MRI SAFETY

Clinical Application
MRI Sequences
MRI Protocols

Dr Ghattas, MD
 MRI HOW IT WORKS?

• Patient is put in a magnet.

• Radiofrequency (RF) EM wave is sent to
patient.
• RF is switched off.
• Patient emits a signal (Echo).
• Signal is received by a receiver coil
(Antenna) and transmit it to Computer.
• Computer process the data and an
image is generated.
 THE COMPONENTS
• A magnet – for nuclear alignment
• A radio frequency source – for RF excitation
• A magnetic field gradient system – for spatial encoding
• A computer system – for the image formation process and
the user interface
• An image processor – to convert ‘signals’ into images.
• Magnetic Field Strength

• S.I. Units = Tesla (T)

• Old units = Gauss (G)
• 1.0 T = 10,000 G
• Earth's magnetic field ~ 0.5 Gauss
• Fridge magnet ~ 5 x 10-3T
• Clinical MRI typically between 0.2T and
3T.
• It’s very strong! 1.5 T magnet (most common
in the medical field) is 30,000 times the Junkyard magnet 1 tesla
earth’s magnetic field
 Magnetism

 Magnetism is a property of matter

that is a result of the orbiting
electrons in atoms.

 The orbiting electrons cause the

atoms to have a magnetic moment
associated with an intrinsic
angular momentum called 'spin'.
 Types of Magnetism
• Ferromagnetic materials
(iron, nickel, or cobalt)
• Both attract and repel other magnets
• Create own field (can exhibit a
spontaneous magnetization). The ability
to remain magnetized when an external
magnetic field is removed is a
distinguishing factor compared to
paramagnetic, superparamagnetic, and
diamagnetic materials.
• Have a strong Positive magnetic
susceptibility
 Ferromagnetic materials

• Should not brought to scan room >

projectiles
• These materials include magnets,
and various objects one might find
in a patient, such as aneurysm
clips, parts of pacemakers,
shrapnel, etc.
• On MR images, these materials
cause susceptibility
artifacts characterized by loss of
signal and spatial distortion.
Paramagnetic materials
(e.g., Gadolinium Gd)
Attracted toward magnets
 Align with other fields
 Said to have Positive magnetic
susceptibility.
 The magnitude of this susceptibility is
less than one-thousands of that
of ferromagnetic materials.
 Gd is used in MRI contrast agents.
 At the proper concentration, Gd
contrast agents cause preferential T1
relaxation enhancement, causing
increase in signal on T1-weighted
images.
Superparamagnetic materials

 is the magnetic behavior associated with

magnetic nanoparticles, generally of
ferromagnetic or ferrimagnetic materials
 Their magnetic susceptibility is between that
of ferromagnetic and paramagnetic materials.
 The figure illustrates the effect of a
superparamagnetic material (grey circle) on
the magnetic field flux lines (blue).
 Examples of superparamagnetic materials
include iron containing contrast agents for
bowel, liver, and lymph node imaging.
Diamagnetic materials
 Repelled by magnets
 Anti-align with other fields
 Said to have Negative magnetic
susceptibility
 Diamagnetism is the property of materials that
have no intrinsic atomic magnetic moment, but
when placed in a magnetic field weakly repel the
field, resulting in a small negative magnetic
susceptibility.
 Materials like water, copper, nitrogen, barium
sulfate, and most tissues are diamagnetic.
 The weak negative magnetic susceptibility
contributes to the loss of signal seen in bowel on
MRI after administration of barium sulfate
suspensions.
 THE MAGNET

• There are three types of magnets used in MRI

systems:
• Resistive magnets
• Permanent magnets
• Superconducting magnets (the most
commonly used type in MRI scanners).

• In addition to the main magnet, the MRI machine

also contains three gradient magnets. These
magnets have a much lower magnetic field and
are used to create a variable field.
 Permanent Magnet

• Permanent magnets are very • The open design frequently appeals

heavy. They are typically to the general population as being
limited in their magnetic field more patient friendly and less prone
to about 0.35T. to feeling of claustrophobia.

