Unimap Project!!

How MRI Works!
Basic MRI Scans!
Specialized MRI Scans!
Safety!!

sAfety!!!

Death and injuries have occurred from projectiles created by the magnetic field, although few compared to the millions of examinations administered.MRI makes use of powerful magnetic fields which, though they have not been demonstrated to cause direct biological damage, can interfere with metallic and electromechanical devices. Additional (small) risks are presented by the radio frequency systems, components or elements of the MRI system's operation, elements of the scanning procedure and medications that may be administered to facilitate

MRI imaging.
Of great concern is the dramatic increase in the number of reported MRI accidents to the U.S. Food and Drug Administration (FDA). Since 2004, the last year in which a decline in the number of MRI accidents was reported, the full spectrum of MRI accidents has increased significantly in the following years. The 2008 FDA accident report data culminates in a 277% increase over the 2004 rate.
There are many steps that the MRI patient and referring physician can take to help reduce the remaining risks, including providing a full, accurate and thorough medical history to the MRI provider.
Several of the specific MRI safety considerations are identified below:

MRI Advantages

· Diagnosing multiple sclerosis (MS)
· Diagnosing tumors of the pituitary gland and brain
· Diagnosing infections in the brain, spine or joints
· Visualizing torn ligaments in the wrist, knee and ankle
These are but a few of the many of reasons to perform an MRI scan.
The fact that MRI systems do not use ionizing radiation is a comfort to many patients, as is the fact that MRI contrast materials have a very low incidence of side effects. Another major advantage of MRI is its ability to image in any plane.An MRI system can create axial images as well as images in the sagitall plane (slicing the bread side-to-side lengthwise) and coronally (think of the layers of a layer cake) or any degree in between, without the patient ever moving. If you have ever had an X-ray, you know that every time they take a different picture, you have to move. The three gradient magnets discussed earlier allow the MRI system to choose exactly where in the body to acquire an image and how the slices are oriented.


MRI Disadvantages

Although MRI scans are ideal for diagnosing and evaluating a number of conditions, they do have drawbacks. For example:
· There are many people who cannot safely be scanned with MRI (for example, because they have pacemakers), and also people who are too big to be scanned.
· There are many claustrophobic people in the world, and being in an MRI machine can be a very disconcerting experience for them.
· The machine makes a tremendous amount of noise during a scan. The noise sounds like a continual, rapid hammering. Patients are given earplugs or stereo headphones to muffle the noise (in most MRI centers you can even bring your own cassette or CD to listen to). The noise is due to the rising electrical current in the wires of the gradient magnets being opposed by the main magnetic field. The stronger the main field, the louder the gradient noise.


other specific MRI safety considerations are identified below:

Pregnancy
No effects of MRI on the fetus have been demonstrated.[56] In particular, MRI avoids the use of ionizing radiation, to which the fetus is particularly sensitive. However, as a precaution, current guidelines recommend that pregnant women undergo MRI only when essential. This is particularly the case during the first trimester of pregnancy, as organogenesis takes place during this period. The concerns in pregnancy are the same as for MRI in general, but the fetus may be more sensitive to the effects—particularly to heating and to noise. However, one additional concern is the use of contrast agents; gadolinium compounds are known to cross the placenta and enter the fetal bloodstream, and it is recommended that their use be avoided.
Radio frequency energy
A powerful radio transmitter is needed for excitation of proton spins. This can heat the body to the point of risk of hyperthermia in patients, particularly in obese patients or those with thermoregulation disorders. Several countries have issued restrictions on the maximum specific absorption rate that a scanner may produce.

Claustrophobia and discomfort
Due to the construction of some MRI scanners, they can be potentially unpleasant to lie in. Older models of closed bore MRI systems feature a fairly long tube or tunnel. The part of the body being imaged needs to lie at the center of the magnet which is at the absolute center of the tunnel. Because scan times on these older scanners may be long (occasionally up to 40 minutes for the entire procedure), people with even mild claustrophobia are sometimes unable to tolerate an MRI scan without management. Modern scanners may have larger bores (up to 70 cm) and scan times are shorter.

Guidance
Safety issues, including the potential for biostimulation device interference, movement of ferromagnetic bodies, and incidental localized heating, have been addressed in the American College of Radiology's White Paper on MR Safety which was originally published in 2002 and expanded in 2004. The ACR White Paper on MR Safety has been rewritten and was released early in 2007 under the new title ACR Guidance Document for Safe MR Practices.
In December 2007, the Medicines in Healthcare product Regulation Agency (MHRA), a UK healthcare regulatory body, issued their Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use.
In February 2008, the Joint Commission, a US healthcare accrediting organization, issued a Sentinel Event Alert #38, their highest patient safety advisory, on MRI safety issues.
In July 2008, the United States Veterans Administration, a federal governmental agency serving the healthcare needs of former military personnel, issued a substantial revision to their MRI Design Guide which includes physical or facility safety considerations.

