Peripheral Nerve Stimulation: Have We Hit the Limits?
Member-Initiated Symposium

ORGANIZERS: Michael Steckner

Tuesday, 19 June 2018

Session Number: MIS-07

Overview
This Symposium was sponsored by the Safety study group.

A new generation of gradient systems are available, such as the Connectome MRI system. These gradients enter an unexplored range of peripheral nerve stimulation (PNS) with potentially reduced patient safety margin, according to Reilly-based cardiac models. There is an urgent need to restart PNS investigations to finally resolve the underlying PNS mechanisms and determine the true cardiac stimulation response
The symposia structure, each covered by one speaker with time for audience questions:
- Introductory overview of current PNS safety margin model derived from dog model extrapolation;
- Review current evidence, unexplained inconsistencies in PNS literature;
- The unique Connectome PNS results vs current commercial systems;
- Introduction to state-of-art (not MRI-specific) neuron modeling and available tools;
- A new neuron model tailored to MRI needs;
and
- An improved PNS understanding supports current investigations on new spatial encoding gradients that simultaneously explore newer and faster spatial encoding mechanisms while simultaneously avoiding PNS
This symposium is timely because the report of new stimuli responses and reaching presently understood cardiac stimulation safety margins implies the limits of performance may now have been reached as well as new gradient encoding technologies under development will benefit from an updated understanding of PNS mechanisms
.
ISMRM has always had safety sessions but there has been virtually no new literature on PNS.

Target Audience
Those interested in MRI safety, those developing new gradients to explore new encoding mechanisms, and experts who write safety requirements.

Educational Objectives
As a result of attending this course, participants should be able to:
- Recognize new neuron models and tools that enable PNS investigations;
- Identify new PNS stimuli reports and outstanding issues to be solved; and
- Name new gradient encoding technologies and potential PNS mitigation.