Operations

From CNI Wiki

Jump to: navigation, search

The operations of the CNI facility are managed to high standards of safety. The operations procedures are designed to be in strict compliance with key government and university regulations. Information about human subjects (IRB) compliance, safety, incidental findings, and training are described on this page.

IRB approval

For information about obtaining IRB approval for new studies at CNI, see the IRB page.

Safety Policy

The full CNI safe operating procedures and policy document is available as a pdf document. The CNI Subject Screening form is available as a pdf document.

The Stanford Center for Cognitive and Neurobiological Imaging (CNI) Committee uses the internationally accepted recommendations from the American College of Radiology to establish Research MR Safety Policies and Procedures. The CNI staff will ensure that all users of the CNI research MR facilities will be well acquainted with these policies and procedures to ensure a safe standard of practice.

Follow this Getting Started link if you are new to the CNI and would like to learn about the basic facilities, and how to get access and training in using the CNI facilities.


New Safety Updates will be posted here.

Safety Alert - January 11, 2012. Potential burn issues with "antimicrobial" clothing.

There is a recent article describing a sedated subject who received 2nd degree burns during an MRI exam. It appears the burns were caused by her wearing an "antimicrobial" shirt which contained invisible silver-embedded microfibers in the Coolmax/Lycra fabric. The presence of these silver fibers was not indicated on any labels on the shirt. The authors point out these antimicrobial fabrics are becoming more popular, especially in athletic wear, socks, and bras.

We currently recommend that during the screening process, study participants be instructed to wear 100% cotton or wool clothing (or in the words of the article, "other safe non-trade name fabrics"). As of now we are not requiring scan participants to wear scrubs.

We currently also recommend that participants be instructed to inform the scanner operator if they feel any uncomfortable local heating sensations during a scan.

Safety Alert - May 22, 2012 New Magnetic Nail Polish could be a safety issue

This is an information from Melissa Henry, who has come across this with her participants -

"We've been scanning teen girls and there seems to be a new nail polish on the market that is advertised as magnetic, I'm not sure if you've heard of it. This may or may not be a hazard but we have begun advising all participants to refrain from using such products on the day of their scan. Just a note on crazy trends that may pose a safety risk."

We currently have nail polish remover available at CNI.

Safety Alert - April 8, 2013 Concerns about colored contact lenses -

Circle contact lenses, also known as color contact lenses and big eye contact lenses, are a type of cosmetic contact lens. It is not generally known that a circle contact lens usually contains iron oxide and other metals, which means their use during magnetic resonance imaging (MRI) is a potential hazard.Case presentation We present a rare case of incidental discovery of circle contact lenses by MRI and MRI images of circle lenses in vitro.

Conclusions: Circle contact lenses usually contain iron oxide, which is a known source of susceptibility artifact on MRI.

Not only radiologists and radiographers but also referring physicians should be familiar with the imaging findings and potential risk of scanning circle contact lenses by MRI.

Author: Hiroyuki TokueAyako Taketomi-TakahashiAzusa TokueYoshito Tsushima Credits/Source: BMC Medical Imaging 2013, 13:11

Safety Alert - June 30, 2014 Concerns about Yoga Pants

This is related to the safety item above dated January 12, 2012.

The comfortable, stretch, barely-there yoga pants all girls know and love have metal mesh built into the fabric, which is what helps keep the body dry during exercise. But it appears that a (seemingly) ordinary pair of yoga pants could end up causing burns in an MRI.

We currently recommend that during the screening process, study participants be instructed to wear 100% cotton or wool clothing (or in the words of the article, "other safe non-trade name fabrics"). As of now we are not requiring scan participants to wear scrubs.

We currently also recommend that participants be instructed to inform the scanner operator if they feel any uncomfortable local heating sensations during a scan.

Intrauterine contraceptive devices (IUD) are in general MR safe, however we currently do not recommend scanning participants with copper IUDs for research projects. Users can refer to this webpage for more information.

Facility and Resources

We think you will find the text for preparing Facilities and Resources useful when preparing sections of NIH or other grants.

Location, Parking Information, Transportation, and Directions

Location The Stanford Center for Cognitive and Neurobiological Imaging (CNI) is located in the basement of the Department of Psychology at Stanford University. The official address of the building is Jordan Hall, Building 420, Stanford, CA 94305. A map of building and parking locations is here and described additionally below.

Parking Information for Volunteers/Participants - "Q" parking passes are available for study participants. Please see the Facility Manager, Laima Baltusis, to obtain these parking passes. There are four parking Q parking spaces and they are currently located at the top of the Oval (same side as Jordan Hall) beside the blue parking spots for the disabled. Parking at the "Q" parking spaces is enforced 24/7. Please fill out or have your participant fill out the 'Q' permit with the date of the appointment (month, day, and year) and leave it on the dashboard of the car.

Campus Map
Q parking space

Campus directions are available as a pdf document.

If all "Q" spaces are full please let the facility manager know and request an "A" parking pass. Your participant may also park in the visitor spaces on Roth Way by the Cantor Center for the Arts. Note, however, that these are pay spaces and that he/she will need to pay at one of the nearby parking kiosks (no maximum time limit). Payment is by debit/credit cards.


Transportation to and from Stanford Hospital to CNI - Study participants who are coming from the hospital can use the hospital tram ("golf cart" shuttle) to go between the hospital and CNI. Arrangements for pickup and drop off can be made be calling the hospital Patient Guest Services at 650 498 3333. The service is normally available between 7AM and 7PM. Off hour arrangements can be made in advance.

