Principles of nerve and heart excitation by time-varying magnetic fields

Prediction of experimental cardiac magnetostimulation thresholds using pig-specific body models

PURPOSE

Modern high-amplitude gradient systems can be limited by the International Electrotechnical Commission 60601-2-33 cardiac stimulation (CS) limit, which was set in a conservative manner based on electrode experiments and E-field simulations in uniform ellipsoidal body models. Here, we show that coupled electromagnetic-electrophysiological modeling in detailed body and heart models can predict CS thresholds, suggesting that such modeling might lead to more detailed threshold estimates in humans. Specifically, we compare measured and predicted CS thresholds in eight pigs.

METHODS

We created individualized porcine body models using MRI (Dixon for the whole body, CINE for the heart) that replicate the anatomy and posture of the animals used in our previous experimental CS study. We model the electric fields induced along cardiac Purkinje and ventricular muscle fibers and predict the electrophysiological response of these fibers, yielding CS threshold predictions in absolute units for each animal. Additionally, we assess the total modeling uncertainty through a variability analysis of the 25 main model parameters.

RESULTS

Predicted and experimental CS thresholds agree within 19% on average (normalized RMS error), which is smaller than the 27% modeling uncertainty. No significant difference was found between the modeling predictions and experiments (p < 0.05, paired t-test).

CONCLUSION

Predicted thresholds matched the experimental data within the modeling uncertainty, supporting the model validity. We believe that our modeling approach can be applied to study CS thresholds in humans for various gradient coils, body shapes/postures, and waveforms, which is difficult to do experimentally.

Measurement of magnetostimulation thresholds in the porcine heart

PURPOSE

Powerful MRI gradient systems can surpass the International Electrotechnical Commission (IEC) 60601-2-33 limit for cardiac stimulation (CS), which was determined by simple electromagnetic simulations and electrode stimulation experiments. Only a few canine studies measured magnetically induced CS thresholds in vivo and extrapolating them to human safety limits can be challenging.

METHODS

We measured cardiac magnetostimulation thresholds in 10 healthy, anesthetized pigs using capacitors discharged into a flat spiral coil to produce damped sinusoidal waveforms with effective stimulus duration ts,eff  = 0.45 ms. Electrocardiography (ECG), blood pressure, and peripheral oximetry signals were recorded to determine threshold coil currents yielding cardiac capture. Dixon and CINE MR volumes from each animal were segmented to generate porcine-specific electromagnetic models to calculate dB/dt and E-field values in the porcine heart at threshold. For comparison, we also simulated maximum dB/dt and E-field values created by three MRI gradient systems in the heart of a human body model.

RESULTS

The average dB/dt threshold estimated in the porcine heart was 1.66 ± 0.23 kT/s, which is 11-fold greater than the IEC dB/dt limit at ts,eff  = 0.45 ms, and 31-fold greater than the maximum value created by the investigated MRI gradients in the human heart. The average E-field threshold estimated in the porcine heart was 92.9 ± 13.5 V/m, which is 6-fold greater than the IEC E-field limit at ts,eff  = 0.45 ms and 37-fold greater than the maximum gradient-induced E-field in the human heart.

CONCLUSION

This first measurement of cardiac magnetostimulation thresholds in pigs indicates that the IEC cardiac safety limit is conservative for the investigated stimulus duration (ts,eff  = 0.45 ms).

A 31-channel integrated "AC/DC" B0 shim and radiofrequency receive array coil for improved 7T MRI

PURPOSE

To test an integrated "AC/DC" array approach at 7T, where B0 inhomogeneity poses an obstacle for functional imaging, diffusion-weighted MRI, MR spectroscopy, and other applications.

METHODS

A close-fitting 7T 31-channel (31-ch) brain array was constructed and tested using combined Rx and ΔB0 shim channels driven by a set of rapidly switchable current amplifiers. The coil was compared to a shape-matched 31-ch reference receive-only array for RF safety, signal-to-noise ratio (SNR), and inter-element noise correlation. We characterize the coil array's ability to provide global and dynamic (slice-optimized) shimming using ΔB0 field maps and echo planar imaging (EPI) acquisitions.

