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Vöröslakos M, Yaghmazadeh O, Alon L, Sodickson DK, Buzsáki G. Brain-implanted conductors amplify radiofrequency fields in rodents: Advantages and risks. Bioelectromagnetics 2024; 45:139-155. [PMID: 37876116 PMCID: PMC10947979 DOI: 10.1002/bem.22489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/26/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
Over the past few decades, daily exposure to radiofrequency (RF) fields has been increasing due to the rapid development of wireless and medical imaging technologies. Under extreme circumstances, exposure to very strong RF energy can lead to heating of body tissue, even resulting in tissue injury. The presence of implanted devices, moreover, can amplify RF effects on surrounding tissue. Therefore, it is important to understand the interactions of RF fields with tissue in the presence of implants, in order to establish appropriate wireless safety protocols, and also to extend the benefits of medical imaging to increasing numbers of people with implanted medical devices. This study explored the neurological effects of RF exposure in rodents implanted with neuronal recording electrodes. We exposed freely moving and anesthetized rats and mice to 950 MHz RF energy while monitoring their brain activity, temperature, and behavior. We found that RF exposure could induce fast onset firing of single neurons without heat injury. In addition, brain implants enhanced the effect of RF stimulation resulting in reversible behavioral changes. Using an optical temperature measurement system, we found greater than tenfold increase in brain temperature in the vicinity of the implant. On the one hand, our results underline the importance of careful safety assessment for brain-implanted devices, but on the other hand, we also show that metal implants may be used for neurostimulation if brain temperature can be kept within safe limits.
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Affiliation(s)
- Mihály Vöröslakos
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA
| | - Omid Yaghmazadeh
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA
| | - Leeor Alon
- Department of Radiology, Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - Daniel K. Sodickson
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA; Department of Radiology, Grossman School of Medicine, New York University, New York, NY 10016, USA
| | - György Buzsáki
- Neuroscience Institute, Langone Medical Center, New York University, New York, NY 10016, USA; Department of Neurology, Grossman School of Medicine, New York University, New York, NY 10016, USA
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Jiang F, Bhusal B, Sanpitak P, Webster G, Popescu A, Kim D, Bonmassar G, Golestanirad L. A comparative study of MRI-induced RF heating in pediatric and adult populations with epicardial and endocardial implantable electronic devices. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4014-4017. [PMID: 36086095 PMCID: PMC10848149 DOI: 10.1109/embc48229.2022.9871087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with congenital heart defects, inherited arrhythmia syndromes, and congenital disorders of cardiac conduction often receive a cardiac implantable electronic device (CIED). At least 75% of patients with CIEDs will need magnetic resonance imaging (MRI) during their lifetime. In 2011, the US Food and Drug Administration approved the first MR-conditional CIEDs for patients with endocardial systems, in which leads are passed through the vein and affixed to the endocardium. The majority of children, however, receive an epicardial CIED, where leads are directly sewn to the epicardium. Unfortunately, an epicardial CIED is a relative contraindication to MRI due to the unknown risk of RF heating. In this work, we performed anthropomorphic phantom experiments to investigate differences in RF heating between endocardial and epicardial leads in both pediatric and adult-sized phantoms, where adult endocardial CIED was the control. Clinical Relevance-This work provides a quantitative comparison of MRI RF heating of epicardial and endocardial leads in pediatric and adult populations.
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Minaskeian N, Hajnal SP, Liu MB, Klooster LM, Devick KL, Schwartz L, Jokerst CE, Sorajja D, Scott LRP. Safety of magnetic resonance imaging in patients with cardiac implantable electronic devices with generator and lead(s) brand mismatch. J Appl Clin Med Phys 2022; 23:e13520. [PMID: 35066975 PMCID: PMC8906220 DOI: 10.1002/acm2.13520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/15/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a valuable imaging modality for the assessment of both cardiac and non‐cardiac structures. With a growing population of patients with cardiovascular implantable electronic devices (CIEDs), 50%–75% of these patients will need an MRI. MRI‐conditional CIEDs have demonstrated safety of MRI scanning with such devices, yet non‐conditional devices such as hybrid CIEDs which have generator and lead brand mismatch may pose a safety risk. In this retrospective study, we examined the outcomes of patients with hybrid CIEDs undergoing MRI compared to those patients with non‐hybrid CIEDs. A total of 349 patients were included, of which 24 patients (7%) had hybrid CIEDs. The primary endpoint was the safety of MRI for patients with hybrid CIEDs as compared to those with non‐hybrid devices, measured by the rate of adverse events, including death, lead or generator failure needing immediate replacement, loss of capture, new onset arrhythmia, or power‐on reset. Secondary endpoints consisted of pre‐ and post‐MRI changes of decreased P‐wave or R‐wave sensing by ≥50%, changes in pacing lead impedance by ≥50 ohms, increase in pacing thresholds by ≥ 0.5 V at 0.4 ms, and decreasing battery voltage of ≥ 0.04 V. The primary endpoint of any adverse reaction was present in 1 (4.2%) patient with a hybrid device, and consistent of atrial tachyarrhythmia, and in 10 (3.1%) patients with a non‐hybrid device, and consisted of self‐limited atrial and non‐sustained ventricular arrhythmias; this was not statistically significant. No significant differences were found in the secondary endpoints. This study demonstrates that MRI in patients with hybrid CIEDs does not result in increased patient risk or significant device changes when compared to those patients who underwent MRI with non‐hybrid CIEDs.