• Permanent magnets can NOT • The most common material used to

be “turned off” in the event of produce a permanent magnet is an
an emergency. alloy of aluminum, nickel and cobalt
known as alnico.
• Once installed permanent
magnets can cost very little to • There are also some ceramic bricks
operate. possessing ferromagnetic properties
that can be magnetized and used to
• Permanent magnets are open produce permanent magnets.
bore magnets.
 Resistive Magnet

• It is an electromagnet - Open bore magnets

• A benefit of resistive magnets is the ability
to quickly shut down the magnetic field if
necessary.
• The magnetic field strength of a resistive
magnet is limited to no more than about 1.0
T by the amount of power required to
generate the magnetic field and by the
amount of heat that is produced by the
power
• Used in MRI mobile units
 SUPERCONDUCTING
MAGNET
• The critical temperature for superconductors is the
temperature at which the electrical resistivity of a
metal drops to zero.
• The conductor used in nearly all modern
superconducting MR scanners is niobium-titanium
(NbTi) that becomes superconductive below 9.4°K.

• To maintain superconductivity the current-carrying

loops of wire are super-cooled with substances
known as cryogens to eliminate resistance. Cryogens
used in MRI include liquid helium (He) and in some
cases liquid nitrogen (N).

An MRI machine that uses a superconducting magnet. The magnet

is inside the doughnut-shaped housing, and can create a 3 tesla
field inside the central hole.
 SUPERCONDUCTING MAGNET

▪ The chemical ▪ superconductive loops of wire

element Helium exists in are submerged in the cryogen.
a liquid form only at the ▪ Helium is an increasingly rare
resource that is extracted from
extremely low temperature of natural gas. There are only a
−269 °C (about 4 K or −452 °F). handful of helium-rich sites on
▪ Helium is used to create the planet.
superconductivity and, if two
cryogens are used, liquid ▪ 1 k = - 272.15 degree C = -
nitrogen (boils at −196 °C ; 77 K 457.87-degree F
; −321 °F) is used to keep the
helium cold. The
 Disadvantages of SCM:
 The SCM is always on
 The coolant (cryogen) must be replenished periodically.
 A characteristic of most superconducting magnets is that
they are in the form of cylindrical or solenoid coils with the
strong field in the internal bore.
 A potential problem is that the relatively small diameter and
the long bore produce claustrophobia in some patients.
 Extremity MRI Scanners
An extremity MRI is a type of scan used specifically for diagnostic
imaging of the arm, leg, hand, or foot.

Scan of Shoulder

Scan of Wrist

Scan of Knee
 High field open system

• High field MRI systems can generate a stronger longitudinal

magnetization and a stronger signal strength compared to low-
field systems.
• Advances in technology have led to the production of high-field
open MRI systems. These systems give the advantage of a patient-
friendly, spacious scan environment, coupled with the benefits of
high-field scanning – high SNR and ideal T1 contrast.
• The scanner construction uses superconducting solenoid magnets
above and below the patient, creating a vertical magnetic field
High field open system

High-Field 1 Tesla Open MRI

 THE GRADIENT COILS

Gradient Function of "Gradient coils

Magnets ⮚Spatial encoding:
• Used to vary magnetic field in -Slice selection
known manner -Frequency encoding
• Each point has slightly -Phase encoding
different rate of precession &
Larmor Frequency. ⮚Gradient coils are used in certain
• Variety of signal released by imaging options such as GMN (
Protons returning to z-plane Gradient Moment Nulling).
can used to determine the
composition of exact location ⮚ In gradient echo sequences they
of each point. are also used to rephase spins and
produce echoes
 THE RF COILS

• An antenna used to transmit and /or receive

radio frequency energy.
• A receiver coil’s size and shape should be
matched as closely as possible to the part of
the anatomy being imaged
• Coil geometry
• Volumetric coil
• Surface coil
Safety Issue of Static Magnetic
Any ferromagnetic substance
Field
taken into the MRI scanner
▪ Currently, typical MRI utilizes static
room will be subjected to:
field with strengths of 0.2 to 7 Tesla
• Translational Force or
▪ FDA guideline is max 4 T for Missile effect
infants < 1 month and 8 T for • Rotational force or torque
others
NB: Objects inside the body
▪ 1 Tesla = 10,000 Gauss
of patient will be subjected
▪ Magnetic field strength of the earth~0.5
to both forces
Gauss
 MRI SAFETY –
PROJECTILES
• Projectile effects of metal
objects seriously compromise
safety.
• This potential harm cannot be
over emphasized.
• For example, paper clips can
travel at a velocity of 40mph @ 3T.
• Larger objects travel at a higher
velocity and may be fatal.
July 2001
Safety Issue of Static Magnetic Field
▪ All non-MR personnel & patients entering the MRI
scanner room must be screened.
▪ ACR recommends that non-emergent Patients should
be screened by two separate individuals.
▪ Consider using plain-film radiographic study to
confirm the absence of metal fragments in critical
parts of the body.
Safety Issue of Static Magnetic Field
▪ All metallic objects brought into the MRI room must
be certified ‘MR Safe’ and use caution when such
object is indicated as ‘MR Conditional’.

