An evaluation of quality assurance guidelines comparing the American College of Radiology and American Association of Physicists in Medicine task group 284 for magnetic resonance simulation.

PURPOSE: The purpose of this study was to evaluate similarities and differences in quality assurance (QA) guidelines for a conventional diagnostic magnetic resonance (MR) system and a MR simulator (MR-SIM) system used for radiotherapy. METHODS: In this study, we compared QA testing guidelines from the American College of Radiology (ACR) MR Quality Control (MR QC) Manual to the QA section of the American Association of Physicists in Medicine (AAPM) Task Group 284 report (TG-284). Differences and similarities were identified in testing scope, frequency, and tolerances. QA testing results from an ACR accredited clinical diagnostic MR system following ACR MR QC instructions were then evaluated using TG-284 tolerances. RESULTS: Five tests from the ACR MR QC Manual were not included in TG-284. Five new tests were identified for MR-SIM systems in TG-284 and pertained exclusively to the external laser positioning system of MR-SIM systems. "Low-contrast object detectability" (LCD), "table motion smoothness and accuracy," "transmitter gain," and "geometric accuracy" tests differed between the two QA guides. Tighter tolerances were required in TG-284 for "table motion smoothness and accuracy" and "low contrast object detectability." "Transmitter gain" tolerance was dependent on initial baseline measurements, and TG-284 required that geometric accuracy be tested over a larger field of view than the ACR testing method. All tests from the ACR MR QC Manual for a conventional MR system passed ACR tolerances. The T2-weighted image acquired with ACR sequences failed the 40-spoke requirement from TG-284, transmitter gain was at the 5% tolerance of TG-284, and geometric accuracy could not be evaluated because of required equipment differences. Table motion passed both TG-284 and ACR required tolerances. CONCLUSION: Our study evaluated QA guidelines for an MR-SIM and demonstrated the additional QA requirements of a clinical diagnostic MR system to be used as an MR-SIM in radiotherapy as recommended by TG-284.

Precise Control of Target Temperature Using N6-Cyclohexyladenosine and Real-Time Control of Surface Temperature.

Targeted temperature management is standard of care for cardiac arrest and is in clinical trials for stroke. N6-cyclohexyladenosine (CHA), an A1 adenosine receptor (A1AR) agonist, inhibits thermogenesis and induces onset of hibernation in hibernating species. Despite promising thermolytic efficacy of CHA, prior work has failed to achieve and maintain a prescribed target core body temperature (Tb) between 32°C and 34°C for 24 hours. We instrumented Sprague-Dawley rats (n = 19) with indwelling arterial and venous cannulae and a transmitter for monitoring Tb and ECG, then administered CHA via continuous IV infusion or intraperitoneal (IP) injection. In the first experiment (n = 11), we modulated ambient temperature and increased the dose of CHA in an attempt to manage Tb. In the second experiment (n = 8), we administered CHA (0.25 mg/[kg·h]) via continuous IV infusion and modulated cage surface temperature to control Tb. We rewarmed animals by increasing surface temperature at 1°C h-1 and discontinued CHA after Tb reached 36.5°C. Tb, brain temperature (Tbrain), heart rate, blood gas, and electrolytes were also monitored. Results show that titrating dose to adjust for individual variation in response to CHA led to tolerance and failed to manage a prescribed Tb. Starting with a dose (0.25 mg/[kg·h]) and modulating surface temperature to prevent overcooling proved to be an effective means to achieve and maintain Tb between 32°C and 34°C for 24 hours. Increasing surface temperature to 37°C during CHA administration brought Tb back to normothermic levels. All animals treated in this way rewarmed without incident. During the initiation of cooling, we observed bradycardia within 30 minutes of the start of IV infusion, transient hyperglycemia, and a mild hypercapnia; the latter normalized via metabolic compensation. In conclusion, we describe an intravenous delivery protocol for CHA at 0.25 mg/(kg·h) that, when coupled with conductive cooling, achieves and maintains a prescribed and consistent target Tb between 32°C and 34°C for 24 hours.

Optimization of Thermolytic Response to A1 Adenosine Receptor Agonists in Rats.

Cardiac arrest is a leading cause of death in the United States, and, currently, therapeutic hypothermia, now called targeted temperature management (TTM), is the only recent treatment modality proven to increase survival rates and reduce morbidity for this condition. Shivering and subsequent metabolic stress, however, limit application and benefit of TTM. Stimulating central nervous system A1 adenosine receptors (A1AR) inhibits shivering and nonshivering thermogenesis in rats and induces a hibernation-like response in hibernating species. In this study, we investigated the pharmacodynamics of two A1AR agonists in development as antishivering agents. To optimize body temperature (Tb) control, we evaluated the influence of every-other-day feeding, dose, drug, and ambient temperature (Ta) on the Tb-lowering effects of N6-cyclohexyladenosine (CHA) and the partial A1AR agonist capadenoson in rats. The highest dose of CHA (1.0 mg/kg, i.p.) caused all ad libitum-fed animals tested to reach our target Tb of 32°C, but responses varied and some rats overcooled to a Tb as low as 21°C at 17.0°C Ta Dietary restriction normalized the response to CHA. The partial agonist capadenoson (1.0 or 2.0 mg/kg, i.p.) produced a more consistent response, but the highest dose decreased Tb by only 1.6°C. To prevent overcooling after CHA, we studied continuous i.v. administration in combination with dynamic surface temperature control. Results show that after CHA administration control of surface temperature maintains desired target Tb better than dose or ambient temperature.