What MRI should I choose to avoid worsening tinnitus? Is Toshiba Vantage Titan 1.5T really silent?

[Lesky]

What MRI should I choose for brain scan to LIMIT DAMAGE of worsening tinnitus, hyperacusis and ear pain?
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With sound levels ranging from 85-130 dB I am terrified beyond words. I had an open MRI brain done in 2003 and it was a trainwreck and I aborted the scan after aprox 60%. And I was in much better shape 10 years ago.

The options I have is the following:

Siemens Avanto 1.5 Tesla

Is said to have acoustic noise limit of 99 dB. Personel says most of a brain scan is performed at aprox 85-95 dB.

Claims to be able to scan Diffusion Weighted Images under 99 dB. Including DWI-EPI. I am skeptical about this as DWI normally produces dB levels of 110-120 on regular scanners.


Information:

Peak dB level: 99 dB

Ear muffs: Ear muffs does fit, but only with 12 dB NRR because of lack of space for bigger ear muffs.

This MRI is only a 30 minute drive away from my home.

More: Patient got hearing loss and tinnitus using this MRI on a routine brain scan (without hearing protection though, still must be very loud) - http://www.hindawi.com/crim/radiology/2013/510258/

Quotes from Siemens:

Siemens Magnetom Avanto Audio Comfort.

SQ-engine Gradient System with Audio Comfort - Innovative integrated measures comprehensively reduce acoustic noise without compromising gradient performance. With Audio Comfort, acoustic noise is reduced by up to 30 dB (A) as compared to conventional systems. This is a reduction of 97% in sound pressure. Patients will benefit significantly from this feature. All gradient demanding protocols using EPI techniques such as diffusion imaging, perfusion imaging or fMRI examinations show a significant acoustic noise reduction Audio Comfort makes MR examinations a comfortable experience even for children. Audio Comfort prevents the necessity of implementing noise-absorbing measures to gain a comfortable noise level for technicians and neighbors.

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Toshiba Vantage Titan 1.5 Tesla

Information:


The Vantage Titan is said to be the most silent MRI available according to many sources. Claims to have a 33 dB reduction on all scans thanks to a vaccuum technology called Piannissiomo. Many people on tinnitus forums have said this is the MRI to choose.

http://www.toshiba-medical.eu/en/Our-Product-Range/MRI/Technologies/Pianissimo/

Peak dB level according to FDA: 115-121 dB http://www.accessdata.fda.gov/cdrh_docs/pdf12/K120638.pdf
Peak dB level according to Toshiba: 90 db

See page 2 - Peak and A-weighted acoustic noise: http://www.accessdata.fda.gov/cdrh_docs/pdf12/K120638.pdf

New Vantage Titan: 106.2 dB (A-weighted) 115.4 dB (peak)
Vantage Titan 105.7 dB (A-weighted) 115.7 dB (peak)
Vantage Titan HSR: 113 dB (A-weighted) 121.6 dB (peak)

Ear muffs: No. Ear muffs can not be fitted to Toshibas head coil. Major disadvantage.

This MRI is a 10 hours minute drive away from my home.

More:

Toshiba medical Europes swedish product specialist claims the Vantage Titan can do normal brain scan without DW-EPI sequence and not go above 85 dB.

They also said they can do a brain scan at ONLY 70 dB with the following protocol:

Do NOT use Diffusion Weighted Images
Changing slice thickness from 4 to 5 mm - reducing sound from 85 dB to 70 dB. Is it really possible to perform a solid brain scan at 70 dB? It sounds too good to be true.

A direct quote from the Toshiba product specialist:

"5 mm in routine brain is very common slice thickness. In MRI by selecting acquisition method has remarkable effect to acoustic noise level. The stronger gradients are used the stronger the noise. That's why I gave instructions how to reduce acoustic noise. If the examination can be performed without diffusion weighted imaging (DW-Epi) the typically acoustic noise levels are much lower."

