MRI Safety The American College of Radiology (ACR) has developed a set of guidelines to be used in the design of the

MRI suite utilizing four zones: Zone I. Any area freely accessible to the general public. It should lie outside the MRI suite but lead to its entrance. Zone II. Serves as a buffer zone. Includes the reception and waiting areas. Zone III. Areas restricted to MRI personnel and other individuals and equipment that have been properly screened. MRI personnel are in charge of supervision and safety of this room. Zone III Includes the MRI control room. The fringe field in this area is . 5mT (5 gauss). A clear red line should be made visible. Zone IV. This is the scan room itself. It should be marked with the necessary warnings and cautions pertaining to the magnetic field and should always be observable by the MRI personnel

The FDA has set limits of the strength of the main magnetic field at 8 T for adults and children and 4 T for infants less than one month old Effects and safety of Radio Frequency Pulses RF may induce electrical current in the body, this results in the generation of heat due to resistance of the tissues Specific Absorption Rate (SAR) The ability of patient to dissipate heat during MRI depends on many factors such coil type, RF pulse amplitude, ambient room temperature, air flow through the bore, sequence type, number of slices, TR,TE, Saturation pulses, and volume of tissue being scanned. Some parts of the body have very limited ability to dissipate heat that may include the cornea and the testicles. Heat deposition is increases with higher magnetic field. The FDA guidelines for maximum Specific Absorption Rate (SAR) exposure, released in 2003, are 4 Watt/kg averaged over 15 minutes for the whole body, 3 Watt/kg averaged over 10 minutes for the head, and 12 Watt/kg per gram of tissue over five minutes for the extremities Rapidly changing magnetic filed

According to Faradays law of induction, changing magnetic fields may cause induced electrical current in conductors within the body. The gradient magnetic force strength increases away from the isocenter. There are a variety of conductors in the body, blood vessels, muscles and nerves, rapidly changing magnetic field especially in EPI sequence may cause nerve stimulation or muscle tissue to excite. The FDA limits the exposure to Time-varying magnetic fields by using the Faradays Law of induction equation db/dt =dV, where db is the magnetic field change (which is caused by the gradients), dt is the change overtime, and dV is the change in voltage that result from altering the magnetic field over time. Physical hazards of MRI 1) Quenching: sudden and massive expansion of liquid helium into gaseous helium due to the increase of heat from a sudden loss of superconductivity of the magnet. If the superconductor becomes resistive, it heats up. As it heats, it becomes more resistive. The result of such a situation is a quench. Quenches may be controlled, as when a magnet is ramped down. On the other hand, quenches may occur as a result of a lack of liquid helium or mechanical trauma to the cryostat that causes the conductor to come in contact with a warmer component of the cryostat. If this contact happens, an uncontrolled quench occurs, and the energy stored in the magnet is converted to heat. Much of this heat boils off the cryogens. However, some of this heat may raise the temperature of the cryostat and damage the superconductive windings. Such a violent quench can destroy a magnet. In the event of an unplanned quench, one may first hear a hissing noise, caused by the release of helium, nitrogen, or both, both gases can displace oxygen and cause asphyxiation Quenching is an emergency situation and the patient must be evacuated immediately and treated for any possible injuries. 2) Physical attraction The strong magnetic force creates an environment in which ferromagnetic objects could become projectiles. Objects may be pulled into the magnet with great force creating dangerous projectiles. Any object, regardless of size, could be considered dangerous. Small objects such as paper clips and hairpins have a terminal velocity of 40 mph when pulled into a 1.5 T magnet. All objects and instruments should be tested before being brought into the scan room, and any device made of or containing metal parts should be verified in writing that they are safe for MRI. Comprehensive safety policies and procedures must in place to ensure the safety of patients and personnel and it is the responsibility of the technologist to see that these are strictly adhered to in order to prevent serious accidents, injuries, or even death. Biological effects As yet, no long term adverse biological effects of extended exposure to the magnetic field associated with MRI have been documented Metal Implanted devices Metal Implanted devices presents two problems, first it may distort the images due to its susceptibility, second it may absorb energy and raise the temperature of the surrounding tissue, smaller implanted metallic objects may be moved by the torque induced by the magnetic filed. Biostimulation Devices

1- The safe limit by FDA limits the Electronic implanted devices to 5-Gauss as maximum limit. The magnetic field may change its mode of operation or even stop it. These devices may include but not limited to Cardiac pacemakers/pacemaker wires, Electronically, magnetically, or mechanically activated implanted devices Absolute contraindications to MRI There are several absolute contraindications to MRI 1. Cardiac pacemakers/pacemaker wires 2. Electronically, magnetically, or mechanically activated implanted devices 3. Metallic orbital foreign bodies 4. Tissue expanders 5. Ocular prostheses 6. Dental implants Relative contraindications include: 1-Intracranial vascular clips2- Extra-cranial vascular clips3- Intravascular coils, filters, and stents4- Heart valves5- Middle ear prostheses6- Penile prostheses 7- Shrapnel/foreign bodies 8- Halo vests Devices that are relatively safe to study include Surgical hemostasis clips (after a 2-3 month post surgery delay) Orthopedic prostheses, pins, rods, and plates Dental fillings and orthodontic braces Intrauterine devices (IUDs) and contraceptive diaphragms Pregnant Patient Magnetic Field Data currently available about hazards of magnetic field on fetus/embryo does not show any contraindication to scan pregnant patient, however, this current information does not exclude future discovery of potential hazards of magnetic field on pregnancy. MRI Contrast medium Contrast medium may cross blood barrier into placenta. Some adverse effects are possible. Contrast medium used in MRI should not be used for pregnant patient or breast feeding patient without the consent of MR medical director Gadolinium Side effects: Site of injectin: pain, burning sensation, redness, phlebitis, and thrombi- phlebitis may occur with the first 24 hours and resolve by supportive treatment Digestive system:Nausea and/or vomiting and Gastrointestinal upset Lab reading results: Slight transitory increase in bilirubin, blood iron reduction in calcium

Neurological system and senses: Mild transitory headaches, dizziness, chest pain, back pain, weakness Hypotension Respiratory side effects: Anaphylaxis and/or respiratory problems, shortness of breath,Dry mouth, dyspnia, thraught irritation, sneezing, cough and sneezing Death (2/500,000 injection Kindneys :Nephrogenic Systemic Fibrosis(NSF). Skin:Rash, sweating, pruritis, and hives Contraindication When scanning pregnant women (Patients who are uncertain as to whether they are pregnant will be required to have a screening urine or blood pregnancy test) In women choosing to breast feed In patients with hemoglobinopathies hemolytic anemia sickle cell anemia hematological disorders In patients with renal disease (CrCl < 20 ml/min) Aute or chronic renal insufficiency of Glomerular Filtration rate less than 30ml/min/1.73m2 In patients with an allergic history or diabetics Patients with unstable angina or New York Heart Association functional class IV heart failure Asthma

Patient screening