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Silver dressings and radiography

Discussion in 'Diabetic Foot & Wound Management' started by gangrene1, Jul 18, 2015.

  1. gangrene1

    gangrene1 Active Member


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    Hi everyone,

    What are your views on patients with the use silver dressings on foot ulcers in regards to its safety concerns during x-rays and MRI investigations? If any one has credible resources to share would be gladly appreciated!

    Cheerios.
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
  3. MischaK

    MischaK Active Member

    A quick search revealed the following studies, I am not sure if this is what you are after? Private message me if you would like the fulltexts.


    Title: Assessing the safety and compatibility of silver based wound dressings in a magnetic resonance environment (2009)

    Authors: Chaudhry, Z., Sammet, S., Coffey, R., Crockett, A., Yuh, W.T., & Miller, S.

    Abstract
    INTRODUCTION:

    Silver dressings are an integral part of the management of burn patients. Package inserts assert a lack of compatibility and safety with magnetic resonance imaging (MRI) and recommend removal prior to any MRI procedure, although there is no clear evidence to support this recommendation. Dressing removal is associated with increased pain, anxiety, stress, and analgesia use. This study was to determine whether these products produce MRI image distortion or if the agitation of the silver particles generates enough heat which might produce further skin damage.
    METHODS:
    Hind limbs from euthanized pigs were used in a 7T MRI scanner with three standard silver wound dressings. Images were obtained with both dry and wet dressings. Temperature was assessed before and during MRI by probes inserted between the dressing and skin. Images were independently reviewed by a radiologist and MR physicist for distortion.
    RESULTS:
    None of the dressings exhibited significant temperature increases nor produced significant distortion that influenced imaging quality.
    CONCLUSION:
    Our data suggests silver containing wound dressings do not cause a significant increase in dressing temperature or image distortion and thus their removal is not warranted for clinical MRI examinations.


    Title: An evaluation of mri safety and compatibility of a silver-impregnated antimicrobial wound dressing (2009)

    Authors: Nyenhuis, J., & Duan, L.

    Abstract
    PURPOSE:

    Wound infections can slow healing, increase pain, and have negative effects on a patient's quality of life. The recent emergence of antibiotic-resistant bacterial strains has led wound care specialists to revisit alternative topical agents such as silver to control wound bioburden. Aquacel Ag is an ionic silver-containing barrier dressing that is able to absorb large amounts of wound exudate. The aim of this study was to assess the magnetic resonance (MR) safety and compatibility of this dressing, according to the standard requirements of the American Society for Testing and Materials (ASTM).
    METHODS:
    Radiofrequency-induced temperature changes associated with the test dressing were assessed using an ASTM phantom at 123 and 64 MHz. Whether the dressing caused any image distortion or magnetic deflection or if the electric resistance of the hydrated dressing differed significantly from that of tissue was also investigated.
    RESULTS:
    Similar radiofrequency-induced temperature changes were observed during 123 MHz (nominal 3 T) MR imaging of the phantom material alone (1.3 degrees C) and when the dressing was added (1.8 degrees C-2.0 degrees C). Similar increases in temperature were also observed at 64 MHz (1.5 T) in the phantom material alone (1.4 degrees C-1.9 degrees C) and with the dressing (1.6 degrees C-1.7 degrees C). The test dressing did not cause any discernible image distortion or magnetic deflection and had similar electric resistance to human body tissues.
    CONCLUSION:
    The wound dressing impregnated with ionic silver evaluated in this study has similar magnetic and electric characteristics to human tissues and is MR safe as defined in ASTM standard F2503-05. Therefore, the dressings can be left in place when a patient is undergoing MR imaging.


    Title: An in vitro assessment of mri issues at 3-tesla for antimicrobial, silver-containing wound dressings (2012)

    Authors: Escher, K.B., & Shellock, F.G.


    Abstract
    Although no reports of adverse events have been published to date, the presence of metallic dressing ingredients may present an magnetic resonance imaging (MRI) safety concern for patients using silver-containing wound dressings. The purpose of this in vitro study was to test magnetic field interactions (ie, translational attraction and torque), heating, artifacts, and conductivity (ie, electrical resistance) when using MRI at 3-Tesla for two (nonborder and border) silver-containing wound dressings. The results indicated the dressings displayed no magnetic field interactions (deflection angle 0˚; no torque), and in each case, MRI-related heating effects were at the same levels as the background temperature increases (ie, <1.8˚C). The dressings created extremely subtle artifacts (one-for-one relationship) on the MR images. With regard to the conductivity assessments, the average resistance values were 20 kOhm and 1.1 kOhm, respectively, for the nonborder and border wound dressings, which were acceptable levels. The findings show the two silver-containing wound dressings tested will not pose hazards or risks to patients and, thus, are considered "MR safe" according to the current labeling terminology used for medical products, and each dressing may be left in place when a patient undergoes an MRI examination. To date, only a hydrofiber silver-containing dressing has been tested for MRI safety. Because of potential variances in material characteristics, MRI test results are specific to the dressings tested and cannot be applied to other products. Future studies to define the level of silver concentration in dressings that may pose a hazard for performing an MRI are warranted.



    References

    Chaudhry, Z., Sammet, S., Coffey, R., Crockett, A., Yuh, W.T., & Miller, S. (2009). Assessing the safety and compatibility of silver based wound dressings in a magnetic resonance environment. Burns, 35(8), 1080-1085. doi: 10.1016/j.burns.2009.02.014

    Escher, K.B., & Shellock, F.G. (2012). An in vitro assessment of mri issues at 3-tesla for antimicrobial, silver-containing wound dressings. Ostomy Wound Manage, 58(11), 22-27.

    Nyenhuis, J., & Duan, L. (2009). An evaluation of mri safety and compatibility of a silver-impregnated antimicrobial wound dressing. J Am Coll Radiol, 6(7), 500-505. doi: 10.1016/j.jacr.2009.02.013
     
  4. gangrene1

    gangrene1 Active Member

    More than often, some radiographers insist that silver dressings shouldn't be used whenever we sent patients for X-ray or MRI. I couldn't find any clinical guidelines to support such indication. Thanks all for the wonderful responses.
     
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