The underestimated role of gradient coils in MRI safety

Orthopedic implants affect the electric field induced by switching gradients in MRI

PURPOSE

To investigate whether the risk of peripheral nerve stimulation increases in the presence of bulky metallic prostheses implanted in a patient's body.

METHODS

A computational tool was used to calculate the electric field (E-field) induced in a realistic human model due to the action of gradient fields. The calculations were performed both on the original version of the anatomical model and on a version modified through "virtual surgery" to incorporate knee, hip, and shoulder prostheses. Five exam positions within a body gradient coil and one position using a head gradient coil were simulated, subjecting the human model to the readout gradient from an EPI sequence. The induced E-field in models with and without prostheses was compared, focusing on the nerves and all other tissues (both including and excluding the bones from the analysis).

RESULTS

In the nerves, the most pronounced increase in the E-field (+24%) was observed around the knee implant during an abdominal MRI (Y axis readout). When extending the analysis to encompass all tissues (excluding bones), the greatest amplification (+360%) occurred around the knee implant during pelvic MRI (Z axis readout). Notable increases in E-field peaks were also identified around the shoulder and hip implants in multiple scenarios.

CONCLUSION

Based on the presented results, further investigations aimed at quantifying the threshold of nerve stimulation in the presence of bulky implants are desirable.

Parameters Affecting Worst-Case Gradient-Field Heating of Passive Conductive Implants

BACKGROUND

Testing MRI gradient-induced heating of implanted medical devices is required by regulatory organizations and others. A gradient heating test of the ISO 10974 Technical Specification (TS) for active implants was adopted for this study of passive hip implants. All but one previous study of hip implants used nonuniform gradient exposure fields in clinical scanners and reported heating of less than 5 °C. This present study adapted methods of the TS, addressing the unmet need for identifying worst-case heating via exposures to uniform gradient fields.

PURPOSE

To identify gradient-field parameters affecting maximum heating in vitro for a hip implant and a cylindrical titanium disk.

STUDY TYPE

Computational simulations and experimental validation of induced heating.

PHANTOM

Tissue-simulating gel.

FIELD STRENGTH

42 T/s RMS, sinusoidal, continuous B fields with high spatial uniformity ASSESSMENT: Hip implant heating at 1-10 kHz, via computational modeling, validated by limited point measurements. Experimental measurements of exposures of an implant at 42 T/s for 4, 6, and 9 kHz, analyzed at 50, 100, and 150 seconds.

STATISTICAL TESTS

One sample student's t-test to assess difference between computational and experimental results. Experimental vs. computational results were not significantly different (p < 0.05).

RESULTS

Maximum simulated temperature rise (10-minute exposure) was 10 °C at 1 kHz and 0.66 °C at 10 kHz. The ratio of the rise for 21 T/s vs. 42 T/s RMS was 4, after stabilizing at 50 seconds (dB/dt ratio squared).

DATA CONCLUSIONS

Heating of an implant is proportional to the frequency of the B field and the implant's cross-sectional area and is greater for a thickness on the order of its skin depth. Testing with lower values of dB/dt RMS with lower cost amplifiers enables prediction of heating at higher values for dB/dt squared (per ISO TS) with identical frequency components and waveforms, once thermal equilibrium occurs.

EVIDENCE LEVEL

1 TECHNICAL EFFICACY: Stage 1.

A contribution to MRI safety testing related to gradient-induced heating of medical devices

PURPOSE

To theoretically investigate the feasibility of a novel procedure for testing the MRI gradient-induced heating of medical devices and translating the results into clinical practice.

METHODS

The concept of index of stress is introduced by decoupling the time waveform characteristics of the gradient field signals from the field spatial distribution within an MRI scanner. This index is also extended to consider the anisotropy of complex bulky metallic implants. Merits and drawbacks of the proposed index of stress are investigated through virtual experiments. In particular, the values of the index of stress evaluated for realistic orthopedic implants placed within an ASTM phantom are compared with accurate heating simulations performed with 2 anatomic body models (a man and a woman) implanted through a virtual surgery procedure.

RESULTS

The manipulation of the proposed index of stress allows to identify regions within the MRI bore where the implant could affect the safety of the examinations. Furthermore, the conducted analysis shows that the power dissipated into the implant by the induced eddy currents is a dosimetric quantity that estimates well the maximum temperature increase in the tissues surrounding the implant.

