"No MRI" identification?
May 8, 2012 4:07 PM Subscribe
As someone who has worked with metal and now has a small piece of metal (non surgical) lodged in my bone, I should not have an MRI. What is the best way to make this known? Do I need a medic alert bracelet/tattoo?
Best answer: At the facility where I work as an MRI technician, an embedded metal fragment is an exclusion criterion for an MRI. Depending on the composition of the metal and the site where it's located, the piece may heat up or try to change position, potentially leading to discomfort or additional injury. It will not necessarily happen, but it may happen with nonzero probability.
On the other hand, IANAD and I have no idea what you'd do as a patient in this case. I imagine you could talk to your general practitioner, who could potentially refer you to a radiologist, if necessary.
Do you, by any chance, have a sample of the material that you were injured with? Is it impractical to try to remove it? Is the fragment located somewhere where the risk of side effects will affect the decision to collect MRI images during a medical emergency?
posted by Nomyte at 4:27 PM on May 8, 2012
On the other hand, IANAD and I have no idea what you'd do as a patient in this case. I imagine you could talk to your general practitioner, who could potentially refer you to a radiologist, if necessary.
Do you, by any chance, have a sample of the material that you were injured with? Is it impractical to try to remove it? Is the fragment located somewhere where the risk of side effects will affect the decision to collect MRI images during a medical emergency?
posted by Nomyte at 4:27 PM on May 8, 2012
Response by poster: Word, karlos. Presumably also any filings in my eyeball big enough to cause trouble would show up on an x-ray? Is the whole OMG U WRK WITH METL NO MRI just straight up misinformation?
posted by beefetish at 4:29 PM on May 8, 2012
posted by beefetish at 4:29 PM on May 8, 2012
Response by poster: Nomyte, it's part of a sewing needle lodged in a metatarsal in my right foot. Removal of the material would necessitate smashing my joint up so the podiatrist decided against it. I totally have the rest of the sewing needle on hand.
posted by beefetish at 4:33 PM on May 8, 2012
posted by beefetish at 4:33 PM on May 8, 2012
I would assume that the needle is strongly attracted to magnets? A positive suggests that a far stronger MRI magnet will give you lots of trouble. A negative… will not really confirm or deny anything. Sorry, I'm genuinely unfamiliar with the protocol on this issue, my facility is research-only.
posted by Nomyte at 4:37 PM on May 8, 2012
posted by Nomyte at 4:37 PM on May 8, 2012
Best answer: Yes, anything in your eyes will show up on an X-Ray, which is probably a good idea, as non-ferromagnetic things might vibrate and heat up a little, which is the biggest deal in your eye, where it can cause the most damage.
Check to see if the needle is ferromagnetic (attracted by a magnet). If it is, then MRIs are, in fact, a bad idea, but if it's not it is likely not enough of an issue to contraindicate medically necessary MRIs (especially the type where you are not conscious enough to turn them down).
Research facilities are much stricter about what they'll accept, as nobody needs to be in there, so they take a much more risk-averse approach than they would take if you are unconscious and they need to know what's going on immediately.
posted by brainmouse at 4:48 PM on May 8, 2012
Check to see if the needle is ferromagnetic (attracted by a magnet). If it is, then MRIs are, in fact, a bad idea, but if it's not it is likely not enough of an issue to contraindicate medically necessary MRIs (especially the type where you are not conscious enough to turn them down).
Research facilities are much stricter about what they'll accept, as nobody needs to be in there, so they take a much more risk-averse approach than they would take if you are unconscious and they need to know what's going on immediately.
posted by brainmouse at 4:48 PM on May 8, 2012
Would a tattoo over the area concerned be a stupid suggestion?
posted by dg at 4:52 PM on May 8, 2012
posted by dg at 4:52 PM on May 8, 2012
According to the EMTs and other medical professionals I've heard discuss this, a tattoo is not legally binding (getting "DNR" tattooed on your chest will have zero effect on whether the paramedics try to resuscitate you) and is highly likely to be overlooked if there's a medical emergency going on.