▪ Unknown objects must be tested with a strong

handheld magnet (ACR recommends >1000 Gauss).

▪ Metal detector is not recommended.

 MR Safe

An implant with the above label would require no restrictions on

MR imaging approach and can safely enter the MR scan room.
Examples include, non-conducting, non-metallic items such as
items made of plastic.
 MR Conditional

An implant with the above label requires that strict manufacturer guidelines be
followed (field strength, scan parameters, duration) to ensure patient safety or
entry into the MR scan room.
Examples include patients with DBS(deep brain stimulus), MRI infusion pumps,
MR monitor.
 MR Unsafe

An implant with the above label would not be permitted to enter the
MR scan room, nor be able to undergo an MR procedure, and
alternative imaging methods would need to be considered.
Before entering the MRI Room, patients on oxygen
will be switched to the oxygen set up in the MRI
room. Check that no oxygen bottles are hidden
under blankets.

•Only MRI IV poles are allowed in the MRI

magnetic field. MRI IV poles will be labeled
accordingly
 Only MRI safe fire extinguishers
are allowed to the magnetic field.

All emergency personnel must

be screened before entering
the magnetic field.
 ABSOLUTE CONTRAINDICATIONS

NOT allowed into the scanning room

• Cardiac Pacemakers
• Cochlear (inner ear) implants
• Ferromagnetic or unidentifiable aneurysm clips of the brain
• Implanted neuro stimulators
• Metal or unidentifiable foreign bodies in the eyes
• Implanted pumps to deliver medicine that cannot be removed
• Full mouth braces or retainers that cannot be removed
 Devices affected by the static field

1 gauss 10 gauss
- Nuclear cameras
- Computers
- PET scanners
- Cyclotrons - Water chiller
- linear accelerators - Emergency generators
- CT scanners - Air conditioning chillers
- Ultrasound equipment - Image processor
3 gauss - Disk drives
- Metal detector
- Road traffic - Magnetic tapes
- Passenger and freight - - Credit cards
elevators - Watches
- Power transformers 30 gauss
5 gauss
- Remote console
- Cardiac pacemakers
- Neurostimulators 50 gauss
- Bio stimulation devices - Operator console
ACR recommended Zone signage for the MR suite:

Zone Area Intended For

1 General Public
2 Unscreened MRI
Patient
3 Screened MRI
Patients/Personnel
4 Screened Patients
under constant
direct supervision of
trained MR
personnel
CONTROLLED ACCESS AREA SIGNS
Quenching
▪ Quenching of the magnet is
very expensive and also In the event of a
hazardous due to the rapid spontaneous helium boil-
expansion of the cryogen off over 1000,000 liters of
(-269 deg C). gas are liberated. This
event is known as a
▪ There is danger of quench and can be fairly
asphyxiation, frostbite, etc. explosive in nature.
as well as fire hazard (due
to liquefied air) in the MR
room during quenching
 QUENCH / EMERGENCY RUN DOWN
BUTTON
• MR scanners are super cooled with gases such as helium.
• If these cryogens boil off either intentionally or unintentionally, a
quench has occurred.
• This is extremely bad.
• An intentional quench is done in an emergency to run the magnetic
field to zero. This is done in extreme situations only (ex- a projectile
that is pinning a patient against the magnet, injuring them).
• If a quench occurs, everyone must be removed from the room
immediately. The vapors and gases are very cold and can cause
frostbite. They also often condense the moisture in air, creating a
highly visible fog that can replace oxygen in the room.
EMERGENCY BUTTONS @ THE SCAN
CENTER: THE QUENCH BUTTON
EMERGENCY BUTTONS @ THE SCAN
CENTER: THE E-STOP BUTTON

Located in the operations room Located in the scanning room

 QUENCHING

• A magnet quench will result in several days’ downtime and

is extremely expensive.

• Do not press the button except in a true emergency.

• The quench button will have a protective covering over the

button so it cannot be pressed inadvertently.

