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European Journal of Nuclear Medicine and Molecular Imaging

Published in:

01-03-2009

Risks and safety aspects related to PET/MR examinations

Authors: Gunnar Brix, Elke A. Nekolla, Dietmar Nosske, Jürgen Griebel

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Special Issue 1/2009

Abstract

Introduction

The introduction of positron emission tomography (PET)/magnetic resonance (MR) systems into medical practice in the foreseeable future may not only lead to a gain in clinical diagnosis compared to PET/computed tomography (CT) imaging due to the superior soft-tissue contrast of the MR technology but can also substantially reduce exposure of patients to ionizing radiation. On the other hand, there are also risks and health effects associated with the use of diagnostic MR devices that have to be considered carefully.

Objectives

This review article summarizes biophysical and biological aspects, which are of relevance for the assessment of health effects related to the exposure of patients to both ionizing radiation in PET and magnetic and electromagnetic fields in MR. On this basis, some considerations concerning the justification and optimization of PET/MR examinations are presented—as far as this is possible at this very early stage.

Discussion

Current safety standards do not take into account synergistic effects of ionizing radiation and magnetic and electromagnetic fields. In the light of the developing PET/MR technology, there is an urgent need to investigate this aspect in more detail for exposure levels that will occur at PET/MR systems.

Townsend DWJ. Dual-modality imaging: combining anatomy and function. Nucl Med 2008;49:938–55.CrossRef

Collins CD. PET/CT in oncology: for which tumours is it the reference standard? Cancer Imaging 2007;7(Spec No A):S77–87.PubMedCrossRef

Facey K, Bradbury I, Laking G, Payne E. Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers. Health Technol Assess 2007;11:iii–iv. xi–267.PubMed

Brix G, Lechel U, Glatting G, Ziegler SI, Munzing W, Muller SP, et al. Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. J Nucl Med 2005;46:608–13.PubMed

Brix G, Beyer T. PET/CT: dose-escalated image fusion? Nuklearmedizin 2005;44:S51–57.PubMed

Shellock FG (editor). Magnetic resonance procedures: health effects and safety. Boca Raton: CRC; 2001.

Brix G. Risks and safety issues related to MR examinations. In: Reiser M, Semmler W, Hricak H, editors. . Magnetic resonance tomography. Berlin, Heidelberg, New York: Springer-Verlag; 2007. p. 153–67.

Mühlenweg M, Schaefers G, Trattnig S. Safety aspects in high-field magnetic resonance imaging. Radiologe 2008;48:258–67.PubMedCrossRef

International Commission on Non-ionizing Radiation Protection. General approach to protection against non-ionizing radiation, Health Physics 2002;82:540–8.CrossRef

10.

International Atomic Energy Agency. Radiation protection aspects in newer imaging techniques. Vol. 1: PET/CT (in press).

11.

United Nations Scientific Committee on the Effects of Atomic Radiation. Report to the general assembly, vol II: Effects, Annex G. New York: United Nations; 2000.

12.

Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, National Research Council. Health Risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press; 2006.

13.

Council of the European Union. Council directive 97/43/Euratom of 30 June 1997 on health protection against the dangers of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom. Document 397L0043. Official Journal NO. L 180, 09/07/1997; 1997; pp. 22–27.

14.

International Commission on Radiological Protection. Publication 60. 1990 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP 1991;21:1–3.

15.

International Commission on Radiological Protection. Publication 103. 2007 Recommendations of the International Commission on Radiological Protection. Annals of the ICRP 2008;37:2–4.

16.

Brix G, Noßke D, Glatting G, Minkov V, Reske SN. A survey of PET activity in Germany during 1999. Eur J Nucl Med Mol Imaging 2002;29:1091–7.PubMedCrossRef

17.

International Commission on Radiological Protection. Publication 80. Radiation Dose to Patients from Radiopharmaceuticals. Annals of the ICRP; Vol. 28/3. Exford: Elsevier Science; 1999.

18.

Addendum 4 to ICRP Publication 53, 2001; http://www.icrp.org/docs/add4_to_p53.pdf

19.

Griebel J, Brix G, Kramer H. Risks of screening and preventive diagnosis. In: Reiser M, van Kaick G, Schönberg S, Fink C, editors. Screening and preventive diagnosis with radiological imaging. Berlin, Heidelberg, New York: Springer-Verlag; 2007. p. 127–36.

20.

Schenck JF. Physical interactions of static magnetic fields with living tissues. Prog Biophys Molec Biol 2005;87:185–204.CrossRef

21.

