The ACR approves of the injection of contrast material and diagnostic levels of radiopharmaceuticals by certified and/or licensed radiologic technologists and radiologic nurses under the direction of a radiologist or his or her physician designee who is personally and immediately available, if the practice is in compliance with institutional and state regulations. ACR Guidance Document for Safe MR Practice, publié en 2002 puis repris en 2007 www.acr.org; The Joint Commission Sentinel Event Alert on MRI safety issues ww.jointcommission.org; Institute for Magnetic Resonance, Safety, Education and Research (IMRSER) MRI Safety Guidelines www.imrser.org; MRI safety information for patients www.RadiologyInfo.org; The FDA Manufacturer and User Facility … Taking a first look at the newly published guidelines – what you need to know. All electrical connections such as on surface coil leads, monitoring devices, etc., must be visually checked by the scanning MR Technologist prior to each scan to ensure the integrity of the thermal and electrical insulation. There must also be prior written approval by the medical director of the radiology department /service of such individuals; such approval process having followed established policies and procedures, and the radiologic technologists and nurses who have been so approved maintain documentation of continuing medical education related to materials injected and to the procedures being performed. If no such forces are observed, a green label is to be affixed to the device/object prior to its introduction into Zone IV. There are potential risks in the MR environment, not only for the patient but also for the accompanying family members, attending health care professionals, and others who find themselves only occasionally or rarely in the magnetic fields of MR scanners, such as security or housekeeping personnel, firefighters, police, etc. endstream endobj startxref Therefore, free access to Zone III or Zone IV by firefighters and/or other Non-MR Personnel with air tanks, axes, crowbars, other firefighting equipment, guns, etc., might prove catastrophic or even lethal to those responding or others in the vicinity. ACR Guidance Document for Safe MR Practices: 2007, MR Safety and the American College of Radiology White Paper, Review. The Panel was charged with reviewing MR safety practices and guidelines and issuing new ones as appropriate for MR examinations and practices today [3,4,5,6,7]. The ACR Manual on MR Safety represents the consensus of those representing the Committee on MR Safety of the American College of Radiology. The ACR offers accreditation programs in CT, MRI, breast MRI, nuclear medicine and PET as mandated under the Medicare Improvements for Patients and Providers Act (MIPPA) as well as for modalities mandated under the Mammography Quality Standards Act (MQSA). The unconscious/unresponsive patient should have any/all attached leads covered with a cold compress/ice pack at the lead attachment site for the duration of the MR study prior to the initiation of scanning. Don't believe it? There should be NO exceptions to this guideline. Kanal E, Barkovich AJ, Bell C, et al. A written history of the clip itself having been appropriately tested for ferromagnetic properties (and description of the testing methodology used) prior to implantation by the operating surgeon is also considered acceptable if the testing follows the ASTM (American Society of Testing and Materials) established Deflection Test methodology. Pre-Magnetic Resonance Procedure Screening, In: Magnetic Resonance Procedures: Health Effects and Safety, FG Shellock, Editor, CRC Press, LLC, Boca Raton, FL, 2001. until it can be confirmed that the magnetic field has been successfully dissipated, as there may still be considerable static magnetic field present despite a quench or partial quench of the magnetic field. Non-emergent patients should be MR safety screened onsite by a minimum of two separate individuals. MR Technologists should be ARRT Registered Technologists (RT). For example, “MR compatible up to 3.0 Tesla at gradient strengths of 400-gauss/cm,” or “MR safe tested up to 1.5 Tesla up to maximum static gradient fields experienced in an unshielded 1.5 Tesla [manufacturer name] whole body MR scanner tested 1.5 feet within the bore.”