From the Guidelines
Informed consent for Magnetic Resonance Cholangiopancreatography (MRCP) should include a thorough discussion of the procedure's purpose, benefits, risks, and alternatives, as outlined in the guidelines for obtaining valid consent for gastrointestinal endoscopy procedures 1. The patient should be informed that MRCP is a non-invasive imaging technique that uses magnetic resonance to visualize the biliary and pancreatic ducts without radiation exposure or contrast injection. Patients should be advised about the need to lie still in an enclosed space for 30-45 minutes, which may cause claustrophobia in some individuals. Important risks to discuss include potential reactions to gadolinium contrast if used (though many MRCP exams don't require contrast), and contraindications such as certain metallic implants, pacemakers, or other electronic devices. Patients should remove all metal objects before the procedure. Pregnancy is a relative contraindication that should be discussed. The consent process should also cover alternatives like endoscopic retrograde cholangiopancreatography (ERCP), which is more invasive but allows for therapeutic intervention, or ultrasound, which may be less sensitive but more readily available. Some key points to consider in the consent process include:
- The taking of a photographic or video record and possible secondary uses of anonymised records, such as for teaching or assessment of health professionals 1.
- Skilled supervision and presence of any trainees and the right of the patient to refuse having a trainee perform the procedure without prejudice to their treatment.
- Use of any experimental technique.
- Contact details in case further information is required by the patient. The consent process should be a process, rather than a one-off event, and should be sought well in advance, when there is time to respond to questions and provide adequate information 1. Documentation of this discussion in the medical record completes the informed consent process, ensuring patients understand what to expect during this diagnostic procedure. It is essential to ensure that the written information has been understood, particularly any material risks, and that the patient is given the opportunity to ask questions or raise concerns and have these answered in a full, open and honest manner 1. If a patient insists that they do not want even this basic information, the potential consequences of them not having it, particularly if it might mean that their consent is not valid, should be explained, and the fact that the patient has declined this information should be recorded 1.
From the Research
MRCP Consent
When considering MRCP (Magnetic Resonance Cholangiopancreatography) consent, several factors come into play, particularly regarding the use of contrast agents and their potential risks.
- Risks Associated with Contrast Agents: The use of gadolinium-based contrast agents in MRI procedures, including MRCP, has been associated with nephrogenic systemic fibrosis (NSF) in patients with severely impaired renal function 2, 3, 4. NSF is a systemic disease characterized by progressive fibrosis of the skin and other organs, leading to significant disability and increased mortality.
- Patient Selection and Screening: It is crucial to assess renal function before administering gadolinium-based contrast agents to minimize the risk of NSF 2, 4. Patients with a glomerular filtration rate (GFR) of less than 30 ml/min per 1.73 m^2 are at higher risk.
- Alternative Techniques: For patients at risk, alternative imaging techniques without contrast or with minimal contrast dose should be considered 2, 4.
- Informed Consent: Patients should be fully informed about the potential risks and benefits of MRCP with contrast agents, especially if they have impaired renal function 5, 3. This includes discussing the risks of NSF and the measures in place to minimize these risks.
- MRCP Techniques and Indications: MRCP is a valuable tool for the non-invasive investigation of pancreatico-biliary disorders, with various techniques available, including functional and secretin-stimulated MRCP 6. The choice of technique depends on the clinical indication and patient factors.