International Commission on Non-Ionizing Radiation Protection. Exposure to static and low frequency electromagnetic fields, biological effects and health consequences (0–100 kHz). In: Matthes R, McKinlay AF, Bernhardt JH, Vecchia P, Veyret B, editors. Publication ICNIRP 13/2003, Oberschleissheim, Germany; 2003.

22.

World Health Organization. Environmental Health Criteria 232. Static fields. Geneva: World Health Organization; 2006.

23.

International Commission on Non-Ionizing Radiation Protection. Medical magnetic resonance (MR) procedures: protection of patients. Health Physics 2004;87:197–216.CrossRef

24.

Foster KR, Schwan HP. Dielectrical properties of tissues. In: Polk C, Postow E, editors. Handbook of biological effects of electromagnetic fields. Boca Raton: CRC; 1996. p. 25–102.

25.

Reilly JP. Applied bioelectricity: From electrical stimulation to electro-pathology. Berlin, Heidelberg, New York: Springer-Verlag; 1998.

26.

Vogt FM, Ladd ME, Hunold P, Mateiescu S, Hebrank FX, Zhang A, et al. Increased time rate of change of gradient fields: effect on peripheral nerve stimulation at clinical MR imaging. Radiology 2004;233:548–54.PubMedCrossRef

27.

Bourland JD, Nyenhuis JA, Schaefer DJ. Physiologic effects of intense MR imaging gradient fields. Neuroimaging Clin N Am 1999;9:363–77.PubMed

28.

International Electrotechnical Commission. IEC 60601-2-33 (second edition), Particular requirements for the safety of magnetic resonance equipment for medical diagnosis; 2002.

29.

Shellock FG. Reference manual for magnetic resonance safety, implants, and devices: 2008 edition. Los Angeles: Biomedical Research; 2008.

30.

Tope WD, Shellock FG. Magnetic resonance imaging and permanent cosmetics (tattoos): Survey of complications and adverse events. J Magn Reson Imging 2002;15:180–4.CrossRef

31.

Colletti PM. Magnetic resonance procedures and pregnancy. In: Shellock FG, editor. Magnetic resonance procedures: health effects and safety. Boca Raton: CRC; 2001. p. 149–82.

32.

Beyer T, Weigert M, Quick HH, Pietrzyk U, Vogt F, Palm C, et al. MR-based attenuation correction for torso-PET/MR imaging: pitfalls in mapping MR to CT data. Eur J Nucl Med Mol Imaging 2008;35:1142–6.PubMedCrossRef

33.

Brix G, Seebass M, Hellwig G, Griebel J. Estimation of heat transfer and temperature rise in partial-body regions during MR procedures: an analytical approach with respect to safety considerations. Magn Reson Imaging 2002;20:65–76.PubMedCrossRef

34.

Miyakoshi J. Effects of static magnetic fields at the cellular level. Prog Biophys Molec Biol 2005;87:213–23.CrossRef

35.

Hintenlang DE. Synergistic effects of ionizing radiation and 60 Hz magnetic fields. Bioelectromagnetics 1993;14:545–51.PubMedCrossRef

36.

Walleczek J, Shiu EC, Hahn GM. Increase in radiation-induced HPRT gene mutation frequency after nonthermal exposure to nonionizing 60 Hz electromagnetic fields. Radiat Res 1999;151:489–97.PubMedCrossRef

37.

Miyakoshi J, Yoshida M, Shibuya K, Hiraoka M. Exposure to strong magnetic fields at power frequency potentiates X-ray-induced DNA strand breaks. J Radiat Res 2000;41:293–302.PubMedCrossRef

38.

Koyama S, Nakahara T, Sakurai T, Komatsubara Y, Isozumi Y, Miyakoshi J. Combined exposure of ELF magnetic fields and x-rays increased mutant yields compared with x-rays alone in pTN89 plasmids. J Radiat Res 2005;46:257–64.PubMedCrossRef

39.

Song CW, Park H, Griffin RJ. Improvement of tumor oxygenation by mild hyperthermia. Radiat Res 2001;155:515–28.PubMedCrossRef

40.

Horsman MR, Overgaard J. Hyperthermia: a potent enhancer of radiotherapy. Clin Oncol (R Coll Radiol) 2007;19:418–26.

Title: Risks and safety aspects related to PET/MR examinations
Authors: Gunnar Brix
Elke A. Nekolla
Dietmar Nosske
Jürgen Griebel
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue Special Issue 1/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-008-0937-4

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Risks and safety aspects related to PET/MR examinations

Abstract

Introduction

Objectives

Discussion

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