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How I Do CMR Scanning Safely: Elisabeth Burman Research Sister Royal Brompton Hospital, London UK
How I Do CMR Scanning Safely: Elisabeth Burman Research Sister Royal Brompton Hospital, London UK
How I Do CMR Scanning Safely: Elisabeth Burman Research Sister Royal Brompton Hospital, London UK
Elisabeth Burman
Research Sister
Royal Brompton Hospital, London UK
This presentation is posted for members of scmr as an
educational guide it represents the views and practices of
the author, and not necessarily those of SCMR.
2011 update: some updates added to terminology, MR conditional
devices, and contrast with renal failure. JMoon
Magnetic Resonance
One of the safest imaging modalities but there
are still safety issues
Advantages
Non-invasive
No ionizing radiation
Repeat studies present no problem
Fewer ethical problems imaging volunteers
biological effects
mechanical effects
Gradient Field
RF Field
RF power deposition
Burns
Other issues
contrast agents
critically ill patients/resuscitation
monitoring
quench
claustrophobia
2.
1.5T
Magnetohydrodynamic effect
seen as augmentation of T-wave
Caused by the effect of the static magnetic field on moving
blood (systole) as a conducting fluid.
The gradient and RF fields also affect the configuration of the
ECG
Morphological ECG changes are therefore difficult to detect
and diagnose, but rhythm is usually recognised
Any concern regarding rhythm, remove patient from scanner
and perform 12 lead ECG
Signage
Infusion pump
Floor buffer
Contraindications to CMR*
Implants & metal
Electromechanical implants
Pacemakers /ICDs
Pacing wires
Cochlear implants
Neurostimulators
Hydrocephalus shunts
Implants
Cerebral clips
Foreign bodies
Maybe situated near vascular or nervous tissue
If in doubt x-ray
Pacemakers
Highly specific guidelines are required
BIOMEDICAL IMPLANTS
OTHER
CARDIAC
sternal wires
heart valves & annuloplasty rings
coronary stents
epicardial wires (cut short and taped)
other vascular stents, coils and filters
orthopaedic implants
contraceptive devices
dental implants
occlusion devices
catheters (without guidewire)
Effects of implants on imaging - signal void / local distortion
Important to know
Previous neurosurgery?
Implants or metal in the body?
Pregnant (prudent approach)?
Drug patch with foil backing?
Essential preparation
(iron oxide)?
Preparation of patient
Prevention of burns
Electrodes
Other Issues
Contrast agents
Claustrophobia
Contrast agents
all gadolinium chelates
overall patient tolerance high
incidence of adverse reactions very low
Contraindications
GFR<30ms/minute
pregnancy (risk versus benefit ratio)
breast feeding mothers
infants < 2 years
Caution
asthmatics, history of previous reactions
Sedated patients
Departmental sedation protocol with anaesthetic
approval
Nil by mouth for 6 hrs (food & milk) 2 hrs water
Medical examination
Informed consent
Tipping trolley, piped oxygen, full resuscitation
equipment
Responsible adult to collect from department and remain
with for 24 hours
Resuscitation
Monitoring
Equipment must be MR Safe or MR Conditional
MR Safe
Device when used in the MR environment, has been demonstrated
to present no additional risk to the patient BUT may affect the
quality of diagnostic information
MR Conditional
The object may or may not be safe for the patient undergoing an
MR procedure or an individual in the MR environment, depending
on the specific conditions that are present.
Ie can be used if certain device specific conditions met.
See http://www.mrisafety.com/list.asp for definitions
2011: MR conditional replaces MR compatible as terminology
Quench
Cryogens maintain the magnetic field - helium
QUENCH = the liquid helium boils off and becomes a gas
Causes
- physical
- human error (accidental)
- intervention (elective)
Effects
Elective Quenching
The magnet should only be quenched in two
situations:
If someone is trapped to the scanner by a
ferromagnetic object and is
injured and/or
distressed (eg O2 cylinder, piece of equipment)
Claustrophobia
Affects 5-10% of patients
Causes
restrictive dimensions of the interior of the magnet
duration of the examination
gradient coil induced noises
the ambient condition within the imaging bore
References
Shellock F.G. and Kanal E. (2001)
- Magnetic Resonance Bioeffects, Safety, and Patient
Management
Health Protection Agency (HPA)
(was National Radiological Protection Board -NRPB)
International Electrical Committee (IEC)
Medical and Healthcare products Regulatory Agency
(MRHA) (was Medical Devices Agency - MDA)
http://www.mrisafety.com (Shellock and Kanal)
http://www.imrser.org/
http://www.magneticresonancesafetytesting.com/