Screening form

General information

Section 1 of a patient screening form contains general information concerning patient demographics and the patient’s medical and work history. Relevant patient-related information is valuable for obtaining current medical conditions and information on prior diagnostic studies that may be helpful in evaluating the patient’s state.

Determining the patient’s work history is important for those who work in machine shops or similar environments. These individuals may have small metal slivers or fragments of steel embedded in their eyes. If metal fragments are suspected, the patient should receive an eye examination to detect and remove hazardous materials before scanning.

Section 1 of a screening form also contains questions needed to help identify high-risk patients, i.e., those with conditions posing higher risk of complications during theMR exam. Questions explore risks due only to the condition of the patient (e.g. elevated risk of seizure or cardiac arrest) and also those due to the elevated SAR possible when operating in First Level Controlled Mode (e.g. for patients with compromised thermoregulatory capacity.)

This section also contains questions for female patients concerning matters that may affect the MR examination. Pregnant patients must be identified before they are permitted to undergo an MR procedure. A physician should carefully compare and discuss the risks and benefits of the MR examination versus alternative procedures before scanning to control risk to the patient.

Hazardous items checklist

The Hazardous items checklist, in section 2 of a patient screening form, is valuable in identifying various implants and devices that may be hazardous to the patient undergoing the MR examination. Items that may produce image artifacts, can also be detected through this section of the screening process.

Some patients, including those suffering from forms of dementia, may not be aware of having a pacemaker. On such patients, palpate the upper torso and abdomen to make sure no pacemaker is present. Pacemakers may be implanted in any of several locations in the chest and abdomen. Pacemaker lead wires are sometimes left in place after removal of the pacing mechanism. The wires can induce current, producing heat during the MR procedure. Therefore, checking for lead wires is also important.

The best way to ensure a metal-free environment is to have patients change into patient examination attire. The checklist also includes items the patient may externally possess. Do not limit your inspection to only ferrous objects alone. Even non-ferrous items, such as gold jewelry, can heat during a scan and burn a patient. Make sure the patient removes all of these objects. In addition, be sure to check small children for safety pins and snaps on diapers or undershirts.

Section 2 of a form also contains an anatomical figure of the human body for patients to mark the location of objects they have inside or on their body. This information can be useful in determining the approximate area of objects that may be hazardous or produce artifacts.

Magnet room pre-entry checklist

The last section of a screening form lists metal or magnetic-sensitive items with which the patient can not enter the magnet room. Ensure the patient removes the checked items prior to magnet room entry. Also obtain signatures to document the person who completed and reviewed the screening form.