Implementation of the new international standards in Swiss legislation on radon protection in dwellings.

The current revision of the Swiss Radiological Protection Ordinance aims to bring Swiss legislation in line with new international standards. In future, the control of radon exposure in dwellings will be based on a reference level of 300 Bq m(-3). Since this value is exceeded in >10 % of the buildings so far investigated nationwide, the new strategy requires the development of efficient measures to reduce radon-related health risks at an acceptable cost. The minimisation of radon concentrations in new buildings is therefore of great importance. This can be achieved, for example, through the enforcement of building regulations and the education of construction professionals. With regard to radon mitigation in existing buildings, synergies with the ongoing renewal of the building stock should be exploited. In addition, the dissemination of knowledge about radon and its risks needs to be focused on specific target groups, e.g. notaries, who play an important information role in real estate transactions.

Accelerated whole-heart 3D CSPAMM for myocardial motion quantification.

Myocardial tissue tagging using complementary spatial modulation of magnetization (CSPAMM) allows detailed assessment of myocardial motion. To capture the complex 3D cardiac motion pattern, multiple 2D tagged slices are usually acquired in different orientations. These approaches are prone to slice misregistration and associated with long acquisition times. In this work, a fast method for acquiring 3D CSPAMM data is proposed that allows measuring deformation of the whole heart in three breath-holds of 18 heartbeats duration each. Three acquisitions are sequentially performed with line tag preparation in each orthogonal direction. Measurement acceleration is achieved by applying localized tagging preparation and a hybrid multishot, segmented echo-planar imaging sequence. Five healthy volunteers and five patients with myocardial infarction were measured. Midwall contours were tracked throughout the cardiac cycle with an enhanced variant of the harmonic phase (HARP) technique. Circumferential shortening at end-systole ranged from 14.1% (base) to 20.1% (apex) in healthy subjects. Hypokinetic regions in patients corresponded well with regions exhibiting hyperenhancement after contrast injection. Time to maximum circumferential shortening varied more significantly over the left ventricle in patients than in volunteers (P<0.01). The proposed measurement scheme was well tolerated by patients and holds considerable potential to investigate cardiac mechanics in various diseases.

Interference of neodymium magnets with cardiac pacemakers and implantable cardioverter-defibrillators: an in vitro study.

Permanent magnets may interfere with the function of cardiac pacemakers and implantable cardioverter-defibrillators (ICDs). Neodymium-iron-boron (NdFeB) magnets have become widely available in recent years and are incorporated in various articles of daily life. We conducted an in-vitro study to evaluate the ability of NdFeB magnets for home and office use to cause interference with cardiac pacemakers and ICDs. The magnetic fields of ten NdFeB magnets of different size and shape were measured at increasing distances beginning from the surface until a field-strength (B-field) value of 0.5 mT was reached. Furthermore, for each magnet the distance was determined at which a sample pacemaker switched from magnet mode to normal mode. Depending on the size and remanence of individual magnets, a B-field value of 0.5 mT was found at distances ranging from 1.5 cm to 30 cm and a value of 1 mT at distances from 1 cm to 22 cm. The pacemaker behavior was influenced at distances from 1 cm to 24 cm. NdFeB magnets for home and office use may cause interference with cardiac pacemakers and ICDs at distances up to 24 centimeters. Patient education and product declarations should include information about the risk associated with these magnets.

Altered myocardial motion pattern in Fabry patients assessed with CMR-tagging.

Progressive left ventricular hypertrophy is the hallmark of cardiac manifestations in patients with Fabry disease. Cardiovascular magnetic resonance with tissue tagging allows detailed assessment of the cardiac motion pattern. The aim was to test the hypothesis that not only Fabry patients with severe left ventricular hypertrophy exhibit changes in myocardial motion, but also Fabry patients with normal left ventricular mass. Magnetic resonance tagging using slice following complementary spatial modulation of magnetization (CSPAMM) combined with harmonic phase analysis (HARP) was applied to measure left ventricular shortening and contraction. Additionally, left ventricular rotation and global left ventricular torsion were examined. Twenty-nine Fabry patients grouped in patients with (n = 13) and without (n = 16) left ventricular hypertrophy were compared with 29 age and sex matched healthy volunteers. Long axis shortening and circumferential contraction showed reduced peak values with increasing left ventricular mass and were significantly reduced in Fabry patients with left ventricular hypertrophy (p < 0.001 and p < 0.05, respectively). Torsional deformation and apical rotation were increased both in Fabry patients with left ventricular hypertrophy as well as in patients with normal left ventricular mass (p < 0.001 for torsion) compared with controls. Applying the magnetic resonance tagging acquisition and analysis methods, myocardial motion abnormalities could not only be measured in Fabry patients with left ventricular hypertrophy but also in patients without macroscopic cardiac involvement.