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Affiliation(s)
- Nareg Minaskeian
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Sofia P Hajnal
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Michael B Liu
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | | | - Katrina L Devick
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Linda Schwartz
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | | | - Dan Sorajja
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
| | - Luis RP Scott
- Department of ElectrophysiologyMayo Clinic ArizonaPhoenixArizonaUSA
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Deshpande S, Kella D, Padmanabhan D. MRI in patients with cardiac implantable electronic devices: A comprehensive review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:360-372. [DOI: 10.1111/pace.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/20/2020] [Accepted: 11/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Saurabh Deshpande
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
| | - Danesh Kella
- Department of Cardiology Piedmont Heart Institute Atlanta Georgia USA
| | - Deepak Padmanabhan
- Department of Cardiac Electrophysiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bangalore India
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Nguyen BT, Pilitsis J, Golestanirad L. The effect of simulation strategies on prediction of power deposition in the tissue around electronic implants during magnetic resonance imaging. ACTA ACUST UNITED AC 2020; 65:185007. [DOI: 10.1088/1361-6560/abac9f] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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6
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Martinez JA, Ennis DB. MRI of Patients with Cardiac Implantable Electronic Devices. CURRENT CARDIOVASCULAR IMAGING REPORTS 2019; 12. [DOI: 10.1007/s12410-019-9502-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Muthalaly RG, Nerlekar N, Ge Y, Kwong RY, Nasis A. MRI in Patients with Cardiac Implantable Electronic Devices. Radiology 2018; 289:281-292. [DOI: 10.1148/radiol.2018180285] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rahul G. Muthalaly
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Nitesh Nerlekar
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Yin Ge
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Raymond Y. Kwong
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
| | - Arthur Nasis
- From the Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Victoria, Australia (R.G.M., N.N., A.N.); and Cardiovascular Division, Brigham and Women’s Hospital and Harvard University, 75 Francis St, Boston, MA 02115 (R.G.M., Y.G., R.Y.K.)
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RF-induced heating in tissue near bilateral DBS implants during MRI at 1.5 T and 3T: The role of surgical lead management. Neuroimage 2018; 184:566-576. [PMID: 30243973 DOI: 10.1016/j.neuroimage.2018.09.034] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/21/2022] Open
Abstract
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.
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9
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Golestanirad L, Rahsepar AA, Kirsch JE, Suwa K, Collins JC, Angelone LM, Keil B, Passman RS, Bonmassar G, Serano P, Krenz P, DeLap J, Carr JC, Wald LL. Changes in the specific absorption rate (SAR) of radiofrequency energy in patients with retained cardiac leads during MRI at 1.5T and 3T. Magn Reson Med 2018; 81:653-669. [PMID: 29893997 PMCID: PMC6258273 DOI: 10.1002/mrm.27350] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the local specific absorption rate (SAR) and heating around retained cardiac leads during MRI at 64 MHz (1.5T) and 127 MHz (3T) as a function of RF coil type and imaging landmark. METHODS Numerical models of retained cardiac leads were built from CT and X-ray images of 6 patients with retained cardiac leads. Electromagnetic simulations and bio-heat modeling were performed with MRI RF body and head coils tuned to 64 MHz and 127 MHz and positioned at 9 different imaging landmarks covering an area from the head to the lower limbs. RESULTS For all patients and at both 1.5T and 3T, local transmit head coils produced negligible temperature rise ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi> <mml:mo><</mml:mo> <mml:mn>0.1</mml:mn> <mml:mo>°</mml:mo> <mml:mi>C</mml:mi></mml:mrow> </mml:math> ) for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>3</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . For body imaging with quadrature-driven coils at 1.5T, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> during a 10-min scan remained < 3°C at all imaging landmarks for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>3</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> and <6°C for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>4</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . For body imaging at 3T, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> during a 10-min scan remained < 6°C at all imaging landmarks for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>2</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . For shorter pulse sequences up to 2 min, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>Δ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> remained < 6°C for <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>3</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . CONCLUSION For the models based on 6 patients studied, simulations suggest that MRI could be performed safely using a local head coil at both 1.5T and 3T, and with a body coil at 1.5T with pulses that produced <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>4</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> . MRI at 3T could be performed safely in these patients using pulses with <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mrow><mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo> <mml:mrow><mml:msubsup><mml:mi>B</mml:mi> <mml:mn>1</mml:mn> <mml:mo>+</mml:mo></mml:msubsup> </mml:mrow> <mml:mo>‖</mml:mo> <mml:mo>‖</mml:mo></mml:mrow> <mml:mo>≤</mml:mo> <mml:mn>2</mml:mn> <mml:mo> </mml:mo> <mml:mo>μ</mml:mo> <mml:mi>T</mml:mi></mml:mrow> </mml:math> .
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Affiliation(s)
- Laleh Golestanirad
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts.,Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Amir Ali Rahsepar
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - John E Kirsch
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Kenichiro Suwa
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jeremy C Collins
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Leonardo M Angelone
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Boris Keil
- Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Giessen, Germany
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Giorgio Bonmassar
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
| | - Peter Serano
- Division of Biomedical Physics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Jim DeLap
- ANSYS Inc., Canonsburg, Pennsylvania
| | - James C Carr
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence L Wald
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts
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Erhardt JB, Fuhrer E, Gruschke OG, Leupold J, Wapler MC, Hennig J, Stieglitz T, Korvink JG. Should patients with brain implants undergo MRI? J Neural Eng 2018. [DOI: 10.1088/1741-2552/aab4e4] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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11
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Kalb B, Indik JH, Ott P, Martin DR. MRI of patients with implanted cardiac devices. J Magn Reson Imaging 2017; 47:595-603. [PMID: 28776823 DOI: 10.1002/jmri.25824] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/20/2017] [Indexed: 11/06/2022] Open
Abstract
Cardiac implanted electronic devices (CIEDs) have historically been regarded as a contraindication for performing magnetic resonance imaging (MRI), limiting the availability of this exam for large numbers of patients who may have otherwise benefited from the unique diagnostic capabilities of MRI. Interactions between CIEDs and the magnetic field associated with MRI systems have been documented, and include potential effects on CIED function, lead heating, and force/torque on the generator. Several device manufacturers have developed "MR-Conditional" CIEDs with specific hardware and software design changes to optimize the device for the MR environment. However, a substantial body of evidence has been accumulating that suggests that MRI may be safely performed in patients with either conditional or nonconditional CIEDs. Institutional policies and procedures, including preexam screening and assessment by skilled electrophysiology personnel and intraexam monitoring, allow MRI to be safely performed in CIED patients, as evidenced by at least two, large multicenter prospective studies and multiple smaller, single-institution studies. Cross-departmental collaboration and a robust safety infrastructure at sites that perform MRI should allow for the safe imaging of CIED patients who have a clinical indication for the study, regardless of the conditionality status of the device. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:595-603.
