| Issue | Implications |
| Pacemaker or intracardiac defibrillator in place | - Manage patient without MRI if clinically feasible. Consult radiology regarding imaging alternatives.
- If MRI is unavoidable, notify cardiology and radiology and time of referral so that patient preparation, monitoring, and imaging performance can be coordinated.*
- Counsel patient that they will undergo special monitoring during the MRI and device checks before and after the exam.
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| Intracranial aneurysm clip, cochlear or otologic implant, ocular implant, or cerebrospinal fluid shunt | - Determine the safety profile of the object by model name and/or number and manufacturer.¶
- If the object is rated MRI unsafe or the safety profile is unknown, manage the patient without MRI.
- If the object is rated MRI conditional, discuss with radiology the necessary conditions for safe MRI at the time of exam ordering.
- Counsel the patient that radiology will be performing a safety screen that may lead to additional procedures (eg, medical records retrieval, radiography).Δ
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| Implantation of a foreign body (eg, stent, coil, staple, port, valve, etc) within the past eight weeks. | - Defer MRI for >8 weeks after implantation if clinical feasible.
- If immediate MRI is clinically necessary, consult radiology to assess the risks of imaging. For many foreign bodies, imaging at <8 weeks following implantation would risk dislodgement.
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| History of penetrating trauma or sheet metal work with a possible indwelling metallic object (eg, bullet, shrapnel, metal fragments in eyes) | - Retrieve any prior CT or radiograph of the anatomic area of concern to verify existence and location of an indwelling metal fragment.
- If relevant imaging is available, discuss safety risks of imaging before referral.
- If relevant imaging is not available, notify radiology of the anatomic area of concern at the time of referral.
- Counsel the patient that radiology will performing a safety screen that may lead to additional procedures (eg, medical records retrieval, radiography).Δ
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| Removable implants, devices, or other foreign bodies (eg, dentures, hearing aid, drug infusion pump or patch, body piercing) | - Forewarn patient that the foreign body will need to be removed for the duration of the MRI visit that could last up to three hours.
- If a drug delivery device is involved, advise patient on how to plan for this gap.
- Counsel the patient that radiology will be performing a safety screen that may lead to additional procedures (eg, medical records retrieval, radiography).Δ
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| Patient requires assistance (eg, translator, guardian) to participate in the safety screen | - Notify radiology of patient's needs at time of referral so they can be anticipated.
- Counsel the patient that radiology will be performing a safety screen that may lead to additional procedures (eg, medical records retrieval, radiography).Δ
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| Patient cannot provide a reliable history (eg, unresponsive) | - If clinically feasible, defer MRI until a reliable safety screen can be performed.
- If the patient is unlikely to improve or if the need for MRI is urgent, leverage other sources to obtain the relevant history. This includes:
- Reviewing medical records and interviewing family and/or caregivers for history of prior surgeries, interventional procedures, trauma, or metal work.
- Examining the patient for scars and prostheses.
- Obtaining radiographs or retrieving prior radiographs or CTs to look for a foreign body in the relevant body part indicated by the history and physical examination.
- At time of MRI referral, notify radiology that patient cannot provide a history for safety screening.
- Advise the health care proxy that written consent for MRI will likely be required.
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