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9/2/2009
1
Patient Preparation and Management
for MRI Clinical ExamsClarian Health 2009
Laurie Owens BSRT (MR)
MRI Patient Preparation Topics
JACHO Patient Safety Goal
MRI patient safety screening prior to the appointment time
MRI patient preparation before, during and after the MRI procedure.
MRI patient comfort ideas
MRI Positioning Techniques
MRI Imaging Techniques
MRI Post Processing
Metallic Imaging Techniques
Patient Preparation Before the MRI Exam When the MRI
appointment is made a preliminary patient screening should be done. Screen for surgical implants such as pacemakers.
A Radiology receptionist should call the patient 1-3 days before the MRI appointment to perform an MRI safety screening and confirm the MRI patient’s appointment.
MRI screening questionsat the time of the confirmation call
Do you have a pacemaker? Do you have a brain aneurysm clip? Do you have a history of metal in your eye or have
you had metal removed from your eye? Do you have an surgical device such as a cardiac
stent, intravascular filter, or drug infusion pump.
The radiology receptionist should get as much information about any surgical device so that prior MRI safe screening can be done by the MRI technologists.
Patient Name:____________________________________
MRN:_____________________________________________
MRI appointment Date:_________________________________
Does the patient have a Cardiac Stent, Vascular stent, coil or filter
Type:________________________________________________
Date of Implant:________________________________________
Physician or Facility that placed the devise:___________________
Additional Information:___________________________________
*Have the patient bring there stent/filter information card with them to their MRI appointment.
Does the patient have a Brain Aneurysm Clip
Type:____________________________________________
Date of Implant:____________________________________
Physician or Facility that placed the devise:___________________
Does the patient have a Heart pacemaker or Heart Valve
Heart Valve type:_____________________________________
Date of Implant:____________________________________
Physician or Facility that placed the devise:___________________
Does the patient have a history of metal in their eye or metal removed from their eye. Patient should arrive 1 hour prior to the MRI appointment time for screening x-rays.
*If the patient has a heart pacemaker cancel the MRI and inform the referring physician’s office.
MRI Safety Screening Device Form
JACHO Patient Safety GoalImprove the accuracy of patient information
Use at least 2 patient identifiers when providing any care, treatments, or services.
Patient name, MRN, Birth date, SSN, Address, Telephone number are examples of patient identifiers that can be used.
Never Use the patient’s room number as a patient
identifier.
Involve the patient and their family, as needed.
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MRI Patient Greeting
Introduce yourself to your patient, smile and make eye contact with the patient
Confirm your MRI patient’s information with 2 patient identifiers.
Review MRI Safety Screening form and Medical reconciliation form
Inform patients of any MRI imaging delays
If your patient’s MRI appointment was delayed give the patient a reason for the delay.
MRI Patient Preparation After taking your patient to
the dressing room area perform a Verbal screening of the MRI screening form with the patient.
Confirm with your MRI patient the MRI order sent by their referring physician. Confirm the body part being imaged.
Inform your MRI patient if an IV is needed for the procedure for contrast. Oral contrast, etc.
Patient Dressing Area
Give your MRI patient comfortable hospital garments to change into, a private area to change their clothes, and a secure place to lock up their personal items.
Remind your patient to use the restroom before beginning the MRI procedure.
MRI Patient Comfort Ideas
During the MRI Procedure
Patient Comfort Systems, Inc.www.patientcomfortsystems.com
Patient Tempur-Pedic pads
Blanket Warmer
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Knee Rest Larger bore Magnets70cmSiemens 3T Verio, Espree, and Pink Espree
Provide extra padding
Ideas for Claustrophobic Patients
Mirrors and Prism glasses Feet First
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Patient entertainment systemsInvivo Esys
Resonance Technologywww.mrivideo.com
MRI room Planning Philips Ambient Experience
The Philips Ambient Experience creates an optimal environment for patients and staff.
Feels less like a hospital
Reduces stress and increase patient comfort.
Painted Mural Patient Communication
Always give your patient the call button
Always stay in constant contact with the patient.
Never be on the computer while imaging a patient.