Contrast agents
The most commonly used intravenous contrast agents are based on chelates of gadolinium. In general, these agents have proved safer than the iodinated contrast agents used in X-ray radiography or CT. Anaphylactoid reactions are rare, occurring in approx. 0.03-0.1%. Of particular interest is the lower incidence of nephrotoxicity, compared with iodinated agents, when given at usual doses—this has made contrast-enhanced MRI scanning an option for patients with renal impairment, who would otherwise not be able to undergo contrast-enhanced CT.

Cryogens
As described above in 'Scanner Construction And Operation', many MRI scanners rely on cryogenic liquids to enable superconducting capabilities of the electromagnetic coils within. Though the cryogenic liquids most frequently used are non-toxic, their physical properties present specific hazards.

Acoustic noise
Switching of field gradients causes a change in the Lorentz force experienced by the gradient coils, producing minute expansions and contractions of the coil itself. As the switching is typically in the audible frequency range, the resulting vibration produces loud noises (clicking or beeping). This is most marked with high-field machines and rapid-imaging techniques in which sound intensity can reach 120 dB(A) (equivalent to a jet engine at take-off).

Peripheral nerve stimulation (PNS)
The rapid switching on and off of the magnetic field gradients is capable of causing nerve stimulation. Volunteers report a twitching sensation when exposed to rapidly switched fields, particularly in their extremities. The reason the peripheral nerves are stimulated is that the changing field increases with distance from the center of the gradient coils (which more or less coincides with the center of the magnet). Note however that when imaging the head, the heart is far off-center and induction of even a tiny current into the heart must be avoided at all costs. Although PNS was not a problem for the slow, weak gradients used in the early days of MRI, the strong, rapidly-switched gradients used in techniques such as EPI, fMRI, diffusion MRI, etc. are indeed capable of inducing PNS. American and European regulatory agencies insist that manufacturers stay below specified dB/dt limits (dB/dt is the change in field per unit time) or else prove that no PNS is induced for any imaging sequence. As a result of dB/dt limitation, commercial MRI systems cannot use the full rated power of their gradient amplifiers

Specialized MRI scans

Diffusion MRI

Diffusion MRI measures the diffusion of water molecules in biological tissues. In an isotropic medium (inside a glass of water for example) water molecules naturally move randomly according to Brownian motion. In biological tissues however, the diffusion may be anisotropic. For example a molecule inside the axon of a neuron has a low probability of crossing the myelin membrane. Therefore the molecule will move principally along the axis of the neural fiber. If we know that molecules in a particular voxel diffuse principally in one direction we can make the assumption that the majority of the fibers in this area are going parallel to that direction.

Magnetization Transfer MRI

Magnetization transfer (MT) refers to the transfer of longitudinal magnetization from free water protons to hydration water protons in NMR and MRI.
In magnetic resonance imaging of molecular solutions, such as protein solutions, two types of water molecules, free (bulk) and hydration, are found. Free water protons have faster average rotational frequency and hence less fixed water molecules that may cause local field inhomogeneity. Because of this uniformity, most free water protons have resonance frequency lying narrowly around the normal proton resonance frequency of 63 MHz (at 1.5 tesla). This also results in slower transverse magnetization dephasing and hence longer T2. Conversely, hydration water molecules are slowed down by interaction with solute molecules and hence create field inhomogeneities that lead to wider resonance frequency spectrum.

Basic MRI scans

Comparison of Different Types of MR Contrast

T1-weighted MRI

T1-weighted scans use a gradient echo (GRE) sequence, with short TE and short TR. This is one of the basic types of MR contrast and is a commonly run clinical scan. The T1 weighting can be increased (improving contrast) with the use of an inversion pulse as in an MP-RAGE sequence. Due to the short repetition time (TR) this scan can be run very fast allowing the collection of high resolution 3D datasets. A T1 reducing gadolinium contrast agent is also commonly used, with a T1 scan being collected before and after administration of contrast agent to compare the difference. In the brain T1-weighted scans provide good gray matter/white matter contrast.

T2-weighted MRI

T2-weighted scans use a spin echo (SE) sequence, with long TE and long TR. They have long been the clinical workhorse as the spin echo sequence is less susceptible to inhomogeneities in the magnetic field. They are particularly well suited to edema as they are sensitive to water content (edema is characterized by increased water content).

T2*-weighted MRI

T2* (pronounced "T 2 star") weighted scans use a gradient echo (GRE) sequence, with long TE and long TR. The gradient echo sequence used does not have the extra refocusing pulse used in spin echo so it is subject to additional losses above the normal T2 decay (referred to as T2'), these taken together are called T2*. This also makes it more prone to susceptibility losses at air/tissue boundaries, but can increase contrast for certain types of tissue, such as venous blood.

