1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Barnsley H, Robertson S, Cruickshank S, McNair HA. Radiographer training for screening of patients referred for Magnetic Resonance Imaging: A scoping review. Radiography (Lond) 2024; 30:843-855. [PMID: 38579383 DOI: 10.1016/j.radi.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Strict safety practices are essential to ensure the safety of patients and staff in Magnetic Resonance Imaging (MRI). Training regarding the fundamentals of MRI safety is well-established and commonly agreed upon. However, more complex aspect of screening patients, such as image review or screening of unconscious patients/patients with communication difficulties is less well discussed. The current UK and USA guidelines do not suggest the use of communication training for MRI staff nor indicate any training to encourage reviewing images in the screening process. This review aims to map the current guidance regarding safety and patient screening training for MRI diagnostic and therapeutic radiographers. METHODS A systematic search of PubMed, Trip Medical database and Radiography journal was conducted. Studies were chosen based on the review objectives and pre-determined inclusion/exclusion criteria using the PRISMA-ScR framework. RESULTS Twenty-four studies were included in the review, which identified some key concepts including MRI safety training and delivery methods, screening and communication, screening of unconscious or non-ambulatory patients and the use of imaging. CONCLUSION Training gaps lie within the more complex elements of screening such as the inclusiveness of question phrasing, particularly to the neurodivergent population, how we teach radiographers to screen unconscious/unresponsive patients and using imaging to detect implants. IMPLICATIONS FOR PRACTICE The consequences of incomplete or inaccurate pre-MRI safety screening could be the introduction of unexpected implants into the scanner or forgoing MRI for a less desirable modality. The development of enhanced training programs in implant recognition using imaging and communication could complement existing training.
Collapse
Affiliation(s)
- H Barnsley
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - S Robertson
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - S Cruickshank
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London, SW3 6JJ, UK; The Institute of Cancer Research, UK.
| |
Collapse
|
4
|
Alsing KK, Johannesen HH, Mårtensson NL, Kempen PJ, Lin MKTH, Qvortrup K, Hansen RH. Unveiling the Temporal Aspect of MRI Tattoo Reactions: A Prospective Evaluation of a Newly-Acquired Tattoo with Multiple MRI Scans. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943411. [PMID: 38648203 PMCID: PMC11056212 DOI: 10.12659/ajcr.943411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/13/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Over the past 30 years, painful reactions during magnetic resonance imaging (MRI) in tattooed individuals have been sporadically reported. These complications manifest as burning pain in tattooed skin areas, occasionally with swelling and redness, often leading to termination of the scanning. The exact cause is unclear, but iron oxide pigments in permanent make-up or elements in carbon black tattoos may play a role. Additionally, factors like tattoo age, design, and color may influence reactions. The existing literature lacks comprehensive evidence, leaving many questions unanswered. CASE REPORT We present the unique case of a young man who experienced recurring painful reactions in a recently applied black tattoo during multiple MRI scans. Despite the absence of ferrimagnetic ingredients in the tattoo ink, the patient reported intense burning sensations along with transient erythema and edema. Interestingly, the severity of these reactions gradually decreased over time, suggesting a time-dependent factor contributing to the problem. This finding highlights the potential influence of pigment particle density in the skin on the severity and risk of MRI interactions. We hypothesize that the painful sensations could be triggered by excitation of dermal C-fibers by conductive elements in the tattoo ink, likely carbon particles. CONCLUSIONS Our case study highlights that MRI-induced tattoo reactions may gradually decrease over time. While MRI scans occasionally can cause transient reactions in tattoos, they do not result in permanent skin damage and remain a safe and essential diagnostic tool. Further research is needed to understand the mechanisms behind these reactions and explore preventive measures.
Collapse
Affiliation(s)
- Kasper Køhler Alsing
- Department of Dermatology & Copenhagen Wound Healing Center, Copenhagen University Hospital – Bispebjerg, Copenhagen, Denmark
| | - Helle Hjorth Johannesen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Nina Løth Mårtensson
- Department of Pathology, Diagnostic Center, Copenhagen University Hospital– Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Paul Joseph Kempen
- National Centre for Nano Fabrication and Characterization, Technical University of Denmark, Lyngby, Denmark
| | - Marie Karen Tracy Hong Lin
- National Centre for Nano Fabrication and Characterization, Technical University of Denmark, Lyngby, Denmark
| | - Klaus Qvortrup
- Core Facility for Integrated Microscopy (CFIM), Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Hvass Hansen
- Section for Radiation Therapy, Department of Oncology, Center for Cancer and Organ Diseases, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
5
|
Harwood M, Fahrenholtz SJ, Wellnitz CV, Kawashima A, Panda A. MRI in Adult Patients with Active and Inactive Implanted MR-conditional, MR-nonconditional, and Other Devices. Radiographics 2024; 44:e230102. [PMID: 38421911 DOI: 10.1148/rg.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Active implanted medical devices (AIMDs) enable therapy and patient monitoring by way of electrical activity and typically have a battery and electrical leads. The most common types of AIMDs include cardiac implantable electronic devices (CIEDs), spinal cord stimulators, deep brain stimulators, bone growth or fusion stimulators, other neurostimulators, and drug infusion pumps. As more patients with AIMDs undergo MRI, it is important to consider the safety of patients who have these implanted devices during MRI. The authors review the physics concepts related to MRI safety, such as peak spatial gradient magnetic field, specific absorption rate, root mean square value of the effective magnetic component of the transmitted RF pulse, and gradient slew rate, as well as the parameters necessary to remain within safety limits. The roles of MRI safety personnel, as set forth by the International Society of Magnetic Resonance in Medicine, are emphasized. In addition, the relevant information provided in vendor manuals is reviewed, with a focus on how to obtain relevant up-to-date information. The radiologist should be able to modify protocols to meet safety requirements, address possible alternatives to MRI, and weigh the potential benefits of MRI against the potential risks. A few more advanced topics, such as fractured or abandoned device leads and patients with multiple implanted medical devices, also are addressed. Recommended workflows for MRI in patients with implanted medical devices are outlined. It is important to implement an algorithmic MRI safety process, including a review of the MRI safety information; patient screening; optimal imaging; and monitoring patients before, during, and after the examination. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Shetty et al in this issue.
Collapse
Affiliation(s)
- Matthew Harwood
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Samuel J Fahrenholtz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Clinton V Wellnitz
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Akira Kawashima
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| | - Anshuman Panda
- From the Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ (M.H., S.J.F., C.V.W., A.K., A.P.); and Carl T. Hayden Veterans' Administration Medical Center, Phoenix, AZ (M.H.)
| |
Collapse
|