Gun incident in the MRI room: See which items require treatment during the exam

The lawyer was shot by his own gun while accompanying his mother in the proceedings in São Paulo

Used to aid in the diagnosis of various diseases in specialties such as oncology, neurology, cardiology and orthopedics, the magnetic resonance imaging (MRI) requires some attention so that the exam is carried out safely and to avoid accidents like the one that happened on Monday the 16th when a 40-year-old man was accidentally shot while accompanying his mother to surgery.

According to the incident report, when the machine was activated, the magnetism pulled the gun on his waist and fired, hitting him in the abdomen area. Before entering the office, the lawyer Leandro Mathias de Novaes signed a term of contraindication of the magnetic field for accompanying persons. He was taken to the São Luiz hospital.

The magnetic resonance exam does not have ionizing radiation like computed tomography and radiography, but involves the use of magnetic fields and radio waves, so it is important to check all the guidelines for carrying out the procedure.

According to Alessandro André Mazzola, medical physicist, specialist in radiodiagnostic physics and director of MRIONLINE – Protocols & Educations, every patient needs to be guided during the examination. “It is important to explain that these are equipment that will use a strong magnetic field (called a static magnetic field), magnetic field variations and radio frequency,” says the member of the organizing committee of the Paulista Radiology Day (JPR 2023).

In addition, the use of gadolinium-based contrast agent should be advised, if mandated by physician. “The set of recommendations for the patient is aimed at guaranteeing his safety in the environment and, more specifically, at the entrance to the examination room (near the magnet where the magnetic field is high) and throughout the visit”, says Mazzola.

In addition to being verbally guided by the nursing and technical team, every patient who undergoes an MRI scan must first be questioned about the presence of implants, prostheses, metal fragments or electronic devices in their body.

This safety investigation can take place, initially, through a few questions asked to the patient by telephone during the appointment or even at the reception of the service.

“It is in any case the assessment through a document containing an MRI safety investigation with specific questions and an informed consent, warning of the risks and with guidelines for the examination, which the patient must fill out in his own hand and sign. Specific questions are also raised about previous illnesses and allergies and help in evaluating the use of gadolinium-based contrast agents,” says the specialist.

The strong magnetic field of the MRI machine is always on, 24 hours a day, 7 days a week, 365 days a year. In this way, care in the environment is permanent and access restrictions, monitoring of people outside the sector and training must be strictly carried out and procedures followed.

As per Ministry of Health, the exam room must display signs on the access doors. “The risks and the prohibition of entry of people with systems or other objects incompatible with technology must be informed, in internationally accepted language or symbols, understandable by the public”, reads the folder.

What are the recommendations for patients who will undergo an MRI examination regarding the use of certain metal objects, due to the magnetic field?

“All patients who will undergo the MRI they must, compulsorily, answer a direct questionnaire in which they are asked about the presence of fixed and/or mobile metallic material in the body, such as: prostheses, pacemakers, piercings, among others”, states the Brazilian College of Radiology and Diagnostic Imaging (CBR).

According to the institution, on the basis of this screening, the patient is guided in the removal of incompatible metallic materials, explaining that their presence in the examination room is forbidden due to the strength of the magnetic field.

Shortly before the examination, the patient must completely change his clothes and leave his belongings in a locker or dressing room.

“If the patient has removable dentures, earrings, piercings, makeup or other accessories, these must be removed before entering the examination room,” adds Mazzola, a specialist in radiodiagnostic physics.

The same guideline applies to any metallic material, such as coins and keys, or even firearms. “A metallic material may not be attracted to the strong magnetic field (non-ferromagnetic materials are not attracted to the equipment), but it may cause other problems, such as becoming too hot during the examination, even causing burns if in contact with the skin or with the patient’s tissues,” says Mazzola.

The legislation, according to him, requires that the service have a metal detector that will have the aim of evaluating the patient just before entering the MRI room, thus ensuring that he has not forgotten or left any metallic material next to his body. except when you have an exam-compatible prosthesis, implant, or device.

Is the guide also valid for a companion?

Yes. “The guide is valid and mandatory for all those entering the exam room: patients, carers and collaborators”, states the CBR.

“The recommendations for companions who will enter the examination room with the patient, as this is often important to help the patient calm down to perform the examination or reduce his feeling of claustrophobia, are the same as for the patient”, adds Mazzola, physical doctor, specialist in the physics of radiodiagnosis.

With the only difference that the escort does not need to change all his clothes, but that all his clothes are checked by the team visually and with a metal detector.

“Having any kind of loose metal material on your body or even personal belongings like cell phone, wallet, credit card, watch, coins etc. These should be left in a closet or specific place,” he says.

What about the accidentally fired gun? What sparked the shooting? Does the person have to declare that they have a gun before entering the exam room?

“It is not possible to say with certainty the cause of the shot. However, it was probably due to the force of the impact of the same with the MRI machine. The companion must – compulsorily – inform that they are carrying a metal object. for safekeeping of personal belongings for this purpose,” states the CBR.

Also according to Mazzola, it is important to point out that many services have a specific firearms policy or routine in place. “The institution can have an adequate guard post alongside the security of the institution’s property, a safe, or even cancel the exam and ask the patient to return without the weapon present,” she says.

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Can some tattoos interfere with the MRI exam result? Are there tattooed people who can’t do it?

The tattoos, rich in an iron component, can generate artifacts that cancel the magnetic signal, compromising the regional analysis. Furthermore, some components of dyes can absorb the heat generated during the examination, eventually leading to local heating. There are no reports of tattoo-related burns.

What rules must be followed?

It is mandatory, according to the CBR, that all patients and carers respond to service questionnaires, comply with employee guidelines and comply with the entire safety protocol (including signs in sectors, safety warnings and the prohibition of material not compatible in exams).

What other exams also have limited access to certain items?

As a general rule, all diagnostic imaging exams should be performed with patients wearing no objects, so as not to generate artifacts that compromise image acquisition and subsequent interpretation. “However, the absolute restrictions on the metallic material are specific to the magnetic field used MRI“says the CBR.

Recommendations before performing an MRI:

• While most are currently scan-compatible, there are some metallic or electronic devices, such as cardiac pacemakers and metal implants, that don’t allow for MRI. You need to know if the device is “unsafe” or “conditional”. Being conditional, you can do this, but you must follow specific manufacturer guidelines.
• It is essential that the patient and accompanying person, if applicable, correctly follow the recommendations for the removal of personal metal objects, as well as inform the examination site of any devices present on the body.
• It is advisable to remove personal items such as earrings, rings, necklaces, piercings, dentures, hearing aids. All elements are informed before the exam is performed.
• The patient who has tattoos, rich in iron, must inform the professional who will perform the magnetic resonance in advance.
• Likewise, it is indicated that the person informs if he has makeup.
• Pregnant women can undergo the examination, but an evaluation will be carried out by the radiologist and the applicant to evaluate the real need and if ultrasound is not an option.

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Source: Terra

Ben

Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.