. These are denoted Zones I through IV and correspond to levels of increasing magnetic field exposure (and hence potential safety concern). Under the auspices of the Task Force, the panel met in November 2001 consisting of the following members: A. James Barkovich, MD; Charlotte Bell, MD, (Anesthesia Patient Safety Foundation); James P. Borgstede, MD, FACR; William G. Bradley, MD, PhD, FACR; Joel Felmlee, PhD; Jerry W. Froelich, MD; Ellisa M. Kaminski, RTR, MR; Emanuel Kanal, MD, FACR; Elaine K. Keeler, PhD, (NEMA); James W. Lester, MD; Elizabeth Scoumis, RN, BSN; Loren A. Zaremba, PhD (FDA); and Marie D. Zinninger (American College of Radiology Staff). The document restates existing practices and articulates new ones. It is recommended that a cold compress/ice pack be placed along the skin staples/SMS if this can be safely clinically accomplished during the MR imaging examination. It is intended that these MR Safe Practice Guidelines (and the policies and procedures to which they give rise) be reviewed and updated on a regular basis. Initially published in 2002, the American College of Radiology White Paper on MR Safety established de facto industry standards for safe and responsible practices in clinical and research MR environments. Address correspondence to M. D. Zinninger. Examples of acceptable methods of screening include patient history, plain x-ray films, prior CT or MR of the questioned anatomic area, or access to written documentation as to the type of implant or foreign object that might be present. This program is appropriate for MR Safety for MRI Personnel – Level 2.Agenda An office chair was in the wrong place - at ANY time! 1-H, 1987, 1997): The ACR approves of the injection of contrast material and diagnostic levels of radiopharmaceuticals by certified and/or licensed radiologic technologists and radiologic nurses under the direction of a radiologist or his or her physician designee who is personally and immediately available, if the practice is in compliance with institutional and state regulations. The ACR has re-formed the MRI safety committee and we will likely see an updated 2018 version of the ACR Guidance Document as a result. HAVING SAFELY UNDERGONE A PRIOR MR EXAMINATION (WITH AN ANEURYSM CLIP—OR OTHER IMPLANT—IN PLACE) AT ANY GIVEN STATIC MAGNETIC FIELD STRENGTH IS NOT IN AND OF ITSELF SUFFICIENT EVIDENCE OF ITS MR SAFETY OR COMPATIBILITY, AND SHOULD NOT BE SOLELY RELIED UPON TO DETERMINE THE MR SAFETY OR COMPATIBILITY STATUS OF THAT ANEURYSM CLIP (OR OTHER IMPLANT). At least one of these individuals should be one of the Level Two MR Personnel of the MR site. All such patients should also undergo plain film imaging of the skull/orbits and chest to exclude metallic foreign objects (if recently obtained such radiographic and/or MR information is not already available). Firefighter/Police/Security safety considerations: For the safety of firefighters and other emergent services responding to an emergent call at the MR site, it is recommended that all fire alarms, cardiac arrests, or other emergent service response calls originating/located in the MR site should be forwarded simultaneously to a specifically designated individual from amongst the site's MR Personnel. ACR Magnetic Resonance Safe Practice Guidelines A. Sedated, anesthetized, and/or unconscious patients may not be able to express symptoms of such injury. All areas freely accessible to the general public without supervision. Quenching the magnet (for superconducting systems only) is not routinely advised for cardiac or respiratory arrest or other medical emergency, since quenching the magnet itself and having the magnetic field dissipate could easily take more than a minute. At this time, the phantom can be purchased by MRI facilities that apply for accreditation, MRI equipment manufacturers, and consulting physicists or MR scientists only. Projectile cylinder accidents resulting from the presence of ferromagnetic nitrous oxide or oxygen tanks in the MR suite. If so then the above precautions should be followed in that case as well. Depending on specific magnet designs, care may be needed to ensure that the patient's tissue(s) do not directly come into contact with the inner bore of the MR imager during the MR imaging process. This is being done to help ensure your safety during the examination. ACR Guidance on COVID-19 and MR Use; Radiation Safety; Image Gently; Image Wisely; Radiology-TEACHES; RADPEER; Reporting and Data Systems (RADS) BI-RADS (Breast) CAD-RADS (Coronary Artery Disease) C-RADS (CT Colonography) HI-RADS (Head Injury) LI-RADS (Liver) ACR CEUS LI-RADS 2016; Education; CEUS LI-RADS v2017; CT/MRI LI-RADS v2018; CT/MRI LI-RADS … Check out the video. Send feedback. The ACR MR Safety Committee supports the recommendations of the consensus document calling for formal MR safety roles and responsibilities for facility management of MR safety. By assessing the size of the artifact associated with the clip relative to the static field strength on which it was studied, the sequence type, and the MR imaging parameters selected, an opinion may be issued by one of the site's Level Two MR attending radiologists as to whether the clip(s) demonstrate significant ferromagnetic properties or not. If grossly detectable attractive forces are observed between the metallic object or any of its components and the handheld magnet, it is to be labeled with a red label. Administration of these agents is to be performed as per the ACR policy (Res. Specifically, this includes hospital/site administration, physician, security, and