AAOC and ACCR provides a complete spectrum of medical care in our office facility. The goal is to provide patients with complete medical treatment in one location, eliminating numerous visits and the need to travel to additional offices or facilities.

Open MRI (Open Magnetic Resonance Imaging) is a safe and painless diagnostic imaging procedure that captures finely detailed pictures of the human anatomy, including internal organs, the nervous system, bones, and soft tissues. Unlike X-ray or CT, MRI sees through bone to image soft tissue in any plane of a given body part. Using a strong magnet, radio waves and a sophisticated computer, the MRI scanner assembles the faint signals emitted from the hydrogen atoms in your body to create a detailed image. MRI produces cross-sectional views of the body in "slices" which are then sent to the computer. The computer combines these images and can create views from any angle. MRI is used to diagnose a variety of medical conditions, and evaluate organs, tissues and bone structures for evidence of disease, abnormalities or injury. MRI provides detailed images without exposure to X-ray radiation.

Open MRI is different from traditional MRI in that it has a large, non-confining opening. It provides an important option for large or claustrophobic patients.

In some cases, your doctor may order an Open MRI scan to be done using a contrast medium to facilitate a clearer image of the area being scanned. The contrast medium may be given by intravenous injection or orally.

Patient Experience
You should arrive at the center approximately 15 minutes before your appointment time for the usual screening procedures and paperwork. You may be asked to change into a patient gown as metal zippers and fasteners can interfere with the scan. At this time, you will also be asked to remove any metal objects or items that can be affected by the magnetic field (including hair pins, belts, jewelry, glasses, clothing with zippers, nonpermanent dentures, credit cards, car keys). Before your exam, the MRI technologist will obtain a brief medical history. Let the technologist or radiologist know if you have any questions.

The MRI examination room is occupied by a large magnet and a padded scanning table. You will be asked to lie down on the scanning table and will be positioned to ensure maximum comfort during your exam. The exam table will gently move into the opening of the magnet. A coil, which is a special radio receiver, may be placed around the body part being scanned (such as your head, knee, chest, etc.).

You will feel nothing unusual during your exam. You will hear humming and a rhythmic tapping noise as the scanner operates. For added comfort, some centers may provide music or ear plugs, or you can bring recordings of your own choosing. It is important that you remain relaxed and still during the exam so the images do not blur. The technologist will speak to you through a two-way intercom system before each sequence, telling you when the scan will begin and how long it will last. You will be able to talk to the technologist if you need assistance at any time during the exam. If you wish, a family friend may accompany you into the MRI examination room, after being screened.

If a contrast medium must be used, it will be given to you intravenously or orally. You might experience flushing, nausea, a headache, or a salty taste in the mouth. Let your technologist know immediately if you experience any of these or any other uncomfortable sensations.

Although MRI exams are scheduled to minimize waiting time, unexpected delays may occur. Each examination is structured to the individual needs of the patient.

Exam Time
Each procedure lasts approximately 30-60 minutes. If more than one part of the body is being imaged, the exam time may be longer.

Results
A specially trained radiologist will review and interpret the images and prepare a report of findings to be sent to your referring physician who ordered the exam. Your physician can then explain to you what the findings mean.

Special Preparations
These are general guidelines. Please contact the center prior to your appointment for detailed instructions.

In most cases, there is no advanced preparation needed for your MRI scan. You may follow your normal diet and take any scheduled medications. Wear something comfortable with no metal (no zippers, etc.) Avoid make-up, as it may contain metal. Should your physician prescribe a mild sedative, someone will need to accompany you to escort you home. If you have had previous diagnostic studies (CT scan, Ultrasound, X-ray, Bone scans, or a previous MRI) of the body part being evaluated, please bring those films and reports, or request they be sent to the center. These studies or reports are very helpful to the radiologist interpreting your MRI scan.

