The World’s Most Powerful MRI Takes Shape

Illustration: Emily Cooper
This one goes to 11: The main superconducting coil for the INUMAC imager is made from 170 kilometers of niobium-titanium. When bathed in liquid helium and charged, it produces a magnetic field of 11.75 teslas.

An MRI scanner equipped with a superconducting magnet strong enough to lift a 60-metric-ton battle tank will offer unprecedented images of the human brain when it comes on line a little more than a year from now, say its builders.

The imager’s superconducting electromagnet is designed to produce a field of 11.75 teslas, making it the world’s most powerful whole-body scanner. Most standard hospital MRIs produce 1.5 or 3 T. A few institutions, including the University of Illinois at Chicago and Maastricht University, in the Netherlands, have recently installed human scanners that can reach 9.4 T. Superconducting magnets used in the Large Hadron Collider, which last year was used in the discovery of the Higgs boson, produce a field of 8.4 T.

The development of the scanner, known as INUMAC (for Imaging of Neuro disease Using high-field MR And Contrastophores), has been in progress since 2006 and is expected to cost €200 million, or about US $270 million. The project reached a key milestone this summer with delivery of more than 200 kilometers of superconducting cable, which is now being wound into coils that will produce the scanner’s magnetic field.

“We’re pretty proud of having met all the requirements, plus given them a little extra,” says Hem Kanithi, vice president of business development at Luvata, in Waterbury, Conn., which built the superconductor.

Standard hospital scanners have a spatial resolution of about 1 millimeter, covering about 10 000 neurons, and a time resolution of about a second. The INUMAC will be able to image an area of about 0.1 mm, or 1000 neurons, and see changes occurring as fast as one-tenth of a second, according to Pierre Védrine, director of the project at the French Alternative Energies and Atomic Energy Commission, in Paris. With this type of resolution, MRIs could detect early indications of brain diseases such as Alzheimer’s or Parkinson’s and perhaps measure the effects of any methods developed to treat those illnesses. It would also allow much more precise functional imaging of the brain at work than is currently available. “You cannot really discriminate today what is happening inside your brain at the level of a few hundred neurons,” Védrine says.

High-field MRI could also allow scientists to explore different methods of imaging. Most MRI machines rely on imaging the nuclei of hydrogen atoms, but stronger scanners might gain useful physiological information by looking for weaker signals from sodium or potassium nuclei.

Improved superconducting wire is key to making such a powerful machine. The wire in the INUMAC magnet is made from niobium-titanium, a common superconductor alloy. But it will experience some uncommon conditions as part of INUMAC. To reach the required field strength, the electromagnet must be able to carry 1500 amperes at 12 T and be cooled by superfluid liquid helium to 1.8 kelvins. That requires specialized manufacturing and precise control of the dimensions of the wire, allowing it to be coiled so the cables are aligned to within a few micrometers of precision. “We are pushing the superconducting material niobium-titanium very close to its limits,” Védrine says.

Another material, niobium-tin, can produce magnetic fields stronger than 20 T, but it was passed over for the job because it’s more expensive than niobium-titanium and very brittle, making it difficult to wind.

Ultimately, Luvata produced 170 km of wire for the main superconducting coil. The company made another 58 km for two secondary coils, which will produce an opposing magnetic field to shield the area outside the machine from stray magnetic fields.

Instead of winding the wire into one long coil, as is standard in systems with lower fields, engineers are using a “double pancake” design, in which the wire is coiled into two reels that are spliced together, one on top of the other. The whole magnet will consist of 170 of these double pancakes connected in series. Védrine explains that this reduces the chances for error: Making a mistake in the winding phase using a single helical coil could ruin the whole magnet. However, a miswound pancake can simply be swapped out for a new one. The design provides space for the liquid helium bath to reach all of the coil and keep the temperature low, and it also allows engineers to place the best-performing coils at the center of the system, which improves the precision of the magnetic field.

The inner diameter of the magnet will be 90 centimeters, wide enough for a human body. Patients getting scanned will lie entirely inside the machine, but the region where the field is precise enough to get maximum resolution will be only 22 cm long. “The very good field region is only in the middle of the magnet,” Védrine says. While patients could be situated so that other body parts would fit inside that region, “first we are concentrating on the brain,” he says. It would take an even more massive machine to enlarge the high-resolution area.