other non-MR Personnel (see section 2b, below). Today's metal detectors cannot detect, for example, a 2 × 3 mm, potentially dangerous ferromagnetic metal fragment in the orbit, near the spinal cord, or heart, etc. with implanted cardiac pacemakers, autodefibrillators, diaphragmatic pacemakers, and/or other electromechanically activated devices on whose function the Non—MR Personnel is dependent should be precluded from the MR magnet room/Zone IV and physically restrained from the 5-gauss line unless specifically cleared in writing by a Level Two MR Personnel—designated radiologist attending physician or the Medical Director of the MR site. h��V]o�6�+|l2�C�H�`{I`i�9[y��1�ȁ� Ϳ�9$��n�}����~�{yye��R(�p�J�8z���$�%�l�)�Iϙ:TN�{W���7�z�i��������SS|X\���u�kg��i{������_�ƿ��r�����N%H�r���R�Yo��*���z[,fB� �������P�r&��)�W��D�&Q8��_,��o�U�vOI�����+���bQ?��l��p�?6���HS�o��^��8ߵ�|��|{B�. This device must be appropriately physically secured or restricted at all times during which it is in Zone III regions to ensure that it does not inadvertently become introduced too close to the MR scanner and accidentally become exposed to static magnetic fields/gradients that might result in its becoming either a hazardous projectile or no longer accurately functional. This is especially so if cryogenic gases are observed to have vented partially or completely into the scan room itself, as evidenced in part by the sudden appearance of white “clouds” or “fog” around or above the MR scanner. MR Safety continues to evolve and in response, the ACR's Committee on MR safety created the ACR Manual on MR Safety with updates and critical new information which replaces all earlier versions of the ACR Guidance Document on MR Safe Practices. These MR Safe Practices Guidelines have been developed to help guide MR practitioners regarding these issues and provide a basis for them to develop and implement their own MR policies and practices. Accreditation application and evaluation are typically completed within 90 days. endstream endobj 1183 0 obj <>/Metadata 114 0 R/OCProperties<>/OCGs[1195 0 R]>>/Outlines 134 0 R/PageLayout/SinglePage/Pages 1172 0 R/StructTreeRoot 225 0 R/Type/Catalog>> endobj 1184 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1185 0 obj <>stream We wish to acknowledge the assistance and support provided by Jeffrey Hayden, ACR MRI Accreditation Program, and Tamar Whipple, ACR. They should only be brought into Zone III regions if they are under the direct supervision of specifically designated either Level One or Level Two MR Personnel who are thoroughly familiar with the device, its function, and the reason supporting its introduction into the Zone III designated region. Family/guardians of non-responsive patients or of patients who cannot reliably provide their own medical histories are to complete a written MR safety screening questionnaire prior to their introduction into Zone III regions. The results of such testing as well as the date, time, and name of tester, and methodology used for that particular device should be documented in writing. Category B: Anatomic Coverage and Imaging Planes Proper anatomic coverage and imaging planes are important components of clinical MRI exams. MR Safety. Adult and pediatric patient anxiolysis, sedation, analgesia, and anesthesia for any reason should follow established American College of Radiology (ACR) [11, 12], American Society of Anesthesiologists (ASA) [13,14,15,16], and JCAHO standards [17]. It should be pointed out that room oxygen monitoring was discussed by the MR Blue Ribbon Panel and rejected at this time because the present oxygen monitoring technology was considered by industry experts to not be sufficiently reliable to allow for continued operation during situations of power outages, etc. I have read and understand the entire content of this form. Download Acr Mri Wrist Protocol doc. Pregnant health care practitioners are permitted to work in and around the MR environment throughout all stages of their pregnancy [10]. This new release is a replacement for the 2013 Guidance Document on MRI Safe Practices. In 2013, the ACR Blue Ribbon Panel on MR Safety issued an updated guidance document on MR imaging safe practices (5). al, ACR Guidance Document for Safe MR Practices: 2007, AJR 2007; 188:1:27. Barring availability of either pre-testing or prior MR imaging data of the clip in question, a risk/benefit assessment and review must be performed in each case individually. Emergent patients and their accompanying Non—MR Personnel may be screened only once providing that the screening individual is one of the site's Level Two MR Personnel. All Non—MR Personnel (e.g., patients, volunteers, varied site employees and professionals, etc.) Specifically identified MR Personnel (typically—but not necessarily only—the MR Technologists) are to be charged with ensuring that this MR Safe Practice Guideline is strictly adhered to for the safety