Tell your doctor or the technologist:

• If you pregnant or breast feeding.
• If you have any implanted devices such as a heart pacemaker, internal drug-infusion pump, neurostimulator, cochlear implants, aneurysm clips, metal plates, cardiac valves, or bone or joint replacements.
• If you have had brain, heart, ear, eye or other surgeries especially prior to 1980).
• If you have been a machine, auto, or metal worker.
• If you have ever been injured by metal which may still be lodged in your body.
• If you have braces or permanent bridges or hearing aids.
• If you have inferior vena cava umbrella.

Magnetic resonance imaging (MRI) is the newest, and perhaps most versatile, medical imaging technology available. Doctors can get highly refined images of the body's interior without surgery, using MRI. By using strong magnets and pulses of radio waves to manipulate the natural magnetic properties in the body, this technique makes better images of organs and soft tissues than those of other scanning technologies. MRI is particularly useful for imaging the brain and spine, as well as the soft tissues of joints and the interior structure of bones. The entire body is visible to the technique, which poses few known health risks.

Purpose
MRI was developed in the 1980s. The latest additions to MRI technology are angiography (MRA) and spectroscopy (MRS). MRA was developed to study blood flow, while MRS can identify the chemical composition of diseased tissue and produce color images of brain function. The many advantages of MRI include:

Detail: MRI creates precise images of the body based on the varying proportions of magnetic elements in different tissues. Very minor fluctuations in chemical composition can be determined. MRI images have greater natural contrast than standard x rays, computed tomography scan (CT scan), or ultrasound, all of which depend on the differing physical properties of tissues. This sensitivity lets MRI distinguish fine variations in tissues deep within the body. It also is particularly useful for spotting and distinguishing diseased tissues (tumors and other lesions) early in their development. Often, doctors prescribe an MRI scan to more fully investigate earlier findings of the other imaging techniques.

Scope: The entire body can be scanned, from head to toe and from the skin to the deepest recesses of the brain. Moreover, MRI scans are not obstructed by bone, gas, or body waste, which can hinder other imaging techniques. (Although the scans can be degraded by motion such as breathing, heartbeat, and normal bowel activity.) The MRI process produces cross-sectional images of the body that are as sharp in the middle as on the edges, even of the brain through the skull. A close series of these two-dimensional images can provide a three-dimensional view of a targeted area.

Safety: MRI does not depend on potentially harmful ionizing radiation, as do standard x-ray and CT scans. There are no known risks specific to the procedure, other than for people who might have metal objects in their bodies.

Given all the advantages, doctors would undoubtedly prescribe MRI as frequently as ultrasound scanning, but the MRI process is complex and costly. The process requires large, expensive, and complicated equipment; a highly trained operator; and a doctor specializing in radiology. Generally, MRI is prescribed only when serious symptoms and/or negative results from other tests indicate a need. Many times another test is appropriate for the type of diagnosis needed.

Doctors may prescribe an MRI scan of different areas of the body.

• Brain and head. MRI technology was developed because of the need for brain imaging. It is one of the few imaging tool that can see through bone (the skull) and deliver high quality pictures of the brain's delicate soft tissue structures. MRI may be needed for patients with symptoms of a brain tumor, stroke, or infection (like meningitis). MRI also may be needed when cognitive and/or psychological symptoms suggest brain disease (like Alzheimer's or Huntington's diseases, or multiple sclerosis), or when developmental retardation suggests a birth defect. MRI can also provide pictures of the sinuses and other areas of the head beneath the face.
  
• Spine. Spinal problems can create a host of seemingly unrelated symptoms. MRI is particularly useful for identifying and evaluating degenerated or herniated spinal discs. It can also be used to determine the condition of nerve tissue within the spinal cord.
  
• Joint. MRI scanning is most commonly used to diagnose and assess joint problems. MRI can provide clear images of the bone, cartilage, ligament, and tendon that comprise a joint. MRI can be used to diagnose joint injuries due to sports, advancing age, or arthritis. MRI can also be used to diagnose shoulder problems, like a torn rotator cuff. MRI can also detect the presence of an otherwise hidden tumor or infection in a joint, and can be used to diagnose the nature of developmental joint abnormalities in children.
  