RESULTS

The SNR and average noise correlation were similar to the 31-ch reference array. Global and slice-optimized shimming provide 11% and 40% improvements respectively compared to baseline second-order spherical harmonic shimming. Birdcage transmit coil efficiency was similar for the reference and AC/DC array setups.

CONCLUSION

Adding ΔB0 shim capability to a 31-ch 7T receive array can significantly boost 7T brain B0 homogeneity without sacrificing the array's rdiofrequency performance, potentially improving ultra-high field neuroimaging applications that are vulnerable to off-resonance effects.

Safety of MRI in patients with retained cardiac leads

Purpose

To evaluate the safety of MRI in patients with fragmented retained leads (FRLs) through numerical simulation and phantom experiments.

Methods

Electromagnetic and thermal simulations were performed to determine the worst‐case RF heating of 10 patient‐derived FRL models during MRI at 1.5 T and 3 T and at imaging landmarks corresponding to head, chest, and abdomen. RF heating measurements were performed in phantoms implanted with reconstructed FRL models that produced highest heating in numerical simulations. The potential for unintended tissue stimulation was assessed through a conservative estimation of the electric field induced in the tissue due to gradient‐induced voltages developed along the length of FRLs.

Results

In simulations under conservative approach, RF exposure at B₁⁺ ≤ 2 µT generated cumulative equivalent minutes (CEM)₄₃ < 40 at all imaging landmarks at both 1.5 T and 3 T, indicating no thermal damage for acquisition times (TAs) < 10 min. In experiments, the maximum temperature rise when FRLs were positioned at the location of maximum electric field exposure was measured to be 2.4°C at 3 T and 2.1°C at 1.5 T. Electric fields induced in the tissue due to gradient‐induced voltages remained below the threshold for cardiac tissue stimulation in all cases.

Conclusions

Simulation and experimental results indicate that patients with FRLs can be scanned safely at both 1.5 T and 3 T with most clinical pulse sequences.

Issues in the Implementation of Directive 2013/35/EU Regarding the Protection of Workers against Electromagnetic Fields

In 2016 the Directive 2013/35/EU regarding the protection of health and safety of workers exposed to electromagnetic fields was transposed in Italy. Since then, the authors of this paper have been faced with several issues related to the implementation of the provisions of the Directive, which pose some interpretative and operative concerns. A primary critical feature of the Directive is that, in some circumstances, conditions of "overexposure", i.e., of exceeding the exposure limits, are allowed. In the case of transient effects, the "flexibility" concerning the compliance with exposure limits is based on the approach introduced by ICNIRP in its guidelines on static magnetic fields and on time-varying electric and magnetic fields. On the contrary, the possibility of exceeding the exposure limits for health effects, formally recognized in the article of the Directive dealing with derogations, is not included in the ICNIRP guidelines. This paper analyzes the main concerns in interpreting and managing some provisions of the Directive with particular reference to the issue of how the employer can manage the situations of overexposure.

The Physics of Magnetic Resonance Imaging Safety

Magnetic resonance (MR) imaging relies on a strong static magnetic field in conjunction with careful orchestration of pulsed linear gradient magnetic fields and radiofrequency magnetic fields in order to generate images. The interaction of these fields with patients as well as materials with magnetic or conducting properties can be a source of risk in the MR environment. This article provides a basic review of the physical underpinnings of the primary risks in MR imaging to foster development of intuition with respect to both patient and risk management in the MR environment.

Investigating cardiac stimulation limits of MRI gradient coils using electromagnetic and electrophysiological simulations in human and canine body models

Purpose:

Cardiac stimulation (CS) limits to gradient coil switching speed are difficult to measure in humans; instead, current regulatory guidelines (IEC 60601–2-33) are based on animal experiments and electric field–to-dB/dt conversion factors computed for a simple, homogeneous body model. We propose improvement to this methodology by using more detailed CS modeling based on realistic body models and electrophysiological models of excitable cardiac fibers.

Methods:

We compute electric fields induced by a solenoid, coplanar loops, and a commercial gradient coil in two human body models and a canine model. The canine simulations mimic previously published experiments. We generate realistic fiber topologies for the cardiac Purkinje and ventricular muscle fiber networks using rule-based algorithms, and evaluate CS thresholds using validated electrodynamic models of these fibers.

