Visit to Holly House Hospital

Visit to Holly House Hospital

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Visit to Holly House Hospital

We visited Holly House Hospital on 26th January 2005 to look at how
physics is used in the medical profession, and how it is used in
medical diagnosis. Whilst being shown around the separate radiology
unit at the hospital, I noticed how Magnetic Resonance Imaging used
different ways to look within patients, and helped specialists to try
to diagnose and treat internal problems.

Magnetic Resonance Imaging (MRI)

MRI was discovered in July 1977. French scientists discovered that
using powerful electromagnetic fields and radio waves could produce
images. The machine in which the patient is placed is very large. Most
machines are so large that they completely fill up an entire room. The
standard size of a scanner is 7 feet tall by 7 feet wide by 10 feet
long, with a hole in the middle that is only just large enough to fit
a patient inside. On top of this hole, and running through the whole
scanner is a magnet, which is known as the ‘bore’. The patient enters
the bore lying on his/her back on a special table, which has the
ability to move in and out of the bore. Many patients find the
examination very uncomfortable, as they have to lay still for about
half an hour whilst the scan takes place. Only the part of the body
that is to be scanned is scanned, and the patient can either enter
head first or feet first, which is determined by the type of
radiographic exam to be performed. Once the area of the body that is
to be examined is in the exact centre of the magnetic field of the
scanner then the examination may begin.


The Examination

Prior to allowing a patient to enter the scan room, he or she is
thoroughly screened for metal objects. Often patients have had
implants inside them that make it very dangerous to be in the presence
of a strong magnetic field. The radiologist who is dealing with the
patient has a reference book, from which can find details of objects

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that are compatible with the scanner, and parts that are not. For
example any patient with a pacemaker cannot enter the machine as it
can cause the magnet in the pacemaker to malfunction, and it is also
very dangerous for patients whom have had certain metal fragments in
their body in the past. When the magnetic field is turned on, these
fragments can be dislodged from their position, and they will be
attracted to the magnet. Sometimes when these fragments are moved they
can travel through dangerous parts of the body, which can cause severe
harm. This is why no one is allowed into a scan room without signing a
consent form. When there are patients who cannot use MRI, there is
usually an alternative method of imaging that can help them, such as
CAT, X-ray or ultrasound. Ultrasound uses high frequency sound pulses
into your body using a probe. A coupling gel is used, as any air
bubbles would immediately reflect the sound waves, and this would
cause a distorted image. With the coupling gel there is no air. The
pulses are then reflected off of various tissues, and then an image is
shown on a monitor nearby. The images are only in 2-D, and are nowhere
as precise as MRI, but it is one hundred percent safe and it has been
tested with many people.

As well as the medical disadvantages mentioned above, there are still
some other disadvantages of having a MRI scan. There are many
claustrophobic people in the world, and being in a MRI scanner is a
very disconcerting experience for these people. The machines are also
very loud during a scan. The noise sounds like a constant, rapid
hammering sound. Patients are given earplugs to soften the sound. The
noise is due to the rising electrical current in the gradient magnets
being opposed by the main magnetic field. The stronger the main
magnetic field, the greater the noise of the machine. MRI machine
systems are extremely expensive (the system in Holly House cost
£750,000) and therefore the individual scans are just as expensive.
(Knee scan is £700 and an abdomen scan is £1000)

The main advantage for MRI scanners is that there are no known
biological hazards to humans being exposed to magnetic fields of the
strength used in medical imaging today, however most facilities prefer
not to scan pregnant women as there has not been much research done in
the area of biological defects on a developing foetus, as obviously it
is very difficult to conduct such research, as many pregnant women do
not want to take this risk. There are many things that MRI is ideal
for: -

o Diagnosing multiple sclerosis (MS)

o Diagnosing tumours of the pituitary gland and brain

o Diagnosing infections in the brain, spine or joints

o Visualizing torn ligaments in the wrist, knee and ankle

o Visualizing shoulder injuries

o Diagnosing tendonitis

o Evaluating masses in the soft tissues of the body

o Evaluating bone tumours, cysts and bulging or herniated discs in the

o Diagnosing strokes in their earliest stages


In Holly House, superconducting magnets are used in the machines. The
magnet is made from niobium titanium alloy, which gives it
superconductivity properties. The wire coiled around the core is
surrounded by liquid helium (-269°C). This substance causes the
resistance in the wire to drop to zero, this is the critical
temperature, and reducing the electrical power needed to operate the
system makes the machine much more economical to operate, although
cooling the system is still extremely expensive, but the key point is
that once the electricity has been introduced into the coils then the
current will continue at full strength for years without any more
electrical input. These magnets produce a 0.5 tesla to 2 tesla
magnetic fields, allowing for much higher quality imaging. This is an
extremely large number, and the average MRI scanner has a magnetic
field that is 10,000 times larger than the magnetic field of the
earth. The entire MRI scanner installation is enclosed in a stainless
steel or copper shield known as a Faraday cage which blocks out radio
frequency signals from local radio and TV stations that might
influence the MRI signals.


How the pictures are taken

The human body is made up of billions of different atoms. The nuclei
of these atoms spin around randomly, and the main atom that MRI
focuses on is the hydrogen atom. The hydrogen atom is ideal because
its nucleus has a single proton and it has a very large magnetic
moment. The large moment means that when placed in a magnetic field,
the hydrogen atom has a strong tendency to line up with the direction
of the field. As the magnet runs along the scanner in the same
direction as the body, the magnetic field therefore does the same. The
atoms will line up in the direction of either the feet or the head.
Many of the atoms cancel out, but as there are so many billions, there
are still enough to produce astounding images.


