MRISC Organizational Chart Research and Graduate Studies Dr. James Tracy College of Medicine Fred de Beer, M.D. Director Dr. Charlie Smith Administrative Staff Officer Nancy Bailey MRI Technologist Beverly Meacham Faculty Support (Primary in Academic Depts) Anders Andersen, Ph.D. Anatomy & Neurobiology Peter Hardy, Ph.D. Radiology MRISC Users David Powell, Ph.D. Biomedical Engineering

MRI Terminology 1. Ferrous- Objects made of metal that are highly attracted to the MRI machine examples: Cast Iron, Steel, Wrought Iron 2. Nonferrous- Objects made of metal that are not attracted to the MRI machine examples: Titanium, Copper, Aluminum

MRI Terminology Tesla or Gauss- Magnetic field strength is measured in one of these two units Tesla or Gauss- Magnetic field strength is measured in one of these two units 1Tesla = 10KG=10,000 Gauss Tesla is used to measure higher magnetic field strengths Tesla is used to measure higher magnetic field strengths Gauss is used to measure lower magnetic field strengths Gauss is used to measure lower magnetic field strengths example: Earth’s magnetic field is 0.6Gauss example: Earth’s magnetic field is 0.6Gauss

MRI Terminology 5 Gauss Line- inside the MRI room 5 Gauss Line- inside the MRI room ****Electronic devices and ferromagnetic objects inside the 5 Gauss line are strictly prohibited**** ****Electronic devices and ferromagnetic objects inside the 5 Gauss line are strictly prohibited****

MRI Terminology Missile Effect- Ferromagnetic metal objects such as an oxygen tank can become airborne as a projectile in the presence of a strong magnetic field. Missile Effect- Ferromagnetic metal objects such as an oxygen tank can become airborne as a projectile in the presence of a strong magnetic field.

MRI Terminology Fringe Field- stray magnetic field outside of the bore of the magnet Fringe Field- stray magnetic field outside of the bore of the magnet

MRI Terminology Static Magnetic Field- is the non-fluctuating main magnetic field Static Magnetic Field- is the non-fluctuating main magnetic field

Bioeffects: Static Magnetic Field There is a great deal of information about the possible bioeffects of static magnetic fields. There is a great deal of information about the possible bioeffects of static magnetic fields. Many effects cannot be reproduced consistently in a controlled environment. Many effects cannot be reproduced consistently in a controlled environment. Most studies conclude that static magnetic fields below 2 Tesla produce no substantial harmful bioeffects. Most studies conclude that static magnetic fields below 2 Tesla produce no substantial harmful bioeffects.

Bioeffects: Static Magnetic Fields Fields above 2 Tesla can cause the following side effects: Nausea Vomiting Dizziness Magnetophospenes

Bioeffects: Static Magnetic Field Magnetophosphenes Defined as flashes of light Caused by the induction of the electricity within the optic nerves

Bioeffects: Static Magnetic Field Other biological effects at fields above 2T include: Other biological effects at fields above 2T include: Fatigue Fatigue Headaches Headaches Hypotension Hypotension Irritability Irritability

Bioeffects: Static Magnetic Field The FDA limits clinical magnets to 8.0 Tesla. Most common clinical field strengths between.3 Tesla and 1.5 Tesla.

MRI Safety

Magnet Safety

THE INVISIBLE FORCE

Safety: Missile Effect

Safety: Projectiles Small objects such as a paperclip can travel up to 60 mph when pulled into a 3Tesla Magnet. Small objects such as a paperclip can travel up to 60 mph when pulled into a 3Tesla Magnet. The amount of force on a projectile depends on the following: The amount of force on a projectile depends on the following: The strength of the magnetic field The strength of the magnetic field The mass of the object The mass of the object The distance from the magnet The distance from the magnet The orientation to the magnetic field The orientation to the magnetic field

Magnet Safety Equipment safe for MRI room: Equipment safe for MRI room: MRI Wheelchairs MRI Wheelchairs MRI Stretchers MRI Stretchers MRI Monitoring equipment MRI Monitoring equipment **Equipment will be identified as MR safe** **Equipment will be identified as MR safe** (The equipment is made of nonferrous material) (The equipment is made of nonferrous material) ***Absolutely NO outside stretchers/wheelchairs allowed in the MR Room

