DOI: 10.1016/j.radi.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/25/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
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14
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Hartwig V, Biagini C, De Marchi D, Flori A, Gabellieri C, Virgili G, Ferrante Vero LF, Landini L, Vanello N, Giovannetti G. Analysis, comparison and representation of occupational exposure to a static magnetic field in a 3-T MRI site. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2020; 28:76-85. [PMID: 32276568 DOI: 10.1080/10803548.2020.1738114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this study is to analyze exposure to the time-varying magnetic field caused by worker movements in a 3-T clinical magnetic resonance imaging (MRI) scanner. Measurements of the static magnetic field (B) in the proximity of the MRI scanner were performed to create a detailed map of the spatial gradient of B, in order to indicate the areas at high risk of exposure. Moreover, a personal exposure recording system was used in order to analyze and compare exposure to the static magnetic field during different routine procedures in MRI. We found that for all of the performed work activities, exposure was compliant with International Commission on Non-Ionizing Radiation Protection levels. However, our findings confirm that there is great variability of exposure between different workers and suggest the importance of performing personal exposure measurements and of detailed knowledge of the magnetic field spatial distribution.
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Affiliation(s)
| | - Cristiano Biagini
- Associazione Italiana Tecnici dell'Imaging in Risonanza Magnetica, AITIRM, Italy
| | - Daniele De Marchi
- Associazione Italiana Tecnici dell'Imaging in Risonanza Magnetica, AITIRM, Italy.,Fondazione CNR-Regione Toscana 'G. Monasterio', Italy
| | | | | | | | | | - Luigi Landini
- Fondazione CNR-Regione Toscana 'G. Monasterio', Italy.,Department of Information Engineering, University of Pisa, Italy
| | - Nicola Vanello
- Department of Information Engineering, University of Pisa, Italy
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Hartwig V, Biagini C, De Marchi D, Flori A, Gabellieri C, Virgili G, Ferrante Vero LF, Landini L, Vanello N, Giovannetti G. The Procedure for Quantitative Characterization and Analysis of Magnetic Fields in Magnetic Resonance Sites for Protection of Workers: A Pilot Study. Ann Work Expo Health 2020; 63:328-336. [PMID: 30852618 DOI: 10.1093/annweh/wxz002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/20/2018] [Accepted: 01/09/2019] [Indexed: 11/14/2022] Open
Abstract
Concerning the occupational exposure in magnetic resonance imaging (MRI) facilities, the worker behavior in the magnetic resonance (MR) room is of such particular importance that there is the need for a simple but reliable method to alert the worker of the highest magnetic field exposure. Here, we describe a quantitative analysis of occupational exposure in different MRI working environments: in particular, we present a field measurement method integrated with a software tool for an accurate mapping of the fringe field in the proximity of the magnetic resonance bore. Three illustrative assessment studies are finally presented, compared and discussed, considering an example of a realistic path followed by an MRI worker during the daily procedure. The results show that the basic restrictions set by ICNIRP can be exceeded during standard procedure even in 1.5 T scanners. Using the described simplified metrics, it is possible to introduce behavioral rules on how to move around an MRI room that could be more useful than a numerical limit to aid magnetic field risk mitigation strategies.
