Patientenüberwachung und -Sicherheit bei kernspintomographischen Untersuchungen

Zusammenfassung

Mit steigender Zahl kernspintomographischer Untersuchungen in Kliniken und Praxen sowie bei rasanter Weiterentwicklung kernspintomographischer Untersuchungstechniken tritt die Frage nach Patientenüberwachung und -Sicherheit immer mehr in den Vordergrund. Von Seiten der Hersteller von Kernspintomographen und von der Legislative wird diesem Problem nur eingeschränkt Rechnung getragen, so daß Eigeninitiative der untersuchenden Institutionen erforderlich ist. Nicht zuletzt auch aus forensischen Gründen sollte ein Überwachungskonzept mit geeigneten Geräten und sorgfältiger Dokumentation in allen Instituten entwickelt werden, die Kernspintomographie betreiben. In diesem Beitrag soll erörtert werden, wie die adäquate Patientenüberwachung bei kernspintomographischen Untersuchungen zu planen und durchzuführen ist.

Summary

With the continuously growing number of MRI examinations and the enormously rapid application of new technical developments, patient monitoring and safety aspects become an increasingly important issue. The vendors of MRI systems and the legislation tend to underestimate and ignore these problems. Therefore the institutions which operate MRI units have to find solutions by their own initiative. Not only due to forensic reasons a monitoring concept should be developed with suitable equipment and careful documentation in any institution operating an MRI unit. This article discusses the planning, implementation and conduct of adequate patient monitoring during MRI examinations.

Schlüsselwörter:

