Provision of Safe Anesthesia in Magnetic Resonance Environments: Degree of Compliance with International Guidelines in Saudi Arabia

BACKGROUND

The lack of local guidelines and regulations for the administration of anesthesia in magnetic resonance imaging (MRI) units presents a potential risk to patient safety in Saudi Arabia. Hence, this study aimed to evaluate the extent to which hospitals in Saudi Arabia follow international guidelines and recommendations for the safe and effective administration of anesthesia in an MRI environment.

METHODS

This study used a questionnaire that was distributed to 31 medical facilities in Saudi Arabia that provided anesthesia in MRI units.

RESULTS

The findings of the study revealed that the mean compliance with the 17 guidelines across the 31 sites was 77%; 5 of the 31 sites (16.1%) had a compliance rate of less than 50% with the recommended guidelines. Only 19.4% of the institutes provided general safety education. Communication breakdowns between anesthesia providers and MRI teams were reported.

CONCLUSIONS

To conclude, this survey highlights the status of anesthesia standards in Saudi Arabian MRI units and emphasizes areas that require better adherence to international guidelines. The results call for targeted interventions, including the formulation of specific national anesthesia guidelines for MRI settings. Communication breakdowns between anesthesia providers and MRI teams were reported at a rate of 83.9% during the administration of a gadolinium contrast agent. There were additional breakdowns, particularly for high-risk patients with implants, such as impaired respirators (74.2%), thus requiring further investigation due to potential safety incidents during MRI procedures. While considering the limitations of this study, such as potential biases and the low response rate, it provides a valuable foundation for refining protocols and promoting standardized practices in Saudi Arabian healthcare.

Safety Survey on Lone Working Magnetic Resonance Imaging Technologists in Saudi Arabia

PURPOSE

The American College of Radiology (ACR) requires MR personnel not to work alone due to the increased risk of safety issues such as projectiles, aggressive patients, and technologist fatigue. As a result, we intend to assess the current safety of lone-working MRI technologists in MRI departments in Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study using a self-report questionnaire was conducted in 88 Saudi hospitals.

RESULTS

A response rate of 64% (174/270) was obtained among the 270 MRI technologists which were identified. The study discovered that 86% of MRI technologists had prior experience working alone. In terms of MRI safety training, 63% of MRI technologists received such training. A question about lone MRI workers' awareness of the ACR's recommendations revealed that 38% were unaware of such recommendations. Furthermore, 22% were misinformed, believing that working alone in an MRI unit is optional or depends on the individual's desire to work alone. Working alone has the primary consequence of being statistically significantly associated with projectile/object-related accidents/mistakes (p = 0.03).

CONCLUSION

Saudi Arabian MRI technologists have extensive experience working alone without supervision. Most MRI technologists are unaware of lone working regulations, which has raised concerns about accidents/mistakes. There is a need for MRI safety training and adequate practical experience to raise awareness of MRI safety regulations and policies related to lone working among departments and MRI workers.

Assessment of Patient Knowledge Level Towards MRI Safety Before the Scanning in Saudi Arabia

Purpose

Magnetic resonance imaging (MRI) is an important diagnostic method in modern clinical medicine. Patients’ ‎‎knowledge about MRI is of utmost importance for optimizing the workflow, ‎safety, and patient comfort and saving valuable time for the MRI department. This study investigates patient knowledge levels regarding MRI safety before an MRI examination.

Patients and Methods

A cross-sectional survey was completed by 200 patients who required MRI. Recruitment occurred over eight weeks in ‎governmental and private hospitals in Saudi ‎Arabia; both hospitals and participants were selected randomly. The ‎questionnaire was given to the patients prior to ‎their MRI scans. Descriptive statistics and chi-square tests were performed to identify relationships between knowledge of MRI safety and selected demographic groupings (age, gender, education level, income level). It also evaluates their source of information and assesses the patient’s previous experience regarding MRI scans.‎

Results

The study sample consisted of 200 patients from 230 surveys distributed in ‎Saudi Arabia, and the response rate was ~ 87%. Depending on the P-values of the chi-square statistical test to find the relationship between ‎socio-demographic factors and patient’ knowledge level, the results showed a significant association (p-value=0.006) between age and gender and the level of knowledge relating to MRI safety issues. A similar significance (p-value=0.042) is observed between the knowledge level of patients and their educational level and annual income. In addition, a highly significant association (p-value<0.001) is found between education level or previous experience and whether people seek information about MRI safety.