Results:

We were able to reproduce the average measured canine CS thresholds within 5%. In all simulations, the Purkinje fibers were stimulated before the ventricular fibers, and therefore set the effective CS threshold. For the investigated gradient coil, simulated CS thresholds for the x-, y-, and z-axis were at least one order of magnitude greater than the International Electrotechnical Commission limit.

Conclusion:

We demonstrate an approach to simulate gradient-induced CS using a combination of electromagnetic and electrophysiological modeling. Pending additional validation, these simulations could guide the assessment of CS limits to MRI gradient coil switching speed. Such an approach may lead to less conservative, but still safe, operation limits, enabling the use of the maximum gradient amplitude versus slew rate parameter space of recent, powerful gradient systems.

Specific Loss Power of Co/Li/Zn-Mixed Ferrite Powders for Magnetic Hyperthermia

An important research effort on the design of the magnetic particles is increasingly required to optimize the heat generation in biomedical applications, such as magnetic hyperthermia and heat-assisted drug release, considering the severe restrictions for the human body’s exposure to an alternating magnetic field. Magnetic nanoparticles, considered in a broad sense as passive sensors, show the ability to detect an alternating magnetic field and to transduce it into a localized increase of temperature. In this context, the high biocompatibility, easy synthesis procedure and easily tunable magnetic properties of ferrite powders make them ideal candidates. In particular, the tailoring of their chemical composition and cation distribution allows the control of their magnetic properties, tuning them towards the strict demands of these heat-assisted biomedical applications. In this work, Co_0.76Zn_0.24Fe₂O_4, Li_0.375Zn_0.25Fe_2.375O₄ and ZnFe₂O₄ mixed-structure ferrite powders were synthesized in a ‘dry gel’ form by a sol-gel auto-combustion method. Their microstructural properties and cation distribution were obtained by X-ray diffraction characterization. Static and dynamic magnetic measurements were performed revealing the connection between the cation distribution and magnetic behavior. Particular attention was focused on the effect of Co²⁺ and Li⁺ ions on the magnetic properties at a magnetic field amplitude and the frequency values according to the practical demands of heat-assisted biomedical applications. In this context, the specific loss power (SLP) values were evaluated by ac-hysteresis losses and thermometric measurements at selected values of the dynamic magnetic fields.

EMF exposure variation among MRI sequences from pediatric examination protocols

The magnetic resonance imaging (MRI) exposure environment is unique due to the mixture and intensity of magnetic fields involved. Current safety regulations are based on well-known acute effects of heating and neuroexcitation while the scientific grounds for possible long-term effects from MRI exposure are lacking. Epidemiological research requires careful exposure characterization, and as a first step toward improved exposure assessment we set out to characterize the MRI-patient exposure environment. Seven MRI sequences were run on a 3-Tesla scanner while the radiofrequency and gradient magnetic fields were measured inside the scanner bore. The sequences were compared in terms of 14 different exposure parameters. To study within-sequence variability, we varied sequence settings such as flip angle and slice thickness one at a time, to determine if they had any impact on exposure endpoints. There were significant differences between two or more sequences for all fourteen exposure parameters. Within-sequence differences were up to 60% of the corresponding between-sequence differences, and a 5-8 fold exposure increase was caused by variations in flip angle, slice spacing, and field of view. MRI exposure is therefore not only sequence-specific but also patient- and examination occurrence-specific, a complexity that requires careful consideration for an MRI exposure assessment in epidemiological studies to be meaningful. Bioelectromagnetics. 40:3-15, 2019. © 2018 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

Magnetic Hyperthermia and Radiation Therapy: Radiobiological Principles and Current Practice †

Hyperthermia, though by itself generally non-curative for cancer, can significantly increase the efficacy of radiation therapy, as demonstrated by in vitro, in vivo, and clinical results. Its limited use in the clinic is mainly due to various practical implementation difficulties, the most important being how to adequately heat the tumor, especially deep-seated ones. In this work, we first review the effects of hyperthermia on tissue, the limitations of radiation therapy and the radiobiological rationale for combining the two treatment modalities. Subsequently, we review the theory and evidence for magnetic hyperthermia that is based on magnetic nanoparticles, its advantages compared with other methods of hyperthermia, and how it can be used to overcome the problems associated with traditional techniques of hyperthermia.