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Affiliation(s)
- Bobby Kalb
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Julia H Indik
- Sarver Hear Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Peter Ott
- Sarver Hear Center, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Diego R Martin
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
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Korutz AW, Obajuluwa A, Lester MS, McComb EN, Hijaz TA, Collins JD, Dandamudi S, Knight BP, Nemeth AJ. Pacemakers in MRI for the Neuroradiologist. AJNR Am J Neuroradiol 2017; 38:2222-2230. [PMID: 28705821 DOI: 10.3174/ajnr.a5314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Cardiac implantable electronic devices are frequently encountered in clinical practice in patients being screened for MR imaging examinations. Traditionally, the presence of these devices has been considered a contraindication to undergoing MR imaging. Growing evidence suggests that most of these patients can safely undergo an MR imaging examination if certain conditions are met. This document will review the relevant cardiac implantable electronic devices encountered in practice today, the background physics/technical factors related to scanning these devices, the multidisciplinary screening protocol used at our institution for scanning patients with implantable cardiac devices, and our experience in safely performing these examinations since 2010.
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Affiliation(s)
- A W Korutz
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - A Obajuluwa
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - M S Lester
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - E N McComb
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - T A Hijaz
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - J D Collins
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.)
| | - S Dandamudi
- Medicine, Division of Cardiology (S.D., B.P.K.)
| | - B P Knight
- Medicine, Division of Cardiology (S.D., B.P.K.)
| | - A J Nemeth
- From the Departments of Radiology (A.W.K., A.O., M.S.L., E.N.M., T.A.H., J.D.C., A.J.N.).,Neurology (A.J.N.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Dandamudi S, Collins JD, Carr JC, Mongkolwat P, Rahsepar AA, Tomson TT, Verma N, Arora R, Chicos AB, Kim SS, Lin AC, Passman RS, Knight BP. The Safety of Cardiac and Thoracic Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices. Acad Radiol 2016; 23:1498-1505. [PMID: 27717762 DOI: 10.1016/j.acra.2016.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/16/2016] [Accepted: 08/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES Studies reporting the safety of magnetic resonance imaging (MRI) in patients with a cardiac implantable electronic device (CIED) have mostly excluded examinations with the device in the magnet isocenter. The purpose of this study was to describe the safety of cardiac and thoracic spine MRI in patients with a CIED. MATERIALS AND METHODS The medical records of patients with a CIED who underwent a cardiac or thoracic spine MRI between January 2011 and December 2014 were reviewed. Devices were interrogated before and after imaging with reprogramming to asynchronous pacing in pacemaker-dependent patients. The clinical interpretability of the MRI and peak and average specific absorption rates (SARs, W/kg) achieved were determined. RESULTS Fifty-eight patients underwent 51 cardiac and 11 thoracic spine MRI exams. Twenty-nine patients had a pacemaker and 29 had an implantable cardioverter defibrillator. Seventeen percent (n = 10) were pacemaker dependent. Fifty-one patients (89%) had non-MRI-conditional devices. There were no clinically significant changes in atrial and ventricular sensing, impedance, and threshold measurements. There were no episodes of device mode changes, arrhythmias, therapies delivered, electrical reset, or battery depletion. One study was prematurely discontinued due to a patient complaint of chest pain of which the etiology was not determined. Across all examinations, the average peak SAR was 2.0 ± 0.85 W/kg with an average SAR of 0.35 ± 0.37 W/kg. Artifact significantly limiting the clinical interpretation of the study was present in 33% of cardiac MRI studies. CONCLUSIONS When a comprehensive CIED magnetic resonance safety protocol is followed, the risk of performing 1.5-T magnetic resonance studies with the device in the magnet isocenter, including in patients who are pacemaker dependent, is low.
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Bailey WM, Mazur A, McCotter C, Woodard PK, Rosenthal L, Johnson W, Mela T. Clinical safety of the ProMRI pacemaker system in patients subjected to thoracic spine and cardiac 1.5-T magnetic resonance imaging scanning conditions. Heart Rhythm 2016; 13:464-71. [DOI: 10.1016/j.hrthm.2015.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Indexed: 10/23/2022]
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15
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Kypta A, Blessberger H, Hoenig S, Saleh K, Lambert T, Kammler J, Fellner F, Lichtenauer M, Steinwender C. Clinical safety of an MRI conditional implantable cardioverter defibrillator system: A prospectiveMonocenterICD-Magnetic resonanceImaging feasibility study (MIMI). J Magn Reson Imaging 2015; 43:574-84. [DOI: 10.1002/jmri.25037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 08/14/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Alexander Kypta
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Hermann Blessberger
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Simon Hoenig
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Karim Saleh
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Thomas Lambert
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Juergen Kammler
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Franz Fellner
- Department of Radiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
| | - Michael Lichtenauer
- Department of Cardiology; Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg; Salzburg Austria
| | - Clemens Steinwender
- Department of Cardiology; Linz General Hospital, Johannes Kepler University School of Medicine; Linz Austria
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16
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Bailey WM, Rosenthal L, Fananapazir L, Gleva M, Mazur A, Rinaldi C, Kypta A, Merkely B, Woodard PK. Clinical safety of the ProMRI pacemaker system in patients subjected to head and lower lumbar 1.5-T magnetic resonance imaging scanning conditions. Heart Rhythm 2015; 12:1183-91. [DOI: 10.1016/j.hrthm.2015.02.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Indexed: 10/24/2022]
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17
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Practice advisory on anesthetic care for magnetic resonance imaging: an updated report by the american society of anesthesiologists task force on anesthetic care for magnetic resonance imaging. Anesthesiology 2015; 122:495-520. [PMID: 25383571 DOI: 10.1097/aln.0000000000000458] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Anesthetic Care for Magnetic Resonance Imaging presents an updated report of the Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging.