Kernspintomographie - Sicherheit - Überwachung

Key words

Magnetic resonance - safety - monitoring

• Literatur

• 1 Abel M, Friedburg H. Medikation und Überwachung junger, pädiatrischer Patienten bei NMR-Untersuchungen. Anästhesist 1987; 36: 137.
• 2 Alexander CM, Teller LE, Gross JB. Principles of pulse oximetry: theoretical and practical considerations. Anesth Analg 1989; 68: 368.
• 3 Barnett GH, Ropper AH, Johnson KA. Physiological support and monitoring of critically ill patients during magnetic resonance imaging. J Neurosurg 1988; 68: 246.
• 4 Boutin RD, Briggs JE, Williamson MR. MRI Screening and safety: A survey of 208 academic institutions. Am J Radiol 1993; 160 (Suppl 4): 56.
• 5 Cohen MD. Pediatric sedation. Radiology 1990; 175: 745.
• 6 Committee on Drugs, Section on Anesthesiology.. Guidelines for the elective use of conscious sedation, deep sedation and general anesthesia in pediatric patients. Pediatrics 1985; 76: 317.
• 7 Dunn V, Coffman CE, McGowan JE, Ehrhardt JC. Mechanical ventilation during magnetic resonance imaging. Magn Reson Imag 1985; 3: 169.
• 8 Fisher MD. Sedation of pediatric patients: an anesthesiologist’s perspective. Radiology 1990; 175: 613.
• 9 Forstner K. Der Applikationsort und die pulsoxymetrische MeBgenauigkeit. Biomed Eng 1988; 33 (Suppl. 03) 28.
• 10 Girard MJ, Hahn PF. Saini et al. Wallstent metallic biliary endoprosthesis: MR imaging characteristics. Radiology 1992; 184: 874.
• 11 Hathout G, Lufkin RB, Jabour B, Andrews J, Castro D. MR-guided aspiration cytology in the head and neck at high field strength. J Magn Reson Imag 1992; 2: 93.
• 12 Holshouser B, Hinshaw DB, Shellock FG. Sedation, anesthesia, and physiologic monitoring during MR imaging: Evaluation of procedures and equipment. J Magn Reson Imag 1993; 3: 553.
• 13 Hall SC, Stevenson GW, Suresh S. Burns associated with temperature monitoring during magnetic resonance imaging. Anesthesiology 1992; 70: 152.
• 14 Hubbard AM, Markowitz RI, Kimmel B, Kroger M, Bartko MB. Sedation for pediatric patients undergoing CT and MRI. J Comput Assist Tomogr 1992; 16: 3.
• 15 Kagetsu NJ, Litt AW. Important considerations in measurement of attractive force on metallic implants in MR imagers. Radiology 1991; 179: 505.
• 16 Kanal E, Shellock FG. Burns associated with clinical MR examinations. Radiology 1990; 175: 585.
• 17 Kanal E, Shellock FG. Patient monitoring during clinical MR imaging. Radiology 1992; 185: 623.
• 18 Kanal E, Shellock FG. Policies, guidelines, and recommendations for MR imaging safety and patient management. SMRI Safety Committee. J Magn Reson Imag 1992; 2: 247.
• 19 Kanal E, Shellock FG, Talagala L. Safety considerations in MR imaging. Radiology 1990; 170: 593.
• 20 Karlik SJ, Heatherley T, Pavan F. et al. Patient anesthesia and monitoring at a 1.5 T MRI installation. Magn Reson Med 1988; 7: 210.
• 21 Kelsey CA, King JN, Keck GM. et al. Ocular hazard of metallic fragments during MR imaging at 0.06 T. Radiology 1991; 180: 282.
• 22 Krestin GP, Schuhmann-Giampieri G, Haustein J. et al. Functional dynamic MRI, pharmacokinetics and safety of Gd-DTPA in patients with impaired renal function. EurRadiol 1992; 2: 16.
• 23 Lanzer P, Botvinick EH, Schiller NS. et al. Cardiac imaging using gated magnetic resonance. Radiology 1984; 150: 121.
• 24 Legendre JP, Misner R, Forester GV, Geoff-rion Y. A simple fiber optic monitor of cardiac and respiratory activity for biomedical magnetic resonance applications. Magn Reson Med 1986; 3: 953.
• 25 Lufkin RB. MR imaging of firearm projectiles. Radiology 1991; 179: 285.
• 26 Mani RL. Potential hazard of metal-filled sandbags in MR imaging. Radiology 1992; 182: 286.
• 27 McArdle CB, Nicholas DA, Richardson CJ, Amparo EG. Monitoring of the neonate undergoing MR imaging: technical considerations. Radiology 1986; 159: 223.
• 28 McGowan J, Erenberg A. Mechanical ventilation of the neonate during magnetic resonance imaging. Magn Reson Imag 1989; 7: 145.
• 29 Mertzlufft FO. Grundlagen der kontinuierlichen nichtinvasiven in-vivo-Messung der arteriellen Sauerstoffsättigung. Anästhesio-logische Aspekte, Bibliomed 88/89
• 30 Metzlufft FO, Brandt L, Nick D. Der Einsatz der Pulsoxymetrie zur Erkennung von Störungen des arteriellen Sauerstoff-Status in der unmittelbar postoperativen Phase am Beispiel von Kombinationsnarkose mit Isofluran. Anaesthesie, Intensivmedizin, Notfallmedizin 1989; 24: 27.