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Affiliation(s)
- Valentina Hartwig
- Institute of Clinical Physiology, CNR, Via G. Moruzzi 1, San Cataldo, Pisa, Italy
| | - Cristiano Biagini
- Associazione Italiana Tecnici dell'Imaging in Risonanza Magnetica, AITIRM, Via XX Settembre 76, Firenze, Italy
| | - Daniele De Marchi
- Associazione Italiana Tecnici dell'Imaging in Risonanza Magnetica, AITIRM, Via XX Settembre 76, Firenze, Italy.,Fondazione CNR-Regione Toscana ''G. Monasterio'', Via G. Moruzzi 1, San Cataldo, Pisa, Italy
| | - Alessandra Flori
- Fondazione CNR-Regione Toscana ''G. Monasterio'', Via G. Moruzzi 1, San Cataldo, Pisa, Italy
| | - Chiara Gabellieri
- Ambulatori Della Misericordia Srl Impresa Sociale, Via Montalvo 8, Campi Bisenzio (FI), Italy
| | | | | | - Luigi Landini
- Fondazione CNR-Regione Toscana ''G. Monasterio'', Via G. Moruzzi 1, San Cataldo, Pisa, Italy.,Department of Information Engineering, University of Pisa, Via G. Caruso 16, Pisa, Italy
| | - Nicola Vanello
- Department of Information Engineering, University of Pisa, Via G. Caruso 16, Pisa, Italy
| | - Giulio Giovannetti
- Institute of Clinical Physiology, CNR, Via G. Moruzzi 1, San Cataldo, Pisa, Italy
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16
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Wilén J, Olsrud J, Frankel J, Hansson Mild K. Valid Exposure Protocols Needed in Magnetic Resonance Imaging Genotoxic Research. Bioelectromagnetics 2020; 41:247-257. [PMID: 32157722 DOI: 10.1002/bem.22257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/22/2020] [Indexed: 11/10/2022]
Abstract
Several in vitro and in vivo studies have investigated if a magnetic resonance imaging (MRI) examination can cause DNA damage in human blood cells. However, the electromagnetic field (EMF) exposure that the cells received in the MR scanner was not sufficiently described. The first studies looking into this could be regarded as hypothesis-generating studies. However, for further exploration into the role of MRI exposure on DNA integrity, the exposure itself cannot be ignored. The lack of sufficient method descriptions makes the early experiments difficult, if not impossible, to repeat. The golden rule in all experimental work is that a study should be repeatable by someone with the right knowledge and equipment, and this is simply not the case with many of the recent studies on MRI and genotoxicity. Here we discuss what is lacking in previous studies, and how we think the next generation of in vitro and in vivo studies on MRI and genotoxicity should be performed. Bioelectromagnetics. © 2020 Bioelectromagnetics Society.
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Affiliation(s)
- Jonna Wilén
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Johan Olsrud
- Department of Diagnostic Radiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jennifer Frankel
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Kjell Hansson Mild
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
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17
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Study on neuropathological mechanisms of primary monosymptomatic nocturnal enuresis in children using cerebral resting-state functional magnetic resonance imaging. Sci Rep 2019; 9:19141. [PMID: 31844104 PMCID: PMC6915704 DOI: 10.1038/s41598-019-55541-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022] Open
Abstract
Primary monosymptomatic nocturnal enuresis (PMNE) is a heterogeneous disorder, which remains a difficult condition to manage due to lack of knowledge on the underlying pathophysiological mechanisms. Here we investigated the underlying neuropathological mechanisms of PMNE with functional MRI (fMRI), combining the amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo), and seed-based functional connectivity (seed-based FC) analyses. Compared to the control group, PMNE group showed decreased ALFF value in the left medial orbital superior frontal gyrus (Frontal_Med_Orb_L), and increased ReHo value in the left superior occipital gyrus (Occipital_Sup_L). With left thalamus as the seed, PMNE group showed significantly decreased functional connectivity to the left medial superior frontal gyrus (Frontal_Sup_Medial_L). We conclude that these abnormal brain activities are probably important neuropathological mechanisms of PMNE in children. Furthermore, this study facilitated the understanding of underlying pathogenesis of PMNE and may provide an objective basis for the effective treatment.