Video- #1 Video- #1 Chair gets stuck in an MRI machine Chair gets stuck in an MRI machine Chair gets stuck in an MRI machine Chair gets stuck in an MRI machine 27 secs 27 secs

Video #2 Video #2 MRI oxygen bottle MRI oxygen bottle MRI oxygen bottle MRI oxygen bottle 9sec 9sec

Video #3 Video #3 Oxygen cylinder in MR scan room Oxygen cylinder in MR scan roomOxygen cylinder in MR scan roomOxygen cylinder in MR scan room 2:01 min 2:01 min

Video #4 Video #4 Gurney let loose in MR scan room Gurney let loose in MR scan room Gurney let loose in MR scan room Gurney let loose in MR scan room 1:28 min 1:28 min

Screening Screening

Safety: Pregnancy Screening Possible Pregnancy   There are no known biological effects of MRI on fetuses.   Many of the mechanisms could potentially cause adverse affects in developing fetuses   FDA requires labeling of MR systems to indicate the safety when imaging a fetus or infant.   Benefit should out weight the risk and caution should be used within the first trimester.

Safety: Pregnant Employees Pregnant Employees No known effects Should avoid RF and gradient magnetic fields. Make your own decision

Subject Screening The MRI subject questionnaire should include the following: The MRI subject questionnaire should include the following: Subject history related to problem Subject history related to problem Previous surgeries Previous surgeries Metallic foreign bodies Metallic foreign bodies Possible Pregnancy Possible Pregnancy Biomedical Implants Biomedical Implants Pacemaker Pacemaker Aneurysm Clips Aneurysm Clips

Subject Screening All subjects will have a screening form completed Forms are filed in the Study Binder kept in the MRI console area.

Safety: Subject Screening Evaluating Implants Evaluating Implants Determine type and location Determine type and location Use published implant list Use published implant list Call surgeon Call surgeon Call manufacturer Call manufacturer

Safety: Subject Screening Evaluating Metallic Foreign Bodies: Evaluating Metallic Foreign Bodies: Determine type, location, and size Determine type, location, and size Use X-ray to evaluate Use X-ray to evaluate Use CT to evaluate orbital objects Use CT to evaluate orbital objects

Safety: Subject Screening Protecting From Missile Effect (Projectiles) Protecting From Missile Effect (Projectiles) Remove any and all metal (lockers available) Remove any and all metal (lockers available) Dress subject in gown or scrubs if required Dress subject in gown or scrubs if required Check all metallic items with bar magnet Check all metallic items with bar magnet Wheelchair, Patient Beds, Oxygen tanks Wheelchair, Patient Beds, Oxygen tanks

Safety: Subject Screening MRI complications with Tattoos: Rarely, tattoos or permanent makeup might cause swelling or burning in the affected areas during MRI exams. In some cases, tattoo pigments can interfere with the quality of the image — such as when a person who has permanent eyeliner has an MRI of the eye.

Safety: Auditory Effects MRI is a noisy procedure. MRI is a noisy procedure. Various noises come from gradients, cryogen pumps, and monitors. Various noises come from gradients, cryogen pumps, and monitors. Gradient noise is the most potentially harmful. Gradient noise is the most potentially harmful. Caused by vibrations of the gradient coils within their fiberglass casing. Caused by vibrations of the gradient coils within their fiberglass casing.

Safety Auditory Effects Effects can include the following: Effects can include the following: Annoyance Annoyance Decreased ability to communicate Decreased ability to communicate Increased anxiety Increased anxiety Potential temporary hearing loss Potential temporary hearing loss Potential permanent hearing loss Potential permanent hearing loss

Safety: Auditory Effects Techniques used to reduce the risk of hearing loss during the MRI procedure include the following: Techniques used to reduce the risk of hearing loss during the MRI procedure include the following: Ear plugs /Ear muffs Ear plugs /Ear muffs Active noise cancellation Active noise cancellation

