Essential MRI Safety Screening Questions
Before ordering an MRI, comprehensive safety screening must be conducted to identify potential contraindications that could lead to serious patient harm or death. 1
Metallic Objects and Implantable Devices
- Screen all patients for the presence of pacemakers or implanted defibrillators, which are absolute contraindications for standard MRI procedures 2
- Identify any ferromagnetic clips or steel fragments near soft tissues of the brain or retina, which pose significant risks 2
- Determine if patients have any implanted medical devices and verify their MRI safety classification (MR Safe, MR Conditional, or MR Unsafe) 1, 3
- Document the presence of any sternal wires, clips, stents, occlusion devices, or prosthetic valves, which are generally safe in a 1.5T magnet but may cause local image artifacts 2, 4
- Verify if patients have any metallic foreign bodies, particularly those that might be near vital structures 2, 1
- Ask about any history of shrapnel wounds or metal-working occupations that might have led to undetected metal fragments 2, 1
Contrast Agent Considerations
- Assess renal function before administering gadolinium-based contrast agents, particularly in patients with known renal insufficiency 2, 5
- Screen for history of allergic reactions to contrast agents 5
- Document if patients have advanced renal failure, as gadolinium administration has been linked to nephrogenic systemic fibrosis in these patients 2, 5
- Ask about pregnancy status, as gadolinium contrast should be used with caution in pregnant patients 1, 5
Patient-Specific Factors
- Assess for claustrophobia, which affects approximately 5% of patients undergoing MRI 2, 6
- Evaluate patient's ability to lie still for the duration of the procedure 2
- Determine if patients can follow breathing instructions, which is essential for certain MRI sequences 2
- Assess patient's ability to comply with positioning requirements, including lifting both arms above the shoulders for certain scans 2
- Screen for any transdermal medication patches containing metal, which must be removed before the procedure 1
Special Considerations
- For patients with potential claustrophobia, consider pre-medication options such as oral benzodiazepines 2, 6
- For patients with implanted devices, verify the specific make and model to determine MRI compatibility 7, 8
- For patients requiring gadolinium contrast, ensure they understand the small risk of gadolinium retention in the body 5
- Verify that patients with metal prostheses have had these in place long enough to be stable 2, 1
Practical Implementation
- Use standardized MRI safety screening forms that cover all potential contraindications 1
- Ensure screening is performed by trained personnel who understand the risks associated with MRI 1
- Document all screening findings in the patient's medical record 1
- When in doubt about the safety of a specific implant or device, consult the manufacturer's guidelines or MRI safety resources 9
MRI safety screening is critical for preventing potentially life-threatening complications. While most patients can safely undergo MRI, thorough screening identifies those at risk and allows for appropriate precautions or alternative imaging modalities when necessary.