Supplemental Digital Content is available in the text.
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Ainslie M, Miller C, Brown B, Schmitt M. Republished: Cardiac MRI of patients with implanted electrical cardiac devices. Postgrad Med J 2014; 90:715-21. [PMID: 25431464 DOI: 10.1136/postgradmedj-2013-304324rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Implantable pulse generators and defibrillators have traditionally been considered contraindications to MRI. However, recent data have challenged this paradigm and demonstrated that patients with newer generation devices can safely undergo MRI, including cardiac MRI, provided basic precautions are taken. Indeed, the introduction of MRI conditional systems has led to a conceptual shift in clinical decision making-'can this patient undergo MRI safely?' is being superseded by 'should this patient be implanted with an MRI conditional device?'. This review outlines the risks associated with MRI in patients with implanted cardiac devices, and discusses practical measures to minimise risks and facilitate safe and diagnostic scanning.
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Affiliation(s)
- Mark Ainslie
- Cardiology Department, University Hospital of South Manchester, Manchester, UK
| | - Christopher Miller
- Cardiology Department, University Hospital of South Manchester, Manchester, UK
| | - Benjamin Brown
- Cardiology Department, University Hospital of South Manchester, Manchester, UK
| | - Matthias Schmitt
- Cardiology Department, University Hospital of South Manchester, Manchester, UK
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19
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van der Graaf AWM, Bhagirath P, Götte MJW. MRI and cardiac implantable electronic devices; current status and required safety conditions. Neth Heart J 2014; 22:269-76. [PMID: 24733688 PMCID: PMC4031361 DOI: 10.1007/s12471-014-0544-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Magnetic resonance imaging (MRI) has evolved into an essential diagnostic modality for the evaluation of all patient categories. This gain in popularity coincided with an increase in the number of implanted cardiac implantable electronic devices (CIEDs). Therefore, questions arose with regard to the MRI compatibility of these devices. Various investigators have reported the harmless performance of MRI in patients with conventional (non-MRI conditional) devices. The recently published European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronisation therapy (CRT) indicate that MRI can be safely performed in patients with an implanted pacemaker or ICD (MRI conditional or not), as long as strict safety conditions are met. This is a major modification of the former general opinion that patients with a pacemaker or ICD were not eligible to undergo MRI. This review paper attempts to elucidate the current situation for practising cardiologists by providing a clear overview of the potential life-threatening interactions and discuss safety measures to be taken prior to and during scanning. An overview of all available MRI conditional devices and their individual restrictions is given. In addition, an up-to-date safety protocol is provided that can be used to ensure patient safety before, during and after the scan. Key points • Historically, MRI examination of patients with a CIED has been considered hazardous. • Ongoing advances in technology and increasing usage of MRI in clinical practice have led to the introduction of MRI conditional CIEDs and to more lenient regulations on the examination of patients with non-conditional CIEDs. • MRI investigations can be performed safely in selected patients when adhering to a standardised up-to-date safety protocol.
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Affiliation(s)
- A W M van der Graaf
- Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, the Netherlands,
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20
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Ahmed FZ, Morris GM, Allen S, Khattar R, Mamas M, Zaidi A. Not all pacemakers are created equal: MRI conditional pacemaker and lead technology. J Cardiovasc Electrophysiol 2014; 24:1059-65. [PMID: 24016320 DOI: 10.1111/jce.12238] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/09/2013] [Accepted: 05/14/2013] [Indexed: 11/30/2022]
Abstract
Due to expanding clinical indications and an aging society there has been an increase in the use of implantable pacemakers. At the same time, due to increased diagnostic yield over other imaging modalities and the absence of ionizing radiation, there has been a surge in demand for magnetic resonance imaging (MRI) assessment, of both cardiac and noncardiac conditions. Patients with an implantable device have a 50-75% chance of having a clinical indication for MRI during the lifetime of their device. The presence of an implantable cardiac device has been seen as a relative contraindication to MRI assessment, limiting the prognostic and diagnostic utility of MRI in many patients with these devices. The introduction of MRI conditional pacemakers will enable more patients to undergo routine MRI assessment without risk of morbidity or device malfunction. This review gives a general overview of the principles and current evidence for the use of MRI conditional implantable cardiac devices. Furthermore, we appraise the differences between those pacemakers currently released to market.
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Affiliation(s)
- Fozia Z Ahmed
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK; Cardiovascular Research Institute, University of Manchester, Manchester, UK
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21
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Cronin EM, Mahon N, Wilkoff BL. MRI in patients with cardiac implantable electronic devices. Expert Rev Med Devices 2014; 9:139-46. [DOI: 10.1586/erd.11.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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McClain CD, Landrigan-Ossar M. Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiol Clin 2013; 32:83-100. [PMID: 24491651 DOI: 10.1016/j.anclin.2013.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article gives a review of 3 challenges in caring for children undergoing neurosurgical and neurointerventional procedures. Anesthesiologists may have experience with certain aspects of these situations but may not have extensive experience with each clinical setting. This review addresses issues with awake craniotomy, intraoperative magnetic resonance imaging, and neurointerventional procedures in children with neurologic disease. Familiarization with these complex clinical scenarios and their unique considerations allows the anesthesiologist to deliver optimal care and helps facilitate the best possible outcome for these patients.
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Affiliation(s)
- Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA.