Safety: Subject Monitoring Who should be monitored? Who should be monitored? Sedated subjects Sedated subjects Subjects with communication difficulties Subjects with communication difficulties Subjects with weak voices or impaired hearing Subjects with weak voices or impaired hearing All Subjects should be monitored visually and verbally. All Subjects should be monitored visually and verbally. Give Subjects emergency squeeze ball Give Subjects emergency squeeze ball

Safety: Subject Monitoring Problems with subject monitoring include the following: Problems with subject monitoring include the following: Monitors attracted to the magnet (8ft) Monitors attracted to the magnet (8ft) RF distorts monitor readings (Shielding) RF distorts monitor readings (Shielding) Monitor causes artifacts on MRI images Monitor causes artifacts on MRI images Monitor wires may cause subject burns (fiber optic) Monitor wires may cause subject burns (fiber optic)

Safety: Subject Monitoring Techniques used to reduce the potential for subject burns from monitors include the following: Techniques used to reduce the potential for subject burns from monitors include the following: Straighten looped cords Straighten looped cords Eliminate direct subject contact where possible Eliminate direct subject contact where possible Use only tested MRI safe devices Use only tested MRI safe devices

Safety: Subject Monitoring Commonly used MRI subject monitoring techniques include the following: Commonly used MRI subject monitoring techniques include the following: EKG EKG Capnography Capnography Blood Pressure Blood Pressure Pulse Oximetry Pulse Oximetry Ventiltor Ventiltor

Safety: Subject Monitoring EKG monitor monitors the heart rate. EKG monitor monitors the heart rate.

Safety: Subject Monitoring Pulse Oximeter measures the oxygen level of the blood. Pulse Oximeter measures the oxygen level of the blood.

Safety: Subject Monitoring Ventilator breaths for heavily sedated subjects that cannot breath on their own. Ventilator breaths for heavily sedated subjects that cannot breath on their own. The monitors used in MRI are MRI safe and only used in the MRI suite. The monitors used in MRI are MRI safe and only used in the MRI suite.

Subject Management

Subject Management - Claustrophobia Claustrophobia is defined as an anxiety disorder that involves the fear of enclosed or confined spaces. Claustrophobia is defined as an anxiety disorder that involves the fear of enclosed or confined spaces. Subjects that experience claustrophobia can have panic attacks. Subjects that experience claustrophobia can have panic attacks.

Subject Management - Claustrophobia Ways to manage claustrophobia include: Ways to manage claustrophobia include: Educate the patient Educate the patient Ensure sufficient air flow Ensure sufficient air flow Provide light within the bore Provide light within the bore Cover eyes or use mirrors Cover eyes or use mirrors Communicate often with patient Communicate often with patient

Emergency Procedures

Quench Quench A quench is the spontaneous release of the liquid gasses that maintain the superconductive magnetic field All systems are built with a "quench button". The primary use for the button is to render the unit non-magnetic in case of an emergency (object projectile into the magnet, etc), but is also utilized to "quench" when the magnet (MRI) is being taken out of service.

Quench What to do if a quench occurs What to do if a quench occurs Evacuate the room Stay low to the ground, Oxygen will be low Asphyxiation/Frostbite/Hearing Loss can occur

Quench Video

Quench Video h_insideSo.htm

Emergency Procedure ***Only Quench the Magnet if it is life or death** ***Only Quench the Magnet if it is life or death** Do not quench: If metal is stuck in the magnet Do not quench: If metal is stuck in the magnet ie buffer, O2 tank ie buffer, O2 tank

Emergency Procedure Medical Distress: 1. Cardiac Arrest 2. Respiratory Distress 3. Seizure ***Call 911, Remove Subject from Magnet ASAP--Shut Magnet Door Begin CPR (if indicated)…..outside of MRI room Begin CPR (if indicated)…..outside of MRI room Crash Cart located next to subject lockers Crash Cart located next to subject lockers ***NEVER Bring Crash Cart into Magnet Room*** Do not allow anyone into Magnet room Do not allow anyone into Magnet room

Emergency Procedure Emergency Electrical Shutdown Button Emergency Electrical Shutdown Button Located: In MRI Console area Used to shut down electrical power to unit Used to shut down electrical power to unit ie. Fire/smoke **This does not Quench the Magnet, Emergency Personnel do not enter MRI room unless they remove all metal**