• Do not attempt to test this button!

Injuries could occur in case of ▪ Helium is odorless, non-
quench flammable and non-toxic, but the
patient should be removed at
▪ All systems should be fitted with a once from the examination room
venting system, which expels the since oxygen depletion provides
escaping gas to the outside air. a risk of asphyxiation, and there
is temperature danger from the
▪ If this system fails, cold helium gas very cold gas( frostbite).
may spread throughout the patient ▪ For this reason, all scan rooms
area. It will collect at the top of the should contain an oxygen monitor
room, because helium is lighter than that sounds an alarm if the
air, and work its way down as the oxygen in the room falls below a
room fills. certain level.
▪ (The O2 level in air is normally
▪ A white fog will form from the cold 21%. The human ability to
helium freezing the water vapor in respond is already limited in an
the air. O2 concentration below 19%.)
 Biological Effect of Biological Effect of
Time-varying Magnetic Field Time-varying Magnetic Field

▪ The primary concerns ▪ ACR recommends that presence of

regarding time varying fields implanted cardiac pacemakers or
implanted cardioverter
are cardiac fibrillation and
defibrillators are inadvisable for
brain stimulation. routine MRI.

▪ But study showed that the risk ▪ (Several such patients have died
of cardiac stimulation in during the examination even
present day MRI gradient though many were okay).
fields is negligible.
Biological Effect of ▪ For whole-body exposures,
Radiofrequency Field no adverse health effects
are expected if the
▪ Radiofrequency energy increase in body core
deposited in the body during an temperature does not
MR examination will be exceed 1 deg C (0.5 deg C
converted into heat. for infants).
▪ ‘Specific Absorption Rate’
(SAR) is defined as the average ▪ FDA guideline for max SAR
energy dissipated in the body is 4 W/Kg for whole-body
per unit mass and time. imaging over 15 min, 3
▪ This heat gain is countered by W/Kg for head imaging
heat loss through sweat glands over 10 min.
and cutaneous blood vessels.
Biological Effect of Biological Effect of
Radiofrequency Field Radiofrequency Field

▪ Avoid any large conductive ▪ Some drug-delivery patches

loops, including tissues (do contain metallic foil and should be
not cross arms or legs in the covered with ice pack during
MR, this forms a loop as well). scanning.

▪ Care should be taken to place ▪ ACR also recommended that cold

thermal insulation between compresses or ice packs be
the patient and electrically placed on tattooed area during
conductive material. scanning.
This patient had a cervical fixation device. Proper scanning
guidelines were not followed. The result was multiple 3rd
degree burns where the titanium pins inserted into his skull.
Tattoos that cover large areas and/or with multiple bright colors
that may contain iron oxide-based pigment can heat up and
potentially burn.

Piercings can heat up through MRI-induced currents and cause

burns. They can move or be displaced, which can even result in a
serious injury.
Burn on patient caused by direct contact with Receiver coil, coil
cables, or skin to skin contact

3rd degree Burn on a child in Alabama due to unsafe practices

during an MRI.
Effect on Pregnant
Effect on Pregnant
Patients (1)
Patients (2)
▪ There is uncertainty in
▪ Thus far, there is no
the RF dosimetry during
evidence of adverse
pregnancy, it is
effect of pregnancy
recommended that
outcome in women
exposure duration
exposed to MRI during
should be reduced to
pregnancy.
minimum and that only
the normal operation
level is used.
Effect on Pregnant Patients (3)

▪ Large doses of MRI gadolinium-based contrast

agents have been shown to cause post-
implantation fetal loss, retarded development,
increased locomotive activity, and skeletal and
visceral abnormalities in experimental animals.

▪ ACR: “MR contrast agents should not be

routinely provided to pregnant patients.”
Effect of Acoustic Noise
▪ It is recommended
The noise occurs during the that every patient
rapid alterations of currents having an MRI be
within the gradient coil, provided
auditory/hearing
producing significant Lorentz
protection in the form
forces that induce vibrational
of earplugs and/or
modes at the coil.
headphones.
 WHAT TO DO IN CASE OF A MEDICAL
EMERGENCY
• Should a condition exist where the patient is having a medical
emergency, every effort should be made to remove the patient from
the scan room.
• Once the patient is removed from the MR scan room, close the door to
prevent re-entry.
• If you cannot remove the patient remember the magnet is always on.
Under no circumstances should anyone be allowed to enter the scan
room without proper screening!
ALL emergency procedures will be run OUTSIDE of the MRI scan
room.
•If there is a CODE, the patient must IMMEDIATELY be removed
from the room for treatment from the code team. During a code,
the MRI technologist will monitor /secure the door to the scan
room.
Clinical Application of MRI
MRI Sequences
MRI Protocols
The basic types of sequences used in brain MRI create either T1-
weighted or T2-weighted images. In T1-weighted images, CSF and
fluid appear dark. ... In T2-weighted images, CSF and fluid have a
higher signal intensity than tissue and therefore appear bright
T1 T2