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
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23
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Ainslie M, Miller C, Brown B, Schmitt M. Cardiac MRI of patients with implanted electrical cardiac devices. Heart 2013; 100:363-9. [DOI: 10.1136/heartjnl-2013-304324] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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Abstract
PURPOSE OF REVIEW Intraoperative magnetic resonance imaging (iMRI) is an evolving technology used to provide precise intraoperative navigation during a variety of neurosurgical and other types of surgical procedures. Anesthesiologists need to be aware of the unique challenges created by this environment. Failure to recognize the differences between the diagnostic MRI environment and the iMRI environment can compromise the safety of the patient and operating room staff and present logistical problems. RECENT FINDINGS Recent surgical reports herald the uses and benefits of iMRI. However, there are a few in the anesthesia literature addressing the significant benefits and the anesthesia-specific issues this technology creates. We will review recent reports describing anesthetic care of patients in this environment as well as examine the recent surgical and radiologic literature as they relate to issues faced by anesthesiologists. SUMMARY We describe the design of different iMRI suites as well as provide a breakdown of both patient and equipment issues encountered by anesthesiologists practicing in this environment. Finally, we offer our ongoing experience in this environment and provide suggestions to optimize patient outcomes.
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26
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Shinbane JS, Colletti PM, Shellock FG. Magnetic resonance imaging in patients with cardiac pacemakers: era of "MR Conditional" designs. J Cardiovasc Magn Reson 2011; 13:63. [PMID: 22032338 PMCID: PMC3219582 DOI: 10.1186/1532-429x-13-63] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 10/27/2011] [Indexed: 11/24/2022] Open
Abstract
Advances in cardiac device technology have led to the first generation of magnetic resonance imaging (MRI) conditional devices, providing more diagnostic imaging options for patients with these devices, but also new controversies. Prior studies of pacemakers in patients undergoing MRI procedures have provided groundwork for design improvements. Factors related to magnetic field interactions and transfer of electromagnetic energy led to specific design changes. Ferromagnetic content was minimized. Reed switches were modified. Leads were redesigned to reduce induced currents/heating. Circuitry filters and shielding were implemented to impede or limit the transfer of certain unwanted electromagnetic effects. Prospective multicenter clinical trials to assess the safety and efficacy of the first generation of MR conditional cardiac pacemakers demonstrated no significant alterations in pacing parameters compared to controls. There were no reported complications through the one month visit including no arrhythmias, electrical reset, inhibition of generator output, or adverse sensations. The safe implementation of these new technologies requires an understanding of the well-defined patient and MR system conditions. Although scanning a patient with an MR conditional device following the strictly defined patient and MR system conditions appears straightforward, issues related to patients with pre-existing devices remain complex. Until MR conditional devices are the routine platform for all of these devices, there will still be challenging decisions regarding imaging patients with pre-existing devices where MRI is required to diagnose and manage a potentially life threatening or serious scenario. A range of other devices including ICDs, biventricular devices, and implantable physiologic monitors as well as guidance of medical procedures using MRI technology will require further biomedical device design changes and testing. The development and implementation of cardiac MR conditional devices will continue to require the expertise and collaboration of multiple disciplines and will need to prove safety, effectiveness, and cost effectiveness in patient care.
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Affiliation(s)
- Jerold S Shinbane
- Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Patrick M Colletti
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
| | - Frank G Shellock
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA90033, USA
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27
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Langman DA, Finn JP, Ennis DB. Abandoned pacemaker leads are a potential risk for patients undergoing MRI. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1051-3. [PMID: 21797902 DOI: 10.1111/j.1540-8159.2011.03176.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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28
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Baikoussis NG, Apostolakis E, Papakonstantinou NA, Sarantitis I, Dougenis D. Safety of Magnetic Resonance Imaging in Patients With Implanted Cardiac Prostheses and Metallic Cardiovascular Electronic Devices. Ann Thorac Surg 2011; 91:2006-11. [DOI: 10.1016/j.athoracsur.2011.02.068] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Revised: 02/19/2011] [Accepted: 02/23/2011] [Indexed: 12/16/2022]
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29
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Langman DA, Goldberg IB, Finn JP, Ennis DB. Pacemaker lead tip heating in abandoned and pacemaker-attached leads at 1.5 Tesla MRI. J Magn Reson Imaging 2011; 33:426-31. [PMID: 21274985 DOI: 10.1002/jmri.22463] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the risk of RF-induced heating in pacemaker-attached and abandoned leads using in vitro temperature measurements at 1.5 Tesla as a function of lead length. MATERIALS AND METHODS Five custom lead lengths, 20-60 cm, were exposed to a uniform magnitude and phase radiofrequency electric field to examine the effect of lead length on pacemaker lead tip heating for pacemaker-attached and abandoned pacemaker leads. RESULTS Abandoned and pacemaker-attached leads show resonant heating behavior and maximum heating occurs at different lead lengths due to the differences in termination conditions. For clinical lead lengths (40-60 cm) abandoned leads exhibited greater lead tip heating compared with pacemaker-attached leads. CONCLUSION Current recommendations for MRI pacemaker safety should highlight the possible increased risk for patients with abandoned leads as compared to pacemaker-attached leads.
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Affiliation(s)
- Deborah A Langman
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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30
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Practice advisory for the perioperative management of patients with cardiac implantable electronic devices: pacemakers and implantable cardioverter-defibrillators: an updated report by the american society of anesthesiologists task force on perioperative management of patients with cardiac implantable electronic devices. Anesthesiology 2011; 114:247-61. [PMID: 21245737 DOI: 10.1097/aln.0b013e3181fbe7f6] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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31
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Pfeil A, Drobnik S, Rzanny R, Aboud A, Böttcher J, Schmidt P, Ortmann C, Mall G, Hekmat K, Brehm B, Reichenbach J, Mayer TE, Wolf G, Hansch A. Compatibility of temporary pacemaker myocardial pacing leads with magnetic resonance imaging: an ex vivo tissue study. Int J Cardiovasc Imaging 2011; 28:317-26. [DOI: 10.1007/s10554-011-9800-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 01/08/2011] [Indexed: 11/25/2022]
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32
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Electromagnetic Interference with Cardiac Implantable Devices by Household and Industrial Appliances. J Arrhythm 2011. [DOI: 10.1016/s1880-4276(11)80007-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Martins RP, Baruteau AE, Treguer F, Césari O, Carsin-Nicol B, Langella B, Leclercq C, Daubert JC, Mabo P. [Magnetic resonance imaging in patients with pacemakers and implantable cardioverter-defibrillators: a systematic review]. Ann Cardiol Angeiol (Paris) 2010; 59:221-228. [PMID: 19962691 DOI: 10.1016/j.ancard.2009.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 04/19/2009] [Indexed: 05/28/2023]
Abstract
The presence of a pacemaker or an implantable cardioverter-defibrillator was historically considered a contraindication to magnetic resonance imaging (MRI), due to the risks for both patient and device: reed-switch closure responsible for asynchronous pacing, inhibition of pacing, rapid ventricular pacing, heating on the lead tip or even device displacement... However, many recent studies demonstrate that if MRI is crucial for the management of the patient, it can be performed under specific monitoring and scanning conditions and after device reprogramming. The growing implication of device constructors in constructing a MRI safety device will perhaps extend in the future the indications of this imaging modality in implanted patients.
