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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.

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Conclusion

Screen your patient prior to the appointment time

Confirm your patient’s identity

Make your patient as comfortable as possible to increase patient satisfaction and reduce patient motion.

Thank you