Study of the thermal effects induced by magnetic resonance on endocardial leads: numerical models and experimental validation

Magnetic resonance imaging (MRI) is today precluded to patients bearing active implantable medical devices AIMDs). The great advantages related to this diagnostic modality, together with the increasing number of people benefiting from implantable devices, in particular pacemakers(PM)and carioverter/defibrillators (ICD), is prompting the scientific community the study the possibility to extend MRI also to implanted patients. The MRI induced specific absorption rate (SAR) and the consequent heating of biological tissues is one of the major concerns that makes patients bearing metallic structures contraindicated for MRI scans. To date, both in-vivo and in-vitro studies have demonstrated the potentially dangerous temperature increase caused by the radiofrequency (RF) field generated during MRI procedures in the tissues surrounding thin metallic implants. On the other side, the technical evolution of MRI scanners and of AIMDs together with published data on the lack of adverse events have reopened the interest in this field and suggest that, under given conditions, MRI can be safely performed also in implanted patients. With a better understanding of the hazards of performing MRI scans on implanted patients as well as the development of MRI safe devices, we may soon enter an era where the ability of this imaging modality may be more widely used to assist in the appropriate diagnosis of patients with devices. In this study both experimental measures and numerical analysis were performed. Aim of the study is to systematically investigate the effects of the MRI RF filed on implantable devices and to identify the elements that play a major role in the induced heating. Furthermore, we aimed at developing a realistic numerical model able to simulate the interactions between an RF coil for MRI and biological tissues implanted with a PM, and to predict the induced SAR as a function of the particular path of the PM lead. The methods developed and validated during the PhD program led to the design of an experimental framework for the accurate measure of PM lead heating induced by MRI systems. In addition, numerical models based on Finite-Differences Time-Domain (FDTD) simulations were validated to obtain a general tool for investigating the large number of parameters and factors involved in this complex phenomenon. The results obtained demonstrated that the MRI induced heating on metallic implants is a real risk that represents a contraindication in extending MRI scans also to patient bearing a PM, an ICD, or other thin metallic objects. On the other side, both experimental data and numerical results show that, under particular conditions, MRI procedures might be consider reasonably safe also for an implanted patient. The complexity and the large number of variables involved, make difficult to define a unique set of such conditions: when the benefits of a MRI investigation cannot be obtained using other imaging techniques, the possibility to perform the scan should not be immediately excluded, but some considerations are always needed.

I drammi per musica di Giacomo Antonio Perti per il teatro della Villa medicea di Pratolino (1700-01; 1707-10)

L’attività nel teatro della Villa medicea di Pratolino, presso Firenze, giunse al culmine nel primo decennio del ’700, quando il principe Ferdinando de’ Medici commissionò e vi fece rappresentare, una per anno, opere in musica di Alessandro Scarlatti e di Giacomo Antonio Perti. Benché le partiture siano perdute, sopravvive un’ingente quantità di materiale documentario, in massima parte inedito, il quale dà un eccezionale resoconto sul mecenatismo del Principe e sul funzionamento della macchina teatrale. La dissertazione si concentra sulle sei opere poste in musica da Perti ("Lucio Vero", 1700, in collaborazione con Martino Bitti; "Astianatte", 1701; "Dionisio re di Portogallo", 1707; "Ginevra principessa di Scozia", 1708; "Berenice regina d’Egitto", 1709; "Rodelinda regina de’ Longobardi", 1710), sui rapporti del compositore col Principe, col librettista Antonio Salvi, col rivale Scarlatti, coi cantanti e con la corte medicea, sullo stile da lui perseguito e – per quanto è dato sapere o lecito ipotizzare – sulla fisionomia dei suoi lavori (strutture e risorse letterarie, teatrali e musicali).