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18
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Delfino JG, Krainak DM, Flesher SA, Miller DL. MRI-related FDA adverse event reports: A 10-yr review. Med Phys 2019; 46:5562-5571. [PMID: 31419320 DOI: 10.1002/mp.13768] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/11/2019] [Accepted: 08/06/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To provide an overview of the types of adverse events reported to the US Food and Drug Administration (US FDA) for magnetic resonance (MR) systems over a 10-yr period. METHODS Two reviewers independently reviewed adverse events reported to FDA for MR systems from 1 January 2008 to 31 December 2017 and manually categorized events into eight event types. Thermal events were further subcategorized by probable cause. Objects that became projectiles were also categorized. RESULTS FDA received 1568 adverse event reports for MR systems between 1 January 2008 and 31 December 2017. This analysis included 1548 reports. Thermal events were the most commonly reported serious injury (59% of analyzed reports). Mechanical events - defined as slips, falls, crush injuries, broken bones, and cuts; musculoskeletal injuries from lifting or movement of the device - (11%), projectile events (9%), and acoustic events (6%) were also observed. CONCLUSIONS Adverse events related to MR systems consistent with the known hazards of the MR environment continue to be reported to FDA. Increased awareness of the types of adverse events occurring for MR imaging systems is important for prevention.
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Affiliation(s)
- Jana G Delfino
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Daniel M Krainak
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Stephanie A Flesher
- Division of Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
| | - Donald L Miller
- Office of In Vitro Devices and Radiological Health, Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire, Ave WO66-Rm 4236, Silver Spring, MD, 20993, USA
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19
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Chandra T, Chavhan GB, Sze RW, Swenson D, Holowka S, Fricke S, Davidson S, Iyer RS. Practical considerations for establishing and maintaining a magnetic resonance imaging safety program in a pediatric practice. Pediatr Radiol 2019; 49:458-468. [PMID: 30923877 DOI: 10.1007/s00247-019-04359-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/26/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Magnetic resonance imaging is a multipurpose imaging modality that is largely safe, given the lack of ionizing radiation. However there are electromagnetic and biological effects on human tissue when exposed to magnetic environments, and hence there is a risk of adverse events occurring with these exams. It is imperative to understand these risks and develop methods to minimize them and prevent consequent adverse events. Implementing these safety practices in pediatric MR imaging has been somewhat limited because of gaps in information and knowledge among the personnel who are closely involved in the MR environment. The American College of Radiology has provided guidelines on MR safety practices that are helpful in minimizing such adverse events. This article provides an overview of the issues related to MR safety and practical ways to implement them across different health care facilities.
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Affiliation(s)
- Tushar Chandra
- Department of Radiology, Nemours Children's Hospital, 13535 Nemours Pkwy., Orlando, FL, 32827, USA.
| | - Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Raymond W Sze
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Swenson
- Department of Radiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Stephanie Holowka
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Stanley Fricke
- Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA
| | | | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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20
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Li X, Jiang L, Chen L, Lei Y, Xu B, Liu B, Li S. A study of the MR imaging manifestations with injection of sedative at the buttocks in pediatric patients. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:73-81. [PMID: 30373997 DOI: 10.3233/xst-180422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND During the MRI examination, pediatric patients sleep under the sedation so that the image artifacts caused by the patient motion could be minimized. However, the sedative injection at the buttocks might cause a difficulty in the diagnosis of the buttock diseases using the MRI manifestations. OBJECTIVE This study aims to explore the imaging characteristics of MR for the pediatric patients with the sedative injected at the buttocks in order to correctly diagnose the diseases. METHODS MR imaging data of 64 pediatric patients injected with the sedative at the buttocks were retrospectively collected, including 8 cases of buttock disease. The imaging manifestations were analyzed and compared. RESULTS Out of 64 patients, 8 were diagnosed as the buttock diseases. MR imaging manifestations of the sedatives injected at the buttocks were the locally patchy and streaky long T1 and long T2 signals and were different from what were shown for the normal tissues and diseases. CONCLUSION The sedative injected at the buttocks has the MRI manifestations different from the normal tissues and diseases. Correctly understanding the MRI manifestations for the pediatric patients with the injection of sedative at the buttocks would reduce the chances of the misdiagnosis on the diseases.
