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Hartwig V, Virgili G, Mattei FE, Biagini C, Romeo S, Zeni O, Scarfì MR, Massa R, Campanella F, Landini L, Gobba F, Modenese A, Giovannetti G. Occupational exposure to electromagnetic fields in magnetic resonance environment: an update on regulation, exposure assessment techniques, health risk evaluation, and surveillance. Med Biol Eng Comput 2021; 60:297-320. [PMID: 34586563 DOI: 10.1007/s11517-021-02435-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 08/27/2021] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) is one of the most-used diagnostic imaging methods worldwide. There are ∼50,000 MRI scanners worldwide each of which involves a minimum of five workers from different disciplines who spend their working days around MRI scanners. This review analyzes the state of the art of literature about the several aspects of the occupational exposure to electromagnetic fields (EMF) in MRI: regulations, literature studies on biological effects, and health surveillance are addressed here in detail, along with a summary of the main approaches for exposure assessment. The original research papers published from 2013 to 2021 in international peer-reviewed journals, in the English language, are analyzed, together with documents published by legislative bodies. The key points for each topic are identified and described together with useful tips for precise safeguarding of MRI operators, in terms of exposure assessment, studies on biological effects, and health surveillance.
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Affiliation(s)
- Valentina Hartwig
- Institute of Clinical Physiology (IFC), Italian National Research Council (CNR), Via G. Moruzzi 1, 56124, Pisa, San Cataldo, Italy.
| | - Giorgio Virgili
- Virgili Giorgio, Via G. Pastore 2, 26040, Crespina-Lorenzana, Italy
| | - F Ederica Mattei
- West Systems S.R.L, Via Don Mazzolari 25, 56025, Pontedera, PI, Italy
| | - Cristiano Biagini
- Associazione Italiana Tecnici Dell'Imaging in Risonanza Magnetica, AITIRM, Via XX Settembre 76, 50129, Florence, Italy
| | - Stefania Romeo
- Institute for Electromagnetic Sensing of the Environment (IREA) , Italian National Research Council (CNR), Via Diocleziano 328, 80124, Naples, Italy
| | - Olga Zeni
- Institute for Electromagnetic Sensing of the Environment (IREA) , Italian National Research Council (CNR), Via Diocleziano 328, 80124, Naples, Italy
| | - Maria Rosaria Scarfì
- Institute for Electromagnetic Sensing of the Environment (IREA) , Italian National Research Council (CNR), Via Diocleziano 328, 80124, Naples, Italy
| | - Rita Massa
- Institute for Electromagnetic Sensing of the Environment (IREA) , Italian National Research Council (CNR), Via Diocleziano 328, 80124, Naples, Italy.,Department of Physics, University Federico II, Via Cinthia 21, 80126, Naples, Italy
| | - Francesco Campanella
- Dipartimento di medicina, epidemiologia, Igiene del Lavoro E Ambientale, Inail, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Luigi Landini
- Fondazione Toscana "G. Monasterio", Via G. Moruzzi 1, 56124, Pisa, San Cataldo, Italy
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125, Modena, Italy
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125, Modena, Italy
| | - Giulio Giovannetti
- Institute of Clinical Physiology (IFC), Italian National Research Council (CNR), Via G. Moruzzi 1, 56124, Pisa, San Cataldo, Italy
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Stress CMR in Known or Suspected CAD: Diagnostic and Prognostic Role. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6678029. [PMID: 33511208 PMCID: PMC7822671 DOI: 10.1155/2021/6678029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
The recently published 2019 guidelines on chronic coronary syndromes (CCS) focus on the need for noninvasive imaging modalities to accurately establish the diagnosis of coronary artery disease (CAD) and assess the risk of clinical scenario occurrence. Appropriate patient management should rely on controlling symptoms, improving prognosis, and guiding each therapeutic strategy as well as monitoring disease progress. Among the noninvasive imaging modalities, cardiovascular magnetic resonance (CMR) has gained broad acceptance in past years due to its unique features in providing a complete assessment of CAD through data on cardiac anatomy and function and myocardial viability, with high spatial and temporal resolution and without ionizing radiation. In detail, evaluation of the presence and extent of myocardial ischemia through stress CMR (S-CMR) has shown a high rule-in power in detecting functionally significant coronary artery stenosis in patients suspected of CCS. Moreover, S-CMR technique may add significant prognostic value, as demonstrated by different studies which have progressively evidenced the valuable power of this multiparametric imaging modality in predicting adverse cardiac events. The latest scientific progress supports a greater expansion of S-CMR with improvement of quantitative myocardial perfusion analysis, myocardial strain, and native mapping within the same examination. Although further study is warranted, these techniques, which are currently mostly restricted to the research field, are likely to become increasingly prevalent in the clinical setting with the scope of increasing accuracy in the selection of patients to be sent to invasive revascularization. This review investigates the diagnostic and prognostic role of S-CMR in the context of CAD, by analysing a strong, long-standing, scientific evidence together with an appraisal of new advanced techniques which may potentially enrich CAD management in the next future.