Directions from Highway 101 North or South to CNI "Q" Parking spaces Take the Embarcadero Road exit west towards Stanford University. At El Camino Real, Embarcadero turns into Galvez Rd. Turn Right onto Arboretum Rd. Get into the left-hand lane and turn left onto Palm Dr. Travel past Campus Dr and Museum Way, and turn right onto Roth Way just before the Oval. Make your first left at Lomita Dr. At the end of Lomita Q Parking will be on your left and the Chemistry Building will be on your right. Please park in any space marked "Q" Parking.

Directions from Highway 280 North or South to CNI "Q" Parking spaces Exit Sand Hill Road east towards Stanford. Continue downhill and turn right on Santa Cruz Ave. Make an immediate left onto Junipero Serra Blvd. Turn left onto Campus Dr West. Continue around Campus Dr West until you reach Palm Drive. Take a right onto Palm Dr. Travel past Museum Way, and turn right onto Roth Way just before the Oval. Make your first left at Lomita Dr. At the end of Lomita Q Parking will be on your left and the Chemistry Building will be on your right. Please park in any space marked "Q" Parking.

Directions from El Camino Real to CNI "Q" Parking spaces Exit El Camino Real at University Avenue. Turn towards the hills (away from Palo Alto). Go over the overpass, University becomes Palm Drive. Travel past Palo Rd, Arboretum Rd, Campus Drive, and Museum Way. Turn right onto Roth Way just before the Oval. Make your first left at Lomita Dr. At the end of Lomita Q Parking will be on your left and the Chemistry Building will be on your right. Please park in any space marked "Q" Parking.

Incidental Findings

On occasion brain images collected during the course of a study may show a potential abnormality. For these cases CNI has a process for the images to be reviewed by a radiologist assigned to CNI.

The current step-by-step process for incidental findings is:

  1. The investigator notifies the CNI facility manager, using a Stanford university e-mail address with the word Secure: in the subject line, of a potential incidental finding. The e-mail should contain the following information: the exam date, exam number (if known), the participant's name, sex, and date of birth and home mailing address, and a short description of the concern. Screen shots of the concern are helpful but are not mandatory. If the participant is a minor (less than 18 yours old), then additionally one of the parent's name must also be provided.
  2. If the exam is still on the GE scanner the facility manager burns a DVD of anatomical images additionally generating both axial and coronal images. If the exam is no longer on the scanner, the images must be downloaded from NIMS, burned onto a DVD (using OsiriX), transferred to the CNI workstation where generating both axial and coronal images is possible, followed by burning another DVD of all the images.
  3. The facility manager then brings the DVD to the hospital admissions desk with the medical number request form to either have the MRN number retrieved from the data base or generated. For minors the same process is done at the Children's hospital admissions desk.
  4. Once there is a medical record number, the facility manager then brings the DVD and the image upload form to the film library, which is located on the main hospital by the stairs leading down to the atrium level.
  5. When the images are uploaded, the film library calls the facility manager for the DVD to be picked up.
  6. The facility manager then e-mails the radiologist to notify him that images have been uploaded and provides in the e-mail the patient name, date of birth, MRN, and summary of the concern.
  7. The radiologist notifies the facility manager via e-mail when the images have been reviewed.
  8. The facility manager then logs into the PACS (GE Centricity) system, sends the radiology report to herself and then forwards the report onto the investigator who initiated the process. There is only one computer that is set up to do this operation at CNI. It is the computer in the mock scanner room and it is only possible to log into the GE Centricity PACS system using the Microsoft Explorer browser.
  9. If communication to the subject is called for, the PI on the study contacts the subject relaying the appropriate information, including the non-clinical/diagnostic nature of the scan and the review. Graduate students, RAs, and postdoctoral fellows should not be for contacting a subject about the review. The PI should generally not attempt to explain to the subject the potential finding or offer medical advice on how to proceed. The report is not an official clinical diagnosis because the research protocol does not qualify as a clinical diagnostic scan. Further, the scans should not be offered to subjects and/or their physicians. However, an individual subject may be entitled to his or her data upon request under the terms specified in the consent form.
  10. E-mail documentation of exam reviews is kept by the facility manager in an e-mail incidental findings folder.
  11. Documentation of each exam review is added to a spread sheet of CNI cases to date that is uploaded periodically to a secure Box folder created by the radiologist. The information for each case includes participant's name, MRN, radiology report download status, exam date, key radiology review points, and followup requirements for the participant.
  12. For any radiology recommended followup cases, the PI should document in the subject's study record when and how the information is communicated to the subject, any questions the subject had, and any other relevant information.

Contact Laima Baltusis, the facility manager, for help with this process.

There are three forms for the incidental finding review process (1) the CNI process form Media:CNI research studies workflow FINAL.pdf , which outlines the process described above and can be given to whoever is uploading images into the hospital system if that person is not familiar with the CNI process, (This is important as participants will be sent a bill if information is not entered correctly into the system) (2) MRN request form Media:SHC-LPCH_MRN_Request_Form_4.9.10.pdf, and (3) the image upload form Media:Film Libraby Image Upload Form.pdf.

Non-human research

Volume rendering of three species: Malus domestica, Citrus Sinensis, and Musa acuminata. (3D CUBE T2 scan from the CNI 3T GE MR750.)

The CNI is intended primarily for studies of human subjects. Permission to use the scanner for non-human animal research must be approved by Research Director on a case-by-case basis. Please contact the Facility Manager (Laima Baltusis, laimab@stanford.edu) or the Research Director (Robert Dougherty, bobd@stanford.edu) for all research, IRB concerns and questions.

During training, users often hone their safety skills on non-human material. Fruits and vegetables may be scanned without prior approval ;).

Communications

This wiki is the primary method for the staff CNI to disseminate knowledge about CNI operations, equipment, and scan protocols. The CNI staff also holds semi-regular seminars.

Personal tools