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Frequency of referral of patients with safety-related contraindications to magnetic resonance imaging |
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„Wir haben uns in diesem Zusammenhang mit der Frage beschäftigt, wie viele Patienten im MRT sicherheitsrelevante Indikationen hatten.
Die anhand von >75.000 ausgewerteten MRT-Untersuchungen ermittelten, interessanten Ergebnisse wurden aktuell im European Journal of Radiology publiziert. Nachdem Teile der Studie auf dem letzten amerikanischen Röntgenkongress 2006 veröffentlicht wurden, ein weiterer stolzer Erfolg für die Radiologie Löbau.“ |
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Marc Dewey,
Departments of Radiology, Charité, Medical School, Humboldt-Universität zu Berlin, Germany
Tania Schink,
Medical Biometry, Charité, Medical School, Humboldt-Universität zu Berlin, Germany
Charles F. Dewey, Radiology, Outpatient Centre Löbau, Poststr. 20, 02738 Löbau, Germany
Received 20. November 2006; received in revised form 19. January 2007;
accepted 24. January 2007 |
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Abstract Purpose: To analyse the frequency of patients with absolute and relative contraindications to magnetic resonance (MR) imaging who were actually referred to an outpatient imaging centre for an MR examination Materials and methods: Altogether a total of 51,547 consecutive patients were included between November 1997 and December 2005. Reasons preventing MR imaging were classified into the following categories: absolute and relative contraindications. Results: The referral frequency of patients with absolute contraindications to MRimaging was 0.41% (211 of 51,547 patients;95%CI, 0.36–0.47%). The absolute contraindications were shrapnels located in biologically sensitive areas (121 patients, 0.23%; 95% CI, 0.20–0.28%), cardiac pacemakers (42 patients, 0.08%; 95% CI, 0.06–0.11%), and other unsafe implants (48 patients, 0.09%; 95% CI, 0.07–0.12%). Also patients with a relative contraindication to MR imaging were referred such as women with a first-trimester pregnancy (13 patients, 0.03%; 95% CI, 0.01– 0.04%). Conclusion: Surprisingly, a considerable number of patients (0.41%) with cardiac pacemakers, other metallic implants (not approved for MR), or shrapnels are referred to MR facilities despite the well-known recommendations not to examine such patients. Thus, absolute contraindications to MR imaging are commonly found among patients referred for MR examinations and every effort needs to be made to screen patients prior to MR imaging for such contraindications to avoid detrimental results. Also, institutions placing implants (approved and unapproved for MR) should become legally responsible for providing the required information to the patients and their physicians. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Safety; Safety management; Magnetic resonance imaging; Contraindications; Pacemakers |
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1. Introduction
Patients with shrapnels, cardiac pacemakers, and some other
metallic implants (such as cochlear implants and certain ferromagnetic
aneurysm clips) cannot undergo magnetic resonance
(MR) examinations because they may be injured in the MRenvironment primarily due to movement or dislodgment of objects
made from ferromagnetic materials or excessive heating and
induction of electric currents [1]. MR imaging on the other hand
has gained pivotal clinical importance over the last 3 decades
and is considered to be one of the two most relevant medical
innovations [2]. Screening patients prior to MRI for the presence
of absolute contraindications is warranted according to
recent guidelines [3] and has been shown to be cost-effective
for instance in the case of orbital metallic fragments [4]. MR
examinations in patients with safety-related contraindications
can result in serious injury [5]. However, the frequency of referral
of patients with such contraindications to an MRexamination
is not known. Thus, we evaluated the rate of patients with safetyrelated
contraindications to MRI who are actually referred for
MR examinations as part of an observational outpatient cohort
study.
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