Every one of them has said that they check for medical alert bracelets and pendants and pay attention to the information on such a bracelet or pendant.
This is anecdata, of course.
posted by Lexica at 4:59 PM on May 8, 2012
Every one of them has said that they check for medical alert bracelets and pendants and pay attention to the information on such a bracelet or pendant.
This is anecdata, of course.
posted by Lexica at 4:59 PM on May 8, 2012
Response by poster: Brainmouse: The rest of the needle is definitely ferromagnetic. Medical alert pendant time?
posted by beefetish at 5:15 PM on May 8, 2012
posted by beefetish at 5:15 PM on May 8, 2012
If you have worked with metal in the past you can be screened with what we call orbital x-rays, these are just plain films of the orbits of your eyes to confirm you don't have any stray metal bits in there.
If you come in and you are unable to communicate with your doctors for some reason (being in a coma) and they are not able to determine if you are safe for an MRI by performing their usual screening questionnaire, they will do orbital x-rays prior to ordering the MRI.
They won't know about the needle so I do think a medic-alert bracelet could be helpful on that count, although having whatever damage might occur to your toe joint due to dislodging the needle might be a risk worth taking if you actually were in one of these scenarios.
Lexica, you are correct, but at the same time, there are not many medical emergencies that cannot be addressed with CT scans and require MRIs emergently.
posted by treehorn+bunny at 5:20 PM on May 8, 2012
If you come in and you are unable to communicate with your doctors for some reason (being in a coma) and they are not able to determine if you are safe for an MRI by performing their usual screening questionnaire, they will do orbital x-rays prior to ordering the MRI.
They won't know about the needle so I do think a medic-alert bracelet could be helpful on that count, although having whatever damage might occur to your toe joint due to dislodging the needle might be a risk worth taking if you actually were in one of these scenarios.
Lexica, you are correct, but at the same time, there are not many medical emergencies that cannot be addressed with CT scans and require MRIs emergently.
posted by treehorn+bunny at 5:20 PM on May 8, 2012
Lexica: "According to the EMTs and other medical professionals I've heard discuss this, a tattoo is not legally binding (getting "DNR" tattooed on your chest will have zero effect on whether the paramedics try to resuscitate you) and is highly likely to be overlooked if there's a medical emergency going on."
Paramedic here, and you're half right. A DNR needs the proper signed paperwork to be binding (a bracelet doesn't qualify either, outside of a hospital) and so we tend to err on the side of life, but that's a case of refusing essential treatment because you don't want it.
A medical alert of some kind (Allergies, conditions, etc) gives us a heads up before we make the situation worse. We pay pretty close attention to those. I would personally recommend a bracelet or tattoo near a wrist or ankle, or a necklace. Those areas always get checked quickly.
Whether or not the attending doctor would accept it is something I'm not qualified to answer. I would suggest consulting a doctor on the ideal wording.
posted by vohk at 5:22 PM on May 8, 2012
Paramedic here, and you're half right. A DNR needs the proper signed paperwork to be binding (a bracelet doesn't qualify either, outside of a hospital) and so we tend to err on the side of life, but that's a case of refusing essential treatment because you don't want it.
A medical alert of some kind (Allergies, conditions, etc) gives us a heads up before we make the situation worse. We pay pretty close attention to those. I would personally recommend a bracelet or tattoo near a wrist or ankle, or a necklace. Those areas always get checked quickly.
Whether or not the attending doctor would accept it is something I'm not qualified to answer. I would suggest consulting a doctor on the ideal wording.
posted by vohk at 5:22 PM on May 8, 2012
At the very least put a card in your wallet with your ID/license with a warning.
posted by crankyrogalsky at 6:18 PM on May 8, 2012
posted by crankyrogalsky at 6:18 PM on May 8, 2012
Again, sorry I'm unable to answer your question definitively. One thing to note is that the fragment is (I'm guessing) quite small and located in your foot, which is quite far from from your abdomen, chest, and especially your head, which are likeliest to be imaged in an emergency. If at all possible, the patient is loaded into the bore supine (i.e., lying on the back) and head-first.
