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0000013088 00000 n 826 0 obj <> endobj 0000013614 00000 n It is prudent to screen all girls and women of reproductive age for pregnancy before granting them access to the MR imaging environment. 0000006074 00000 n Reducing the read bandwidth or increasing the repetition time can reduce dB/dt. An action plan that lays out personnel responsibilities in the event of a quench should also be in place. Additional technical and safety policies relate to pediatric, unconscious, incapacitated, or pregnant patients and pregnant imaging personnel. Newer magnets are built to minimize the field strength outside the bore of the magnet, a technique termed shielding. If the patient’s eGFR is 45–60 mL/min/1.73 m2, we check for any prior eGFR result to ensure that there has not been a decrease in the eGFR of 10 mL/min/1.73 m2 since a prior eGFR calculation within 6 months or from the patient’s baseline level (if multiple prior measurements are available). h���1 0ð4\k\c=t��՞4mi�. At present, although results of only a few studies with small numbers of patients, variable data, and confounding factors are available, there is no definitive evidence of harmful effects from performing routine (nonenhanced) MR imaging examinations in pregnant patients. For this reason, the entry doors to an MR imaging suite are bulkier than conventional doors and contain specialized handles that form a conductive seal around the entire frame when turned to the closed position. 0000015749 00000 n There are several recognized mechanisms for thermal injury. Connect with us . To achieve such currents in a conventional electromagnet would require a massive amount of continuous power. Zone III.—This is the area where there is a potential danger of serious injury or death from interaction between unscreened people or ferromagnetic objects and the magnetic field of the MR imaging unit. 0000069740 00000 n Specific examples of the latter include physicians, nurses, and nonimaging technologists who enter the MR imaging suite in urgent situations; security and cleaning personnel who are responding to emergencies or are unaware of MR imaging safety hazards; and patients’ family members and friends. Radiofrequency coils need to be very sensitive to acquire MR signal, which unfortunately makes them sensitive to unintentional background electronic noise. The ACR Manual on MR Safety addresses numerous MR safety-related topics such as: hތQ�OSq�~]x/(�� Moreover, in our institution, all pregnant patients must sign an “MRI in Pregnant Patient” consent form provided by a physician (either from the radiology department or from the ordering service) before they undergo any MR imaging examination. This mechanism is suspected in the case of a patient who was imaged while a pulse oximeter was attached to his fingertip; despite proper cable placement and careful spacing with padding and cloth, a third-degree burn occurred at the lead tip, necessitating amputation of the digit (31). AUSTRALIA. Patients at the highest risk for a reaction to GBCAs are those with a history of reactions to the same agent and those who have experienced multiple other allergic reactions. The main magnetic field of an MR imaging unit places unique constraints on how emergencies are handled inside an MR imaging suite, in particular within zone IV. To prevent this, receive coils contain electronics to block the resonance induction during radiofrequency transmission, but this works only if the coils are properly connected to the MR imaging system. 0000201699 00000 n However, if an emergent situation arises when the magnetic field must be shut off immediately (eg, a patient is pinned by a projectile), a magnet quench can be initiated. It is especially critical that all potential emergency responders are aware of the hazards associated with zone IV, as it is easy to forget to properly screen for potential ferromagnetic projectiles during an emergency response. Health care workers at outpatient facilities in particular may need to prescreen patients before their appointment to minimize this potential delay at the time of MR imaging. endstream endobj 899 0 obj <>/Filter/FlateDecode/Index[113 713]/Length 46/Size 826/Type/XRef/W[1 1 1]>>stream With most modern clinical imaging units, if any one of the FDA limits is going to be exceeded within an examination, the user is notified automatically, and the parameters must be changed so that the SAR limits are not exceeded. It should be noted that there is no direct evidence that immediate and/or prolonged hemodialysis in these patients offers any protection against NSF; current European and ACR guidelines recommend this but acknowledge that the theory is speculative (40,53). Resuscitation equipment, including the crash cart, should be verified and labeled as MR safe or MR conditional and sited in close proximity, either within zone II or zone III (5). Magnetic fields ess than 5 Gauss are inconsequential to MRI safety. This is also our recommendation for patients who are undergoing chronic hemodialysis. These specifications are available in the medical devices section of the FDA searchable database (6). As field strengths increase, techniques for estimating and managing the SAR will become more critical for patient safety. For all inpatients, we calculate an eGFR within 24 hours if an MR imaging examination with a GBCA is desired and apply the same rules described previously. GBCAs are well tolerated by a majority of patients, and their safety profile is excellent and, by most measures, more favorable than those for iodinated contrast agents. A burn has even been attributed to iron oxide particles within a patient’s wrist identification bracelet. 0000199458 00000 n The largest gradients occur well away from the isocenter and in some cases may be near the ends of the magnet bore. The ACR Manual on Contrast Media provides a guideline outlining the timing of eGFR determination for at-risk patients (40). 0000138774 00000 n The coil cable showed no indication of a burn. These were subsequently reviewed and updated in May of 2004 (3). The document forms the basis for the safety aspect of ACR MR imaging institutional accreditation, which requires renewal every 3 years. However, abandoned intracardiac pacer wire leads lack such protection and are currently considered a contraindication to MR imaging. Each MR imaging site must also have a diagnostic medical physicist or MR imaging scientist to evaluate the performance of the MR imaging unit and receiver coils and to document that each unit meets the requirements for imaging performance set by the Joint Commission, the ACR, or other regulatory body. Hence it is crucial to secure the magnet area after a quench to ensure that first responders enter the area safely and only if they are needed. Level 2 personnel must undergo safety screening, as level 1 personnel do. For our outpatient examinations, if the Choyke screening questionnaire is completely negative and the patient is younger than 60 years of age, the imaging examination can proceed with any of our standard protocols that use GBCAs, without the need for eGFR calculation. In 2013, the ACR Blue Ribbon Panel on MR Safety issued an updated guidance document on MR imaging safe practices (5). h. MR Zones. 1, 3 March 2016 | Abdominal Radiology, Vol. xref In addition to a known history of renal insufficiency, other risk factors outlined by the ACR include a history of diabetes or hypertension requiring therapy, age older than 60 years, and prior renal surgery or malignancies (40). 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