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Affiliation(s)
- Xiaobo Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liuqing Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Lifang Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu Lei
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Biying Liu
- Department of Radiology, The People's Hospital of Fujian Traditional Chinese Medicine University, Fuzhou, China
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA
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21
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Hartwig V, Virgili G, Ferrante Vero LF, De Marchi D, Landini L, Giovannetti G. TOWARDS A PERSONALISED AND INTERACTIVE ASSESSMENT OF OCCUPATIONAL EXPOSURE TO MAGNETIC FIELD DURING DAILY ROUTINE IN MAGNETIC RESONANCE. RADIATION PROTECTION DOSIMETRY 2018; 182:546-554. [PMID: 30053260 DOI: 10.1093/rpd/ncy114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 06/27/2018] [Indexed: 06/08/2023]
Abstract
Magnetic resonance imaging (MRI) is one of the most common sources of electromagnetic (EM) fields as a diagnostic technique widely used in medicine. MRI staff during the working day is constantly exposed to static and spatially heterogeneous magnetic field. Also, moving around the MRI room to perform their functions, workers are exposed to slowly time-varying magnetic fields that induce electrical currents and fields in the body. The development of new exposure assessment methodologies to collect exposure data at a personal level using simple everyday equipment is hence necessary, also in view of future epidemiological studies. This paper describes the design and testing of a novel device for assessing personal exposure to static and time-varying magnetic fields during daily clinical practice. The dosemeter will be also used to ensure effective training of technicians who will be instructed to avoid, where possible, risk behaviour in terms of high exposure.
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Affiliation(s)
- Valentina Hartwig
- Institute of Clinical Physiology, CNR, Via Moruzzi 1, Pisa, Italy
- Fondazione CNR-Regione Toscana 'G. Monasterio', Via Moruzzi 1, Pisa, Italy
| | | | | | - Daniele De Marchi
- Fondazione CNR-Regione Toscana 'G. Monasterio', Via Moruzzi 1, Pisa, Italy
- Associazione Italiana Tecnici dell'Imaging in Risonanza Magnetica, AITIRM, via XX Settembre 76, Firenze, Italy
| | - Luigi Landini
- Fondazione CNR-Regione Toscana 'G. Monasterio', Via Moruzzi 1, Pisa, Italy
| | - Giulio Giovannetti
- Institute of Clinical Physiology, CNR, Via Moruzzi 1, Pisa, Italy
- Fondazione CNR-Regione Toscana 'G. Monasterio', Via Moruzzi 1, Pisa, Italy
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22
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Establishment of image quality for MRI of the knee joint using a list of anatomical criteria. Radiography (Lond) 2018; 24:196-203. [DOI: 10.1016/j.radi.2018.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022]
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23
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Mamas N, Andreanos K, Brouzas D, Diagourtas A, Droulias A, Georgalas I, Papaconstantinou D. Acute ocular pain during magnetic resonance imaging due to retained intraocular metallic foreign body: the role of ultrasonography and ultrasound biomicroscopy in diagnosis and management of this condition. J Ultrasound 2018; 21:159-163. [PMID: 29500812 PMCID: PMC5972104 DOI: 10.1007/s40477-018-0289-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To report the case of a 65-year-old metalworker with no known history of ocular trauma, who suffered from intense ocular pain during magnetic resonance imaging (MRI) of the brain, due to a retained intraocular metallic foreign body (IOFB). CASE REPORT Meticulous ophthalmological examination was inconclusive. An IOFB was confirmed with X-ray scan, whereas its exact localization was enabled by means of ultrasonography and ultrasound biomicroscopy (UBM). CONCLUSIONS Despite appropriate screening protocols, MRI-related ocular complications might occur in the presence of a hidden metallic IOFB. Clinical detection of ocular foreign bodies can sometimes be challenging. Ultrasonography and UBM are valuable adjuncts for the accurate localization, especially of small or hidden particles.
