0:00

Other risks for MRI patients include the things that might be in

0:05

them or on them.

0:08

This particular case is a patient who had bilateral

0:13

deep brain stimulators.

0:15

Patient was also a competitive shooter and didn't

0:20

want the pulse generator in their upper chest

0:25

on their shooting side.

0:26

They didn't want to have to worry about the butt of a shotgun up

0:31

against the pulse generator. So they asked the implanting physician,

0:36

is there some other place other than my upper pectoral region where

0:42

the pulse generator can go? And the surgeon said, sure,

0:45

we can just add a lead extender and we can put it down in the lower abdomen.

0:50

And so bilateral deep brain stimulator pulse generator on one side

0:56

in the pectoral region and pulse generator for the opposite

1:01

side with lead extender was down in the lower abdomen.

1:06

This patient was having lower back pain,

1:10

and even though both of the deep brain stimulators

1:15

were Mr. Conditionally labeled,

1:17

they were MR Conditional at 1.5 Tesla.

1:21

So this site that did the imaging study was doing a lumbar

1:26

study on this patient and wound up

1:31

irradiating the pulse generator in the abdomen and the leads

1:36

as a part of doing that lumbar study.

1:39

And that induced energy traveled the entire length of the lead

1:44

to its terminus in the patient's deep brain.

1:48

The image on the right is a CT study after the mr,

1:54

and you can see on the left side of the image a little bit of

1:59

spark artifact from where the lead terminated in the

2:03

deep brain. But on the right side,

2:06

you can see some pretty significant damage.

2:11

This is a burn resulting from the exposure

2:16

of the pulse generator and the lead in the abdomen

2:21

to the radiofrequency energy from that lumbar spine study.

2:26

Now the site presumed that because they were doing the image

2:31

on a one Tesla open magnet,

2:34

one Tesla is a smaller number than 1.5 Tesla,

2:38

ergo it must be at least as safe if not safer.

2:42

In this particular instance, that was not the case. And this patient,

2:48

well, the patient did poorly after having a couple

2:53

centimeters of their deep brain ablated from the RF energy

2:58

from that

2:58

Particular study.

3:00

This is an article from an adverse event.

3:05

Oregon Health Sciences University hit with a second lawsuit.

3:10

This one was related to a patient who had an

3:15

external insulin pump purportedly.

3:18

The patient told the MRI department about the presence of the insulin

3:23

pump, but the patient was imaged with it in place.

3:28

After the mri, the pump malfunction caused an uh,

3:33

bolus over delivery of insulin leading her to suffer

3:38

a diabetic seizure and near death.

3:41

What's not included in this particular excerpt is that it was not immediately

3:46

attributed to the fact that the MRI caused the malfunction and

3:51

the patient continued using this pump and the same thing

3:56

happened the following day.

3:58

So two insulin overdoses in the space of 24

4:03

to 48 hours as a result of per the suit,

4:07

an interaction between the insulin pump and the mri.

4:12

For this study,

4:15

insulin pumps can be very difficult to

4:20

observe because they're small.

4:24

They are frequently self-contained and packaged and placed on

4:29

the body of the patient In areas around the abdomen,

4:34

they may not be particularly obvious and patients who are insulin

4:39

dependent and use these unplanted or wearable pumps may

4:43

largely forget about them in terms of disclosing them at the

4:48

time of an MRI study,

4:51

making them even more difficult to identify and

4:56

capture.

4:57

The point of injection often in the abdomen does not have to be the

5:03

location of the pump itself.

5:06

Here we have a pump strapped to the boot of this particular person

5:10

with a small catheter going up to the abdominal injection site.

5:15

So simply patting somebody down around the abdomen itself

5:21

may not be sufficient if the pump is remote.

5:25

In addition to interferences with implants and medical

5:29

devices and the projectile related accidents,

5:33

you may remember the number one source of injury accidents

5:38

in MRI is burns related to

5:42

radiofrequency. Now, we looked at that with a deep brain stimulator,

5:46

but the more common manifestation of that are

5:51

superficial burns.

5:53

Now this particular slide features large

5:56

Caliber body loop related burns,

6:00

and as you can see with the drawing of the figure exposure

6:05

to the radiofrequency energies induces electrical voltages

6:10

in the patient's own tissues.

6:12

This is not electrical shock sensible voltages,

6:18

but the voltages are there. Nonetheless,

6:21

when the body creates circuits, think circles,

6:27

when there is a closure of a circle of human

6:32

tissue,

6:33

the point of closure going through the skin and the

6:37

subdermal fat is a point at which we believe there is increased

6:43

electrical resistance or resistance to the flow of those induced voltages within

6:48

the body of the patient.

6:49

It is not uncommon to see kissing burns

6:54

bilateral burns at the points of contact.

6:58

The image on the left of the screen, it's cropped rather badly,

7:02

and I apologize for that.

7:03

There's a burn on the thumb of the patient and then adjacent to that,

7:08

between the thumb and the diagram of the figure is a burn on

7:13

that patient's thigh.

7:15

So the contact point between the thumb and the thigh is the

7:20

closure of that circuit.

7:23

That circle of electrical current flowing through the body of

7:27

the patient on the right hand side are bilateral

7:32

thighs. And again,

7:33

we see kissing third degree burns on the thighs,

7:38

and this can be again,

7:40

if the medial thighs also sometimes seen medial calves

7:46

are the point of contact that allow a circuit to be closed.

7:51

These burns can happen outside of the field of view because

7:57

RF energy is distributed over a volume of space

8:02

that if you're using the body coil for rf,

8:05

transmit that volume of space, maybe 50,

8:08

60 centimeters in the SI direction.

8:12

That entire volume about the center of

8:17

your region of interest is receiving RF energy and the

8:22

induced currents can happen from that energy that's induced

8:27

inside that volume. The next image is a little bit upsetting.

8:33

This is the forearm of an infant.

8:37

Infant was in the hospital, brought down for an mri,

8:40

was swaddled and asleep.

8:44

They didn't want to wake the child,

8:46

so they decided to leave the child swaddled.

8:49

But what they didn't realize was that the child had a pulse

8:54

oximeter

8:55

Wrapped around their forearm,

8:57

the wrist and forearm that somebody had just unplugged and then

9:02

wrapped up in the blankets and not removed when that

9:07

patient was imaged.

9:08

The pulse oximeter not an MR conditional device and

9:13

not used per MR conditional conditions,

9:16

heated and produced circumferential burns

9:21

around the patient's wrist and forearm.

9:24

This is actually resulted in the amputation of this infant's

9:29

forearm. The burn was so severe that the limb could not be saved.

9:35

These are some of the types of risks that

9:40

we ask MRI facilities, technologists, and yes,

9:45

even radiologists to prospectively manage through

9:50

best practices and policies and procedures that

9:55

I implement,

9:57

the preventative steps that can help these horrific accidents from

10:02

occurring.