Conclusion

The study findings suggest that a complex combination of factors affects patient knowledge regarding MRI safety before an MRI examination. Hence, the hospital and radiological department must ‎‎provide the ‎patient with accurate information about MRI.‎

Improving cervical spinal cord lesion detection in multiple sclerosis using filtered fused proton density-T2 weighted images

Background

Magnetic Resonance Imaging (MRI) is considered a vital in depicting multiple sclerosis (MS) lesions. Current studies demonstrate that proton density (PD) weighted images (WI) are superior to T2 WI in detecting MS lesions (plaques) in the spinal cord.

Purpose

To evaluate the diagnostic value of filtered fused PD/T2 weighted images in detecting cervical spinal cord MS lesions.

Material and Methods

In this retrospective study, we selected a sample size of 50 MS patients. Using contrast limited adaptive histogram equalization (CLAHE), a digital image processing filter was used on the (PD/T2) fused images. The produced images were inspected and compared to the original PD images by two experienced neuroradiologists using interobserver and intraobserver. An ROI analysis was also performed on the processed and original PD images.

Results

The repeatability measurement of the match between the two examinations was highly consistent for both neuroradiologists. The repeatability for both neuroradiologists was 96.05%, and the error measurement was 3.95%. The reproducibility measurement of the neuroradiologist’s evaluation shows that the processed images could help to identify lesions better [excellent (84.87%)] than PD images [good (61.19%)]. ROIs analysis was performed on 113 MS lesions and normal areas in different images within the sample size. It revealed an enhanced ratio of 2.2 between MS lesions and normal spinal cord tissue in processed fused images compared to 1.34 in PD images.

Conclusion

The processed images of the fused images (PD/T2) have superior diagnostic sensitivity for MS lesions in the cervical spine than PD images alone.

Estimation of patient effective doses in PET/CT- 18F-Sodium Fluoride examinations

The positron emitters (¹⁸F-Sodium Fluoride (NaF)) and X-rays used in Positron emission tomography (PET) combined with computed tomography (PET/CT) imaging have a high radiation dose, which results in a high patient dose. The present research intends to determine the radiation dose and risks associated with PET/CT- 18F-Sodium fluoride examinations in patients. The 18F-NaF PET/CT was used to investigate the doses of 86 patients. Patient exposure parameters and ImPACT software were used to calculate mean effective doses. The administered activity of 185 MBq (5.0 mCi) per procedure has a mean and range based on the patient's BMI (BMI). The range of patient effective doses per procedure was found to be 4-10 mSv, with a radiation risk of 1 × 10^-5 per procedure. Patient doses are determined by the patient's size, scanner type, imaging protocol, and reconstruction method. For further dose reduction, proper justification and radiation dose optimization is required.

Radiation risk for patients undergoing cardiac computed tomography examinations

The various technological advancements in computed tomography (CT) have resulted in remarkable growth in the use of CT imaging in clinical practice, not the least of which has been its establishment as the most valuable imaging examination for the assessment of cardiovascular system disorders. The objective of this study was to assess the effective radiation dose and radiation risk for patients during cardiac CT procedures, based on studies from four different hospitals equipped with 128 slice CT equipment. A total of eighty-three patients were investigated in this study with different clinical indications. Effective doses were also calculated using software based on Monte Carlo simulation. The mean patient age (years), weight (kg), and body mass index (BMI (kg/m²)) were 49 ± 11, 82 ± 12, and 31 ± 6, respectively. The results of the study revealed that the tube voltage (kVp) and tube current-exposure time product (mAs) ranged between 100 to 140 and 50 to 840 respectively. The overall average patient dose values for the volume CT dose index [(CTDI_vol), in mGy)] and dose length product (DLP) (in mGy·cm) were 34.8 ± 15 (3.7-117.0) and 383.8 ± 354 (46.0-3277.0) respectively. The average effective dose (mSv) was 15.2 ± 8 (1.2-61.8). The radiation dose values showed wide variation between different hospitals and even within the same hospital. The results indicate the need to optimize radiation dose and to establish diagnostic reference levels (DRLs) for patients undergoing coronary computed tomography angiography (CCTA), also to harmonize the imaging protocols to ensure reduced radiation risk.