Védrine expects to deliver the fully assembled magnet by September of next year. Other parts of the imaging system will then be added in and around the magnet, followed by about three months of testing. “Probably we’ll have the first images by the beginning of 2015,” he says.

Source: IEEE Spectrum

WellStar plans another “health park”

 

WellStar Health System said Wednesday that is planning its third “health park’’ in Cobb County. The facility will be located in the Smyrna/Vinings area, an affluent area close to the city of Atlanta. It is expected to open in late 2015 or early 2016, WellStar said. The health park concept seeks to provide an array of outpatient services at one location, aimed at customer convenience. WellStar  – See more at: http://www.georgiahealthnews.com/2013/10/wellstar-plans-health-park/

Happy International Day of Radiology!

Wilhelm Röntgen

Radiology emerged from humble beginnings, thanks in large part to Wilhelm Röntgen. On International Day of Radiology, we celebrate those who have continued his work and have contributed to safe patient care.

Source: Ratiological Society of North America (RSNA)

RSNA Facebook Page

Herbal, Weight Loss Supplements, Energy Drink Associated With Liver Damage, Liver Failure

Severe liver damage, and even failure, has been associated with the consumption of weight loss supplements, an herbal supplement and an energy drink, according to four separate case reports presented at the American College of Gastroenterology’s 78th Annual Scientific Meeting in San Diego, CA. Use of herbal and dietary supplements is widespread for a variety of health problems. Because many patients do not disclose supplement use to their physicians, important drug side effects can be missed.

Case Report 1: SlimQuick™- Associated Hepatotoxicity Resulting in Fulminant Liver Failure

There have been many reports of toxicity associated with dietary supplement use over the years, some with severe and even fatal outcomes. Lead investigator Dina Halegoua-De Marzio, M.D., reported a rare case of fulminant liver failure associated with the ingestion of SlimQuick™, a weight loss supplement containing green tea extract.

A 52-year old female patient was admitted to the emergency room after one week of vomiting and progressive jaundice. The patient reported she had ingested SlimQuick™ for two days, while fasting three weeks prior to intake. Past medical and family histories of the patient were normal. According to Dr. Halegoua-De Marzio, the patient’s physical examination showed normal mental status, icteric sclera, mild abdominal distension and lower extremity edema. Her liver biopsy was consistent with confluent hepatic necrosis with collapse. The steroid prednisone was started but discontinued after two days, as liver function worsened and mental status deteriorated. After being evaluated and listed for liver transplant, the patient underwent transplantation two days later.

“There is a lack of knowledge about the status of Food and Drug Administration regulation of dietary supplements,” said Dr. Halegoua-De Marzio. “Currently, dietary supplements are not required to have safety or efficacy studies before they are marketed to the public, and they remain popular among consumers despite reports of hepatotoxicity. This case report is an example of how even minimal use of these unregulated dietary supplements can lead to fulminant liver failure requiring liver transplant. It is important that patients talk with their doctors before starting any new dietary supplements.”

Dr. Halegoua-De Marzio believes this is the first reported case of fulminant liver failure due to the consumption of SlimQuick™. The main ingredient in SlimQuick™ is green tea extract, a common ingredient in several dietary supplements, some of which have been withdrawn from the market due to safety concerns.

Case Report 2: Black Cohosh-induced Hepatotoxicity Leading to Early Cirrhosis

Lead investigator Khadija Haroon Chaudrey, M.D., presented a rare case of black cohosh-induced hepatotoxicity leading to early cirrhosis. A 44-year-old female had developed jaundice for one month.

Initial lab work revealed elevated liver function tests (LFTs). The patient had no history of alcohol intake, IV drug use, unprotected sex, recent travel outside the United States, NSAID ingestion or blood transfusions. After unsuccessful outpatient improvement on steroids, she was referred to inpatient evaluation because of gradual progression of her symptoms, marked scleral icterus and jaundiced skin.

The patient then reported she had started taking black cohosh about one month prior, to help with her menstrual symptoms. “Her ultrasound abdomen showed nodular contour of liver consistent with cirrhosis,” said Dr. Chaudrey. “Her liver biopsy showed histologic pattern consistent with cholestasis, hepatocellular injury and early cirrhosis. Given patient’s history of black cohosh use and the timing of her abnormal liver chemistries, it was clinically evident the culprit agent was black cohosh.”

