Magnetic Resonance Imaging

Eric Case Fall 2013

History

History
How old do you think it is? Basic principles were proposed in the early 1920s. Investigations continued for over 20 years with no major breakthroughs. Felix Bloch and Edward Purcell separately discovered the basic principle in solid matter during this time. Blochs technique was commercialized by 1953 and marketed as nuclear magnetic resonance for evaluating pharmaceuticals and chemicals.

History
Paul Lauterbur suggested in 1973 that Blochs discovery could be applied to imaging. 1977 brings us the first images using this technique. Clinical trials as an imaging tool began in 1981. Advancements in equipment and technology are continually changing the field even today including PET/MRI.

Basic Principles

Basic principles
Every atom in the body spins on its own magnetic pole. Hydrogen atoms are used most for imaging When the protons of atoms are placed in a strong magnetic field, they try to align themselves in that field The protons are spinning as well. They start to wobble when they realign. This is called precession The precessing protons will absorb RF (radiofrequency) pulses when they are applied. This absorption is called resonance.

Basic Principles

Each precessing proton has a natural resonance. It can be calculated using the Larmor frequency: = B is the frequency of precession is a constant gyromagnetic ratio based on the nucleus B is the strength of the magnetic field in Tesla

Basic Principles

The RF pulse is then turned off. When this happens, the precessing protons will return to a normal state. As they return, they release energy. This is called relaxation. There are two states of relaxation.

Basic Principles
The two types of relaxation are: Spin-lattice (T1 or longitudinal) energy is released into the general environment around the proton. This is also the time it takes to return to the net Magnetization vector (net Mv) Net Mv is the sum of the directions and magnitudes of the magnetic spins Spin-Spin (T2 or transverse) energy is released inside the nuclei Both are used in signal production. Images weighted either way will give different kinds of information such as tissue vs. fluid

Basic Principles
This released energy is detected by the gradient coils. The gradient coils convert the signals to an electrical signal. Signal strength is dependent on proton density, or the concentration of protons The electrical signal is sent to a processing computer which compiles the signals into the image.

Basic Equipment

MRI Scanner
Closed MRI

Magnets
There are two types of magnets used in MRI: Permanent Electromagnetic Magnets used in MRI have field strengths of 1.5 3 Tesla Magnetic strength is also measured in gauss. The Earths magnetic field measures 0.5 gauss. 1 Telsa = 10,000 gauss

Magnets
These are Neodymium Rare Earth Magnets. They have the almost the same magnetic strength as a scanner, but their size reduces the magnetic field. They have a field strength of 1.3 Tesla.

Equipment cont.
Open MRI Machines

Equipment cont.
Mobile MRI

Other Equipment

Head Coil Extremity Coils

Torso Coil

Control Room

Common Procedures

Brain
MRI is the preferred method for imaging the Central Nervous System Since it images tissues so well, the radiologists can tell the difference between white and gray matter Indicated for tissue pathologies, i.e. tumor, inflammation, distention, malfunction

Spine
Indicated for spinal pathologies, i.e. tumor, inflammation, osseous deformity or trauma

Chest
Able to provide great definition of the cardiac and lung tissue Mainly used in Cardiology Other indications for tissue pathologies, i.e. tumor, inflammation, distention, malfunction

Abdomen
Indicated for tissue pathologies, i.e. tumor, inflammation, distention, malfunction

Pelvis
Indicated for tissue pathologies, i.e. tumor, inflammation, distention, malfunction

Extremities
Great distinction between soft tissue and bone Useful in diagnosing tissue injuries

Typical Activities

Typical activities
Radiographer Patient preparation and screening Equipment inspection and safety Patient history gathering Communication with radiologists and other staff Performing exams Basic housekeeping

Typical activities
Radiologist Typically not in the room during the exam Reads the exam from a PACS workstation with enhanced monitors Prepares the report and makes findings available to the ordering physician Answers any questions from the ordering physician or their staff

Patient Care

Before the exam

Verify order Ensure exam room is ready and get patient Complete MRI checklist with patient Properly dress patient Advise patient on what will happen Address any concerns with the patient

During the exam..

Ensure patient remains calm and still during the exam. Monitor patient

Slide Master

After the exam

Address any concerns the patient had Inform them of any post procedure instructions Assist patient with getting dressed if necessary Follow up on any concerns the patient had

Contrast notes
Gadolinium is the preferred contrast agent Barium is not used because. It cannot be injected! It will no appear on some T1 or T2 weighted exams

Radiation Protection and Safety

Radiation Protection
There is no way to protect the patient from radiation because There is no radiation! However, there are some very critical safety concerns with MRI. Some deal with patient safety, others with equipment safety.