• Skeleton. The properties of MRI that allow it to see though the skull also allow it to view the inside of bones. It can be used to detect bone cancer, inspect the marrow for leukemia and other diseases, assess bone loss (osteoporosis), and examine complex fractures.
  
• The rest of the body. While CT and ultrasound satisfy most chest, abdominal, and general body imaging needs, MRI may be needed in certain circumstances to provide better pictures or when repeated scanning is required. The progress of some therapies, like liver cancer therapy, needs to be monitored, and the effect of repeated x-ray exposure is a concern.

Precautions
MRI scanning should not be used when there is the potential for an interaction between the strong MRI magnet and metal objects that might be imbedded in a patient's body. The force of magnetic attraction on certain types of metal objects (including surgical steel) could move them within the body and cause serious injury. Metal may be imbedded in a person's body for several reasons.

• Medical. People with implanted cardiac pacemakers, metal aneurysm clips, or who have had broken bones repaired with metal pins, screws, rods, or plates must tell their radiologist prior to having an MRI scan. In some cases (like a metal rod in a reconstructed leg) the difficulty may be overcome.
  
• Injury. Patients must tell their doctors if they have bullet fragments or other metal pieces in their body from old wounds. The suspected presence of metal, whether from an old or recent wound, should be confirmed before scanning.
  
• Occupational. People with significant work exposure to metal particles (working with a metal grinder, for example) should discuss this with their doctor and radiologist. The patient may need prescan testing--usually a single, regular x ray of the eyes to see if any metal is present.

Chemical agents designed to improve the picture and/or allow for the imaging of blood or other fluid flow during MRA may be injected. In rare cases, patients may be allergic to or intolerant of these agents, and these patients should not receive them. If these chemical agents are to be used, patients should discuss any concerns they have with their doctor and radiologist.

The potential side effects of magnetic and electric fields on human health remain a source of debate. In particular, the possible effects on an unborn baby are not well known. Any woman who is, or may be, pregnant should carefully discuss this issue with her doctor and radiologist before undergoing a scan.

As with all medical imaging techniques, obesity greatly interferes with the quality of MRI.

Description
In essence, MRI produces a map of hydrogen distribution in the body. Hydrogen is the simplest element known, the most abundant in biological tissue, and one that can be magnetized. It will align itself within a strong magnetic field, like the needle of a compass. The earth's magnetic field is not strong enough to keep a person's hydrogen atoms pointing in the same direction, but the superconducting magnet of an MRI machine can. This comprises the "magnetic" part of MRI.

Once a patient's hydrogen atoms have been aligned in the magnet, pulses of very specific radio wave frequencies are used to knock them back out of alignment. The hydrogen atoms alternately absorb and emit radio wave energy, vibrating back and forth between their resting (magnetized) state and their agitated (radio pulse) state. This comprises the "resonance" part of MRI.

The MRI equipment records the duration, strength, and source location of the signals emitted by the atoms as they relax and translates the data into an image on a television monitor. The state of hydrogen in diseased tissue differs from healthy tissue of the same type, making MRI particularly good at identifying tumors and other lesions. In some cases, chemical agents such as gadolinium can be injected to improve the contrast between healthy and diseased tissue.

A single MRI exposure produces a two-dimensional image of a slice through the entire target area. A series of these image slices closely spaced (usually less than half an inch) makes a virtual three-dimensional view of the area.

Magnetic resonance spectroscopy (MRS) is different from MRI because MRS uses a continuous band of radio wave frequencies to excite hydrogen atoms in a variety of chemical compounds other than water. These compounds absorb and emit radio energy at characteristic frequencies, or spectra, which can be used to identify them. Generally, a color image is created by assigning a color to each distinctive spectral emission. This comprises the "spectroscopy" part of MRS. MRS is still experimental and is available in only a few research centers.