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Affiliation(s)
- Nikolaos Mamas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece.
| | - Konstantinos Andreanos
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece
| | - Dimitrios Brouzas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece
| | - Andreas Diagourtas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece
| | - Andreas Droulias
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece
| | - Dimitrios Papaconstantinou
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Mesogeion Ave 154, 15667, Athens, Greece
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Occupational exposure to electromagnetic fields in magnetic resonance environment: basic aspects and review of exposure assessment approaches. Med Biol Eng Comput 2018; 56:531-545. [PMID: 29344902 DOI: 10.1007/s11517-017-1779-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
The purpose of this review is to make a contribution to build a comprehensive knowledge of the main aspects related to the occupational exposure to electromagnetic fields (EMFs) in magnetic resonance imaging (MRI) environments. Information has been obtained from original research papers published in international peer-reviewed journals in the English language and from documents published by governmental bodies and authorities. An overview of the occupational exposure scenarios to static magnetic fields, motion-induced, time-varying magnetic fields, and gradient and radiofrequency fields is provided, together with a summary of the relevant regulation for limiting exposure. A particular emphasis is on reviewing the main EMF exposure assessment approaches found in the literature. Exposure assessment is carried out either by measuring the unperturbed magnetic fields in the MRI rooms, or by personal monitoring campaigns, or by the use of numerical methods. A general lack of standardization of the procedures and technologies adopted for exposure assessment has emerged, which makes it difficult to perform a direct comparison of results from different studies carried out by applying different assessment strategies. In conclusion, exposure assessment approaches based on data collection and numerical models need to be better defined in order to respond to specific research questions. That would provide for a more complete characterization of the exposure patterns and for identification of the factors determining the exposure variability. Graphical abstract Main approaches adopted in the literature to perform occupational exposure assessment to electromagnetic fields (EMFs) in magnetic resonance imaging (MRI) environments. SMF: static magnetic field; GMF: gradient magnetic fields; RF: radio-frequencies.
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25
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Kim HA, Kim KA, Choi JI, Lee JM, Lee CH, Kang TW, Ku YM, Lee SL, Park YS, Yoon JH, Kim SH, Choi MH. Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol. BMC Cancer 2017; 17:877. [PMID: 29268722 PMCID: PMC5740703 DOI: 10.1186/s12885-017-3819-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/22/2017] [Indexed: 01/07/2023] Open
Abstract
Background Ultrasonography (US) is recommended as a standard surveillance tool for patients with a high risk of developing hepatocellular carcinoma (HCC). However, the low sensitivity of US for small HCC can lead to surveillance failure, resulting in advanced stage tumor presentations. For the early detection of HCC in high-risk patients and to improve survival and prognosis, a new efficient imaging tool with a high sensitivity for HCC detection is needed. The purpose of this study is to evaluate and compare the feasibility and efficacy of non-contrast magnetic resonance imaging (MRI) with US as a surveillance tool for HCC in patients with liver cirrhosis. Methods MAGNUS-HCC is a prospective, multicenter clinical trial with a crossover design for a single arm of patients. This study was approved by six Institutional Review Boards, and informed consent was obtained from all participants. All patients will undergo liver US every 6 months and non-contrast liver MRI every 12 months during a follow-up period of 3 years. If a focal liver lesion suspected of harboring HCC is detected, dynamic liver computed tomography (CT) will be performed to confirm the diagnosis. After the last surveillance round, patients without suspicion of HCC or who are not diagnosed with HCC will be evaluated with a dynamic liver CT to exclude false-negative findings. The primary endpoint is to compare the rate of detection of HCC by US examinations performed at 6-month intervals with that of yearly non-contrast liver MRI studies during a 3-year follow-up. The secondary endpoint is the survival of the patients who developed HCC within the 3-year follow-up period. Discussion MAGNUS-HCC is the first study to compare the feasibility of non-contrast MRI with US as a surveillance tool for the detection of HCC in high-risk patients. We anticipate that the evidence presented in this study will establish the efficacy of non-contrast MRI as a surveillance tool for HCC in high-risk patients. Trial registration The date of trial registration (NCT02551250) in this study was September 15, 2015, and follow-up is still ongoing.
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Affiliation(s)
- Hyun A Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea.
| | - Joon-Il Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Urodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Young-Mi Ku
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheon bo-ro, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Su Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271 Cheon bo-ro, Uijeongbu, Gyeonggi-do, Republic of Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Urodong-ro, Guro-gu, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Moon Hyung Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea
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