Radio Waves

The MRI machine then applies a radio frequency to the body that is
specific only to hydrogen. These waves are directed at the part of the
body that is needed to be examined. This pulse causes the protons in
the area to absorb the energy that is needed to make them spin once
again, but now pointing in a different direction. This part of the
process is the ‘resonance’ in Magnetic Resonance Imaging. The radio
frequency causes the atoms to spin at a particular frequency and in a
particular direction. The frequency of the atoms is called the ‘Larmor
frequency’ and can be calculated by the specific tissue being imaged
and the strength of the main magnetic field. When the magnetic field
is 1 tesla, the frequency is 42.58Mhz, and when the magnetic field is
2 tesla, the frequency of the hydrogen atom is 85.16Mhz. The Larmor
frequency can be calculated by knowing the gyromagnetic ratio (also
known as the magnetogyric ratio) and the magnetic field, and finding
the product.

Gradient Magnets

MRI scanners can ‘slice’ the human body in separate slices only a few
millimetres thick. They can do this by using gradient magnets. When
gradient magnets turn on and off rapidly, they can compose different
slices of the body. They move around inside the main magnet, and thus
the main advantage is that a picture can be taken of any particular
region in a patient’s body without having to move the patient or the
machine. Three gradient magnets are used, so that a patient’s body can
be dissected in the sagittal plane, and coronally, as well as axial
images. When taking an X-ray, patients have to move after every
picture is taken, and CAT scanners cannot slice in the sagittal plane
or coronally, so it is immediately obvious why MRI scanners have
transformed medical imaging to assist diagnosis. The Gradient Magnets
are the cause of the extreme noise in the machines. (Mentioned above).

Reference plane



Sagittal plane

All planes parallel to the median plane through the body

Sagittal plane

Coronal plane

Planes dividing the body back and forth perpendicular to the sagittal

Frontal plane

Horizontal plane

Planes parallel to the floor perpendicular to the sagittal plane and
frontal plane

Horizontal plane

When the Radio Wave pulse is turned off, the hydrogen atoms begin to
return relatively slowly to their original alignment within the
magnetic field and release their excess stored energy. When they do
this, they give off a signal that the coil around the magnet picks up
and sends to a computer system in the radiographer’s office. The
system then converts this data into a picture which can then be put
onto film, or be sent anywhere in the world via the Internet.


A screenshot of the software used by radiologists. This shows the huge
amount of images taken and how they can be manipulated.

Other Uses of the Imaging

If it is necessary, patients can be injected with a special dye that
contrasts with normal tissue on a scan. MRI contrast works by altering
the magnetic field in the tissue being examined. Normal and abnormal
tissue will respond differently to this dye, and therefore different
signals will be emitted to the computer system. The severity and the
position of the abnormal tissue will then be assessed by the
specialist, who can therefore use this information to determine the
severity of the condition. The name of the dye that is used is
gadolinium. Gadolinium contrasts, have been used for more than 15
years in MRI, and have been extremely well tolerated by patients with
a much lower risk of allergic reaction or kidney impairment compared
to iodine containing contrasts. New Gadolinium compounds are
emerging, such as MS-325, which are designed specifically for imaging
of blood vessels. The molecule forms a reversible bond to albumen and
stays in the circulation for a longer period of time, allowing high
resolution images to be obtained. This offers the potential to safely
image the blood vessels of the body with MRI with higher accuracy than
currently possible.


A MRI image of the spine.

The Future Of Magnetic Resonance Imaging

MRI is relatively new in medical imaging; it has only been in
widespread use for about 20 years whereas x-ray imaging has been
around for over 100 years. The future for MRI looks very exciting.
Very small scanners are being produced, and there are even scanners
developed that can simply be placed on an arm, a foot or a knee.
Functional brain mapping which is when someone scans a person's brain
while he or she is performing a certain physical task such as
squeezing a ball, or looking at a particular type of picture, is
helping researchers better understand how the brain works. Research is
under way in a few institutions to image the ventilation dynamics of
the lungs through the use of hyperpolarized helium gas (helium gas
that has had its polarity increased). The development of new, improved
ways to image cerebral vascular accidents (strokes) in their earliest
stages is ongoing. New MRI scanners are being used with a lower
magnetic field (0.1T to 0.5T). These machines do not use a
superconducting magnet and therefore the hospitals do not need to
worry about cooling these, and therefore the economical implication,
however the imaging being recorded has to go through more complex
computer systems so that it has the same quality images. New scanners
such as PET scanners (Positron Emission Tomography) are coming readily
available, and these produce even better images, with the opportunity
for images to be constructed in 3-D. however, the NHS is not investing
in this technology, there are only 6 of these scanners in Britain
whereas Germany and France have over 80 of these each. It looks as if
MRI will not be overtaken in the forefront of medical imaging for a
long time, especially not in the UK.


A small head scanner.

MRI+.jpg (41113 bytes)

The patient is receiving treatment on his left knee. This is a new
type of scanner that is significantly smaller, and therefore has more


The almost limitless benefits of MRI for most patients far outweigh
the few drawbacks. MRI scanning has revolutionised medical imaging,
and has helped to treat many patients who could not be treated in any
other way. MRI uses physics techniques that have been identified above
to overcome problems where CAT scanners could not do so as well. It is
an extremely safe method of imaging, and the technology is rapidly
advancing, which will only make this method better.


Holly House Hospital MRI Consent Form

‘Economics of the NHS’ BBC2 7th February

‘Medical Physics’ by Martin Hollins, pages 186 - 187
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