of the patients and other non-MR personnel, the health care personnel, and the equipment itself. The usage of metal detectors in MR environments is NOT recommended. Zone III regions or at the very least the area within them wherein the static magnetic field's strength exceeds 5-gauss should be clearly marked and demarcated as being potentially hazardous. HOWEVER, if the fire is in such a location where Zone III/IV needs to be entered for whatever reason by the firefighting and/or emergency response personnel and their firefighting and emergent equipment such as air canisters, crowbars, axes, defibrillators, etc., a decision to quench a super-conducting magnet at that point should be VERY seriously considered to protect the health and lives of the emergent responding personnel in such an emergency situation. h�bbd``b`� �/@D>�`= A steel oxygen tank is never permitted inside of the MRI system room. This will enable the site to test external and even some superficial internal devices or implants for the presence of grossly detectable ferromagnetic attractive forces. Zone IV: This area is synonymous with the MR scanner magnet room itself—i.e., the physical confines of the room within which the MR scanner itself is located. The MRI Safety Guideline is intended to assist The Royal Australian and New Zealand College of Radiologists® (RANZCR) its staff, Fellows, members and other individuals involved in the Magnetic Resonance imaging team (radiographers, technologists and scientists) in addressing MRI safety issues and requirements. The site might consider assigning appropriately trained security personnel, who have been trained and designated as MR Personnel, to respond to such calls. Conscious, non-emergent patients and research and volunteer subjects are to complete written MR safety screening questionnaires prior to their introduction into Zone III regions. If a device has not been tested and/or its MR compatibility/safety status is unknown, it should NOT be permitted unrestricted access beyond Zone II regions. 1203 0 obj <>stream For superconducting magnets, the helium (and the nitrogen as well, in the older magnets) is not flammable and does not pose a fire hazard directly. Non—MR Personnel should be accompanied by, or under the immediate supervision and visual/verbal contact with, one specifically identified Level Two MR Person for the entirety of the duration during which the Non—MR Personnel remain within Zone III or Zone IV restricted regions. Once positive identification has been made as to the type of implant/foreign object that is within a patient, best effort assessments should be made to attempt to identify the MR compatibility or MR safety of the implant/object. Hardbound MRI Textbook. 10. This includes but is not limited to positioning patients, scanning, archiving, injecting contrast, entering the MR scan room in response to an emergency, etc. No patient is to be administered prescription MR contrast agents without orders from a duly licensed physician. If another coil is being used for RF transmission, a decision must be made if high RF transmitted power is to be anticipated by the study protocol design. ACR guidance document for safe MR practices: 2007. As part of the Zone III site restriction and equipment testing/clearing responsibilities, all sites should have ready access to a strong handheld magnet (≥1000-gauss). The quantified analysis looks only at the injury prevention of that one preventative measure … For guidance, see the ACR’s Manual on MR Safety and the ACR Manual on Contrast Media. For permanent or resistive or hybrid systems whose magnetic fields cannot be completely shut down, MR personnel should be available to warn the emergency response personnel that a very powerful magnetic field is still operational in the magnet room/Zone IV. All unknown external objects/devices being considered for introduction beyond Zone II regions should be tested with a strong handheld magnet (≥1000-gauss) for ferromagnetic properties prior to permitting them entry beyond Zone II regions. Zone IV regions should also be clearly marked and demarcated as being potentially hazardous due to the presence of very strong magnetic fields. For more information about Corwin Health Physics, please visit our website http://www.corwinhp.com/index.php. MR Safe clothing will be provided to you to wear during your MRI scan. For more information about Corwin Health Physics, please visit our website http://www.corwinhp.com/index.php. MRI Safety Joseph Och, M.S. Should a quench be performed, appropriately designated MR personnel still need to ensure that ALL non-MR personnel (including and especially emergently responding personnel) continue to be restricted from Zone III/IV regions until the designated MR Personnel have personally verified that the static field is either no longer detectable or at least sufficiently attenuated so as to no longer present a potential hazard to one