Magnetic Nanotransducers in Biomedicine

Owing to their abilities to identify diseased conditions, to modulate biological processes, and to control cellular activities, magnetic nanoparticles have become one of the most popular nanomaterials in the biomedical field. Targeted drug delivery, controlled drug release, hyperthermia treatment, imaging, and stimulation of several biological entities are just some of the several tasks that can be accomplished by taking advantage of magnetic nanoparticles in tandem with magnetic fields. The huge interest towards this class of nanomaterials arises from the possibility to physically drive their spatiotemporal localization inside the body, and to deliver an externally applied stimulation at a target site. They in fact behave as actual nanotransducers, converting energy stemming from the external magnetic field into heat and mechanical forces, which act as signals for therapeutic processes such as hyperthermia and controlled drug release. Magnetic nanoparticles are a noninvasive tool that enables the remote activation of biological processes, besides behaving as formidable tracers for different imaging modalities, thus allowing to simultaneously carry out diagnosis and therapy. In view of all this, owing to their multifunctional and multitasking nature, magnetic nanoparticles are already one of the most important nanotechnological protagonists in medicine and biology, enabling an actual theranostic approach in many pathological conditions. In this Concept, we first provide a brief introduction on some physical properties of magnetic materials and on important features that determine the physical properties of magnetic nanoparticles. Thereafter, we will consider some major biomedical applications: hyperthermia, drug delivery/release, and nanoparticle-mediated control of biological processes, even at subcellular level.

The development and modelling of devices and paradigms for transcranial magnetic stimulation

Magnetic stimulation is a non-invasive neurostimulation technique that can evoke action potentials and modulate neural circuits through induced electric fields. Biophysical models of magnetic stimulation have become a major driver for technological developments and the understanding of the mechanisms of magnetic neurostimulation and neuromodulation. Major technological developments involve stimulation coils with different spatial characteristics and pulse sources to control the pulse waveform. While early technological developments were the result of manual design and invention processes, there is a trend in both stimulation coil and pulse source design to mathematically optimize parameters with the help of computational models. To date, macroscopically highly realistic spatial models of the brain, as well as peripheral targets, and user-friendly software packages enable researchers and practitioners to simulate the treatment-specific and induced electric field distribution in the brains of individual subjects and patients. Neuron models further introduce the microscopic level of neural activation to understand the influence of activation dynamics in response to different pulse shapes. A number of models that were designed for online calibration to extract otherwise covert information and biomarkers from the neural system recently form a third branch of modelling.

Polyethylene Glycol-Mediated Synthesis of Cubic Iron Oxide Nanoparticles with High Heating Power

Iron oxide magnetic nanoparticles (IOMNPs) have been successfully synthesized by means of solvothermal reduction method employing polyethylene glycol (PEG200) as a solvent. The as-synthesized IOMNPs are poly-dispersed, highly crystalline, and exhibit a cubic shape. The size of IOMNPs is strongly dependent on the reaction time and the ration between the amount of magnetic precursor and PEG200 used in the synthesis method. At low magnetic precursor/PEG200 ratio, the cubic IOMNPs coexist with polyhedral IOMNPs. The structure and morphology of the IOMNPs were thoroughly investigated by using a wide range of techniques: TEM, XRD, XPS, FTIR, and RAMAN. XPS analysis showed that the IOMNPs comprise a crystalline magnetite core bearing on the outer surface functional groups from PEG200 and acetate. The presence of physisorbed PEG200 on the IOMNP surface is faintly detected through FT-IR spectroscopy. The surface of IOMNPs undergoes oxidation into maghemite as proven by RAMAN spectroscopy and the occurrence of satellite peaks in the Fe2p XP spectra. The magnetic studies performed on powder show that the blocking temperature (TB) of IOMNPs is around 300 K displaying a coercive field in between 160 and 170 Oe. Below the TB, the field-cooled (FC) curves turn concave and describe a plateau indicating that strong magnetic dipole-dipole interactions are manifested in between IOMNPs. The specific absorption rate (SAR) values increase with decreasing nanoparticle concentrations for the IOMNPs dispersed in water. The SAR dependence on the applied magnetic field, studied up to magnetic field amplitude of 60 kA/m, presents a sigmoid shape with saturation values up to 1700 W/g. By dispersing the IOMNPs in PEG600 (liquid) and PEG1000 (solid), it was found that the SAR values decrease by 50 or 75 %, indicating that the Brownian friction within the solvent was the main contributor to the heating power of IOMNPs.