• 31 Meyer G, Meyer G, Hohlbach G. Zur nichtinvasiven Pulsoximetrie als Bestimmungsmethode der arteriellen Sauerstoffsättigung bei chirurgischen Intensivpatienten. Intensivmed 1989; 26: 85.
• 32 Morvan D, Leroy Willig A, Jehenson P, Cuenod CA, Syrota A. Temperature changes induced in human muscle by radio-frequency hydrogen-1 decoupling: measurement with an MR imaging diffusion technique. Radiology 1992; 185: 871.
• 33 Neumark J, Petricek W, Schramm W. Patientenferne Beatmung und Narkose bei der Kernspintomograhie. Anaesthesist 1989; 38: 273.
• 34 Rejger VS, Cohn BF, Vielvoye GJ, de Raadt FB. A simple anesthetic and monitoring system for magnetic resonance imaging. Eur J Anaesthesiol 1986; 6: 373.
• 35 Roey R, Wendt RE, Johnston DL. Monitoring of acutely ill patients during nuclear magnetic resonance imaging: use of a time varying filter electrocardiographic gating device to reduce gradient artifacts. Magn Reson Med 1988; 6: 240.
• 36 Roos CF, Caroll FE. Fiber-optic pressure transducer for use near MR magnetic fields. Radiology 1985; 156: 548.
• 37 Roth JL, Nugent M, Gray JE. et al. Patient monitoring during magnetic resonance imaging. Anesthesiology 1985; 62: 80.
• 38 Sellden H, De Cateau P, Ekman G. et al. Circulatory monitoring of children during anesthesia in low-field magnetic resonance imaging. Acta Anesthesiol Scand 1990; 34: 41.
• 39 Shapiro BA, Cane RD. Blood gas monitoring: Yesterday, today, and tomorrow. Critical Care Med 1989; 17/6: 573.
• 40 Shellock FG, Slimp GL. Severe burn of the finger caused by using a pulse oximeter during MR imaging. Am J Radiol 1989; 153: 1105.
• 41 Shellock FG. Monitoring sedated pediatric patients during MR imaging. Radiology 1990; 177: 586.
• 42 Shellock FG, Schatz CJ. Metallic otologic implants: in vitro assessment of ferromagne-tism at 1.5 T. Am J Neuroradiol 1991; 12: 279.
• 43 Shellock FG, Curtis JS. MR imaging and biomedical implants, materials, and devices: an updated review. Radiology 1991; 180: 541.
• 44 Shellock FG, Mink JH, Curtin S, Friedman MJ. MR imaging and metallic implants for anterior cruciate ligament reconstruction: assessment of ferromagnetism and artifacts. J Magn Reson Imag 1992; 2: 225.
• 45 Shellock FG, Kanal E. SMRI report: Policies, guidelines, and recommendations for MR imaging safety and patient management. SMRI Safety Committee. J Magn Reson Imag 1991; 1: 97.
• 46 Shellock FG, Myers SM, Kimble KJ. Monitoring heart rate and oxygen saturation with a fiberoptic pulse oximeter during MR imaging. Am J Radiol 1992; 158: 663.
• 47 Spiss CK, Mauritz W, Zadrobilek E, Draxléf V. Nichtinvasive Pulsoximetrie zur Bestimmung der Sauerstoffsättigung bei Intensivpatienten. Anaesthesist 1985; 34: 405.
• 48 Standards for basic intraoperative monitoring. In: Directory of members. 56th ed. American Society of Anesthesiologists 1991: 670.
• 49 Taber KH, Hayman LA. Temperature monitoring during MR imaging: comparison of fluoroptic and standard thermistors. J Magn Reson Imag 1992; 2: 99.
• 50 Teiltelbaum GP, Yee CA, Van Horn DD, Kim HS, Colletti PM. Metallic ballistic fragments: MR imaging safety and artifacts. Radiology 1990; 75: 855.
• 51 Teitelbaum GP. Metallic ballistic fragments: MR imaging safety and artifacts. Radiology 1990; 177: 883.
• 52 von Roemeling R, Lanning RM, Fames FA. MR imaging of patients with implanted drug infusion pumps. J Magn Reson Imag 1991; 1: 77.
• 53 Wendt RE, Rokey R, Vick GW, Johnston DL. Electrocardiographic gating and monitoring during NMR imaging. Magn Reson Imag 1988; 6: 89.
• 54 Wickersheim KA, Sun MH. Fluoroptic thermometry. Med Electron. Feb 1987: 84.
• 55 Wiener MD, Garay SM, Leitman BS, Wiener DN. Imaging of the intensive care unit patient. Clin Chest Med 1991; 12 (Suppl. 01) 169.
• 56 Weikl A, Moshage W, Hentschel D, Schittenhelm R, Bachmann K. EKG-Veränderungen durch Einwirkung von statischen Magnetfeldern bei der Kernspintomographie in Magneten der Feldstärke 0,5 bis 4,0 Tesla. Z Kardiol. 78. 578.
• 57 Yuh WTC, Hanigan MT, Nerad JA. et al. Extrusion of eye socket magnetic implant after MR imaging: potential hazard to patient with eye prosthesis. J Magn Reson Imag 1991; 1: 711.
• 58 Yuh WTC, Fisher DJ, Shields RK, Ehrhardt JC, Shellock FG. Phantom limb pain induced in amputee by strong magnetic fields. J Magn Reson Imag 1992; 2: 221.
• 59 Zimmermann BH, Faul DD. Artifacts and hazards in NMR imaging due to metal implants and clinical pacemakers. Diagn Imaging Clin Med 1984; 53 (Suppl. 01) 53.