CONCLUSION

The results support the adoption of an anisotropic index of stress to regulate the gradient-induced heating of geometrically complex implants. They also pave the way for a laboratory characterization of the implants based on electrical measurements, rather than on thermal measurements. The next step will be to set up a standardized experimental procedure to evaluate the index of stress associated with an implant.

External Waveguide Magnetic Resonance Imaging for lower limbs at 3 T

INTRODUCTION

We report a method based on the travelling-wave MRI approach, in order to acquire images of human lower limbs with an external waveguide at 3 T.

METHOD

We use a parallel-plate waveguide and an RF surface coil for reception, while a whole-body birdcage is used for transmission. The waveguide and the surface coil are located right outside the magnet, in the MR conditional devices zone. We ran numerical simulations to investigate the B₁ field generated by the surface coil located at one of the waveguides, as well as a saline-solution phantom positioned on the opposite side (150 cm away) inside the magnet.

RESULTS

We obtained phantom images by varying the distance between the coil and the phantom, in order to investigate the signal-to-noise ratio and to validate our numerical simulations. Lower limb images of a healthy volunteer were also acquired, demonstrating the viability of this approach. Standard pulse sequences were used and no physical modifications were made to the MR imager.

CONCLUSIONS

These numerical and experimental results show that travelling-wave MRI can produce high-quality images with only a simple waveguide and an RF coil located outside the magnet. This can be particularly favorable when acquiring images of lower limbs requiring a larger field of view.

Heating of hip joint implants in MRI: The combined effect of RF and switched-gradient fields

PURPOSE

To investigate how the simultaneous exposure to gradient and RF fields affects the temperature rise in patients with a metallic hip prosthesis during an MRI session.

METHODS

In silico analysis was performed with an anatomically realistic human model with CoCrMo hip implant in 12 imaging positions. The analysis was performed at 1.5 T and 3 T, considering four clinical sequences: turbo spin-echo, EPI, gradient-echo, and true fast imaging sequence with steady precession. The exposure to gradient and RF fields was evaluated separately and superposed, by adopting an ad hoc computational algorithm. Temperature increase within the body, rather than specific absorption rate, was used as a safety metric.

RESULTS

With the exception of gradient-echo, all investigated sequences produced temperature increases higher than 1 K after 360 seconds, at least for one body position. In general, RF-induced heating dominates the turbo spin-echo sequence, whereas gradient-induced heating prevails with EPI; the situation with fast imaging sequence with steady precession is more diversified. The RF effects are enhanced when the implant is within the RF coil, whereas the effects of gradient fields are maximized if the prosthesis is outside the imaging region. Cases for which temperature-increase thresholds were exceeded were identified, together with the corresponding amount of tissue mass involved and the exposure time needed to reach these limits.

CONCLUSION

The analysis confirms that risky situations may occur when a patient carrying a hip implant undergoes an MRI exam and that, in some cases, the gradient field heating may be significant. In general, exclusion criteria only based on whole-body specific absorption rate may not be sufficient to ensure patients' safety.

RF-induced heating in tissue near bilateral DBS implants during MRI at 1.5 T and 3T: The role of surgical lead management

Access to MRI is limited for patients with deep brain stimulation (DBS) implants due to safety hazards, including radiofrequency (RF) heating of tissue surrounding the leads. Computational models provide an exquisite tool to explore the multi-variate problem of RF heating and help better understand the interaction of electromagnetic fields and biological tissues. This paper presents a computational approach to assess RF-induced heating, in terms of specific absorption rate (SAR) in the tissue, around the tip of bilateral DBS leads during MRI at 64MHz/1.5 T and 127 MHz/3T. Patient-specific realistic lead models were constructed from post-operative CT images of nine patients operated for sub-thalamic nucleus DBS. Finite element method was applied to calculate the SAR at the tip of left and right DBS contact electrodes. Both transmit head coils and transmit body coils were analyzed. We found a substantial difference between the SAR and temperature rise at the tip of right and left DBS leads, with the lead contralateral to the implanted pulse generator (IPG) exhibiting up to 7 times higher SAR in simulations, and up to 10 times higher temperature rise during measurements. The orientation of incident electric field with respect to lead trajectories was explored and a metric to predict local SAR amplification was introduced. Modification of the lead trajectory was shown to substantially reduce the heating in phantom experiments using both conductive wires and commercially available DBS leads. Finally, the surgical feasibility of implementing the modified trajectories was demonstrated in a patient operated for bilateral DBS.