Occupational exposure of healthcare and research staff to static magnetic stray fields from 1.5-7 Tesla MRI scanners is associated with reporting of transient symptoms

Objectives

Limited data is available about incidence of acute transient symptoms associated with occupational exposure to static magnetic stray fields from MRI scanners. We aimed to assess the incidence of these symptoms among healthcare and research staff working with MRI scanners, and their association with static magnetic field exposure.

Methods

We performed an observational study among 361 employees of 14 clinical and research MRI facilities in The Netherlands. Each participant completed a diary during one or more work shifts inside and/or outside the MRI facility, reporting work activities and symptoms (from a list of potentially MRI-related symptoms, complemented with unrelated symptoms) experienced during a working day. We analysed 633 diaries. Exposure categories were defined by strength and type of MRI scanner, using non-MRI shifts as the reference category for statistical analysis. Non-MRI shifts originated from MRI staff who also participated on MRI days, as well as CT radiographers who never worked with MRI.

Results

Varying per exposure category, symptoms were reported during 16–39% of the MRI work shifts. We observed a positive association between scanner strength and reported symptoms among healthcare and research staff working with closed-bore MRI scanners of 1.5 Tesla (T) and higher (1.5 T OR=1.88; 3.0 T OR=2.14; 7.0 T OR=4.17). This finding was mainly driven by reporting of vertigo and metallic taste.

Conclusions

The results suggest an exposure-response association between exposure to strong static magnetic fields (and associated motion-induced time-varying magnetic fields) and reporting of transient symptoms on the same day of exposure.

Trial registration number

11-032/C

A Proposed Method for Thermal Specific Bioimaging and Therapy Technique for Diagnosis and Treatment of Malignant Tumors by Using Magnetic Nanoparticles

The objective of this research program is to develop a novel, noninvasive, low-cost infrared (8–12 μm spectral range) imaging technique that would improve upon current methods using nanostructured core/shell magnetic/noble metal-based imaging and therapies. The biocompatible magnetic nanoparticles are able to produce heat under AC magnetic field. This thermal radiation propagates along the tissue by thermal conduction reaching the medium's (tissue's) surface. The surface temperature distribution is acquired by a thermal camera and can be analyzed to retrieve and reconstruct nanoparticles' temperature and location within the tissue. The technique may function as a diagnostic tool thanks to the ability of specific bioconjugation of these nanoparticles to tumor's outer surface markers. Hence, by applying a magnetic field, we could cause a selective elevation of temperature of the targeted nanoparticles up to 5∘C, which detects the tumor. Furthermore, elevating the temperature over 65∘C and up to 100∘C stimulates a thermo ablating interaction which causes a localized irreversible damage to the cancerous site with no harm to the surrounding tissue. While functioning as a diagnostic tool, this procedure may serve as a targeted therapeutic tool under thermal feedback control as well.

The role of tissue heterogeneity in neural stimulation by applied electric fields

Heterogeneity of electrical conductivity is a new mechanism by which excitable tissues can be stimulated via applied electric fields. Stimulation of axons crossing internal boundaries can arise at those boundaries where the electric conductivity of the volume conductor changes abruptly. The effectiveness of this and other stimulation mechanisms was compared in the context of transcranial magnetic stimulation. While, for a given stimulation intensity, the largest membrane depolarization occurred where an axon terminates or bends sharply in a high electric field region, a slightly smaller membrane depolarization, still sufficient to generate action potentials, also occurred at an internal boundary simulating a white matter-grey matter interface. Tissue heterogeneity can also give rise to local electric field gradients that are considerably stronger and more focal than those impressed by the stimulation coil. Tissue heterogeneity may play an important role in electric and magnetic "far field" stimulation.

