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MRI screening (MRI specific)

 

A thorough screening process is used to assess all individuals entering the MRI environment

 

+ Screening procedure

  • Screening is a critical component of an MRI safety program and one of the most important responsibilities assumed by MRI technologists.1
    • Performed correctly, screening is an effective method to identify potential hazards and reduce the likelihood of patient harm
    • Most MRI safety incidents have been related to deficiencies in screening methods or properly restricting access to the MRI environment1

 

  • All patients, family members and health facility employees must be screened before entering the MRI environment.1,2
    (also see Authorized MRI personnel guideline)
    • A written screening form must be completed each time a patient (and/or an attending family member) undergoes an MRI scan, or enters the MRI environment1
    • The screening form should be signed by the MRT and patient or substitute decision maker prior to entry into the MRI environment
    • The importance of screening is carefully explained to the patient, who may forget to mention something, or neglect to mention an issue for fear of losing their appointment3
    • MRI personnel are to be screened at initial employment and are subsequently responsible to self screen thereafter

 

  • Screening procedures are carried out on three separate occasions:1,3
    • A first screening is performed at the time the exam is ordered and is completed by the ordering physician in discussion with the patient
    • A second screening is performed upon arrival and registration at the clinical MRI facility
    • The third screening is performed by the MRT who reviews the MRI screening form completed by the patient upon arrival, and includes at least one verbal interview with the patient4

 

  • If information gathered through screening is incomplete or in question, the technologist may:1
    • Consult with the radiologist to obtain or clarify information
    • Contact the referring physician to obtain or clarify information
    • Refer to previous diagnostic imaging to identify potential concerns
    • Look for surgical scars or other indications of the presence of implants.
    • Obtain radiographic images of the areas in question

 

  • If something is discovered through the screening process that contraindicates MRI, the MRT:
    • Discusses the findings with the radiologist to determine the appropriate course of action to ensure continuity of care
    • Explains the situation to the patient, answering any questions the patient has to the best of their ability (and within their scope of practice)
    • Communicates the finding to the referring healthcare professional for consideration as per facility procedure

+ Screening questions

  • Screening questions focus on issues that could pose a potential danger to the patient in the MRI environment.
  • The screening process includes questioning about the presence of any metallic objects.1
    • The patient is asked to list all prior surgical procedures
    • Injuries to the body involving metallic foreign bodies are noted1,5
    • Injuries involving penetrating metallic objects in the eye are identified, and followed up with an x-ray examination to establish the presence or absence of any remnants (also see Investigation of foreign bodies guideline)
    • Patients are queried about the presence of medical implants or devices
    • Confirm all implanted devices are identified by manufacturer and model via device card issued by medical facility at time of implantation or surgical report
    • If the information is not available, the exam is postponed until the required documentation is obtained and cleared
    • If the implant/device is not listed in the MRI Safety Reference Manual, the manufacturer is contacted directly to obtain the necessary safety information3

 

  • The screening process identifies any past and present medical conditions that may affect the MRI procedure or the use of a contrast media, including:1
    • Current or recently taken medications
    • Known drug allergies
    • Potential or confirmed pregnancy3
    • Pre-existing psychiatric disorders, anxiety or claustrophobia
    • History of renal impairment or hepatic insufficiency (nephrogenic systemic fibrosis (NSF) is associated with gadolinium use in such patients)3,6

 

  • The IMRSER Magnetic Resonance (MR) Environment Screening Forms provides a template which can be adapted for local use.4

+ Special cases

  • There are scenarios where completing the screening process with the patient directly is impractical, or impossible:
    • Underage patients
    • Unconscious patients
    • Patients with a language barrier

 

  • In these scenarios, it is important that the MRT completes the screening process as per best practices described:
    • This will require screening with someone who is the next most knowledgeable individual regarding the patient’s present condition and medical history
    • For underage patients, the screening process is carried out with the parent or guardian for the child patient
    • For unconscious patients, a caregiver, family member, or physician may be consulted

 

  • If no reliable history can be otherwise obtained and if the requested MRI procedure cannot reasonably wait, patients are physically examined by Level 2 MRI Personnel*.6
    • Patients are examined for visible scarring or deformities that might be indicative of an implant
      (also see Investigation of foreign bodies guideline)
    • X-rays or CT may be obtained (if not already available) to investigate the presence of metallic foreign objects in the skull/orbits, chest, abdomen, pelvis, or for areas that correspond to unidentified scarring

 

  • For patients with a language barrier, measures are taken to secure the services of an interpreter in advance of the patient examination.


* Level 2 MRI personnel are defined as those with MRI safety education to ensure safety of all individuals and facility resources within the MRI environment

+ References

  1. Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices. 2012 Ed. Los Angeles, CA: Biomedical Research Publishing Group; 2012.
  2. Westbrook C, Kaut Roth C, Talbot J. MRI in Practice. 3rd Ed. London, UK: Blackwell Publishing Ltd.; 2005.
  3. Canadian Association of Radiologists. CAR Standard for Magnetic Resonance Imaging. Available at: http://www.car.ca/uploads/standards%20guidelines/20110428_en_standard_magnetic_resonance.pdf. Accessed February 21, 2013.
  4. Institute for Magnetic Resonance Safety, Education and Research. Guidelines for screening patients for MR procedures and individuals for the MR environment. Available at: http://www.imrser.org/PaperPDFRecord.asp?WebRecID=44&PgName=Guidelines&WebRecID=&sb_SummaryTitle%&. Accessed February 21, 2013.
  5. Seidenwurm, DJ, et al. Cost utility analysis of radiographic screening for an orbital foreign body before MR imaging. Am J Neuroradiol 2000;21:426-433.
  6. Kanal E, et al. American College of Radiology White Paper on MRI safety. AJR 2007;188:1–27.

 

 

Validation

May 8, 2013

 

 
Canadian Association of Medical Radiation Technologists
85 Albert St, Suite 1000, Ottawa, ON, K1P 6A4
phone: 613 234-0012 / 800 463-9729
fax: 613 234-1097
www.camrt.ca