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                                            Safety Information Article
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      Surgical Instruments and Devices 

Interventional magnetic resonance (MR) techniques have evolved into clinically viable surgical and therapeutic applications. This has resulted in the development and performance of innovative procedures that include percutaneous biopsy (e.g., breast, bone, brain, abdominal, etc.), endoscopic surgery of the abdomen, spine, and sinuses, open brain surgery, and MR-guided monitoring of thermal therapies (i.e., laser-induced, RF-induced, and cryomediated procedures). 

Surgical instruments and devices are an important necessity for interventional MR. Besides the typical MR safety concerns, there are possible hazards in the interventional MR environment related to the surgical instruments and devices that must be addressed to ensure the safety of healthcare practitioners and patients. Many of the conventional instruments and devices are made from metallic materials that can create substantial problems in association with interventional MRI.

The interventional MR safety issues that exist for surgical instruments and devices include unwanted movement caused by magnetic field interactions (e.g., the “missile effect”, translational attraction, torque), issues related to eddy currents, and heat generated by RF power deposition. Furthermore, the operational aspects of various instruments may be adversely impacted by the electromagnetic fields used for MR imaging. 

Artifacts associated with the use of a surgical instrument or device can be particularly problematic if in the imaging area of interest during its intended use. To address these problems, various surgical instruments and devices have been developed that do not present an additional risk or problem to the patient or MRI healthcare practitioner in the interventional MRI environment.

REFERENCES
Hinks RS, et al. MR systems for image-guided therapy. J Magnetic Resonance Imaging 1998;8:19-25.

Jolesz FA. Interventional and intraoperative MRI: A general overview of the field. J Magn Reson Imag 1998;8:3-7.

Jolesz FA. Image-guided procedures and the operating room of the future. Radiology 1997;204:601-612.

Jolesz FA, et al. Compatible instrumentation for intraoperative MRI: Expanding resources. J Magnetic Resonance Imaging 1998;8:8-11.

Maldonado IL, et al. Magnetic resonance-based deep brain stimulation technique: A series of 478 consecutive implanted electrodes with no perioperative intracerebral hemorrhage. Neurosurgery 2009;65(6 Suppl):196-201.

Shellock FG. Compatibility of an endoscope designed for use in interventional MR imaging procedures. Amer J Roentgenol 1998;171:1297-1300.

Shellock FG. Metallic surgical instruments for interventional MRI procedures: Evaluation of MR safety. J Magn Reson Imag 2001;13:152-157.

Shellock FG. MRI safety of instruments designed for interventional MRI: Assessment of ferromagnetism, heating, and artifacts. Workshop on New Insights into Safety and Compatibility Issues Affecting In Vivo MR, Syllabus, International Society of Magnetic Resonance in Medicine, Berkeley, 1998; pp. 39.

Shellock FG, Shellock VJ. Ceramic surgical instruments: Evaluation of MR-compatibility at 1.5 Tesla. J Magn Reson Imag 1996;6:954-956.

Thomas C, et al. Carbon fibre and nitinol needles for MRI-guided interventions: First in vitro and in vivo application. Eur J Radiol 2011;79:353-358.



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