 High Signal = Hyperintense = bright on image

 Low signal = Hypointense = dark on image
 Isointense = tissues with the same signal intensity on image
The proton density (PD) weighted image
• visualizes the number of protons per volume.
• Tissues with few protons have low signal intensity, tissues with many protons
have high signal intensity.
• Fat has a relatively high signal intensity, however, not as high as in a T1
weighted image
• PD offer excellent signal distinction between fluid, hyaline cartilage and
fibrocartilage, which makes this sequence ideal in the assessment of joints.
DWI Diffusion Weighted
Image

DWI & ADC are very valuable sequence in

stroke diagnosis and provides information
about prognosis.

ADC
Apparent Diffusion Coefficient
DWI, left and ADC, right: High diffusion signal involving the entire left
caudate nucleus and cortex of left temporal, parietal and occipital lobes.
 MRA
Magnetic Resonance Angiography
Without using contrast agent
MR arthrogram Magnetic Resonance
Venography
MRV
 Advantages of Disadvantages of
MRI MRI
 No ionizing radiation & no short/long-  Long scanning time(average 20
term effects demonstrated minutes)
 Variable thickness, any plane  Claustrophobia (in closed
system)
 Better contrast resolution & tissue
discrimination  Certain patients can’t exposed
to strong magnet e.g. patients
 Can differentiate between Grey Matter
and White Matter with pacemakers, implants, ...
 Various sequences to play with, to
characterize the abnormal tissue -
multiparametric
 Many details without I.V contrast
 MR contrast media

• Gadolinium (Gd) based, paramagnetic, when injected it reduce

relaxation time of nearby water molecule, appears bright on T1
weighted images.
• Less incidence of allergy
• Caution with renal impairment  Nephrogenic Systemic Fibrosis
NSF
• Not used if GFR < 30 ml/min (healthy Kidneys GFR > 90 ml/min.)
• Contraindicated in pregnancy
 Post-Gadolinium Enhancement

Effect of contrast agent on images: Defect of the blood–brain barrier after

stroke shown in MRI. T1-weighted images, left image without, right image
with contrast medium administration
 Nephrogenic Systemic Fibrosis
NSF

• Patients with impaired renal

function
• Disfiguring and potentially
disabling or fatal disorder
involving skin, muscles, lungs,
pleura, pericardium, and bones.

NSF: cachexia and contracture

 Neuroimaging = MRI
• No neurology or neurosurgery without MRI
• MR brain has largely replaced CT brain in USA (but for head injury)
• Superior to CT in most occasions
Indications of MRI study
• Anatomy • Trauma
• Congenital anomalies • Dementia
• Hereditary and metabolic • Hydrocephalus
diseases • Cranial nerves
• Infections
• Arteriograms
• Demyelination • Venograms
• Vascular event • Skull base
• Tumours
• Pituitary gland
 MRI protocol in neuroimaging
• T2WI • DWI
• T1WI • ADC
• FLAIR • Diffusion tensor imaging
• MRA • fMRI
• MRV • Perfusion mapping
• GE • CSF flow mapping
• Gadolinium • MR spectroscopy
 Stroke imaging

• MR superior to CT in diagnosing
hyperacute infarct
• MR is as sensitive as CT in
diagnosing acute intracranial
haemorrhage
• CT is currently widely used to
exclude hemorrhage before
thrombolysis
Brain Tumors
 Spine imaging

• MR is the investigation of choice

• Conventional CT, CT myelogram and conventional myelogram are no longer
performed, unless MR is contraindicated.
• Indications and contraindications – same
• First line of investigation in suspected spinal infection, cord compression, cauda
equina, sciatica
 Disc lesion and MRI

