How Magnetic Resonance Imaging (MRI) WorksOn July 3, 1977, an event took place that would forever alter the landscape of modern medicine. Outside the medical research community, this event made scarcely a ripple at first. This event was the first MRI exam ever performed on a human being.
It took almost five hours to produce one image. The images were, by today's standards, quite ugly. Dr. Raymond Damadian, a physician and scientist, along with colleagues Dr. Larry Minkoff and Dr. Michael Goldsmith, labored tirelessly for seven long years to reach this point. They named their original machine "Indomitable" to capture the spirit of their struggle to do what many said could not be done.
This machine is now in the Smithsonian Institution. As late as 1982, there were but a handful of MRI scanners in the entire United States. Today there are thousands. We can image in seconds what used to take hours.The Basic Idea
If you have ever seen an MRI machine, you know that the basic design used in most is a giant cube. The cube in a typical system might be 7 feet tall by 7 feet wide by 10 feet long (2 m by 2 m by 3 m), although new models are rapidly shrinking. There is a horizontal tube running through the magnet from front to back. This tube is known as the bore of the magnet. The patient, lying on his or her back, slides into the bore on a special table. Whether or not the patient goes in head first or feet first, as well as how far in the magnet they will go, is determined by the type of exam to be performed. MRI scanners vary in size and shape, and newer models have some degree of openness around the sides, but the basic design is the same. Once the body part to be scanned is in the exact center or isocenter of the magnetic field, the scan can begin.
In conjunction with radio-wave pulses of energy, the MRI scanner can pick out a very small point inside the patient's body and ask it, essentially, "What type of tissue are you?" The point might be a cube that is half a millimeter on each side. The MRI system goes through the patient's body point by point, building up a 2-D or 3-D map of tissue types. It then integrates all of this information together to create 2-D images or 3-D models.
MRI provides an unparalleled view inside the human body. The level of detail we can see is extraordinary compared with any other imaging modality. MRI is the method of choice for the diagnosis of many types of injuries and conditions because of the incredible ability to tailor the exam to the particular medical question being asked. By changing exam parameters, the MRI system can cause tissues in the body to take on different appearances. This is very helpful to the radiologist (who reads the MRI) in determining if something seen is normal or not. We know that when we do "A," normal tissue will look like "B" -- if it doesn't, there might be an abnormality. MRI systems can also image flowing blood in virtually any part of the body. This allows us to perform studies that show the arterial system in the body, but not the tissue around it. In many cases, the MRI system can do this without a contrast injection, which is required in vascular radiology.Magnetic Intensity
To understand how MRI works, let's start by focusing on the "magnetic" in MRI. The biggest and most important component in an MRI system is the magnet. The magnet in an MRI system is rated using a unit of measure known as a Tesla. Another unit of measure commonly used with magnets is the gauss (1 Tesla = 10,000 gauss). The magnets in use today in MRI are in the 0.5-Tesla to 2.0-Tesla range, or 5,000 to 20,000 gauss. Magnetic fields greater than 2 Tesla have not been approved for use in medical imaging, though much more powerful magnets -- up to 60 Tesla -- are used in research. Compared with the Earth's 0.5-gauss magnetic field, you can see how incredibly powerful these magnets are.
Numbers like that help provide an intellectual understanding of the magnetic strength, but everyday examples are also helpful. The MRI suite can be a very dangerous place if strict precautions are not observed. Metal objects can become dangerous projectiles if they are taken into the scan room. For example, paperclips, pens, keys, scissors, hemostats, stethoscopes and any other small objects can be pulled out of pockets and off the body without warning, at which point they fly toward the opening of the magnet (where the patient is placed) at very high speeds, posing a threat to everyone in the room. Credit cards, bank cards and anything else with magnetic encoding will be erased by most MRI systems.
The magnetic force exerted on an object increases exponentially as it nears the magnet. Imagine standing 15 feet (4.6 m) away from the magnet with a large pipe wrench in your hand. You might feel a slight pull. Take a couple of steps closer and that pull is much stronger. When you get to within 3 feet (1 meter) of the magnet, the wrench likely is pulled from your grasp. The more mass an object has, the more dangerous it can be -- the force with which it is attracted to the magnet is much stronger. Mop buckets, vacuum cleaners, IV poles, oxygen tanks, patient stretchers, heart monitors and countless other objects have all been pulled into the magnetic fields of MRI machines. The largest object I know of being pulled into a magnet is a fully loaded pallet jack (see below). Smaller objects can usually be pulled free of the magnet by hand. Large ones may have to be pulled away with a winch, or the magnetic field may even have to be shut down.
Prior to allowing a patient or support staff member into the scan room, he or she is thoroughly screened for metal objects. Up to this point, we have only talked about external objects. Often however, patients have implants inside them that make it very dangerous for them to be in the presence of a strong magnetic field. Metallic fragments in the eye are very dangerous because moving those fragments could cause eye damage or blindness. Your eyes do not form scar tissue as the rest of your body does. A fragment of metal in your eye that has been there for 25 years is just as dangerous today as it was then -- there is no scar tissue to hold it in place. People with pacemakers cannot be scanned or even go near the scanner because the magnet can cause the pacemaker to malfunction. Aneurysm clips in the brain can be very dangerous as the magnet can move them, causing them to tear the very artery they were placed on to repair. Some dental implants are magnetic. Most orthopedic implants, even though they may be ferromagnetic, are fine because they are firmly embedded in bone. Even metal staples in most parts of the body are fine -- once they have been in a patient for a few weeks (usually six weeks), enough scar tissue has formed to hold them in place. Each time we encounter patients with an implant or metallic object inside their body, we investigate thoroughly to make sure it is safe to scan them. Some patients are turned away because it is too dangerous. When this happens, there is usually an alternative method of imaging that can help them.
There are no known biological hazards to humans from being exposed to magnetic fields of the strength used in medical imaging today. Most facilities prefer not to image pregnant women. This is due to the fact that there has not been much research done in the area of biological effects on a developing fetus. The first trimester in a pregnancy is the most critical because that is the time of the most rapid cellular reproduction and division. The decision of whether or not to scan a pregnant patient is made on a case-by-case basis with consultation between the MRI radiologist and the patient's obstetrician. The benefit of performing the scan must outweigh the risk, however small, to the fetus and mother. Pregnant MRI technologists can still work in the department. In most cases, they are simply kept out of the actual scan room during their pregnancy.The Magnets
There are three basic types of magnets used in MRI systems:
A very uniform, or homogeneous, magnetic field of incredible strength and stability is critical for high-quality imaging. It forms the main magnetic field. Magnets like those described above make this field possible.
Another type of magnet found in every MRI system is called a gradient magnet. There are three gradient magnets inside the MRI machine. These magnets are very, very low strength compared to the main magnetic field; they may range in strength from 180 gauss to 270 gauss, or 18 to 27 millitesla (thousandths of a Tesla). The function of the gradient magnets will become clear later in this article.
The main magnet immerses the patient in a stable and very intense magnetic field, and the gradient magnets create a variable field. The rest of an MRI system consists of a very powerful computer system, some equipment that allows us to transmit RF (radio frequency) pulses into the patient's body while they are in the scanner, and many other secondary components.