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Betz LH, Dillman JR, Jones BV, Tkach JA. MRI safety screening of children with implants: updates and challenges. Pediatr Radiol 2023; 53:1454-1468. [PMID: 37079039 DOI: 10.1007/s00247-023-05651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 04/21/2023]
Abstract
MRI is the imaging modality of choice for assessing many pediatric medical conditions. Although there are several inherent potential safety risks associated with the electromagnetic fields exploited for MRI, they are effectively mitigated through strict adherence to established MRI safety practices, enabling the safe and effective use of MRI in clinical practice. The potential hazards of the MRI environment may be exacerbated by/in the presence of implanted medical devices. Awareness of the unique MRI safety and screening challenges associated with these implanted devices is critical to ensuring MRI safety for the affected patients. In this review article, we will discuss the basics of MRI physics as they relate to MRI safety in the presence of implanted medical devices, strategies for assessing children with known or suspected implanted medical devices, and the particular management of several well-established common, as well as recently developed, implanted devices encountered at our institution.
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Affiliation(s)
- Lisa H Betz
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH, 45229, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Wang CY, Chang WC, Huang HH, Chang WK, Shih YL, Hsieh TY, Lin HH. Safety Issues in Magnetic Resonance Imaging Scan with Retention of Olympus Long Clips in the Gastrointestinal Tract. Curr Med Imaging 2021; 17:1243-1247. [PMID: 34170809 DOI: 10.2174/1573405617666210624125335] [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: 10/19/2020] [Revised: 12/29/2020] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Not all endoscopic clips are compatible with magnetic resonance imaging (MRI). The aim of this study is to investigate the safety of MRI-incompatible endoscopic clips in patients undergoing MRI scans. METHODS We retrospectively reviewed the medical records of patients who had received endoscopic clip placement of Olympus Long Clip MRI-incompatible clips and then had undergone MRI scans within two weeks in our hospital between 2014 and 2019. RESULTS A total of 44,292 patients had undergone an MRI examination at our hospital. Only 15 patients had MRI scans within two weeks after the endoscopic clip placement. Their median age was 65.5 years, and 12 of the 15 patients were men. At the time of the clip placement and MRI scan, four patients were taking anti-coagulation or anti-platelet agents. The indication for endoscopic clip placement of the 15 patients was mucosal/submucosal defect or hemorrhage and colonic perforation. Endoscopic clips were placed in the colon of 14 patients and in the stomach of only one patient for gastric hemorrhage. One patient experienced clip migration and three displayed artifacts in abdominal images. No patient complications of mortality, hemorrhage, or organ perforation occurred. CONCLUSION No serious adverse event occurred during MRI scans of patients with MRI-incompatible clips in this study, suggesting that MRI-incompatible clips may be safe to use in MRI scans. However, this does not guarantee the safety of the Long Clip for MRI scans, as further tests are needed to verify that this clip is safe for use during MRI.
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Affiliation(s)
- Cheng-Yi Wang
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lueng Shih
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tsai-Yuan Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsuan-Hwai Lin
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Shin DY, Park S, Kim A, Kim ES, Jeon HH. Compatibility of endoclips in the gastrointestinal tract with magnetic resonance imaging. Sci Rep 2020; 10:16537. [PMID: 33024206 PMCID: PMC7539000 DOI: 10.1038/s41598-020-73726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022] Open
Abstract
There are no clear guidelines on the compatibility between endoclips that remain in the gastrointestinal (GI) tract and magnetic resonance imaging (MRI). The purpose of this study was to investigate the effect of 3T (T) MRI on endoclips placed in excised pig tissues. Two types of endoclips were assessed: Olympus EZ (HX-610-135L) and QuickClip Pro (HZ-202LR). We assessed tissue damage or perforation and detachment of endoclips under 3T MRI magnetic field. We also evaluated the magnitude of force required to detach the endoclips from the porcine tissue. We measured the magnetic force acting on the Olympus EZ clips. QuickClip Pro clips were used as a control in this study. There was no tissue damage and no detachment of the endoclips (Olympus EZ and QuickClip Pro) during 3T MRI. The force required to detach the Olympus EZ clips ranged from 0.9 to 3.0 N. The translational magnetic force acting on the endoclips was 3.18 × 10-3 N. Ex vivo experiments showed that the magnetic field generated by 3 MRI did not cause tissue damage or perforation and did not detach the endoclips. Olympus EZ clips and QuickClip Pro clips in the GI tract appear to be safe during 3T MRI.
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Affiliation(s)
- Dong Yeol Shin
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro Ilsan-donggu, Goyang-si, Goyang, 10444, Korea
| | - Sumi Park
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ain Kim
- Department of Human Biology, University of Toronto, Toronto, ON, Canada
| | - Eung-Sam Kim
- Department of Biological Sciences and Research Center of Ecomimetics, Chonnam National University, Gwangju, Korea.
| | - Han Ho Jeon
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro Ilsan-donggu, Goyang-si, Goyang, 10444, Korea.
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Jabehdar Maralani P, Schieda N, Hecht EM, Litt H, Hindman N, Heyn C, Davenport MS, Zaharchuk G, Hess CP, Weinreb J. MRI safety and devices: An update and expert consensus. J Magn Reson Imaging 2019; 51:657-674. [PMID: 31566852 DOI: 10.1002/jmri.26909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high-volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi-inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657-674.
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Affiliation(s)
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University, New York, New York, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Hindman
- Department of Radiology, New York University, New York, New York, USA
| | - Chinthaka Heyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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Wellington J, Canakis A, Kim R. Endoscopic closure devices: A review of technique and application for hemostasis. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jennifer Wellington
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Canakis
- Department of Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Raymond Kim
- Division of Gastroenterology & Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
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Accorsi F, Lalonde A, Leswick DA. Endoclip Magnetic Resonance Imaging Screening: A Local Practice Review. Can Assoc Radiol J 2018; 69:162-168. [PMID: 29706253 DOI: 10.1016/j.carj.2017.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/17/2017] [Accepted: 12/07/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Not all endoscopically placed clips (endoclips) are magnetic resonance imaging (MRI) compatible. At many institutions, endoclip screening is part of the pre-MRI screening process. Our objective is to determine the contribution of each step of this endoclip screening protocol in determining a patient's endoclip status at our institution. METHODS A retrospective review of patients' endoscopic histories on general MRI screening forms for patients scanned during a 40-day period was performed to assess the percentage of patients that require endoclip screening at our institution. Following this, a prospective evaluation of 614 patients' endoclip screening determined the percentage of these patients ultimately exposed to each step in the protocol (exposure), and the percentage of patients whose endoclip status was determined with reasonable certainty by each step (determination). RESULTS Exposure and determination values for each step were calculated as follows (exposure, determination): verbal interview (100%, 86%), review of past available imaging (14%, 36%), review of endoscopy report (9%, 57%), and new abdominal radiograph (4%, 96%), or CT (0.2%, 100%) for evaluation of potential endoclips. Only 1 patient did not receive MRI because of screening (in situ gastrointestinal endoclip identified). CONCLUSIONS Verbal interview is invaluable to endoclip screening, clearing 86% of patients with minimal monetary and time investment. Conversely, the limited availability of endoscopy reports and relevant past imaging somewhat restricts the determination rates of these. New imaging (radiograph or computed tomography) is required <5% of the time, and although costly and associated with patient irradiation, has excellent determination rates (above 96%) when needed.
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Affiliation(s)
- Fabio Accorsi
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Alain Lalonde
- Department of Medical Imaging, Saskatoon Health Region and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David A Leswick
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Medical Imaging, Saskatoon Health Region and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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