Dynamic contrast-enhanced myocardial perfusion MRI accelerated with k-t sense.

In the k-t sensitivity encoding (k-t SENSE) method spatiotemporal data correlations are exploited to accelerate data acquisition in dynamic MRI studies. The present study demonstrates the feasibility of applying k-t SENSE to contrast-enhanced myocardial perfusion MRI and using the speed-up to increase spatial resolution. At a net acceleration factor of 3.9 (k-t factor of 5 with 11 training profiles) accurate representations of dynamic signal intensity (SI) changes were achieved in computer simulations. In vivo, 5x k-t SENSE was compared with 2x SENSE (identical acquisition parameters except for in-plane spatial resolution = 1.48 x 1.48 mm(2) vs. 2.64 x 2.64 mm(2), respectively). In 10 volunteers no differences in myocardial SI profiles were found (relative peak enhancement = 151% vs. 149.7%, maximal upslope = 12.9%/s vs. 13.3%/s for 2x SENSE and 5x k-t SENSE, respectively, all P > 0.05). Overall image quality was similar, but endocardial dark rim artifacts were reduced with k-t SENSE. Signal-to-noise ratio (SNR) in the myocardium was greater with 5x k-t SENSE by a factor of 1.36 +/- 0.23 at peak contrast enhancement with the relative yield decreasing with increasing dynamics in the object in accordance to theory. Higher nominal acceleration factors of up to 10-fold were shown to be feasible in computer simulations and in vivo.

Assessment of human brain motion using CSPAMM.

PURPOSE: To quantify periodic displacement in the cranium using complementary spatial modulation of magnetization (CSPAMM) with harmonic phase (HARP) postprocessing. MATERIALS AND METHODS: CSPAMM tagging sequence with separate tag-line preparation in two orthogonal directions was applied on 10 healthy volunteers in combination with HARP for tissue displacement mapping. RESULTS: Important features of brain dynamics, such as caudal displacement amplitude and the time-to-peak of the pulse wave were derived for six regions in the brain. Peak displacement values amounted to 0.18+/-0.02 mm, 0.10+/-0.01 mm, 0.09+/-0.02 mm, and 0.04+/-0.01 mm for regions in the pons, cerebellum, corpus callosum (splenium), and frontal lobe, respectively. Displacement values of the pons differed significantly from all other regions measured. With the additional information of the time-to-peak measure all six regions except the corpus callosum (splenium) and cerebellum can be distinguished. The values found suggest that the pulse wave travels from the brain stem first occipitally and then to the frontal lobe, where peak values appear later and are significantly attenuated. CONCLUSION: Direct quantification of periodic caudal brain tissue displacement is feasible with the proposed method, and several brain regions can be distinguished through peak displacement and time-to-peak values.

Potential interference of small neodymium magnets with cardiac pacemakers and implantable cardioverter-defibrillators.

BACKGROUND: Magnetic fields may interfere with the function of cardiac pacemakers and implantable cardioverter-defibrillators (ICDs). Neodymium-iron-boron (NdFeB) magnets, which are small in size but produce strong magnetic fields, have become widely available in recent years. Therefore, NdFeB magnets may be associated with an emerging risk of device interference. OBJECTIVE: We conducted a clinical study to evaluate the potential of small NdFeB magnets to interfere with cardiac pacemakers and ICDs. METHODS: The effect of four NdFeB magnets (two spherical magnets 8 and 10 mm in diameter, a necklace made of 45 spherical magnets, and a magnetic name tag) was tested in forty-one ambulatory patients with a pacemaker and 29 patients with an ICD. The maximum distance at which the magnetic switch of a device was influenced was observed. RESULTS: Magnetic interference was observed in all patients. The maximum distance resulting in device interference was 3 cm. No significant differences were found with respect to device manufacturer and device types. CONCLUSION: Small NdFeB magnets may cause interference with cardiac pacemakers and ICDs. Patients should be cautioned about the interference risk associated with NdFeB magnets during daily life.

