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Title: SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective

Abstract

Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality ismore » compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over 30 patients with pacemakers without complications, including 3 cardiac MR exams.« less

Authors:
; ;  [1];  [2];  [3];  [4]
  1. Mayo Clinic, Scottsdale, AZ (United States)
  2. Mayo Clinic College of Medicine, Rochester, MN (United States)
  3. Mayo Clinic, Rochester, MN (United States)
  4. Mayo Clinic, Jacksonville, FL (United States)
Publication Date:
OSTI Identifier:
22334008
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 6; Other Information: (c) 2014 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; BLOOD PRESSURE; CARBON 18; CARDIAC PACEMAKERS; IMAGES; IN VIVO; MAMMARY GLANDS; NMR IMAGING; OPTIMIZATION; PATIENTS; RECOMMENDATIONS; SAFETY

Citation Formats

James, J, Place, V, Panda, A, Edmonson, H, Felmlee, J, and Pooley, R. SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective. United States: N. p., 2014. Web. doi:10.1118/1.4887914.
James, J, Place, V, Panda, A, Edmonson, H, Felmlee, J, & Pooley, R. SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective. United States. doi:10.1118/1.4887914.
James, J, Place, V, Panda, A, Edmonson, H, Felmlee, J, and Pooley, R. 2014. "SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective". United States. doi:10.1118/1.4887914.
@article{osti_22334008,
title = {SU-D-18C-06: Initial Experience with Implementing MRI Safety Guidelines for Patients with Pacemakers - Medical Physicist Perspective},
author = {James, J and Place, V and Panda, A and Edmonson, H and Felmlee, J and Pooley, R},
abstractNote = {Purpose: Several institutions have developed MRI guidelines for patients with MR-unsafe or MR-conditional pacemakers. Here we highlight the role of a medical physicist in implementing these guidelines for non-pacemaker dependent patients. Guidelines: Implementing these guidelines requires involvement from several medical specialties and a strong collaboration with the site MRI supervisor to develop a structured workflow. A medical physicist is required to be present during the scan to supervise the MR scanning and to maintain a safety checklist that ensures: 1) uninterrupted patient communication with the technologist, 2) continuous patient physiologic monitoring (e.g. blood pressure and electrocardiography) by a trained nurse, 3) redundant patient vitals monitoring (e.g. pulse oximetry) due to the possibility of in vivo electrocardiography reading fluctuations during image acquisition. A radiologist is strongly recommended to be available to review the images before patients are discharged from the scanner. Pacemaker MRI should be restricted to 1.5T field strength. The MRI sequences should be optimized by the physicist with regards to: a) SAR: limited to <1.5 W/Kg for MR-unsafe pacemakers in normal operating mode, b) RF exposure time: <30 min, c) Coils: use T/R coils but not restricted to such, d) Artifacts: further optimization of sequences whenever image quality is compromised due to the pacemaker. In particular, cardiac, breast and left-shoulder MRIs are most susceptible to these artifacts. Possible strategies to lower the SAR include: a) BW reduction, 2) echo-train-length reduction, 3) increase TR, 4) decrease number of averages, 5) decrease flip angle, 6) reduce slices and/or a combination of all the options. Conclusion: A medical physicist in collaboration with the MR supervisor plays an important role in the supervision/implementation of safe MR scanning of pacemaker patients. Developing and establishing a workflow has enabled our institution to scan over 30 patients with pacemakers without complications, including 3 cardiac MR exams.},
doi = {10.1118/1.4887914},
journal = {Medical Physics},
number = 6,
volume = 41,
place = {United States},
year = 2014,
month = 6
}
  • Purpose: Case Method Teaching approach is a teaching tool used commonly in business school to challenge students with real-world situations—i.e. cases. The students are placed in the role of the decision maker and have to provide a solution based on the multitude of information provided. Specifically, students must develop an ability to quickly make sense of a complex problem, provide a solution incorporating all of the objectives (at time conflicting) and constraints, and communicate that solution in a succinct, professional and effective manner. The validity of the solution is highly dependent on the auxiliary information provided in the case andmore » the basic didactic knowledge of the student. A Case Method Teaching approach was developed and implemented into an on-going course focused on AAPM Task Group reports at UTHSCSA. Methods: A current course at UTHSCSA reviews and discusses 15 AAPM Task Group reports per semester. The course is structured into three topic modules: Imaging QA, Stereotactic Radiotherapy, and Special Patient Measurements—i.e. pacemakers, fetal dose. After a topic module is complete, the students are divided into groups (2–3 people) and are asked to review a case study related to the module topic. Students then provide a solution presented in an executive summary and class presentation. Results: Case studies were created to address each module topic. Through team work and whole-class discussion, a collaborative learning environment was established. Students additionally learned concepts such vendor relations, financial negotiations, capital project management, and competitive strategy. Conclusion: Case Method Teaching approach is an effective teaching tool to further enhance the learning experience of radiation oncology physics students by presenting them with though-provoking dilemmas that require students to distinguish pertinent from peripheral information, formulate strategies and recommendations for action, and confront obstacles to implementation.« less
  • The focus of work of medical physicists in 1980’s was on quality control and quality assurance. Radiation safety was important but was dominated by occupational radiation protection. A series of over exposures of patients in radiotherapy, nuclear medicine and observation of skin injuries among patients undergoing interventional procedures in 1990’s started creating the need for focus on patient protection. It gave medical physicists new directions to develop expertise in patient dosimetry and dose management. Publications creating awareness on cancer risks from CT in early part of the current century and over exposures in CT in 2008 brought radiation risks inmore » public domain and created challenging situations for medical physicists. Increasing multiple exposures of individual patient and patient doses of few tens of mSv or exceeding 100 mSv are increasing the role of medical physicists. Expansion of usage of fluoroscopy in the hands of clinical professionals with hardly any training in radiation protection shall require further role for medical physicists. The increasing publications in journals, recent changes in Safety Standards, California law, all increase responsibilities of medical physicists in patient protection. Newer technological developments in dose efficiency and protective devices increase percentage of time devoted by medical physicists on radiation protection activities. Without radiation protection, the roles, responsibilities and day-to-day involvement of medical physicists in diagnostic radiology becomes questionable. In coming years either medical radiation protection may emerge as a specialty or medical physicists will have to keep major part of day-to-day work on radiation protection. Learning Objectives: To understand how radiation protection has been increasing its role in day-to-day activities of medical physicist To be aware about international safety Standards, national and State regulations that require higher attention to radiation protection than in past To be aware about possible emergence of medical radiation protection as a specialty and challenges for medical physicists.« less
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  • Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medicalmore » physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.« less