• Virtually everyone after the age of 40 years will have at least one degenerative
disc/ end plate
• Not all patients with sciatica will have a positive MRI
• Ask MRI to answer a specific question; otherwise MRI might completely mislead
the clinician.
Metastasis
 Head and Neck imaging

• MR is complementary or second line of investigation in

many of head and neck pathologies
• Superior to CT in staging head and neck malignancies
• Characterise the head and neck lesions better than CT
• Complementary to CT in petrous temporal and paranasal
sinus evaluation
• First line of investigation in orbital lesions
 Musculoskeletal
imaging Indications

 Initial evaluation of bones  Occult fractures

– Plain films; then MRI  Marrow abnormality
 MRI sensitive than CT in  Ligament pathologies
diagnosing occult fractures  Tendon pathologies
 Initial evaluation of soft  Muscular injuries
tissues – USG; then MRI  Infection
 Joint imaging = MRI  Bone and soft tissue tumour
 Labral pathologies
 MRI Protocol in MSK imaging

• T1WI
• T2WI
• Fat sat T1
• STIR
• Fat sat T2
• Gadolinium studies
• MR arthrography

Avascular necrosis
KNEE JOINT:
ANTERIOR CRUCIATE LIAMENT AND
POSTERIOR CRUCIATE LIGAMENT _ ACL & PCL
Rotator cuff tear
 Abdominal MRI

• Problem solving tool in liver, pancreatic,

renal and adrenal lesions
• Primary modality in local staging of
rectal ca, endometrial ca, cervical ca,
prostate ca, vaginal ca
• Non-invasive modality in evaluating
pancreaticobiliary tract – MRCP
• Scrotal and penile imaging
• Uterus and ovary imaging
 Vascular MRI

• Peripheral vascular arteriogram

with or without I.V contrast
• Aortogram
• Dissection

• Pulmonary arteriogram
• When CT is contraindicated
AORTIC
Coarctation
AORTIC
ANEURYSM
 Cardiac MRI

• Coming in a big way

• Very useful in congenital
heart diseases,
cardiomyopathies
• Evidence is emerging in the
evaluation of myocardial
infarction
 Breast MRI
Breast MRI is an indispensable
modality, along with Breast MRI Coil
mammography and US. Its main
indications are staging of known
cancer, screening for breast
cancer in women at increased
risk, and evaluation of response
to neoadjuvant chemotherapy
 CT MR

• Ionizing radiation • No ionising radiation

• Faster • Greater details, hence more
sensitive and more specific
• Less sensitive to patient
movements • Any plane scanning
• Easier in claustrophobics • Contrast less allergic
• Acute haemorrhage • Brain: tumors, stroke
• Calcification • Herniated disc
• Bone details • Joints: Knee, shoulder, hip,..
• Foreign body • MRA without contrast
• Superior to mammography in
detecting breast cancer.
 SPECTROSCOPY - MRS

• MRS is most commonly used in the brain.

• It can be helpful in diagnosing metabolic conditions, tumor recurrence versus
necrosis, and pathologic processes. The use of MRS is becoming more widespread
in breast, prostate and is undertrial for skeletal muscles imaging to differentiate
between normal and abnormal tissue.
 FUNCTIONAL MRI fMRI

Functional MRI is now in use for the localization of visual, motor, and
somatosensory responses in surgery of tumors, and elucidation of brain
function and metabolism altered by pathologies such as stroke, multiple
sclerosis, schizophrenia, and the like.

Moreover, neuroscientists rely heavily on fMRI to elucidate complex

processes in the brain that are associated with behavior, reading and
language skills, fear, and pain.
fMRI Alzheimer’s disease
 Conclusion

 MRI invaluable imaging tool in  Non-ionizing Imaging

the diagnosis of various diseases Modality
from head to toe  Longer scan time compared
 Chief modality in neuroimaging, to CT
and musculoskeletal imaging  Complex physics, too many
 Problem solving tool in abdominal sequences, difficult to
pathologies interpret to untrained eyes
 Invaluable tool in local staging of  Relatively safe, but there are
most of the malignancies definite contraindications
 References

http://www.mrisafety.com/
https://www.ncbi.nlm.nih.gov
https://static.healthcare.siemens.com
https://mri-q.com/whats-new.html
https://radiopaedia.org
https://www.sciencedirect.com
https://www.healthnewsreview.org
https://advances.massgeneral.org
https://www.medscape.com
https://www.startradiology.com/the-basics/mri-technique/index.html

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