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This article reviews occupational exposure in clinical MRI; it specifically considers units of exposure, basic physical interactions, health effects, guideline limits, dosimetry, results of exposure surveys, calculation of induced fields and the status of the European Physical Agents Directive. Electromagnetic field exposure in MRI from the static field B(0), imaging gradients and radiofrequency transmission fields induces electric fields and currents in tissue, which are responsible for various acute sensory effects. The underlying theory and its application to the formulation of incident and induced field limits are presented. The recent International Commission on Non-Ionizing Radiation Protection (ICNIRP) Bundesministerium für Arbeit und Soziales and Institute of Electrical and Electronics Engineers limits for incident field exposure are interpreted in a manner applicable to MRI. Field measurements show that exposure from movement within the B(0) fringe field can exceed ICNIRP reference levels within 0.5 m of the bore entrance. Rate of change of field dB/dt from the imaging gradients is unlikely to exceed the new limits, although incident field limits can be exceeded for radiofrequency (RF) exposure within 0.2-0.5 m of the bore entrance. Dosimetric surveys of routine clinical practice show that staff are exposed to peak values of 42 ± 24% of B(0), with time-averaged exposures of 5.2 ± 2.8 mT for magnets in the range 0.6-4 T. Exposure to time-varying fields arising from movement within the B(0) fringe resulted in peak dB/dt of approximately 2 T s(-1). Modelling of induced electric fields from the imaging gradients shows that ICNIRP-induced field limits are unlikely to be exceeded in most situations; however, movement through the static field may still present a problem. The likely application of the limits is discussed with respect to the reformulation of the European Union (EU) directive and its possible implications for MRI.

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BACKGROUND: Obstructive sleep apnoea (OSA) is a common disease that leads to daytime sleepiness and cognitive impairment. Attempts to investigate changes in brain morphology that may underlie these impairments have led to conflicting conclusions. This study was undertaken to aim to resolve this confusion, and determine whether OSA is associated with changes in brain morphology in a large group of patients with OSA, using improved voxel-based morphometry analysis, an automated unbiased method of detecting local changes in brain structure. METHODS: 60 patients with OSA (mean apnoea hypopnoea index 55 (95% CI 48 to 62) events/h, 3 women) and 60 non-apnoeic controls (mean apnoea hypopnoea index 4 (95% CI 3 to 5) events/h, 5 women) were studied. Subjects were imaged using T1-weighted 3-D structural MRI (69 subjects at 1.5 T, 51 subjects at 3 T). Differences in grey matter were investigated in the two groups, controlling for age, sex, site and intracranial volume. Dedicated cerebellar analysis was performed on a subset of 108 scans using a spatially unbiased infratentorial template. RESULTS: Patients with OSA had a reduction in grey matter volume in the right middle temporal gyrus compared with non-apnoeic controls (p<0.05, corrected for topological false discovery rate across the entire brain). A reduction in grey matter was also seen within the cerebellum, maximal in the left lobe VIIIb close to XI, extending across the midline into the right lobe. CONCLUSION: These data show that OSA is associated with focal loss of grey matter that could contribute to cognitive decline. Specifically, lesions in the cerebellum may result in both motor dysfunction and working memory deficits, with downstream negative consequences on tasks such as driving.

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The effectiveness and relevance of independent acceptance testing was assessed by means of an audit of acceptance procedures for 17 MRI systems, with field strengths in the range 0.5-1.5 T, acquired over 8 years. Signal-to-noise ratio and geometric linearity were found to be the image quality parameters most likely to fall below acceptable or expected standards. These received confirmed successful corrective action in 69% of instances. Non-uniformity, ghosting and poor fat suppression were the next most common non-compliant parameters, but yielded less satisfactory outcomes. Spatial resolution was not found to be a sensitive parameter in determining acceptability. 49% of all non-compliant parameters received verifiable corrective attention. A schedule of actual acceptance criteria is presented and shown to be reasonable. Parameter failure rates were shown not to have improved with time. A safety audit of 11 of the installations revealed the most common failings to be inadequate suite layout and poor use of signs. The mean number of safety issues per installation identified as requiring attention was 5, from a questionnaire of 100 points. A number of anecdotal errors and omissions are reported. The data support the importance of an appropriate acceptance procedure for new clinical MRI equipment and for the involvement of a suitably qualified safety adviser on the project team from the outset.

