ACHIEVA 3T

Description of Event or Problem

PATIENT WAS GETTING AN MRI SCAN INVOLVING HER PELVIS WHEN PATIENT COMPLAINED OF A BURNING SENSATION ON HER LEFT SIDE. THE PATIENT SQUEEZED THE EMERGENCY BALL AND TWO TECHNOLOGISTS WENT IN TO INVESTIGATE. THE PATIENT HAD REDNESS TO THE SKIN AND THE APPARATUS USED IN THE PROCEDURE WAS QUITE WARM. ON SITE PERSONNEL FROM PHILIPS WAS CALLED AS WELL AS OUR ON PHYSICIST WAS NOTIFIED.THE COIL IN USE WHEN THE PATIENT COMPLAINED OF HEAT WAS THE 6 CHANNEL CARDIAC COIL FOR THE CLINICAL 3T SCANNER. THIS COIL WAS IMMEDIATELY REMOVED BY THE TECHS FOR THE COMPLETION OF THE SCAN. THE PHILIPS SERVICE ENGINEER AND I INSPECTED THE COIL. THERE WAS VISIBLE WEAR AT ONE OF RF BALUN COMPONENTS. THE SERVICE ENGINEER REMOVED THE PLASTIC COVERING OF THIS BALUN TO REVEAL THAT THE SOLDER AROUND GROUND SHIELD SLEEVE WAS MECHANICALLY BROKEN ESSENTIALLY AROUND THE ENTIRE CIRCUMFERENCE OF THE SLEEVE. I SPECULATE THE HIGH IMPEDANCE PATH TO GROUND AT THIS FAILURE POINT WAS THE SOURCE OF HEATING FELT BY THE PATIENT. THE COIL WAS REMOVED FROM SERVICE FOR REPAIR/REPLACEMENT BY PHILIPS.