Once the patient stopped taking black cohosh, her symptoms improved and her LFTs normalized. Dr. Chaudrey adds that clinician awareness can be the key to early diagnosis, therapeutic intervention, and even prevention of drug-induced liver injury (DILI). DILI is a common problem associated with herbal supplements and over the counter medications. Although drug-induced hepatitis with most herbal supplements is considered rare, significant outcomes can occur.

Case Report 3: Acute Liver Failure Following Consumption of a Popular Sugar-free Energy Drink for a Year

Lead author Brian Huang M.D., Chief Resident of the Internal Medicine Residency Program at Cedars Sinai Medical Center, presented a case which is one of only a few known reports that directly link energy drink consumption with liver failure. A 36-year-old male without prior medical history sought medical attention after symptoms of right upper quadrant abdominal pain, jaundice and fatigue. After abnormal lab work, he was brought to the hospital. The patient admitted to binge drinking (10 beers in a three-hour period) prior to symptom onset. He denied consuming herbal supplements, but admitted to having three energy drinks, specifically Rockstar® Sugar Free, on a daily basis for the past year.

According to Dr. Huang, “The patients’ pathology reports showed massive hepatocellular necrosis and parenchymal collapse consistent with drug-induced liver injury. We believe his prior history of binge drinking may have provided initial damage on his liver, making him more susceptible to develop liver failure. Although the patient had a history of weekend binge drinking, his liver biopsy was not consistent with alcoholic hepatitis. Thus, we believe the liver failure was linked to the long-term energy drink consumption.”

According to the authors, the patient’s liver biopsy showed severe active hepatitis with bridging necrosis consistent with an herbal/drug-toxicity pattern. Upon worsening LFTs, the patient was placed on a donor waiting list and within a couple days found a suitable donor and underwent a successful liver transplantation.

“As energy drinks have become increasingly popular over the years, their ingredients are being looked at more closely, many which do not have a well-established safety profile. Some of these products have even been banned in other countries. While drinking modest amounts of energy drinks may be relatively safe, frequent consumption over an extended period of time has been linked with liver injury,” said Dr. Huang. More studies are needed to look at the relationships between energy drinks and liver damage.

Case Report 4: A Case of Drug-induced Liver Injury Arising from Ripped Fuel®

Another case of drug-induced liver injury was found in the advanced weight loss supplement, Ripped Fuel®. The supplement contains herbal extract with 60 percent flavoids, caffeine and cacao. The following case report illustrates drug-induced liver injury secondary to its use.

A 36-year old female with history of depression and no prior liver disease was seen after having one week of abdominal pain, anorexia and nausea. On physical examination, she had scleral icterus and mild jaundice. The patient had started to take Ripped Fuel® three weeks prior to developing these symptoms, to lose weight. She denied use of other herbal medicine, supplements or acetaminophen. There had been no recent changes in her depression medication.

“Initial laboratory findings suggested fulminant hepatic failure,” said lead author Hye Yeon Jhun, M.D. “Findings of the liver biopsy was consistent with marked portal inflammation, with circumferential interface activity and bridging hepatocyte necrosis consistent with DILI.” With treatment, the patient continued to improve clinically, with no evidence of hepatic failure during hospitalization, and was safely discharged.

Flavonoids have been thought to cause significant liver injury in several case reports. Treatment after development of drug-induced liver injury has been poorly defined, besides discontinuing the triggering substance. Previously, steroids have been studied to prevent tissue damage from inflammatory response, which failed to show beneficial effects. Dr. Jhun adds, “The usage of ursodeoxycholic acid (UDCA) has been shown to be favorable, due to protection of hepatocytes against cytotoxic effects of bile acids and stimulating hepatobiliary secretion. Recently, the combination of steroids and UDCA proved to benefit the outcome of patients with severe drug-induced liver injury.”

Source: Science Daily

Three Most Common Cancers Among Men

Three Most Common Cancers Among Men

Prostate cancer (137.7)
First among men of all races and Hispanic* origin populations.

Lung cancer (78.2)
Second among white, black, American Indian/Alaska Native, and Asian/Pacific Islander men.
Third among Hispanic* men.