Doctors primarily use MRS to study the brain and disorders, like epilepsy, Alzheimer's disease, brain tumors, and the effects of drugs on brain growth and metabolism. The technique is also useful in evaluating metabolic disorders of the muscles and nervous system. Magnetic resonance angiography (MRA) is another variation on standard MRI. MRA, like other types of angiography, looks specifically at fluid flow within the blood (vascular) system, but does so without the injection of dyes or radioactive tracers. Standard MRI cannot make a good picture of flowing blood, but MRA uses specific radio pulse sequences to capture usable signals. The technique is generally used in combination with MRI to obtain images that show both vascular structure and flow within the brain and head in cases of stroke, or when a blood clot or aneurysm is suspected.

Regardless of the exact type of MRI planned, or area of the body targeted, the procedure involved is basically the same and occurs in a special MRI suite. The patient lies back on a narrow table and is made as comfortable as possible. Transmitters are positioned on the body and the cushioned table that the patient is lying on moves into a long tube that houses the magnet. The tube is as long as an average adult lying down, and the tube is narrow and open at both ends. Once the area to be examined has been properly positioned, a radio pulse is applied. Then a two-dimensional image corresponding to one slice through the area is made. The table then moves a fraction of an inch and the next image is made. Each image exposure takes several seconds and the entire exam will last anywhere from 30-90 minutes. During this time, the patient is not allowed to move. If the patient moves during the scan, the picture will not be clear.

Depending on the area to be imaged, the radio-wave transmitters will be positioned in different locations.

For the head and neck, a helmet-like hat is worn

For the spine, chest, and abdomen, the patient will be lying on the transmitters.

For the knee, shoulder, or other joint, the transmitters will be applied directly to the joint.

Additional probes will monitor vital signs (like pulse, respiration, etc.).

The process is very noisy and confining. The patient hears a thumping sound for the duration of the procedure. Since the procedure is noisy, music supplied via earphones is often provided. Some patients get anxious or panic because they are in the small, enclosed tube. This is why vital signs are monitored and the patient and medical team can communicate between each other. If the chest or abdomen are to be imaged, the patient will be asked to hold his/her breath as each exposure is made. Other instructions may be given to the patient, as needed. In many cases, the entire examination will be performed by an MRI operator who is not a doctor. However, the supervising radiologist should be available to consult as necessary during the exam, and will view and interpret the results sometime later.

Preparation
In some cases (such as for MRI brain scanning or an MRA), a chemical designed to increase image contrast may be given by the radiologist immediately before the exam. If a patient suffers from anxiety or claustrophobia, drugs may be given to help the patient relax.

The patient must remove all metal objects (watches, jewelry, eye glasses, hair clips, etc). Any magnetized objects (like credit and bank machine cards, audio tapes, etc.) should be kept far away from the MRI equipment because they can be erased. The patient cannnot bring their wallet or keys into the MRI machine. The patient may be asked to wear clothing without metal snaps, buckles, or zippers, unless a medical gown is worn during the procedure. The patient may be asked to remove any hair spray, hair gel, or cosmetics that may interfere with the scan.

Aftercare
No aftercare is necessary, unless the patient received medication or had a reaction to a contrast agent. Normally, patients can immediately return to their daily activities. If the exam reveals a serious condition that requires more testing and/or treatment, appropriate information and counseling will be needed.

Risks
MRI poses no known health risks to the patient and produces no physical side effects. Again, the potential effects of MRI on an unborn baby are not well known. Any woman who is, or may be, pregnant, should carefully discuss this issue with her doctor and radiologist before undergoing a scan.

Normal results
A normal MRI, MRA, or MRS result is one that shows the patient's physical condition to fall within normal ranges for the target area scanned.

Abnormal results
Generally, MRI is prescribed only when serious symptoms and/or negative results from other tests indicate a need. There often exists strong evidence of a condition that the scan is designed to detect and assess. Thus, the results will often be abnormal, confirming the earlier diagnosis. At that point, further testing and appropriate medical treatment is needed. For example, if the MRI indicates the presence of a brain tumor, an MRS may be prescribed to determine the type of tumor so that aggressive treatment can begin immediately without the need for a surgical biopsy.