implant imaging with pmri
DESCRIPTION
Implant Imaging with PMRI. Ross Venook, Meena Ramachandran, Sharon Ungersma, Nathaniel Matter, Nicholas Giori 1 , Garry Gold, Albert Macovski, Greig Scott & Steven Conolly 2. 1 Orthopedics, Palo Alto VA 2 Bioengineering, U.C. Berkeley. Outline. Motivation Why should we image implants? - PowerPoint PPT PresentationTRANSCRIPT
Implant Imaging with PMRI
Ross Venook, Meena Ramachandran, Sharon Ungersma, Nathaniel Matter, Nicholas Giori1, Garry Gold, Albert Macovski,
Greig Scott & Steven Conolly2
1Orthopedics, Palo Alto VA2Bioengineering, U.C. Berkeley
4 Feb, 2005PMRIL 2
Outline
• Motivation– Why should we image implants?
• Background on Implants• Susceptibility• Imaging Experiments• Conclusion
4 Feb, 2005PMRIL 3
Implants—so hot right now
• 300,000 total knee replacements per year
• 40-50% of orthopedic surgeries result in a patient with some metal inside– All trauma, joint replacement, or spine– Half of hand or foot
4 Feb, 2005PMRIL 4
Why image implants? (short term)
• Post-operative evaluation is limited to traditional radiographs
• No soft-tissue imaging modality to track progress or identify complications
4 Feb, 2005PMRIL 5
Why image implants? (long term)
“Loosening” is a longer-term complication:
• Septic loosening => Removal– Immediate surgery, serious risks– Loss of function
• Aseptic loosening => “Revision”– Lower risks– Restores function
• Average implant age increases as people live longer and as younger people get more implants
4 Feb, 2005PMRIL 6
Outline
• Motivation• Background on Implants
– Show and Tell– Orthopedic methods, materials, manufacturers– Problems with imaging implants
• Susceptibility• Imaging Experiments• Conclusion
4 Feb, 2005PMRIL 7
Show and Tell
Hips
AcetabularCup Tibial Joint
Femoral Joint
Screw
Intermedullary Nail
4 Feb, 2005PMRIL 8
Orthopedic Methods
• Once involved mostly screws and plates– Still used for traumatic cases, vertebrae
• Now working with bone cements, and special surface geometries– Certain surface features promote bone adhesion
• Previously very few sizes/shapes of implants– Now implants are modular for optimal size and
shape to match anatomy
4 Feb, 2005PMRIL 9
Manufacturers and Materials
• Zimmer• Alphatech• Synthes• Smith & Nephew• DePuy (J & J)• Howmedica (?)• Others…
• Stainless Steel• Cobalt-chrome• Titanium• Titanium alloys
– Tivanium™• Zirconium• Zirconium alloys
– Oximium™– Zimalloy™
Optimized for safety and efficacy
4 Feb, 2005PMRIL 10
Problem with Imaging Metal Implants is …
• Radiography works fine
• Soft tissue somewhat lacking
they are made of metal.
Cyteval, et al., Rad 2002
4 Feb, 2005PMRIL 11
Why not use CT?
• People do…
Cyteval, et al., Rad 2002
4 Feb, 2005PMRIL 12
Why not use CT?• …but there are problems
– Beam hardening– ‘Streaking’ artifacts
• Unable to differentiate aseptic loosening Cyteval, et al., Rad 2002
4 Feb, 2005PMRIL 13
Why not use MR?
• Short answer: MR is just so darn sensitive• Jongho’s talk
– Lung air susceptibility
– B0 changes ~1Hz
• Air has ~9 ppm shift–More than 1 radius from lungs
• Titanium has ~180 ppm shift–Image right on top of it
4 Feb, 2005PMRIL 14
4 Feb, 2005PMRIL 15
Outline
• Motivation• Background on Implants• Susceptibility
– Basics– Why PMRI
• Imaging Experiments• Conclusion
4 Feb, 2005PMRIL 16
Susceptibility: Basics
• All materials have r
– Magnetic permeability– Magnetic analog of
electric polarizability
• Susceptibility defined:
r – 1– How ‘susceptible’ to
applied magnetic field
http://antigravitypower.tripod.com/BioGravity/clarklev.html
4 Feb, 2005PMRIL 17
Susceptibility: Wide Range
Schenck, JF, Med Phys 1996
4 Feb, 2005PMRIL 18
Susceptibility in an MR Magnet
• Off-resonance artifacts depend on:– Orientation of object with
respect to B0
– Magnitude of B0 (ppm)
– Susceptibility difference
i-e
Ludeke, et al., MRI 1985Butts, et al., JMRI 1999
4 Feb, 2005PMRIL 19
Susceptibility in an MR Magnet
• Creates an object-dependent, orientation-dependent, serious off-resonance artifact
(for right cylinder)
Materials (ppm)
HbO2, dHb
Air, Water
Water, Titanium
0.3
9
180
4 Feb, 2005PMRIL 20
Susceptibility Wrap-up
• As complicated as you want it to be– Trajectory– Readout Gradient Strength– Slice Selection (RF and Gradient)
• Problems
– Material properties: – Scanner property: B0 (if only we had a low-field…)
Woohoo!
4 Feb, 2005PMRIL 21
Outline
• Motivation• Background on Implants• Susceptibility• Imaging Experiments
– PMRI (27mT) vs. 1.5T Spin Echo
• Conclusion
4 Feb, 2005PMRIL 22
Goals• Compare standard spin-echo images
– 1.5T Signa scanner (64MHz)
TE =10ms, 31.25 kHz BW, 256x128, 24cm FOV, 3mm slice
– 27mT PMRI scanner (1.1MHz)
TE = 6ms, 16 kHz BW, 128x128, 12cm FOV, 1cm slice
• Simple experiment with actual implant– Titanium tibial knee joint replacement
4 Feb, 2005PMRIL 23
Images
1.5T, Signa 27mT, PMRI
4 Feb, 2005PMRIL 24
Images
1.5T, Signa 27mT, PMRI
4 Feb, 2005PMRIL 25
Images
1.5T, Signa 27mT, PMRI
4 Feb, 2005PMRIL 26
Outline
• Motivation• Background on Implants• Automatic Tuning• Imaging Experiments• Conclusion
– Wait a minute…– Future work
4 Feb, 2005PMRIL 27
Techniques for 1.5T• View Angle Tilting
(VAT)– Re-registers water-fat
and other inhomogeneities
– Presumes good slice– Some blurring
• “MARS”– VAT with bigger
gradients
• VAT deblurring– Kim, John, Garry– Quadratic-phase RF
Standard SE with MARS
Olsen, et al., Radiographics 2000
4 Feb, 2005PMRIL 28
Future Work
• Image every implant in our collection– Catalog artifacts at low-field
• Do susceptibility artifacts scale with field?– Compare with 0.5T, 1.5T– Compare with different PMRI fields (1MHz-2MHz)
• Other artifacts– RF eddy currents– Gradient switching
• Optimal field?
4 Feb, 2005PMRIL 29
Acknowledgements
• GE Medical Systems• NIH• Nick Giori (implants)