Screening Forms for Patients for MR Procedures and Individuals for the MR Environment

Frank G. Shellock1

1 Keck School of Medicine, University of Southern California and Institute for Magnetic Resonance Safety, Education, and Research, Los Angeles, California
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Appendix 1
DOI:  10.1002/0471142719.mix01s11
Online Posting Date:  February, 2004
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Abstract

This appendix presents the screening forms that are to be filled by the patient prior to being scanned. Completion of these screening forms is also required for any person accompanying the patient into the magnet room. There are certain answers that will absolutely contraindicate the patient being scanned (e.g., if the patient has a cardiac pacemaker or ferromagnetic implant) while other questions are more designed to evaluate the patient's tolerance (such as whether they are claustrophobic). Other questions (such as those relating to renal disease) will determine if it is safe to use a contrast agent and make the physician aware of the medical status of the patient.

     
 
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Table of Contents

  • Magnetic Resonance (MR) Procedure Screening for Patients
  • Magnetic Resonance (MR) Environment Screening for Individuals
  • Acknowledgment
  • Literature Cited
  • Figures
     
 
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Materials

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Figures

Videos

Literature Cited

   Kanal, E., Borgstede, J.P., Barkovich, A.J., Bell, C., Bradley, W.G., Felmlee, J.P., Froelich, J.W., Kaminski, E.M., Keeler, E.K., Lester, J.W., Scoumis, E.A., Zaremba, L.A., Zinninger, M.D. 2002. American college of radiology white paper on MR safety. Am. J. Roentgen. 178:1335‐1347.
   Sawyer‐Glover, A. and Shellock, F.G. 2000. Pre‐MRI procedure screening: Recommendations and safety considerations for biomedical implants and devices. J. Magn. Reson. Imag. 12:92‐106.
   Sawyer‐Glover, A. and Shellock, F.G. 2001. Pre‐magnetic resonance procedure screening. In Magnetic Resonance Procedures: Health Effects and Safety (F.G. Shellock, Ed.). CRC Press, LLC, Boca Raton, Fla.
   Shellock, F.G. 2001. New recommendations for screening patients for suspected orbital foreign bodies. Signals, No. 36, Issue 4. pp. 8‐9.
   Shellock, F.G. 2002a. Biomedical implants and devices: Assessment of magnetic field interactions with a 3.0‐Tesla MR system. J. Magn. Reson. Imaging 16:721‐732.
   Shellock, F.G. 2002b. MR safety update 2002: Implants and devices. J. Mag. Res. Imaging 16:485‐496.
   Shellock, F.G. 2003. Reference Manual for Magnetic Resonance Safety. Edition. Amirsys, Salt Lake City, Utah.
   Shellock, F.G. and Crues, J.V. 2002. Commentary. MR safety and the American College of Radiology White Paper. Am. J. Roentgen. 178:1349‐1352.
   Shellock, F.G. and Kanal, E. 1991. Policies, guidelines, and recommendations for MR imaging safety and patient management. J. Magn. Reson. Imaging 1:97‐101.
   Shellock, F.G. and Kanal, E. 1994. SMRI Report. Policies, guidelines and recommendations for MR imaging safety and patient management. Questionnaire for screening patients before MR procedures. J. Magn. Reson. Imaging 4:749‐751.
   Shellock, F.G. and Kanal, E. 1996. Magnetic Resonance: Bioeffects, Safety, and Patient Management. Second Edition, Lippincott‐Raven Press, New York.
Internet Resources
   http://www.MRIsafety.com
   http://www.IMRSER.org
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