Spin density weighted MRI

Spin density, also called proton density, weighted scans try to have no contrast from either T2 or T1 decay, the only signal change coming from differences in the amount of available spins. It uses a spin echo or sometimes a gradient echo sequence, with short TE and long TR.

How MRI Works!!

The body is largely composed of water molecules which each contain two hydrogen nuclei or protons. When a person goes inside the powerful magnetic field of the scanner, the magnetic moments of these protons align with the direction of the field.
A radio frequency electromagnetic field is then briefly turned on, causing the protons to alter their alignment relative to the field. When this field is turned off the protons return to the original magnetization alignment. These alignment changes create a signal which can be detected by the scanner. The frequency the protons resonate at depends on the strength of the magnetic field. The position of protons in the body can be determined by applying additional magnetic fields during the scan which allows an image of the body to be built up. These are created by turning gradients coils on and off which creates the knocking sounds heard during an MR scan.
MRI is used to image every part of the body, and is particularly useful for neurological conditions, for disorders of the muscles and joints, for evaluating tumors, and for showing abnormalities in the heart and blood vessels.

Physics principle

Nuclear magnetism

Subatomic particles such as protons have the quantum mechanical property of spin. Certain nuclei such as 1H (protons), 2H, 3He, 23Na or 31P, have a non–zero spin and therefore a magnetic moment. In the case of the so-called spin-1/2 nuclei, such as 1H, there are two spin states, sometimes referred to as "up" and "down". Nuclei such as 12C have no unpaired neutrons or protons, and no net spin; however, the isotope 13C (referred to as "carbon 13") does.
When these spins are placed in a strong external magnetic field they precess around an axis along the direction of the field. Protons align in two energy "eigenstates" (the "Zeeman effect"): one low-energy and one high-energy, which are separated by a very small splitting energy.

Imaging

A number of schemes have been devised for combining field gradients and radio frequency excitation to create an image:
· 2D or 3D reconstruction from projections, much as in Computed Tomography.
· Building the image point-by-point or line-by-line.
· Gradients in the RF field rather than the static field.
The 3DFT technique is rather similar except that there is no slice selection and phase-encoding is performed in two separate directions.
Scanner construction and operation
The major components of an MRI scanner are: the main magnet, which polarizes the sample, the shim coils for correcting inhomogeneities in the main magnetic field, the gradient system which is used to localize the MR signal and the RF system, which excites the sample and detects the resulting NMR signal. The whole system is controlled by one or more computers.

Magnet

The magnet is the largest and most expensive component of the scanner, and the remainder of the scanner is built around it. The strength of the magnet is measured in tesla (T). Clinical magnets generally have a field strength in the range 0.1—3.0 T, with research systems available up to 9.4 T for human use and 21 T for animal systems
Just as important as the strength of the main magnet is its precision. The straightness of the magnetic lines within the center (or, as it is technically known, the iso-center) of the magnet needs to be near-perfect. This is known as homogeneity. Fluctuations (inhomogeneities in the field strength) within the scan region should be less than three parts per million (3 ppm). Three types of magnets have been used:

Gradients

Gradient coils are used to spatially encode the positions of protons by varying the magnetic field linearly across the imaging volume. The Larmor frequency will then vary as a function of position in the x, y and z-axes.Gradient coils are usually resistive electromagnets powered by sophisticated amplifiers which permit rapid and precise adjustments to their field strength and direction.

Radio frequency system

The radio frequency (RF) transmission system consists of an RF synthesizer, power amplifier and transmitting coil. This is usually built into the body of the scanner. The power of the transmitter is variable, but high-end whole-body scanners may have a peak output power of up to 35 kW, and be capable of sustaining average power of 1 kW. The receiver consists of the coil, pre-amplifier and signal processing system. While it is possible to scan using the integrated coil for RF transmission and MR signal reception, if a small region is being imaged, then better image quality (i.e. higher signal-to-noise ratio) is obtained by using a close-fitting smaller coil. A variety of coils are available which fit closely around parts of the body such as the head, knee, wrist, breast, or internally, e.g. the rectum.

What is MRI?

Magnetic Resonance Imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize the internal structure and function of the body. MRI provides much greater contrast between the different soft tissues of the body. Radio frequency (RF) fields are used to systematically alter the alignment of this magnetization, causing the hydrogen nuclei to produce a rotating magnetic field detectable by the scanner. This signal can be manipulated by additional magnetic fields to build up enough information to construct an image of the body. MRI use a powerful magnetic field to align the nuclear magnetization of (usually) hydrogen atoms in water in the body. In very simple terms, MRI uses an enormously powerful electromagnet to align all the unbound protons in your body with the poles of the magnet. The protons are then 'plucked' or 'struck', either by radio waves or other magnetic fields.