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Affiliation(s)
- R-P Martins
- Service de cardiologie et maladies vasculaires, CHU de Rennes, 35033 Rennes cedex, France.
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Strach K, Naehle CP, Muhlsteffen A, Hinz M, Bernstein A, Thomas D, Linhart M, Meyer C, Bitaraf S, Schild H, Sommer T. Low-field magnetic resonance imaging: increased safety for pacemaker patients? Europace 2010; 12:952-60. [DOI: 10.1093/europace/euq081] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Given the advances of MRI and cardiovascular technology, it is becoming increasingly likely that a patient with a cardiovascular device will be a candidate for an MRI procedure. However, many cardiac devices are currently considered to be contraindicated in the MR environment. This may prove to be a significant public health problem as many patients in need of MRI are denied the procedure because of the presence of a cardiovascular device. However, research studies have shown that with proper precautions and technique patients with cardiac devices can undergo successful MRI safely on the current platforms.
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Affiliation(s)
- Edward T Martin
- Cardiovascular Magnetic Resonance, Oklahoma Heart Institute, 9228 S. Mingo Road, Tulsa, OK 74133, USA.
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36
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Stecco A, Saponaro A, Carriero A. Patient safety issues in magnetic resonance imaging: state of the art. Radiol Med 2007; 112:491-508. [PMID: 17563855 DOI: 10.1007/s11547-007-0154-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2006] [Accepted: 10/23/2006] [Indexed: 11/25/2022]
Abstract
The presence of a static magnetic field (Bo), a radiofrequency field (RF), a dynamic gradient which varies in time and loud noises during an MR examination could increase patient risk. Specifically, a magnetic field could interfere with ferromagnetic material leading to one of the following five dangerous interactions: 1) projectile effect, 2) twisting, 3) burning, 4) artefacts and 5) device malfunction. The projectile effect is when an object is attracted by the magnet with the risk, as reported in literature, of hitting the patient, operators and/or the instrument. Objects which typically can undergo this effect are oxygen and helium cylinders, IV stands, cleaning trolleys, chairs, lamp holders, scissors, forceps, clampers, traction weights, monitoring instruments, and especially metallic splinters within the patient. Twisting (torsion) typically occurs with cerebral vascular clamps and cochlear implants. If parts of implants are involved a malfunction may result. Burns can be caused when electrically conductive material is introduced within the magnet, for example, ECG electrodes, monitoring cables and coils which are in contact with the patient's skin, as well as tattoos and eye-liners that contain iron-oxides. Artefacts can be induced by RF emission of implanted devices which can be mistaken for noise of the receiving coil. Implanted devices can induce signal voids which mask or simulate pathologies. Electrical or mechanical malfunction of implanted devices includes pacemakers which can stimulate inappropriately or at an elevated frequency yielding a distorted ECG with altered T-waves. The risk for patients can be reduced by specific educational programs within individual radiology departments which include other specializations and external referring physicians with the aim of developing a standardized safety protocol.
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Affiliation(s)
- A Stecco
- SCDU Radiologia, Università del Piemonte Orientale A. Avogadro, ASO Maggiore della Carità, Corso Mazzini 18, I-28100 Novara, Italy.
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Abstract
High-resolution computed tomography (CT) and magnetic resonance imaging (MRI) have become indispensable tools for the evaluation of conditions involving the head and neck. Complex anatomic structures and regions, such as the orbit, skull base, paranasal sinuses, deep spaces of the neck, larynx, and lymph nodes, require that the radiologist be familiar with the imaging modalities available and their appropriate applications. The purpose of this article is to review the techniques of CT and MRI and the roles they play in clinical practice, including head and neck disorders.
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Affiliation(s)
- Franz J Wippold
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Tammer R, Ehrenreich L, Boretius S, Watanabe T, Frahm J, Michaelis T. Compatibility of glass-guided recording microelectrodes in the brain stem of squirrel monkeys with high-resolution 3D MRI. J Neurosci Methods 2005; 153:221-9. [PMID: 16343640 DOI: 10.1016/j.jneumeth.2005.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 10/20/2005] [Accepted: 10/31/2005] [Indexed: 11/20/2022]
Abstract
Knowledge of the precise position of recording microelectrodes within the brain of a non-human primate is essential for a reliable exploration of very small anatomic structures. This work demonstrates the compatibility of a newly developed glass-guided microelectrode design and microfeed equipment with high-resolution 3D magnetic resonance imaging (MRI). T1- and T2-weighted images allow for the non-invasive visualization of chronically implanted microelectrodes within the brain stem of squirrel monkeys in vivo. Neural extracellular multi-unit recordings proved the functionality of the microelectrode before and after the use of 3D MRI suggesting the preservation of normal brain tissue at the tip of the electrode. Because histology confirmed the absence of lesions attributable to MRI, the approach offers an interactive monitoring during the course of neuroethological experiments. Consequently, MRI may become an in vivo alternative to common histological post mortem verifications of electrode tracks and hence may avoid the early sacrificing of primates after only a small number of experiments.
