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Purpose: To assess magnetic resonance imaging (MRI)-related heating for a neurostimulation system (Activa Tremor Control System, Medtronic, Minneapolis, MN) used for chronic deep brain stimulation (DBS). Materials and Methods:Different configurations were evaluated for bilateral neurostimulators (Soletra® Model 7426), extensions, and leads to assess worst-case and clinically relevant positioning scenarios. In vitro testing was performed using a 1.5-T/64-MHz MR system and a gelfilled phantom designed to approximate the head and upper torso of a human subject. MRI was conducted using the transmit/receive body and transmit/receive head radio frequency (RF) coils. Various levels of RF energy were applied with the transmit/receive body (whole-body averaged specific absorption rate (SAR); range, 0.98 -3.90 W/kg) and transmit/receive head (whole-body averaged SAR; range, 0.07-0.24 W/kg) coils. A fluoroptic thermometry system was used to record temperatures at multiple locations before (1 minute) and during (15 minutes) MRI.Results: Using the body RF coil, the highest temperature changes ranged from 2.5°-25.3°C. Using the head RF coil, the highest temperature changes ranged from 2.3°-7.1°C.Thus, these findings indicated that substantial heating occurs under certain conditions, while others produce relatively minor, physiologically inconsequential temperature increases. Conclusion:The temperature increases were dependent on the type of RF coil, level of SAR used, and how the lead wires were positioned. Notably, the use of clinically relevant positioning techniques for the neurostimulation system and low SARs commonly used for imaging the brain generated little heating. Based on this information, MR safety guidelines are provided. These observations are restricted to the tested neurostimulation system.

Because there are many potential risks in the MR environment and reports of adverse incidents involving patients, equipment and personnel, the need for a guidance document on MR safe practices emerged. Initially published in 2002, the ACR MR Safe Practices Guidelines established de facto industry standards for safe and responsible practices in clinical and research MR environments. As the MR industry changes the document is reviewed, modified and updated. The most recent version will reflect these changes. J. Magn. Reson. Imaging 2013;37:501–530. © 2013 Wiley Periodicals, Inc.

Purpose:To develop and demonstrate a method to calculate the temperature rise that is induced by the radio frequency (RF) field in MRI at the electrode of an implanted medical lead. Materials and Methods:The electric field near the electrode is calculated by integrating the product of the tangential electric field and a transfer function along the length of the lead. The transfer function is numerically calculated with the method of moments. Transfer functions were calculated at 64 MHz for different lengths of model implants in the form of bare wires and insulated wires with 1 cm of wire exposed at one or both ends.Results: Heating at the electrode depends on the magnitude and the phase distribution of the transfer function and the incident electric field along the length of the lead. For a uniform electric field, the electrode heating is maximized for a lead length of approximately one-half a wavelength when the lead is terminated open. The heating can be greater for a worst-case phase distribution of the incident field. Conclusion:The transfer function is proposed as an efficient method to calculate MRI-induced heating at an electrode of a medical lead. Measured temperature rises of a model implant in a phantom were in good agreement with the rises predicted by the transfer function. The transfer function could be numerically or experimentally determined. IMPLANTED MEDICAL DEVICES such as deep brain stimulators and cardiac pacemakers interact with the magnetic fields in magnetic resonance imaging (MRI) (1-5). One of the interactions is tissue heating. The heating arises from the scattered electric field due to interaction of the MRI radio frequency (RF) magnetic field (B 1 ) and a medical implant. The greatest, and potentially dangerous, temperature rises occur at the ends of elongated implants, such as at the electrode of an implanted lead (6,7).In vitro testing in phantoms has been undertaken to characterize the RF-induced temperature rise (8). Recently, there has been an increased interest in mathematical modeling to assess the in vivo temperature rise. Numerical modeling based on the finite difference time domain (FDTD) method has been used to calculate the RF-induced electric field in human (9,10) and phantom models (11). It is difficult to numerically solve human and lead models simultaneously due to the complex structure of medical lead systems. It may be advantageous to model the lead and the human separately and then combine the results to determine the heating. The focus in this work is on modeling the lead. We describe the transfer function of a lead that relates the incident electric field to the scattered electric field in the vicinity of the electrode. From knowledge of the transfer function, the heating at the electrode and the resonant behavior of leads in phantom and human models can be predicted. Figure 1 shows the concept of the transfer function of a lead wire. An incident electric field with a tangential component E tan couples with the lead. The overall length of the lead is L, is the dis...

Purpose:To compare the magnetic resonance imaging (MRI)-related heating per unit of whole body averaged specific absorption rate (SAR) of a conductive implant exposed to two different 1.5-Tesla/64 MHz MR systems. Materials and Methods:Temperature changes at the electrode contacts of a deep brain stimulation lead were measured using fluoroptic thermometry. The leads were placed in a typical surgical implant configuration within a gel-filled phantom of the human head and torso. MRI was performed using two different transmit/receive body coils on two different generation 1.5-Tesla MR systems from the same manufacturer. Temperature changes were normalized to whole body averaged SAR values and compared between the two scanners.Results: Depending on the landmark location, the normalized temperature change for the implant was significantly higher on one MR system compared to the other (P Ͻ 0.001). Conclusion:The findings revealed marked differences across two MR systems in the level of radiofrequency (RF)-induced temperature changes per unit of whole body SAR for a conductive implant. Thus, these data suggest that using SAR to guide MR safety recommendations for neurostimulation systems or other similar implants across different MR systems is unreliable and, therefore, potentially dangerous. Better, more universal, measures are required in order to ensure patient safety.

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There are three principal magnetic fields in magnetic resonance imaging (MRI) that may interact with medical implants. The static field will induce force and torque on ferromagnetic objects. The pulsed gradients are of audio frequency and the implant may concentrate the induced currents, with a potential for nerve stimulation or electrical inference. The currents induced in the body by the radio frequency (RF) field may also be concentrated by an implant, resulting in potentially dangerous heating of surrounding tissues. This paper presents basic information about MRI interactions with implants with an emphasis on RF-induced heating of leads used for deep brain stimulation (DBS). The temperature rise at the electrodes was measured in vitro as a function of the overall length of a DBS lead at an RF frequency of 64 MHz. The maximal temperature rise occurred for an overall length of 41 cm. The method of moments was used to calculate the current induced in the lead. From the induced currents, the RF power deposition near the electrodes was calculated and the heat equation was used to model the temperature rise. The calculated temperature rises as a function of lead length were in good agreement with the measured values.

A heterogeneous model of the human body and the scalar potential finite difference method are used to compute electric fields induced in tissue by magnetic field exposures. Two types of coils are considered that simulate exposure to gradient switching fields during magnetic resonance imaging (MRI). These coils producing coronal (y axis) and axial (z axis) magnetic fields have previously been used in experiments with humans. The computed fields can, therefore, be directly compared to human response data. The computed electric fields in subcutaneous fat and skin corresponding to peripheral nerve stimulation (PNS) thresholds in humans in simulated MRI experiments range from 3.8 to 5.8 V/m for the fields exceeded in 0.5% of tissue volume (skin and fat of the torso). The threshold depends on coil type and position along the body, and on the anatomy and resolution of the human body model. The computed values are in agreement with previously established thresholds for neural stimulation.