mri bioeffects and safety dr. peterson. history and background bloch (stanford) & purcell...
TRANSCRIPT
History and BackgroundHistory and Background
Bloch (Stanford) & Purcell (Harvard) - 1946
Nobel Prize - 1952 - Discovery of Spectroscopy
Raymond Damadian – Rat Tumor – 1974– Cover of Science
Paul Lauterbur – Water image - 1973
Edinburgh Group/Peter Mansfield
New Diagnostic ModalityNew Diagnostic Modality
Compared to x-rays (1895!)
More Comparable to Ultrasound (1950’s)
Need to understand physics for safety
Basic Magnetic Field Basic Magnetic Field ConceptsConcepts
Units of Field Strength
Magnetic Domains
Static Fields (Main Magnet)
Time-Variant Fields (Gradient Magnets)
Units of Field StrengthUnits of Field Strength
The Gauss (a.k.a. The Oersted)– Measures the Earth's Field (~0.5 G)
The Tesla– Measures the MRI Field
The Relationship: 1T = 10,000 G– Also used: 1 mT = 10 G– Also used: 1 kG = 0.1 T
The Static Field and the The Static Field and the EnvironmentEnvironment
Effects of the Environment on the Static Field
Effects of the Static Field on the Environment
Effects of the Environment Effects of the Environment on the Static Fieldon the Static Field
Why do we care?– Effects on the image
Shimming to Compensate
Effects of the Static Field Effects of the Static Field on the Environmenton the Environment
Why do we care?– Credit cards, computer disks, CRTs.
Shielding to Protect
Bioeffects of Static Bioeffects of Static Magnetic FieldsMagnetic Fields
Cell FunctionsGrowth and healing of boneThrombolysisNerve FunctionCardiovascular EffectsTemperatureMagnetophosphenes
Cell FunctionsCell Functions
Rats had the permeability of the blood-brain barrier modified after 23 minutes at 0.15 T
Bone Growth and HealingBone Growth and Healing
There is much controversy on the effects of magnetic fields on the growth and healing of bone. No conclusions yet.
Nerve FunctionNerve Function
Rats showed strong avoidance behavior to magnetic fields.
Neuro function tests on humans before and after MR at fields up to 2T show that the bioelectric properties of neurons are not affected.
Fields of 4T resulted in nausea, vertigo and metallic taste, indicating neural involvement.
Cardiovascular EffectsCardiovascular Effects
Small increases in BP have been reported.
Also a slight leukopenia.
Magnetohydrodynamic Magnetohydrodynamic EffectEffect
Blood is a conductor flowing through the magnetic field.
This usually results in an increase in T- wave amplitude.
TemperatureTemperature
Reports go both ways; the best studies say static fields don’t affect body temperature.
Don’t confuse this with RF effects.
MagnetophosphenesMagnetophosphenes
Flashes of Light in the Visual Field
– None at 2T
– Reported at 4T
Static Field Bioeffects Static Field Bioeffects SummarySummary
Whole body: No effects at 2T Circulatory at 5T Extremities: No effects at 5T Discomfort; no adverse effects: 10T
Conclusion: Don’t go above 2T for head & trunk; 5T for extremities
Bioeffects of Time-Bioeffects of Time-Variant Fields Variant Fields
(Gradients)(Gradients)
MechanismNerve/Muscle StimulationNerves and EPIMagnetophosphenesAuditory ConsiderationsOther Biological Effects
Gradient Bioeffects MechanismGradient Bioeffects Mechanism
Changing magnetic field over time (dB/dt) induces voltage and current in conductors.
Example: Peak gradient of 1 G/cm, rise time = 500 sec 30 cm from the isocenter. This is 2,000 G/sec 30 cm, or 60,000 G/sec, or 6 T/sec.
The induced current is 1 A/cm2 for this gradient.
Biological effects usually occur beyond 3 A/cm2
Nerve/Muscle StimulationNerve/Muscle Stimulation
Example gradient induced a current of 1 A/cm2.
Need 15 to 100 A/cm2 for tetanic contractions of breathing muscles.
Need 0.2 to 1.0 A/cm2 to produce fibrillation.
MagnetophosphenesMagnetophosphenes
None at 17 A/cm2 in 1.95 T systems.
Lots at 4 T and any gradient.
Other Biological Effects.Other Biological Effects.
Reduced effects of mannitol, fentanyl and morphine-induced analgesia.
No effect on amphibian embryogenesis, murine cell cytotoxicity, and litter number or growth rates of pregnant mice.
Gradient Magnet Gradient Magnet Bioeffects ConclusionsBioeffects Conclusions
No effects at 6 T/sec.
Nerve stimulation at 20 T/sec.