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Affiliation(s)
- R Tammer
- Department of Neurobiology, Deutsches Primatenzentrum GmbH, Kellnerweg 4, 37077 Göttingen, Germany.
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39
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Del Ojo JL, Moya F, Villalba J, Sanz O, Pavón R, Garcia D, Pastor L. Is Magnetic Resonance Imaging Safe in Cardiac Pacemaker Recipients? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:274-8. [PMID: 15826258 DOI: 10.1111/j.1540-8159.2005.50033.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Magnetic resonance imaging (MRI) is currently contraindicated in cardiac pacemaker (PM) recipients. The objectives of this prospective study were to (1) reassess the risks of performing an MRI scan in patients with PM, (2) compared the pacing functions before and after the exposure to MRI, and (3) monitor the development of possible adverse effects. Thirteen patients implanted with an Affinity DR model 5330 PMs (St. Jude Medical) connected to a Tendril model 1388 leads (St. Jude Medical) underwent 2.0 T-MRI for a variety of indications. All patients displayed a stable spontaneous rhythm at the time of the MRI scan and were not considered to be PM-dependent. The sensing and pacing functions were analyzed and the impedance of both leads was measured before and after the scan. The MRI scan was performed with all PM programmed in DDD mode. The sensing configuration was bipolar. All patients were monitored utilizing a standard electrocardiographic monitor and direct verbal communication. PM Inhibition, asynchronous pacing, or inappropriately rapid pacing was not observed. No patient reported discomfort, heat, or motion sensation at the PM implant site. There were no significant differences in the sensing, stimulation, AutoCapture threshold, and lead impedance measurements before and after MRI. The results of this study suggest that performing 2.0 T-MRI scans in patients with Affinity DR model 5330 PM connected to a Tendril model 1388 lead is safe.
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Affiliation(s)
- J Leal Del Ojo
- Servicio de Cardiología Hospital de Valme, Cardiology Service, Carretera Sevilla-Cádiz s/n, 41014 Seville, Spain.
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Loewy J, Loewy A, Kendall EJ. Reconsideration of Pacemakers and MR Imaging. Radiographics 2004; 24:1257-67; discussion 1267-8. [PMID: 15371606 DOI: 10.1148/rg.245045014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The presence of an implanted pacemaker is widely regarded as an absolute contraindication to magnetic resonance (MR) imaging; however, this viewpoint is based largely on safety concerns in the 1982-1996 period. Since 1996, changes in pacemaker electronics including decreased ferromagnetic content, increased sophistication of the circuitry, and onboard computer capabilities suggest that the absolute contraindication of MR imaging for pacemaker patients should be reconsidered. In addition, there are now data from prospective trials of 232 patients with demand pacemakers who underwent MR imaging at 0.5-1.5 T. Although a variety of pacemaker parameters were evaluated before, during, immediately after, and 3 months after MR imaging, no significant pacemaker changes were identified. No patients reported abnormal sensations such as pacemaker movement or irregular heartbeats even at direct questioning. These results suggest that peripheral locations such as the brain and knee may be considered for MR imaging. Thus, pacemaker patients should be assessed individually for their suitability for MR imaging, which may be performed safely under defined conditions.
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Affiliation(s)
- John Loewy
- Department of Medical Imaging, Humber River Regional Hospital, 2115 Finch Ave W, Toronto, ON, Canada M3N 1N1.
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Abstract
PURPOSE OF REVIEW This review focuses on the technological principles, safety considerations, monitors and equipment, patient issues, and a general overview of the anesthetic management of both conventional and intraoperative magnetic resonance imaging based on the most recent literature. RECENT FINDINGS As a diagnostic imaging modality, magnetic resonance imaging remains unparalleled in its diagnostic and clinical value. The clinical applications for magnetic resonance imaging continue to evolve, and include its latest use in minimally invasive procedures as well as in the operating room. Intraoperative magnetic resonance imaging is steadily gaining acceptance for neurosurgical procedures. The safety considerations, monitor and equipment issues for intraoperative magnetic resonance imaging are similar to the conventional setting. However, they differ in their focus on anesthesia management. Most monitoring compatible with magnetic resonance imaging has been available for many years. In the USA, the newest available monitoring option during magnetic resonance imaging is for temperature. This option has been available in other countries for a number of years. A fiberoptic surface sensor provides a safe and accurate monitor of adult, pediatric, and neonatal body temperature. SUMMARY The magnetic resonance imaging suite is a challenging environment for the anesthesiologist, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner, and patient-related factors. Understanding the implications of the magnetic resonance imaging environment will facilitate ensuring the safety of the patient and personnel.
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Affiliation(s)
- Cheryl K Gooden
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York 10029, USA.
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Abstract
The technology used for magnetic resonance (MR) procedures has evolved continuously during the past 20 years, yielding MR systems with stronger static magnetic fields, faster and stronger gradient magnetic fields, and more powerful radiofrequency transmission coils. Most reported cases of MR-related injuries and the few fatalities that have occurred have apparently been the result of failure to follow safety guidelines or of use of inappropriate or outdated information related to the safety aspects of biomedical implants and devices. To prevent accidents in the MR environment, therefore, it is necessary to revise information on biologic effects and safety according to changes that have occurred in MR technology and with regard to current guidelines for biomedical implants and devices. This review provides an overview of and update on MR biologic effects, discusses new or controversial MR safety topics and issues, presents evidence-based guidelines to ensure safety for patients and staff, and describes safety information for various implants and devices that have recently undergone evaluation.
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Affiliation(s)
- Frank G Shellock
- Keck School of Medicine, University of Southern California, USA.