Device Categories
MRI Safe Any device that is safe entering a 1.5T exam room Devices must have been tested and approved
MRI Conditional Seven different subcategories Devices are rated based on their ferrous affinity May or may not pose a threat to the patient or others MRI Unsafe Devices pose a significant danger in the presence of a magnetic field Two different subcategories Severe complications may arise

Patient Safety
Patients need to be screened before having an MRI. Why? We need to know what, if any, metal objects are on or in them. Some possibilities of danger are flying objects, forced removal from the body, burns from heating and malfunction of implants. Checklists help the technologists accomplish this.

Screening Checklist
MRI Checklist Sample!!!!

Equipment Safety
All ancillary equipment that enters the exam room MUST be MRI compliant! This includes carts, oxygen tanks, chairs and IV poles to name a few.

Safety Videos
http://www.youtube.com/watch?v=lEJ2notNLo0\ http://www.youtube.com/watch?v=byRIwDk21sw

Back to the Neodymium

This could be interesting! http://www.youtube.com/watch?v=L00t5nuy2JE

Educational Requirements

Basic Requirements
Standards are changing January 1, 2014 Must hold current certification in Radiography, Nuclear Medicine, Sonography, or Radiation Therapy or have completed a bachelors program within the last three years Beginning in 2016, candidates must also complete 16 hours of structured training

Clinical Requirements
The Clinical Experience Requirements for MRI consist of 53 procedures in seven different categories. The seven categories include: A. Head and Neck B. Spine C. Thorax D. Abdomen and Pelvis E. Musculoskeletal F. Special Imaging Procedures G. Quality Control

Clinical Requirements, Cont.

Candidates must document the performance of complete, diagnostic-quality procedures according to the following rules: Choose a minimum of 25 different procedures out of the 53 available procedures Complete and document a minimum of three and a maximum of five repetitions of each chosen procedure; less than three will not be counted. Complete a total of 125 repetitions across all procedures. No more than one procedure may be documented on one patient. For example, if an order requests an MRI of the Head and Neck for one patient, only one of these, including the post-processing procedures, can be documented for clinical experience documentation.

Examination

Application for exam is mailed to the ARRT once requirements are met Application is reviewed for completeness and a 90 day testing window is scheduled Exam is 200 questions Candidates are allowed three attempts within a three year window

Comparisons To Diagnostic Radiography

Comparisons
Diagnostic Radiography MRI
Uses ionizing radiation to produce Uses magnetic fields and RF pulses to the image produce the image Two-dimensional Patient manipulation required to show area of interest No new significant progression in technique Tissues superimpose on image Three-dimensional Patient movement is detrimental to the exam New understanding and technology has created new techniques, i.e. PET/MRI Certain frequencies can be omitted for tissue visualization

Both require anatomical knowledge, computer skills, technological training and outstanding patient care

Quiz time!!

Question 1
Radiation protection is important in MRI because: a. Reduces patient dose b. Reduces radiographer dose c. ALARA still applies d. None of the above

Answer : D

Question 2
Magnetic Resonance was first realized in the : a. 1920s b. 1940s c. 1960s d. 1970s

Answer : A

Question 3
Only MRI ___________ equipment is allowed in the exam room. a. Conditional b. Compliant c. Coordinated d. Any equipment is allowed

Answer : B

Question 4
Certification requirements for MRI are changing in: a. 2014 b. 2016 c. Both d. Neither

Answer : C

Question 5
The spin-lattice relaxation process is also known as : a. T1 b. Rest time c. T2 d. Sequestration time

Answer : A

Question 6
The spin-spin relaxation process is also known as : a. T1 b. Rest time c. T2 d. Dizzy time

Answer : C

Question 7
Most diagnostic magnets have a strength of: a. 1T b. 1.5T c. 5T d. 5.5T

Answer : B

Question 8
The sum of the magnitudes and directions of the magnetic spins is known as the : a. Net magnetization vector b. Additional variable c. Geometric factor d. I give up factor

Answer : A

Question 9
All of the following are types of MRI units except a. Open b. Mobile c. Fonar d. Bloch

Answer : D

Question 10
Which magnets are used in MRI: 1. Permanent 2. Electromagnetic 3. Rare Earth a. 1 b. 2 c. 3 d. 1 & 2 e. 1, 2 & 3 Answer : D