Metallic ballistic fragments: MR imaging safety and artifacts.

Teitelbaum, G P; Yee, Corine; Horn, Debbie; Kim, H S; Colletti, Patrick M.

doi:10.1148/radiology.177.3.2244005

Cited by 38 publications

(21 citation statements)

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“…Previous studies have confirmed the safety of MRI scanning in patients with retained non-ferrous bullet fragments in 1.5 Tesla magnets. [39][40][41][42] Dedini et al showed that MR imaging of the spine with retained bullet fragments is safe, even up to 7 Tesla. 43 Fragment migration was not a concern.…”

Section: Imagingmentioning

confidence: 99%

Civilian gunshot wounds of the spine: A literature review

Botha¹,

Booysen²,

Dunn³

2016

SA orthop. j.

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Section: Imagingmentioning

confidence: 99%

Civilian gunshot wounds of the spine: A literature review

Botha¹,

Booysen²,

Dunn³

2016

SA orthop. j.

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“…5,12,16,22,25 A total of 95 hunting, civilian, police, and military projectiles were analyzed in MR scanners with magnetic strengths of 1, 1.5, 3, and 7 T. Eighty-eight bullets were made in the US (domestic), and 7 were from 6 different countries (foreign). 25 Eightyseven projectiles were bullets and 8 were pellets. The most common projectile composition was lead core/copper jacket (43 [45.3%]), followed by lead core/unjacketed (30 [31.6%]).…”

Section: In Vitro Studiesmentioning

confidence: 99%

“…According to the authors, none of the patients experienced any adverse effects from MR imaging. Teitelbaum et al 25 reported on 7 patients who underwent MR imaging at 0.5 or 1.5 T. These patients had bullets, shotgun pellets, or shrapnel fragments lodged in the following areas: intra-and paraspinous (2 patients), extremities (2 patients), intramyocardial (1 patient), intrathoracic (1 patient), and intracranial (1 patient). The authors found mild metal artifact on 85.7% of the patients' MR images, and only the intracranial shrapnel caused severe black void artifact, obscuring the image.…”

Section: Clinical Studiesmentioning

confidence: 99%

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Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

Martinez-del-Campo¹,

Rangel-Castilla²,

Soriano-Baron³

et al. 2014

FOC

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Object Performance of MR imaging in patients with gunshot wounds at or near the lumbar spinal canal is controversial. The authors reviewed the literature on the use of MR imaging in gunshot wounds to the spine. They discuss the results from in vitro and clinical studies, analyze the physical properties of common projectiles, and evaluate the safety and indications for MR imaging when metallic fragments are located near the spinal canal. Methods A review of the English-language literature was performed. Data from 25 articles were analyzed, including 5 in vitro studies of the interaction between 95 projectiles and the MR system's magnetic fields, and the clinical outcomes in 22 patients with metallic fragments at or near the spinal canal who underwent MR imaging. Results Properties of 95 civilian and military projectiles were analyzed at a magnet strength of 1, 1.5, 3, and 7 T. The most common projectiles were bullets with a core of lead, either with a copper jacket or unjacketed (73 [76.8%] of 95). Steel-containing (core or jacket) projectiles comprised 14.7%. No field interaction was evident in 78 (96.3%) of the 81 nonsteel projectiles. All steel projectiles showed at least positive deflection forces, longitudinal migration, or rotation. Heating of the projectiles was clinically insignificant. Image artifact was significant in all 9 steel bullets tested, but was not significant in 39 (88.6%) of the 44 nonsteel bullets tested. Overall, 22 patients with complete (82%) and incomplete (14%) spinal cord injury secondary to a projectile lodged inside the spinal canal underwent MR imaging. Discomfort and further physical or neurological deficits were not reported by any patient. Two patients with spinal cord injuries underwent MR imaging studies before surgical decompression and had subsequent, significant neurological improvement. Conclusions Metallic implants near or at the spinal canal are a relative contraindication for MR imaging. However, safe MR imaging might be feasible when a projectile's properties and a patient's individualized clinical presentation are considered.

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“…Fax: þ972-2-6423074. E-mail: ramim@cc.huji.ac.il; serez@hadassah.org.il magnetic fields such as those associated with MR imaging [8,9].…”

Section: Introductionmentioning

confidence: 99%

Implementing metal detector technology and a navigation system in the removal of shrapnel

Peleg

Harari

Liebergall

et al. 2009

Computer Aided Surgery

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Introduction: The removal of metal shrapnel in the sub-acute phase of casualty treatment requires the utmost accuracy in detection and removal, especially when there is proximity to major neurovascular structures. Inability to successfully locate and remove retained fragments may lead to a variety of complications due to fragment migration. In this study we prove the feasibility of a new technique which uses metal detector technology combined with a surgical navigation system, resulting in improved accuracy and decreased operating time. Methods: In each of the experiments, 6 metal nuts were inserted into a dummy leg to simulate shrapnel wounds. Two major experiments were then conducted. Experiment 1 was a comparison of two methods: (a) localization of the nuts using surgical navigation alone, and (b) localization by means of metal detector technology combined with a surgical navigation system (StealthStation Õ TREON Õ plus). Experiment 2 employed the same two methods, but this time migration of the metal fragments was introduced. The localization time was measured from incision of the dummy skin to the moment the metal fragment was touched by the searching device. Results: In experiment 1 the results showed no significant differences between the two approaches. In experiment 2 the new technique was found to significantly decrease the mean fragment localization time, taking 9.6 seconds (AE7.2 seconds) as compared to 26.4 seconds (AE13.8 seconds) when using the regular technique. Conclusion: Combining a metal detector probe and a surgical navigation system was found to significantly decrease operating time and increase the surgeon's confidence, especially in cases where migration of the metal fragment occurred during searching and extraction.

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Metallic ballistic fragments: MR imaging safety and artifacts.

Cited by 38 publications

References 0 publications

Civilian gunshot wounds of the spine: A literature review

Civilian gunshot wounds of the spine: A literature review

Magnetic resonance imaging in lumbar gunshot wounds: an absolute contraindication?

Implementing metal detector technology and a navigation system in the removal of shrapnel

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