Parallel imaging in non-bijective, curvilinear magnetic field gradients: a concept study

Objectives

The paper presents a novel and more generalized concept for spatial encoding by non-unidirectional, non- bijective spatial encoding magnetic fields (SEMs). In combination with parallel local receiver coils these fields allow one to overcome the current limitations of neuronal nerve stimulation. Additionally the geometry of such fields can be adapted to anatomy.

Materials and methods

As an example of such a parallel imaging technique using localized gradients (PatLoc)- system, we present a polar gradient system consisting of 2 × 8 rectangular current loops in octagonal arrangement, which generates a radial magnetic field gradient. By inverting the direction of current in alternating loops, a near sinusoidal field variation in the circumferential direction is produced. Ambiguities in spatial assignment are resolved by use of multiple receiver coils and parallel reconstruction. Simulations demonstrate the potential advantages and limitations of this approach.

Results and conclusions

The exact behaviour of PatLoc fields with respect to peripheral nerve stimulation needs to be tested in practice. Based on geometrical considerations SEMs of radial geometry allow for about three times faster gradient switching compared to conventional head gradient inserts and even more compared to whole body gradients. The strong nonlinear geometry of the fields needs to be considered for practical applications.

A new method for spatially selective, non-invasive activation of neurons: concept and computer simulation

Currently available non-invasive neurostimulation devices, using skin electrodes or externally applied magnetic coils, are not capable of producing a local stimulation maximum deep inside a homogeneous conductor, because of a fundamental limitation inherent to the Laplace equation. In this paper, a new neurostimulation method (the DeepFocus method) is presented, which avoids this limitation by using an indirect method of producing electric currents inside tissues: First, cylinder-shaped ferromagnetic rotating disks of non-permanent magnetic material are placed near the skin and magnetized by a non-rotating magnetic coil. Each of the disks rotates at high speed around its own axis of symmetry, thus producing a purely electric Lorentz force field having a non-zero divergence outside the disk, and therefore giving rise to charge accumulations inside the tissues. Subsequently, the magnetic field is switched off suddenly, causing a re-distribution of charge, and hence short-lived electrical currents, which can be used to activate neurons. Two magnet configurations are presented in this paper, and analyzed by computer simulation, showing that the DeepFocus method produces a maximum current density (the 'focus') deep inside the conducting body. The field strength thus created in the focus (7.9 V/m) is strong enough to activate thick myelinated fibers, but can be kept below the threshold for C-fibers, which makes the new method a possible tool for pain mitigation by targeted neurostimulation.

Increased Time Rate of Change of Gradient Fields: Effect on Peripheral Nerve Stimulation at Clinical MR Imaging

PURPOSE

To increase gradient stimulation from 100% to a fixed 120% level and to assess patient acceptance of the degree of peripheral nerve stimulation (PNS) at magnetic resonance (MR) imaging.

MATERIALS AND METHODS

Two hundred ten patients underwent MR imaging of various body regions according to clinical indications. An additional three-dimensional fast low-angle shot sequence with the 120% stimulation level was performed. A patient questionnaire was distributed after MR imaging to document the presence, degree, and location of PNS. Degree was measured with an 11-point scale (score range, 0-10). Age was analyzed between the sexes for significant statistical differences. Furthermore, correlation between location of examination and location and degree of stimulation was performed. To determine stimulation discomfort relative to other factors typically present at MR imaging, the degree of discomfort due to room temperature, size of magnet bore, acoustic noise, examination time, and heating sensation was determined for comparison, as well.

RESULTS

Thirty-five (16.7%) patients reported a stimulation sensation during imaging in one or more locations, while six (2.9%) felt very uncomfortable local stimulation (score of 8-10). No significant difference between male and female patients regarding age, sex, and appearance or degree of stimulation sensation could be detected. No significant correlation between location of examination and location and degree of stimulation was recorded. Compared with other side effects, PNS was considered relatively unimportant.

CONCLUSION

The 120% gradient stimulation level seems acceptable for routine clinical imaging with this gradient system, since only 2.9% of patients experienced very uncomfortable local stimulation.