Lesion load assessment among multiple sclerosis patient using DIR, FLAIR, and T2WI sequences

Background

Magnetic resonance imaging (MRI) is one of the diagnostic imaging modalities employing in lesion detection in neurological disorders such as multiple sclerosis (MS). Advances in MRI techniques such as double inversion recovery (DIR) made it more sensitive to distinguish lesions in the brain. To investigate the lesion load on different anatomical regions of the brain with MS using DIR, fluid attenuated inversion recovery (FLAIR) and T2-weighted imaging (T2WI) sequences. A total of 97 MS patients were included in our retrospective study, confirmed by neurologist. The patients were randomly selected from the major hospital in Saudi Arabia. All images were obtained using 3T Scanner (Siemens Skyra). The images from the DIR, FLAIR, and T2WI sequence were compared on axial planes with identical anatomic position and the number of lesions was assigned to their anatomical region.

Results

Comparing the lesion load measurement at various brain anatomical regions showed a significant difference among those three methods (p < 0.05).

Conclusion

DIR is a valuable MRI sequence for better delineation, greater contrast measurements and the increasing total number of MS lesions in MRI, compared with FLAIR, and T2WI and DIR revealed more intracortical lesions as well; therefore, in MS patients, it is recommended to add DIR sequence in daily routine imaging sequences.

In vivo high angular resolution diffusion-weighted imaging of mouse brain at 16.4 Tesla

Magnetic Resonance Imaging (MRI) of the rodent brain at ultra-high magnetic fields (> 9.4 Tesla) offers a higher signal-to-noise ratio that can be exploited to reduce image acquisition time or provide higher spatial resolution. However, significant challenges are presented due to a combination of longer T₁ and shorter T₂/T₂* relaxation times and increased sensitivity to magnetic susceptibility resulting in severe local-field inhomogeneity artefacts from air pockets and bone/brain interfaces. The Stejskal-Tanner spin echo diffusion-weighted imaging (DWI) sequence is often used in high-field rodent brain MRI due to its immunity to these artefacts. To accurately determine diffusion-tensor or fibre-orientation distribution, high angular resolution diffusion imaging (HARDI) with strong diffusion weighting (b >3000 s/mm²) and at least 30 diffusion-encoding directions are required. However, this results in long image acquisition times unsuitable for live animal imaging. In this study, we describe the optimization of HARDI acquisition parameters at 16.4T using a Stejskal-Tanner sequence with echo-planar imaging (EPI) readout. EPI segmentation and partial Fourier encoding acceleration were applied to reduce the echo time (TE), thereby minimizing signal decay and distortion artefacts while maintaining a reasonably short acquisition time. The final HARDI acquisition protocol was achieved with the following parameters: 4 shot EPI, b = 3000 s/mm², 64 diffusion-encoding directions, 125×150 μm² in-plane resolution, 0.6 mm slice thickness, and 2h acquisition time. This protocol was used to image a cohort of adult C57BL/6 male mice, whereby the quality of the acquired data was assessed and diffusion tensor imaging (DTI) derived parameters were measured. High-quality images with high spatial and angular resolution, low distortion and low variability in DTI-derived parameters were obtained, indicating that EPI-DWI is feasible at 16.4T to study animal models of white matter (WM) diseases.

Current developments in MRI for assessing rodent models of multiple sclerosis

ABSTRACT: 

MRI is a key radiological imaging technique that plays an important role in the diagnosis and characterization of heterogeneous multiple sclerosis (MS) lesions. Various MRI methodologies such as conventional T 1/T 2 contrast, contrast agent enhancement, diffusion-weighted imaging, magnetization transfer imaging and susceptibility weighted imaging have been developed to determine the severity of MS pathology, including demyelination/remyelination and brain connectivity impairment from axonal loss. The broad spectrum of MS pathology manifests in diverse patient MRI presentations and affects the accuracy of patient diagnosis. To study specific pathological aspects of the disease, rodent models such as experimental autoimmune encephalomyelitis, virus-induced and toxin-induced demyelination have been developed. This review aims to present key developments in MRI methodology for better characterization of rodent models of MS.