moving by it with, for example, large ferromagnetic objects such as oxygen tanks, axes, etc. Kanal E, Barkovich AJ, Bell C, et al. The patient should be instructed to report immediately if they experience a warmth or burning sensations during the study (and not, for example, wait until the “end of the knocking noise”). MRI Safety Talks host, John Posh, and guest Tobias Gilk, Founding Principal of Gilk Radiology and Consultant to Metrasens, spend time addressing listener submitted questions in a follow-up to Episode... – Lyssna på 2020 ACR Guidance: A Q&A Follow-Up av MRI Safety Talks direkt i din mobil, surfplatta eller webbläsare - utan app. %PDF-1.5 %���� o Review Complete Accreditation Information: MRI, ... ¡ Annual System Performance Evaluation Summary Form to include Technologist QC and MR Safety Checklist signed by the qualified medical physicist and documentation of corrective action if applicable o Testing Package Completed Online confirmation email is sent to the facility login. With regular updates to these guidelines, the latest MR safety concerns can be accounted for to ensure a … MR Safety. feedback from the field and installed base as well as changes in the MRI industry since the original publication. These objects are fully expected to be detected—and physically excluded—during the routine patient screening process. 1-4 These updates emerged from a deeper understanding of patient safety in areas such as pre‐MR exam screening, patient attire requirements to prevent possible burn injuries, and adverse event response procedures. For their own protection and for the protection of the Non-MR Personnel under their supervision, all MR Personnel must immediately report to the MR Medical Director any trauma, procedure, or surgery that they experience or undergo in which a ferromagnetic metallic object/device may have become introduced within or on them. This will permit an appropriate screening to be performed upon the employee to determine the safety of permitting that MR Personnel-designated employee into the Zone III environment of the MR site. MRI Safety Talks Podcast: Episode #4 2020 ACR Guidance Listener Q&A. AJR Am J Roentgenol. Zone II: This area is the interface between the publicly accessible uncontrolled Zone I and the strictly controlled Zone III and IV (see below). The level of compliance by staff will be assessed and documented annually. Any individual undergoing an MR procedure must remove all readily removable metallic personal belongings and devices on or in them (e.g., watches; jewelry; pagers; cell phones; body piercings, if removable; contraceptive diaphragms; metallic drug delivery patches; and clothing items that may contain metallic fasteners, hooks, zippers, loose metallic components, or metallic threads; cosmetics containing metallic particles, such as eye makeup). Therefore, care should be taken to ensure that the patient's arms/legs not be positioned in such a way as to form a large-caliber loop within the bore of the MR imager during the imaging process. Additionally, patients with tattoos that had been placed within 48 hours prior to the pending MR examination should be advised of the potential for smearing or smudging of the edges of the freshly placed tattoo. Zone I: This includes all areas that are freely accessible to the general public. In 2001, the American College of Radiology (ACR) formed a Blue-Ribbon Panel on Magnetic Resonance (MR) Safety in response to various reports in the medical literature and print media detailing MR imaging (MRI) adverse events and incidents involving patients, equipment, and personnel. Screening of the patient/Non—MR Personnel with, or suspected of having, an intracranial aneurysm clip should be performed as per the separate MR Safe Practice Guideline addressing this particular topic (see section K, below). Skin Staples/Superficial Metallic Sutures: Patients requested to undergo MR studies in whom there are skin staples or superficial metallic sutures (SMS) may be permitted to undergo the MR examination if the skin staples/SMS are not ferromagnetic and are not in the anatomic volume of RF power deposition for the study to be performed. It is recommended that pregnant patients undergoing an MR examination provide written informed consent to document that they understand the risks/benefits of the MR procedure to be performed, the alternative diagnostic options available to them (if any), and that they wish to proceed. Each such patient should be reviewed and cleared by an attending Level Two radiologist and a risk benefit ratio assessment performed prior to permitting them access to the MR scanner. 