Colorectal cancer (49.2)
Second among Hispanic* men.
Third among white, black, American Indian/Alaska Native, and Asian/Pacific Islander men.

Leading Causes of Cancer Death Among Men ~

Lung cancer (62.0)
First among men of all races and Hispanic* origin populations.

Prostate cancer (22.0)
Second among white, black, American Indian/Alaska Native, and Hispanic* men.
Fourth among Asian/Pacific Islander men.

Colorectal cancer (19.1)
Third among men of all races and Hispanic* origin populations.

Liver cancer
Second among Asian/Pacific Islander men.

Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2009 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2013. Available at: http://www.cdc.gov/uscs.

*Hispanic origin is not mutually exclusive from race categories (white, black, Asian/Pacific Islander, American Indian/Alaska Native).

Expanding Flu Vaccination Policies to Include Children Could Reduce Infections and Mortality

The current influenza (flu) vaccination policy in England and Wales should be expanded to target 5 to 16-year-olds in order to further reduce the number of deaths from flu, according to a study by UK researchers published in this week’s Pmed

The results of the study by Marc Baguelin and colleagues from the London School of Hygiene & Tropical Medicine in the UK, Public Health England, and Athens University of Economics and Business, show that the current flu vaccination policy that targets people aged 65 years and over and also those in high risk groups has reduced the number of flu infections and associated deaths in these groups over the past 14 years. The authors show that offering the flu vaccine to children will have beneficial effects especially as children are key “spreaders” of the flu virus.
In their modelling study, the authors combine clinical information collected in a primary care (general practice) surveillance scheme over 14 years in England and Wales with information on social contacts, and with information on immunity to flu viruses in the population. They use this information to estimate the number of influenza infections and deaths that might have occurred without vaccination, with the current vaccination program, and if the program were expanded. Compared to no vaccination, the authors estimate that the current program probably averted 0.39 infections per dose of vaccine and 1.74 deaths per 1,000 doses. Furthermore, expanding the program to target 5-16-year-old children would avert 0.70 infections per dose and 1.95 deaths per 1,000 doses compared to no vaccination.
These findings are encouraging given that a new flu vaccination program for children is being rolled out in England and Wales from this month (September 2013). However, the accuracy of the authors’ predictions may be limited because the vaccination model was based on several assumptions.
The authors say: “The most efficient way of reducing overall influenza-attributable morbidity and mortality appears to be to target the key spreaders — children.”
They continue: “Even with modest coverage, substantial further reductions in morbidity and mortality could be achieved.”

Infographic: Most Expensive Health Care Technology

Infographic via: MIT Technology Review

Does Stress Make You Hungry?

Yes, but only for junk food.

Much of what scientists know about stress eating comes from cramming animals into Plexiglas tubes. When researchers subject lab rats to this particular discomfort for several hours every day, the rodents lose their appetites for healthy pet food. But if given access to junk foods, such as a high-sugar or high-fat treat, the rats pig out.

“Sometimes an animal’s calorie intake actually doesn’t increase overall, but the kind of foods it’s eating shifts,” says Kevin Laugero, a Research Nutritionist at the Western Human Nutrition Research Center/ARS/USDA and Professor of Nutrition at the University of California Davis who has studied stress eating for more than a decade. “We think it’s a selective focus on these highly energetic or energy-dense foods.”

When animals are stressed, they need additional energy to fight off a predator or flee to safer ground. As a result, their bodies produce a spike in cortisol. The hormone unlocks glucose stored in fat and muscle, and glucose fuels the body’s vital functions. It also drives animals to seek out foods with the most calories per bite, so ones high in sugar and fat.

Some humans have a similar response. Studies show that if you cause stress in people in the lab—by making them participate in a mock job interview, for example—and then offer them a buffet of snacks, they may be more inclined to graze on chocolate bars than carrot sticks. According to Laugero, such effects are not universal, but stress affects diet in some form in about 80 percent of the population. “It is possible that some of it is just the reward-based association,” Laugero explains, “but I think with food, there is definitely a metabolic basis. Having a bowl of ice cream when we’re stressed can actually be adaptive. But it’s the repeated nature over time that can be absolutely maladaptive.”

Source: Popular Science