Check with your patient regularly to make sure that they are ok.
Inform your patient of scanning procedures.
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Pediatric Imaging
Explain the MRI to the child. Invite the child to bring an MRI safe toy with them.
Involve the child and their parents.
Provide music, kid songs, stories on a CD.
Snuggle, knee rest, blanket
Anesthesia
MRI Patient Positioning
Head/Spine Imaging Knee MRI
Position the knee joint within the center of the knee coil 1-2 fingers below the patella.
Prop the opposite knee up with a knee rest or pillows to reduce phase wrap.
Insert sponges around the knee being imaged to minimize patient motion.
Knee Positioning Knee ACL Angles
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Shoulder MRI (external Rotation) Shoulder MRI Externally rotate the
patient’s arm.
If the patient is in too much pain position their arm in a neutral position. Never position the patient’s arm on their abdomen.
Use MRI safe sand bags and restraints to minimize patient
motion.
B IC EPS TEN D O N
G R EA TER
TU BER O SITY
LESSER
TU BER O SITY
BO N Y
G LEN O ID H U M ER A L
H EA D
External Shoulder rotation for the Right Shoulder
THE BICEPS TENDON SHOULD BE IN THE
11 O’CLOCK POSITION FOR THE RIGHT SHOULDER AND THE
1 O’CLOCK POSITION FOR THE LEFT SHOULDER
Wrist MRI Position patient feet
first supine with the arm done the patient’s side.
Provide extra padding under their arm.
Use restraints to position the wrist coil and minimize patient motion.
Position the patient as far as possible to the opposite side to optimize fat saturation.
Abdominal MRI Give Your patient oxygen
if they feel that they won’t be able to hold their breath adequately.
Coach your patient with the breathing instructions before the MRI. Expiration is the best technique to ensure consistent anatomy position.
Provide headphones so that breathing instructions can be heard consistently.
Abdominal Imaging Before injecting contrast
inform your patient. Let them know what they will feel.
You have one chance to inject contrast. Make sure that the patient understands the
breathing instructions.
Let your patient know that the contrast part of the study is the most important.
Wrap the arm with the IV with a towel for contrast/saline leakage.
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Clarian Contrast Extravasation Policy
Policies/Procedures, department, Radiology
Make sure there is free blood flow
Observe the injection site
When injecting contrast in an existing I.V. line, be very sure there is free return of blood.
If extravasation occurs. Remove IV, apply cold compresses, notify radiologist. Physician should exam the patient, record findings and action taken.
File incident report.
Pace Trigger PACE: Prospective Acquisition
Correction: 2D Pace with short breath-holds or non-breath holds.
User places a small box across the diaphragm. The change in signal intensity along the axis of the box is used to determine the position of the diaphragm.
Slices are acquired only when the diaphragm position falls in the acceptance window.
MRCP Slab Positions Haste
TE : ~600
Thick slice thickness 20-40mm
MRI Post ProcessingTechniques
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Metallic Imaging Techniques
Magnetic susceptibility effect
The magnetization of the metal results in local magnetic field
inhomogeneity which interferes with the imaging gradients
- alters the phase and frequency of the local spins in the bone and soft tissues around the metallic hardware.
The artifact generated are:
1. Signal void within the hardware
2. High signal intensity rim at the
periphery and
3. Geometric image distortion
Tips for reducing metallic artifacts Bandwidth: Increasing the receiver bandwidth (rBW)
reduces the mis-registration of signal in the frequency encoding direction due to Bo inhomogeneity.
• Increase rBW shortens the data window acquisition. For TSE sequences, this means shorter echo spacings
• When imaging in the presence of metal rBW may be increased to 400 – 800 Hz/pixel, depending on the trade-off between the extent of artifact and the tolerable signal loss.
• Other Tips:• Increase ETL for TSE Sequences• 3D Space sequence will minimize metallic artifacts.• The frequency encoded direction should be changed such
that it is not parallel to the anatomy of interest.• Avoid GRE, or frequency selective fat suppression
techniques; they produce massive signal voids.• Avoid imaging on 3Tor greater scanners.