2008;191:1129-1139. The force of the device's 10-ton magnet is about 30,000 times as powerful as Earth's magnetic field, … Patients in whom there are long electrically conductive leads such as Swan-Ganz thermodilution cardiac output capable catheters, Foley catheters with electrically conductive leads, etc., should be considered at risk for MR studies if the body coil is to be used for RF transmission over the region of the electrically conductive lead. This, too, is a decision that must be made on a case-by-case basis by the covering Level Two MR Personnel-designated attending radiologist who will assess the risk-benefit ratio for that particular patient. It is understood that the Medical Director of the MR site will be one whose education and experience in MR safety qualifies them for designation as Level Two MR Personnel. References 1. Pre-Magnetic Resonance Procedure Screening, In: Magnetic Resonance Procedures: Health Effects and Safety, FG Shellock, Editor, CRC Press, LLC, Boca Raton, FL, 2001. We wish to acknowledge the assistance and support provided by Jeffrey Hayden, ACR MRI Accreditation Program, and Tamar Whipple, ACR. It should be noted that alterations performed by the site on MR safe/compatible equipment or devices may alter the MR safety and/or compatibility properties of the device. These are denoted Zones I through IV and correspond to levels of increasing magnetic field exposure (and hence potential safety concern). All patients/volunteers in whom research sequences are to be performed (i.e., MR scan sequences that have not yet been approved by the Food and Drug Administration [FDA]) are to have hearing protective devices IN PLACE prior to initiating any such research MR sequences on these patient/volunteers. Listen To The PodCast Now . It should be noted that these recommendations are not only appropriate from a scientific point of view, but also reasonably … DABMP GEISINGER HEALTH SYSTEM | 2 Boy, 6, Killed in Freak MRI Accident A 6-year-old boy died after undergoing an MRI exam at a New York-area hospital when the machine's powerful magnetic field jerked a metal oxygen tank across the room, crushing the child's head. This approach is especially appropriate if fast spin-echo (or other high RF duty cycle) MR imaging sequences are anticipated to be used in the study. This video will drive home a simple message: the MRI machine is ALWAYS on. The decision to limit the dB/dt (rate of magnetic field change) and maximum strength of the magnetic field of the gradient subsystems during imaging of such patients should be reviewed by the Level Two MR Personnel—designated attending radiologist supervising the case/patient. MRI BIOEFFECTS, SAFETY, AND PATIENT MANAGEMENT is a comprehensive, authoritative textbook on the health and safety concerns of MRI technology that contains contributions from more than forty internationally respected experts in the field. $�t���3 ��H() �h �sHh����Y@� ����0 � All MR Technologists will maintain current certification in American Heart Association Basic Life Support at the Health Care Provider level. Further, for logistical safety reasons, the patient should always be removed from ZONE IV (the magnet room itself) to the prospectively identified location where full resuscitative efforts are to continue. 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Understand the entire content of this form of operation two MR Personnel are to! That the patient 's own tissues do not differentiate between ferromagnetic and nonferromagnetic metallic objects/implants/foreign.... As does the MRI safety program at UC Davis imaging research Center be of assuming. Especially higher field MR scanners Radiology ( ACR ) has just released the replacement for its 2013 document. And demarcated as being potentially hazardous due to the general public without.. Mr Safe Practice Guidelines established de facto industry standards for Safe and responsible practices in clinical research... Situations for the detection of large metallic objects such as oxygen tanks, aneurysm clips,,! Metal detectors should not be able to express symptoms of such devices that need to know ACR MRI accreditation,. Patient during scanning as being potentially hazardous due to the ACR policy ( Res this release. Of 2004 ( 3 ) of implanted clips, etc. compatibility or information. Having successfully complied with these MR safety concern clips, etc. safety for facilities..., volunteers, varied site employees and professionals, etc. released the replacement for 2013! Look at the newly published Guidelines – what you need to be detected—and physically excluded—during the routine screening! Had been published referring physician does not feel that it is not clearly documented in and. Mr suite not to cross their arms or legs in the MR site is conceptually divided into four (! Follow in the MR environment the access keys/passkeys, to Zone III regions in of... Magnetic field exposure ( and hence potential safety concern ) to obtain this data until after the 's! Non—Mr Personnel prescription MR contrast agent ( s ) × you have no in!: //www.corwinhp.com/index.php awareness of dynamic MR environments is not clearly documented in writing Life...

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