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Martin ET, Coman JA, Shellock FG, Pulling CC, Fair R, Jenkins K. Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla. J Am Coll Cardiol 2004; 43:1315-24. [PMID: 15063447 DOI: 10.1016/j.jacc.2003.12.016] [Citation(s) in RCA: 257] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The study was done to determine whether patients with pacemakers could safely undergo magnetic resonance imaging (MRI) at 1.5-Tesla (T). BACKGROUND Because of theoretical risks, it is an absolute contraindication for a patient with a pacemaker to undergo MRI. However, there are times when an MRI is needed to provide valuable clinical information. METHODS Fifty-four patients underwent a total of 62 MRI examinations at 1.5-T. The type of MRI examination was not limited and included cardiac, vascular, and general MRI studies using various whole-body averaged specific absorption rate (SAR) of radiofrequency power. Restrictions were not placed on the type of pacemaker present in the patient. All pacemakers were interrogated immediately before and after MRI scanning, and patients were continuously monitored. Before and after MRI, interrogation was done, and pacing and sensing thresholds, as well as lead impedances, were all measured. RESULTS A total of 107 leads and 61 pulse generators were evaluated. No adverse events occurred. Forty (37%) of the leads underwent changes, whereas 10 (9.4%) leads underwent a significant change. Only 2 of the 107 (1.9%) leads required a change in programmed output. Threshold changes were unrelated to cardiac chamber, anatomical location, peak SAR, and time from lead implant to the MRI examination. Electrocardiographic changes and patient symptoms were minor and did not require cessation of MRI. CONCLUSIONS Safety was demonstrated in this series of patients with pacemakers at 1.5-T.
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Affiliation(s)
- Cheryl K Gooden
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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Herzog RJ, Ghanayem AJ, Guyer RD, Graham-Smith A, Simmons ED. Magnetic resonance imaging: use in patients with low back pain or radicular pain. Spine J 2003; 3:6S-10S. [PMID: 14589213 DOI: 10.1016/s1529-9430(02)00559-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Richard J Herzog
- Division of Teleradiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Abstract
The preservation of a safe magnetic resonance (MR) environment requires constant vigilance by MR healthcare professionals, particularly with regard to the management of patients with metallic biomedical implants or devices. The variety and complexity of implants and devices constantly changes, requiring continuous attention and diligence with regard to obtaining the most current and accurate information about these objects relative to the MR environment. This review article discusses MR safety and MR compatibility issues and presents important information for a variety of implants and devices, with an emphasis on those objects that have recently undergone evaluation or that require additional consideration because of existing controversy or confusion.
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Affiliation(s)
- Frank G Shellock
- Institute for Magnetic Resonance Safety, Education, and Research, Los Angeles, California, USA.
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Greatbatch W, Miller V, Shellock FG. Magnetic resonance safety testing of a newly-developed fiber-optic cardiac pacing lead. J Magn Reson Imaging 2002; 16:97-103. [PMID: 12112509 DOI: 10.1002/jmri.10129] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To assess magnetic resonance (MR) safety for a newly developed, fiber-optic cardiac pacing lead. MATERIALS AND METHODS MR safety was assessed for the fiber-optic cardiac pacing lead by evaluating magnetic field interactions and heating. Translational attraction and torque were evaluated using a 1.5-Tesla MR system and previously described, standardized techniques. MR imaging-related heating was assessed using a 1.5-Tesla MR system and a transmit/receive, body radiofrequency (RF) coil with the fiber-optic lead positioned to simulate an in vivo condition in a saline-filled phantom. The phantom had dimensions similar to a human subject's torso and head. A fluoroptic thermometry system was used to record temperatures on and near the electrodes of the fiber-optic pacing lead at five-second intervals immediately before and during 20 minutes of MR imaging performed at a whole-body-averaged specific absorption rate (SAR) of 1.5 W/kg. Temperatures were also recorded from a reference site during this experiment. RESULTS Magnetic field interactions for the fiber-optic lead were minimal (deflection angle, 23 degrees; torque, +2). The highest temperature change recorded for the fiber-optic cardiac pacing lead and reference site was +0.8 degrees C. CONCLUSION The minor magnetic field interactions and relative lack of heating for the fiber-optic pacing lead indicate that it should be safe for patients with this device to undergo MR imaging procedures using MR systems operating at 1.5-T or less and at a whole-body-averaged SARs up to 1.5 W/kg.
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Papadopoulos MA, Christou PK, Christou PK, Athanasiou AE, Boettcher P, Zeilhofer HF, Sader R, Papadopulos NA. Three-dimensional craniofacial reconstruction imaging. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:382-93. [PMID: 12029276 DOI: 10.1067/moe.2002.121385] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This review article aims to describe and discuss the imaging techniques most commonly used in medicine and dentistry to obtain three-dimensional images of the craniofacial complex. Three-dimensional imaging techniques provide extensive possibilities for the detailed and precise analysis of the whole craniofacial complex, for virtual (on-screen) simulation and real simulation of orthognathic surgery cases on biomodels before treatment, as well as for the detailed evaluation of the effects of treatment. Laser scanning in combination with the stereolithographic biomodeling seems to be a very promising combination for three-dimensional imaging, although there is still considerable room for improvement. Constant efforts should be made in the direction of developing and enhancing the existing techniques as well as exploring the potential for developing new methods based on emerging sectors of technology.
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Affiliation(s)
- Moschos A Papadopoulos
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Greece.
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Sawyer-Glover AM, Shellock FG. Pre-MRI procedure screening: recommendations and safety considerations for biomedical implants and devices. J Magn Reson Imaging 2000; 12:92-106. [PMID: 10931569 DOI: 10.1002/1522-2586(200007)12:1<92::aid-jmri11>3.0.co;2-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Maintaining a safe MR environment is a daily challenge for MR healthcare workers, especially in consideration of the increasing number of clinical MR applications and the large and growing variety of biomedical implants and devices that are currently used in patients. This review article presents policies and procedures that should be used to screen all patients and individuals before allowing them to enter the magnetic resonance (MR) environment. Information pertaining to MR safety and the relative risk factors for implants, devices and materials is discussed. A comprehensive pre-MRI procedure screening form that is recommended for use by MR facilities is also included.
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Affiliation(s)
- A M Sawyer-Glover
- Department of Radiology, Stanford University School of Medicine, California 94305, USA.
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