Is post-systolic shortening a reliable indicator of myocardial viability? An MR tagging and late-enhancement study.

PURPOSE: In ischemic myocardium systolic strain is reduced and followed by a deformation after systole, the so-called post-systolic shortening. The presence of post systolic shortening is therefore considered a marker of viability even though its mechanism remains unclear. The hypothesis was tested whether post-systolic shortening might be a passive recoil phenomenon and therefore not uniquely associated with viability. METHODS: Five patients with a history of myocardial infarctions and fully transmural scars in late enhancement imaging and five age-matched healthy volunteers underwent a tagging study to analyze systolic and post-systolic deformation in transmurally infarcted and contra-lateral non-infarcted myocardium. From CSPAMM myocardial tagging data, mid-wall circumferential fiber shortening, radial displacement, and rotation parameters were semi-automatically extracted by harmonic phase (HARP). RESULTS: In transmurally infarcted myocardium, a post systolic shortening of 6.2 +/- 1.8% was present occurring in early diastole (time to maximum circumferential fiber shortening increased versus both, contralateral myocardium and corresponding sectors in healthy volunteers, p < 0.01). Maximum radial displacement was decreased in scar tissue (p < 0.001 versus contra-lateral), but time to maximum radial displacement did not differ. Rotation did not discriminate between infarcted and non-infarcted myocardium. CONCLUSIONS: The pure finding of post-systolic shortening is not sufficient for the diagnosis of residual myocardial viability. Post-systolic shortening may be explained in part by passive recoil, which releases energy stored in the scar tissue during systolic intra-ventricular unloading. Circumferential fiber shortening appears best suited for characterization of regional deformation, whereas radial displacement and rotation are more dependent on tethering effects, and thus, are more likely to reflect global chamber mechanics.

Accelerated tagging for the assessment of left ventricular myocardial contraction under physical stress.

A TFEPI-CSPAMM sequence is introduced, which is optimized with respect to acquisition speed and image quality. The sequence is used in a stress study, where a short breath-hold duration is crucial, and tested for reproducibility of deformation parameters extracted by HARP for repeated measurements.

Peak-combination HARP: a method to correct for phase errors in HARP.

PURPOSE: To introduce a method to correct phase errors (e.g., from B0 inhomogeneity) in tagging images, which may affect harmonic phase (HARP) evaluation. MATERIALS AND METHODS: The phase images corresponding to the negative and positive harmonic peaks in k-space are combined before HARP evaluation to eliminate any spurious phase. To validate in vivo, two complementary spatial modulation of magnetization (CSPAMM) data sets were collected for each volunteer and evaluated with conventional HARP, using either the positive or the negative harmonic peak, and with peak-combination HARP. RESULTS: Elimination of phase distortion by peak combination was observed in vitro and in vivo. Improved reproducibility of motion parameters was found with peak-combination HARP. CONCLUSION: With peak-combination HARP, reproducibility of contractile parameters is improved, and consequently, the number of subjects needed to detect statistically significant changes in contractile function can be reduced to one third compared to conventional HARP evaluation.

Spiral MR myocardial tagging.

In the present study, complementary spatial modulation of magnetization (CSPAMM) myocardial tagging was extended with an interleaved spiral imaging sequence. The use of a spiral sequence enables the acquisition of grid-tagged images with a tagline distance as low as 4 mm in a single breath-hold. Alternatively, a high temporal resolution of 77 frames per second was obtained with 8-mm grid spacing. Ten healthy adult subjects were studied. With this new approach, high-quality images can be obtained and the tags persist throughout the entire cardiac cycle.

Myocardial tagging with 3D-CSPAMM.

PURPOSE: To introduce a true three-dimensional (3D) tagging technique for the assessment of myocardial tissue motion. MATERIALS AND METHODS: To generate a 3D tagging grid, a complementary spatial modulation of magnetization (CSPAMM) was applied in three spatial directions. Imaging was performed using a conventional fast 3D gradient-echo sequence. For automatic analysis of the 3D-CSPAMM data set, evaluation software, based on a 3D extension of the HARP technique, was used. RESULTS: Successful application of the 3D-CSPAMM technique in healthy subjects allowed the accurate determination of quantitative 3D motion patterns in the human heart. CONCLUSION: 3D-CSPAMM may contribute to the quantification of the local 3D myocardial motion pattern throughout the cardiac cycle.