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A pacemaker is a device for internal or external battery-operated cardiac pacing to overcome cardiac arrhythmias or heart block. All implanted electronic devices are susceptible to the electro magnetic fields used in magnetic resonance imaging. Therefore, the main magnetic field, the gradient field, and the radio frequency (RF) field are potential hazards for cardiac pacemaker patients.
The pacemaker's susceptibility to static field and its critical role in life support have warranted special consideration. The static magnetic field applies force to magnetic materials. This force and torque effects rise linearly with the field strength of the MRI machines. Both, RF fields and pulsed gradients can induce voltages in circuits or on the pacing lead, which will heat up the tissue around e.g. the lead tip, with a potential risk of thermal injury.
Regulations for pacemakers provide that they have to switch to the magnet mode in static magnetic fields above 1.0 mT. In MR imaging, the gradient and RF fields may mimic signals from the heart with inhibition or fast pacing of the heart. In the magnet mode, most of the current pacemakers will pace with a fix pulse rate because they do not accept the heartsignals. However, the state of an implanted pacemaker will be unpredictable inside a strong magnetic field. Transcutaneous controller adjustment of pacing rate is a feature of many units. Some achieve this control using switches activated by the external application of a magnet to open/close the switch. Others use rotation of an external magnet to turn internal controls. The fringe field around the MRI magnet can activate such switches or controls. Such activations are a safety risk.
Areas with fields higher than 0.5 mT ( 5 Gauss Limit) commonly have restricted access and/or are posted as a safety risk to persons with pacemakers.
A Cardiac pacemaker is because the risks, under normal circumstances an absolute contraindication for MRI procedures.
Nevertheless, with special precaution the risks can be lowered. Reprogramming the pacemaker to an asynchronous mode with fix pacing rate or turning off will reduce the risk of fast pacing or inhibition. Reducing the SAR value reduces the potential MRI risks of heating. For MRI scans of the head and the lower extremities, tissue heating also seems to be a smaller problem. If a transmit receive coil is used to scan the head or the feet, the cardiac pacemaker is outside the sending coil and possible heating is very limited. | | | | • For this and other aspects of MRI safety see our InfoSheet about MRI Safety. | | | • Patient-related information is collected in our MRI Patient Information.
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Diamagnetism is a form of magnetism that is only exhibited by a substance in the presence of an externally applied magnetic field. It is the result of changes in the orbital motion of electrons due to the application of an externally applied magnetic field. Applying a magnetic field causes a momentary electromotive force (a consequence of Faraday's law), which modifies the electronic orbitals of atoms/molecules in a substance in such a way, that the orbitals produce an induced magnetic field, which opposes the applied field (a consequence of Lenz's law).
However, the induced magnetic moment is very small in most everyday materials.
Diamagnets are repelled by magnetic fields. However, since diamagnetism is such a weak property its effects are not observable in every-day life.
However, in Magnetic Resonance Imaging for example barium sulfate suspensions lead with its weak negative magnetic susceptibility to a decrease in signal.
See also magnetism, ferromagnetism, paramagnetism, and superparamagnetism. | | | | • View the DATABASE results for 'Diamagnetism' (7).
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| | | | • View the DATABASE results for 'Gradient Coil' (19).
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It is important to remember when working around a superconducting magnet that the magnetic field is always on. Under usual working conditions the field is never turned off. Attention must be paid to keep all ferromagnetic items at an adequate distance from the magnet. Ferromagnetic objects which came accidentally under the influence of these strong magnets can injure or kill individuals in or nearby the magnet, or can seriously damage every hardware, the magnet itself, the cooling system, etc..
See MRI resources Accidents.
The doors leading to a magnet room should be closed at all times except when entering or exiting the room. Every person working in or entering the magnet room or adjacent rooms with a magnetic field has to be instructed about the dangers. This should include the patient, intensive-care staff, and maintenance-, service- and cleaning personnel, etc..
The 5 Gauss limit defines the 'safe' level of static magnetic field exposure. The value of the absorbed dose is fixed by the authorities to avoid heating of the patient's tissue and is defined by the specific absorption rate.
Leads or wires that are used in the magnet bore during imaging procedures, should not form large-radius wire loops. Leg-to-leg and leg-to-arm skin contact should be prevented in order to avoid the risk of burning due to the generation of high current loops if the legs or arms are allowed to touch. The patient's skin should not be in contact with the inner bore of the magnet.
The outflow from cryogens like liquid helium is improbable during normal operation and not a real danger for patients.
The safety of MRI contrast agents is tested in drug trials and they have a high compatibility with very few side effects. The variations of the side effects and possible contraindications are similar to X-ray contrast medium, but very rare. In general, an adverse reaction increases with the quantity of the MRI contrast medium and also with the osmolarity of the compound.
See also 5 Gauss Fringe Field, 5 Gauss Line, Cardiac Risks, Cardiac Stent, dB/dt, Legal Requirements, Low Field MRI, Magnetohydrodynamic Effect, MR Compatibility, MR Guided Interventions, Claustrophobia, MRI Risks and Shielding. | | | | | | | | | • View the DATABASE results for 'MRI Safety' (42).
| | | • View the NEWS results for 'MRI Safety' (13).
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Rapid echo planar imaging and high-performance MRI gradient systems create fast-switching magnetic fields that can stimulate muscle and nerve tissues produced by either changing the electrical resistance or the potential of the excitation. There are apparently no effects on the conduction of impulses in the nerve fiber up to field strength of 0.1 T. A preliminary study has indicated neurological effects by exposition to a whole body imager at 4.0 T. Theoretical examinations argue that field strengths of 24 T are required to produce a 10% reduction of nerve impulse conduction velocity.
Nerve stimulations during MRI scans can be induced by very rapid changes of the magnetic field. This stimulation may occur for example during diffusion weighted sequences or diffusion tensor imaging and can result in muscle contractions caused by effecting motor nerves. The so-called magnetic phosphenes are attributed to magnetic field variations and may occur in a threshold field change of between 2 and 5 T/s. Phosphenes are stimulations of the optic nerve or the retina, producing a flashing light sensation in the eyes. They seem not to cause any damage in the eye or the nerve.
Varying magnetic fields are also used to stimulate bone-healing in non-unions and pseudarthroses. The reasons why pulsed magnetic fields support bone-healing are not completely understood. The mean threshold levels for various stimulations are 3600 T/s for the heart, 900 T/s for the respiratory system, and 60 T/s for the peripheral nerves.
Guidelines in the United States limit switching rates at a factor of three below the mean threshold for peripheral nerve stimulation. In the event that changes in nerve conductivity happens, the MRI scan parameters should be adjusted to reduce dB/dt for nerve stimulation. | | | | • View the DATABASE results for 'Nerve Conductivity' (2).
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