Local cOinage and Hospital Equipment Index (Lo Hei): projectile distance of Singapore coinage and healthcare-related equipment in a 3T magnetic resonance imaging scanner.

INTRODUCTION: Modern magnetic resonance imaging (MRI) scanners utilise superconducting magnets that are permanently active. Patients and healthcare professionals have been known to unintentionally introduce ferromagnetic objects into the scanning room. In this study, we evaluated the projectile risk of Singapore coinage as well as some common healthcare equipment within a 3 T MRI scanner. METHODS: A rig termed 'Object eNtry Guidance and Linear Acceleration Instrument' (ONG LAI) was custom-built to facilitate safe trajectory of the putative ferromagnetic objects. A ballistic gel target was utilised as a human tissue surrogate to estimate tissue penetration. The point at which objects would self-propel towards the scanner was named 'Huge Unintended Acceleration Towards Actual Harm (HUAT AH)'. RESULTS: Singapore third-series coins (10-cent to 1-dollar coins) are highly ferromagnetic and would accelerate towards the MRI scanner from more than one metre away. Cannulas with their needles are ferromagnetic and would self-propel towards the scanner from a distance of 20 cm. Standard surgical masks are ferromagnetic and may lose their sealing efficacy when they are worn too close to the magnet. Among the tested objects, a can of pineapple drink (Lee Pineapple Juice) had the highest HUAT AH at a distance of more than 1.5 m. CONCLUSION: Some local coinage and commonly found objects within a healthcare setting demonstrate ferromagnetic activity with projectile potential from a distance of more than 1 m. Patients and healthcare professionals should be cognisant of the risk associated with introducing these objects into the MRI scanning room.

Common Healthcare Related Instruments Subjected To Magnetic Attraction Study (CHRISTMAS): prospective in situ experimental study.

OBJECTIVE: To investigate the behaviour of common healthcare related objects in a 3 tesla (T) MRI (magnetic resonance imaging) scanner, examining their ability to self-propel towards the scanner bore and their potential for tissue penetration. DESIGN: Prospective in situ experimental study. SETTING: Clinical 3 T MRI scanner. Customised rig designed and built to guide objects towards the scanner bore. PARTICIPANTS: 12 categories of objects commonly found in hospitals, or on patients or healthcare professionals, or near an MRI scanning room. Human tissue penetration simulated with ballistic gel (Federal Bureau of Investigation and North Atlantic Treaty Organisation graded). MAIN OUTCOME MEASURES: SANTA (site where applied newtonian mechanics triggers acceleration) measurements and depth of tissue penetration of the objects. RESULTS: SANTA measurements ranged from 0 cm for the 20 pence, 50 pence, and £2 coins to 152-161 cm for a knife and the biscuit tins. One penny, two pence, five pence, and 10 pence coins showed self-propulsion and acceleration towards the scanner bore at a distance >100 cm from the gantry entry point. Linear regression analysis showed no apparent correlation between the weight of the objects and their SANTA measurements (R2<0.1). Only five objects penetrated the ballistic gel (simulated human tissue). The deepest penetration was by the knife (5.5 cm), closely followed by the teaspoon (5.0 cm), fork (4.0 cm), spoon (3.5 cm), and a 10 pence coin (0.5 cm). Although the biscuit tins did not penetrate the simulated human tissue, they exerted substantial impact force which could potentially cause bone fractures. A smartphone, digital thermometer, metallic credit card, and pen torch remained fully functional after several passes into the MRI scanner. No discernible loss of image quality for the MRI scanner after the experiments was found. CONCLUSIONS: The study highlights the potential for harm (major tissue damage and bone fractures) when commonly found objects in a healthcare setting are unintentionally brought into the MRI scanner room. Patients and healthcare professionals need to be aware of the dangers associated with bringing ferromagnetic objects into the MRI environment.

Ischemic and hemorrhagic strokes in young adults: Comparison of functional outcomes and return to work after stroke.

BACKGROUND: Functional recovery and return to work (RTW) after stroke are important rehabilitation goals that have significant impact on quality of life. Comparisons of functional outcomes and RTW between ischemic stroke (IS) and hemorrhagic stroke (HS), especially among young adults with stroke, have either been limited or yielded inconsistent results. We aimed to assess functional outcomes and ability to RTW in young adults with IS and HS, specifically primary spontaneous intracranial hemorrhage (SICH). METHODS: Young adults with IS or SICH aged 18-50-years-old were included. Outcome measures were modified Rankins score (mRS) on discharge and 3-months and RTW at 3-months after stroke. Good functional outcome was defined as an mRS of 0-2. RESULTS: We included 459 patients (71.5% male) with a mean age of 43.3 ± 5.7 years, comprising 49.2% IS and 50.8% SICH. Patients with SICH were more likely to have unfavourable shifts in ordinal mRS on discharge (OR 7.52, CI 5.18-10.87, p < 0.001) and at 3-months (OR 6.41, CI 4.17-9.80, p < 0.001). Patients with IS more likely achieved good functional outcomes (80.2% vs. 51.8%, p < 0.001) and were able to RTW at 3-months (54.4% vs. 36.3%, p = 0.004). Among all stroke patients with good functional outcomes, one-third did not RTW at 3-months. Patients with longer length of hospitalisation and higher National Institutes of Health Stroke Scale (NIHSS) score on admission, especially in the domain categories of level of consciousness, vision, motor function, language and neglect, were less likely to RTW at 3-months. CONCLUSION: Patients with IS were more likely to RTW when compared to SICH patients. Many young stroke patients did not RTW despite good functional outcomes. Further research should therefore address differences in prognosis and identify predictors that influence ability to RTW after stroke in the young adult population.

The effectiveness of the Safety in Interventional Radiology (SIR) Shield in reducing droplet transmission and its effect on image quality and radiation dose.

OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.