Don’t go above 20 T/sec.
Keep an eye on EPI in the future.
The Problem with the FieldThe Problem with the Field
Faraday’s Law:
– When a conductor moves in a magnetic field, a voltage is induced in the conductor. It will also happen if the conductor is stationary and the magnetic field moves.
The Oxford PigThe Oxford Pig
A pig was placed in the bore.
1.6T magnet quenched at 1.76 T
Results: The pig was startled.
Quench ConclusionsQuench Conclusions
Quenches have happened several times with patients in the bore– Once it happened with the Chief Tech
in the bore (in Queensland, Australia)!
No deleterious effects have been reported, except for startle reflex.
Radiofrequency Radiofrequency BioeffectsBioeffects
RF Defined
Bioeffects
Temperature-sensitive organs
Quantifying Bioeffects
Limits
RF DefinedRF Defined
Non-ionizing electromagnetic radiation
Frequency range: DC to 3,000 GHz
Includes radar, TV, AM and FM radio
BioeffectsBioeffects
Include visual, auditory, endocrine, cardio- vascular, immune system, reproductive, and developmental functions.
Simplified: It heats the tissues.
Cardiac output & blood flow increase
Sweat secretion & evaporation increase
Temperature-sensitive Temperature-sensitive organsorgans
The testes
The eyes
Limits: 10 W/kg for more than 10 minutes
Quantify bioeffects using:Quantify bioeffects using:
SAR: Specific Absorption Rate– Rate at which RF energy is coupled into
tissues.– Units: Watts per kilogram (W/kg)
SAR - Time Product– Units: W-min/kg or W-hr/kg
Temperature (°C)
FDA SAR LimitsFDA SAR Limits
Body average of 0.4 W/kg
Peak for any gram of tissue of 8.0 W/kg
Head average of 3.2 W/kg
FDA Temperature LimitsFDA Temperature Limits
A body core rise of less than 1 C No more than 38 C in the head No more than 39 C in the trunk No more than 40 C in the extremities
Exceptions: Patients with compromised heat regulation
Bioeffects of the Static, Bioeffects of the Static, Gradient and RF FieldsGradient and RF Fields
Not enough is known for specific recommendations.
See the following study of Health Care Workers and it’s Conclusions.
Health Care WorkersHealth Care Workers
A survey of 2,000 female MR operators reported 1421 pregnancies; 280 were MR techs or nurses; 894 worked at another job, 54 were students, 193 were homemakers. There were no statistically significant differences between MR operator pregnancies and the group before it worked in MR. Spontaneous abortion rate, pre-term delivery rate, low birth weight, infertility and offspring gender were analyzed. Adjustments for maternal age, smoking, and alcohol use didn’t change the results.
Pregnancy ConclusionsPregnancy Conclusions
“MR imaging may be used in pregnant women if other non-ionizing forms of diagnostic imaging are inadequate or if the examination provides important information that would otherwise require exposure to ionizing radiation (e.g., fluoroscopy, CT, etc.). It is recommended that pregnant patients be informed that, to date, there has been no indication that the use of clinical MR during pregnancy has produced deleterious effects. However, as noted by the FDA, the safety of MR during pregnancy has not been proved.”
-SMRI Safety Committee
Bioeffects of Contrast Bioeffects of Contrast MediaMedia
Gadolinium is toxic but is caged by a chelate (DTPA).
The chelate may be dissolved by the kidneys, releasing the gadolinium.
Some IV contrast agents cross the placenta, are swallowed by the fetus, filtered and excreted by the kidneys as urine, swallowed; and the cycle then repeats many times. The end result of this cyclic process is not known.
CryogenicsCryogenics
Necessary for superconductivity– Niobium-titanium metal used for wires– Becomes superconducting at 10 kelvins
Liquid helium boils at 4.2 kelvinsLiquid nitrogen boils at 77 kelvinsThis classroom is at 295 kelvins
CryogensCryogens
Liquid Boils at:====== ================= Air 86 k -187° C -305° F
Nitrogen 77 k -196° C -321° F
Helium 4.2 k -269° C -452° F
CryogensCryogens
Helium is lighter than airNitrogen is heavier than airThey will drive the air out of the magnet
room if released into itBoth are incredibly cold and will burn
flesh on contact
Auditory EffectsAuditory Effects
Gradient magnet sounds– Protection or Distraction
Ear plugs/Headsets Noise cancellation devices
RF sounds– Clicks, buzzes, chirps or knocks– Seems to come from the back of the head– Usually masked by gradient noise
Cryogen release sounds (think hurricane!)
Laser Positioning Laser Positioning SystemsSystems
Possibility of eye damage
None has ever been reported
Most manufacturers now use incandescent lamps instead of lasers