I contacted Toshiba Medical in ALL european countries by email and only received one response:

In below mail, which I received through multiple channels, you ask for details about the absolute sound level produced by a Toshiba MRI system.

As you might have noticed from various messages there is no indication about the absolute value, but we talk about a maximal reduction of about 30dB. Reason is that the various scan sequences produce different sound levels. Common brain scans are a so called FLAIR, T1 and T2w and even within one technique there is a difference because of different timing within the pulse. Dependent on the clinical indication these standard sequences can be extended with for example EPI and Diffusion scans, usually oncology related. The disadvantage of these scans is that they belong to the noisiest sequences. In systems without Pianissimo technique, like the scanners of GE, these latter type of sequences produce between 110 and 120 dB. That is why you will always get hearing protection with these type of scanners.
In our Toshiba Vantage 1.5T scanner this Pianissimo technique produces about 90dB maximum. while other sequences start with about 60 - 65db.
Because all sequences are ranging between the 60 - 90 dB there is in normal circumstances no hearing protection required.

Looking in your particular condition I suggest to use ear protection in any case, even when you have the possibility to be scanned on a Toshiba Vantage system.
It is very common that the facility provides airplugs. Additional to this you could take sound dampers like used in construction work. Due to the limited space available in head coils select sound dampers which are as slim as possible.

More quotes from Toshibas product specialist:

There are same kind of warning messages in the Operation manuals as for Titan 1.5 tesla and Titan 3.0 tesla.

In EXCELART Vantage systems, a noise reduction system (Pianissimo) is provided to suppress noise. However, the equivalent noise level may reach a maximum of approximately 104 dB (A) in some cases when the noise level is measured according to the method specified in IEC60601-2-33 (2002). Be sure to provide the patient with earplugs to protect his or her ears. In addition, if the vacuum level in the vacuum seal used to reduce noise in EXCELART Vantage systems is insufficient, the noise level may increase to approximately 110 dB (A).

If the vacuum level falls, loud noises are generated during scanning. A warning message prompting the user to provide the patient with ear protection is displayed. "Loud noises are generated during scan. Please provide patient with ear protection."

Confirm that the patient is provided with suitable ear protection. In addition, contact your Toshiba representative.

The most important question - how can the peak level of noise on the Vantage titan differ from 90 dB according to Toshiba to 120 dB according to the FDA?

Why is it then that the sound measurements the FDA have done of the Vantage Titan is so much higher? Toshiba mentioned 113 dB in one message saying it was without vacuum. But is it really possible the FDA have measured sound levels without vacuum on 3 separate machines, on 3 separate dates spanning over several years? To me its clear something is not right about that difference.

Has anyone here on the board had an MRI done with the Toshiba Vantage Titan? And even better have you done MRI with a different company as well and could make a comparison?

Whats the sound difference between open and closed MRI? Some say its like 3 x times louder in a close machine, but the companys claim there is basicly no difference. Whats the truth here?

At last, I have done alot of reading and I have seen PATIENT COMFORT mentioned many times while mentioning the acoustic noise - but never has anyone mentioned PATIENT SAFETY when it comes to the sound levels - and tinnitus, hyperacusis or sound sensitivty is not mentioned even once anywhere either. Are the manufactorers of the MRIs really not aware that people get tinnitus and hyperacusis every single day from their machines? Or do the companys simply dont care about the patients ears?

Footnote: GE Healthcares silent scan is not mentioned here, since its only available for NEURO scan and only 1 single brain sequence at the moment.

Thanks in advance for any advise and information you can help with.

Cheeers
L​

 

[LeQuack]

So which one did you choose? Any other opinions?

 

[frohike]

Last MRI I had I was wearing earplugs, but I had a couple of pads on both sides of my head to keep it still. Cons: I couldn't wear earmuffs, pros: the pads were blocking sound because they were pressing both sides of my head. I don't recall the MRI model, it was an old one.

 

[JohnDoe]

I wish somebody had told me that an MRI could cause ear damage before I went in. This is how I got Tinnitus. The nurse sent me in and I came out with ringing in the ears.