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Delgado V, Popescu BA, Plein S, Achenbach S, Knuuti J, Bax JJ. The Year in Cardiology 2018: imaging. Eur Heart J 2020; 40:508-517. [PMID: 30601985 DOI: 10.1093/eurheartj/ehy848] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Victoria Delgado
- Department of Cardiology, Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr C. C. Iliescu", Bucharest, Romania
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität, Erlangen, Germany
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centrum, Leiden University Medical Center, Albinusdreef 2, RC Leiden, The Netherlands
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Brix G, Günther E, Rössler U, Endesfelder D, Kamp A, Beer A, Eiber M. Double-strand breaks in lymphocyte DNA of humans exposed to [ 18F]fluorodeoxyglucose and the static magnetic field in PET/MRI. EJNMMI Res 2020; 10:43. [PMID: 32346810 PMCID: PMC7188749 DOI: 10.1186/s13550-020-00625-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/30/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Given the increasing clinical use of PET/MRI, potential risks to patients from simultaneous exposure to ionising radiation and (electro)magnetic fields should be thoroughly investigated as a precaution. With this aim, the genotoxic potential of 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) and a strong static magnetic field (SMF) were evaluated both in isolation and in combination using the γH2AX assay detecting double-strand breaks in lymphocyte DNA. METHODS Thirty-two healthy young volunteers allocated to three study arms were exposed to [18F]FDG alone, to a 3-T SMF alone or to both combined over 60 min at a PET/CT or a PET/MRI system. Blood samples taken after in vivo exposure were incubated up to 60 min to extend the irradiation of blood by residual [18F]FDG within the samples and the time to monitor the γH2AX response. Absorbed doses to lymphocytes delivered in vivo and in vitro were estimated individually for each volunteer exposed to [18F]FDG. γH2AX foci were scored automatically by immunofluorescence microscopy. RESULTS Absorbed doses to lymphocytes exposed over 60 to 120 min to [18F]FDG varied between 1.5 and 3.3 mGy. In this time interval, the radiotracer caused a significant median relative increase of 28% in the rate of lymphocytes with at least one γH2AX focus relative to the background rate (p = 0.01), but not the SMF alone (p = 0.47). Simultaneous application of both agents did not result in a significant synergistic or antagonistic outcome (p = 0.91). CONCLUSION There is no evidence of a synergism between [18F]FDG and the SMF that may be of relevance for risk assessment of PET/MRI.
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Affiliation(s)
- Gunnar Brix
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany.
| | - Elisabeth Günther
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
| | - Ute Rössler
- Department of Effects and Risks of Ionizing and Non-Ionizing Radiation, Federal Office for Radiation Protection, Neuherberg, Germany
| | - David Endesfelder
- Department of Effects and Risks of Ionizing and Non-Ionizing Radiation, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Alexandra Kamp
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Neuherberg, Germany
| | - Ambros Beer
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
- Department of Nuclear Medicine, University Ulm, Ulm, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Munich, Germany
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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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