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By Terrie Reed, MedSun Project Coordinator

We have had several MedSun reports describing metal tips, drill bits, graspers, and clamps that have broken inside the patient during surgical procedures. In some cases, the fragment could not be found. In others, the decision was made to leave the debris inside the patient to avoid potential harm from attempted removal. The Center for Devices and Radiologic Health MR Working group recommends that health care providers inform the patient about the size, composition, and location of any metal fragments from broken devices left in a patient. While the fragment may or may not be a safety hazard, it is important to disclose this information to the patient and instruct the patient that they must report the details concerning the metal fragments to other health care providers prior to any future MR exam.

Additional MR Screening Resources

In the January/February issue of MedSun News we posted an example of an MR screening form. As part of the research to analyze the MedSun metal debris reports, we learned of additional resources that may be helpful in improving your organization’s MR screening process. A brief summary and a link to each reference is given below:

Kanal E, Borgstede JP, Barkovich AJ, Bell C, Bradley WG et al. American College of Radiology White Paper on MR Safety. AJR 2002; 178: 1335-1347. Available online: http://www.acr.org/departments/stand_accred/standards/pdf/ACR_white_paper.pdf
(last viewed on 4/2/03).

A report from the American College of Radiology Blue Ribbon Panel on MR Safety providing specific recommendations on issues related to Magnetic Residence safety practices including: access to equipment, personnel and patient screening, and considerations for special populations. The report includes sample patient screening forms and an MR hazard checklist for patients and staff.

Shellock FG. Screening patients for MR Procedures and Individuals for the MR Environment. Institute for Magnetic Resonance Safety, Education, and Research.
Available online: http://www.mrisafety.com/SCREENING_FORM/PreScrnF.pdf
(last viewed on 4/2/03).

Dr. Shellock provides a comprehensive screening form for patients and a form to be used by all ‘non-patients’ entering the MR environment. Included with the forms is a detailed explanation of why specific questions are included. The screening forms include a checklist of implants and appliances that may be contraindicated with MR and allows the patient to mark where they think implanted or metal debris may be located in or on their body.

Updated August 4, 2003