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The design of a test object for the volumetric evaluation of geometric image quality parameters in magnetic resonance imaging (MRI) is presented. Two-dimensional parameters: linearity, distortion, slice position, slice width, slice oblique angle, spatial resolution, line spread function (LSF) are measurable in all slice planes within a volume corresponding to a typical head examination. Additionally, parameters particular to three-dimensional Fourier transform (3-DFT) imaging are measurable: 3D ghosting and 3D LSF. Parameter measurements are correctable with regard to test object positioning through the determination of the six degrees of freedom of the test object within the scanner's field of view.

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The absolute signal-to-noise ratio (SNR) measurable from images is defined and related to the theoretical fundamental SNR for MRI. Absolute SNR for quadrature head coils was obtained by both measurement and analysis of published data for MRI systems in the range 0.5-1.5 T. Mean absolute SNR for 22 MRI systems was 1.59 +/- 0.25 x 10(4) Hz1/2 ml-1 T-1 and did not vary significantly with the static field strength or gradient strength and signal bandwidth. This can be related to the fundamental SNR calculated as 2.36 x 10(4) Hz1/2 ml-1 T-1 through an effective noise figure with an average value of 3.4 dB for the 22 systems. Use of this methodology is discussed in relation to acceptance testing and performance assessment.

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A technique for the measurement of the modulation transfer function (MTF) of image intensifier systems by means of video signal analysis is presented. The MTF can be measured in both horizontal and vertical directions. The method is applicable to routine quality assurance testing in the field. The limitations on accuracy of the technique are investigated by computer simulation. Experimental results reported for several image intensifier systems correlate well with subjective assessments of limiting resolution and other parameters.

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A theoretical derivation of the equivalent loading resistance of an annular volume conductor within a magnetic resonance imaging radio frequency (RF) coil is presented. Theoretical predictions of the magnitude of the load resistance agree well with measurement over a range of frequencies. The loading resistance is proportional to the sample conductivity, the frequency and coil sensitivity squared, and depends strongly upon the sample dimensions. The orientation of the magnetic vector potential for the specific coil geometry is also important. An experimental comparison of loading by annular and cylindrical objects with the human head over the imaging frequency range is made. Cylindrical test objects are adversely affected by the skin effect. The optimum means of simulating RF induced losses for quality assurance and performance evaluation is discussed in the light of these results.

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A dimensionless figure of merit (F), which combines key aspects of the performance of image intensifier systems, is derived. This figure is ideally independent of input air kerma rate and field size and relates to the fundamental characteristics of the image reception chain. In practice it is calculated from measurements of the threshold contrast (noise) and limiting resolution using the Leeds test objects and the input air kerma rate. Several practical examples illustrate its usefulness in simple performance assessment and quality assurance procedures. A comparison is made with the use of detection index diagrams.

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Application of magnetic resonance imaging (MRI) in two-dimensional quantitative assessment of blood-retinal barrier dysfunction was investigated in rabbits using a 0.1 T (4.25 MHz) resistive system. Reliable and consistent measurements of vitreous T1 were obtained repeatedly, in slices of width 5 mm and X-Y resolution of 1.2 mm. Calibration of reduction of T1 in eyes after injection of gadolinium-DTPA (Gd-DTPA) was performed, resulting in a dose-related response of relaxation rate (1/T1) to the dose of Gd-DTPA injected. Follow-up scans of injected eyes demonstrated a gradual spread of the T1 "hot-spot" as the contrast agent diffused through the vitreous. T1 rose gradually to basal levels by 72 hr. No local effect of Gd-DTPA was found by ophthalmoscopy. Xenon arc photocoagulation of rabbit retina reduced T1 from 1638 +/- 54 (n = 6, mean +/- SD) ms to 1408 +/- 118 (n = 4) msec (P less than 0.01) throughout the vitreous 5-7 hr after treatment. In treated rabbits receiving 1.0 mmol/l Gd-DTPA intravenously, T1 adjacent to lesions 90-120 min after injection was further reduced in a 63 microliter voxel to 670 +/- 50 ms (mean +/- SD, n = 5) with a minimum pixel value of 285 +/- 52 ms. It was estimated that this represented leakage into vitreous of 8.3 nmol Gd-DTPA. Plasma Gd-DTPA concentrations declined rapidly, with half-life of 20-40 min. The findings indicate that MRI is a technique with the potential for repeated quantitative three-dimensional assessment of blood-retinal barrier dysfunction.

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A trial was carried out in which the protocols and prototype test objects developed under a European Economic Community concerted research project for the assessment of MR imaging equipment were tested in a series of commercial imaging systems situated throughout Europe. In general, many imperfections were discovered in the imaging performance of the scanners and, in particular, the accuracy and precision with which the relaxation times T1 and T2 could be measured from the images were found to be rather disappointing.

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