Biological effects of exposure to magnetic resonance imaging: an overview

The literature on biological effects of magnetic and electromagnetic fields commonly utilized in magnetic resonance imaging systems is surveyed here. After an introduction on the basic principles of magnetic resonance imaging and the electric and magnetic properties of biological tissues, the basic phenomena to understand the bio-effects are described in classical terms. Values of field strengths and frequencies commonly utilized in these diagnostic systems are reported in order to allow the integration of the specific literature on the bio-effects produced by magnetic resonance systems with the vast literature concerning the bio-effects produced by electromagnetic fields. This work gives an overview of the findings about the safety concerns of exposure to static magnetic fields, radio-frequency fields, and time varying magnetic field gradients, focusing primarily on the physics of the interactions between these electromagnetic fields and biological matter. The scientific literature is summarized, integrated, and critically analyzed with the help of authoritative reviews by recognized experts, international safety guidelines are also cited.

Review of patient safety in time-varying gradient fields

In magnetic resonance, time-varying gradient magnetic fields (dB/dt) may stimulate nerves or muscles by inducing electric fields in patients. Models predicted mean peripheral nerve and cardiac stimulation thresholds. For gradient ramp durations of less than a few milliseconds, mean peripheral nerve stimulation is a safe indicator of high dB/dt. At sufficient amplitudes, peripheral nerve stimulation is perceptible (i.e., tingling or tapping sensations). Magnetic fields from simultaneous gradient axes combine almost as a vector sum to produce stimulation. Patients may become uncomfortable at amplitudes 50%-100% above perception thresholds. In dogs, respiratory stimulation has been induced at about 300% of mean peripheral nerve thresholds. Cardiac stimulation has been induced in dogs by small gradient coils at thresholds near Reilly's predictions. Cardiac stimulation required nearly 80 times the energy needed to produce nerve stimulation in dogs. Nerve and cardiac stimulation thresholds for dogs were unaffected by 1.5-T magnetic fields.

Electromyography in MRI--first recordings of peripheral nerve activation caused by fast magnetic field gradients

Prior studies on the evaluation of stimulation by MRI were based on the subjective feeling of the volunteers. A wide variety of stimulation thresholds between the subjects was observed. In order to exclude subjective perception levels as a cause of this variation, we developed a method to investigate the activation of peripheral nerves after gradient switching by electromyography (EMG) within the MR-imager. Five healthy volunteers were positioned in the MR-scanner with the bridge of the nose at isocenter. The amplitude of sinusoidal pulse trains of the anterior-posterior gradient (rise-times: 200 or 300 micros, various numbers of oscillations) was increased stepwise. Four surface electrodes were placed on the region where a muscle-twitch was reported. Electric activity of the muscle during stimulation experiments was recorded with an MR-compatible electro-physiologic amplifier. Stimulation thresholds were defined by the appearance of an EMG-signal. Thresholds were sharp and consistent with the report of the subjects.

Maximum pulsed electromagnetic field limits based on peripheral nerve stimulation: application to IEEE/ANSI C95.1 electromagnetic field standards

This communication proposes a rationale for maximum pulsed magnetic field limits in the electromagnetic-field standards of IEEE/ANSI C95.1. The peak limits, intended to protect against peripheral nerve excitation by pulsed fields, are adapted from existing standards for patient exposure in magnetic resonance imaging (MRI) examinations.

Peripheral nerve stimulation by time-varying magnetic fields

PURPOSE

A study was performed to assess the stimulation threshold for healthy adults using sinusoidally oscillating gradients.

METHOD

One hundred thirteen healthy adults were examined in the study. ECG and physiological parameters were measured. All measurements were performed of both the head and the abdomen. The subjects were measured in the supine position with the region of interest positioned in the center of the gradient coils. The measurement was performed for three orthogonal, four oblique, and double oblique orientations.

RESULTS

No volunteer reported painful, severe stimulation. The mean thresholds for peripheral stimulation in head and body measurement were similar: 85.5% of stimulation during examination of the head and 87.6% during measurements of the abdomen were reported when the y-gradient was used.

CONCLUSION

The greatest frequency of reported stimulations occurs when the y-gradient is used. This was confirmed by the results and supports the hypothesis that orthogonal to the y-axis the body has its largest conductive loop, resulting in the strongest peripheral stimulation.