Since the force the field exerts grows and decays as the square of the distance from the isocenter (i.e., the center of the bore), I don't think it's likely that a minute foreign body in your foot will experience much. I'm sure your case is one that emergency medical staff have had to deal with before. If an emergency MRI is ordered for some reason, it will have been decided that the substantial and immediate benefit significantly outweighs the unlikely discomfort.
posted by Nomyte at 6:45 PM on May 8, 2012
Since the force the field exerts grows and decays as the square of the distance from the isocenter (i.e., the center of the bore), I don't think it's likely that a minute foreign body in your foot will experience much. I'm sure your case is one that emergency medical staff have had to deal with before. If an emergency MRI is ordered for some reason, it will have been decided that the substantial and immediate benefit significantly outweighs the unlikely discomfort.
posted by Nomyte at 6:45 PM on May 8, 2012
I think it's unlikely that you'll need an MRI of your foot in an emergency, and if you do, chances are dislodging the needle is going to be a lesser problem than whatever you're getting the MRI for. I think they usually will X-ray you first anyway.
Anecdata: I went through an MRI of my lumbar spine wearing clogs with staples (this was stupid--the heat had gone out in the facility and they said I could keep my socks and shoes on. I don't think anyone realized that there was metal in my shoes). I could feel the magnet pulling at my shoes, but it didn't dislodge any staples. This was five years ago and the shoes are still sound as can be. This could be dumb luck, however. I wouldn't recommend doing it. But it does suggest to me that an MRI of your chest or head, which you might need in emergency, probably wouldn't damage your foot.
So for me, if the metal was near something vital, I would wear a medic alert bracelet, but not for something stuck in my foot. That's just me. Do whatever gives you peace of mind.
posted by elizeh at 7:17 PM on May 8, 2012
Anecdata: I went through an MRI of my lumbar spine wearing clogs with staples (this was stupid--the heat had gone out in the facility and they said I could keep my socks and shoes on. I don't think anyone realized that there was metal in my shoes). I could feel the magnet pulling at my shoes, but it didn't dislodge any staples. This was five years ago and the shoes are still sound as can be. This could be dumb luck, however. I wouldn't recommend doing it. But it does suggest to me that an MRI of your chest or head, which you might need in emergency, probably wouldn't damage your foot.
So for me, if the metal was near something vital, I would wear a medic alert bracelet, but not for something stuck in my foot. That's just me. Do whatever gives you peace of mind.
posted by elizeh at 7:17 PM on May 8, 2012
elizeh, please note that the staples were in your shoes, not in your feet. It's not inconceivable that someone may undergo imaging while wearing a belt with a magnetizable buckle, or an underwire bra. I would be very, very hesitant to subject someone with an embedded metal fragment to the same experience.
posted by Nomyte at 7:40 PM on May 8, 2012
posted by Nomyte at 7:40 PM on May 8, 2012
No, I realize that. I just meant that if it was in your foot, the odds of needing an emergency MRI in a place where it would be affected and in a situation where you could not communicate your contraindication seem low, based on my single experience. If the needle was in my torso, arms, or head, i would absolutely wear a bracelet.
By all means, if it worries you or if your doctor suggests it, get a bracelet. Or maybe an anklet, if you want something less obrtrusive.
posted by elizeh at 8:16 PM on May 8, 2012
By all means, if it worries you or if your doctor suggests it, get a bracelet. Or maybe an anklet, if you want something less obrtrusive.
posted by elizeh at 8:16 PM on May 8, 2012
Also, is this noted in your medical records? If not, make sure it is.
posted by elizeh at 8:18 PM on May 8, 2012
posted by elizeh at 8:18 PM on May 8, 2012
Since the force the field exerts grows and decays as the square of the distance from the isocenter
Wouldn't it fall of as the inverse cube, being a dipole field and all?
posted by hattifattener at 8:25 PM on May 8, 2012 [1 favorite]
Wouldn't it fall of as the inverse cube, being a dipole field and all?
posted by hattifattener at 8:25 PM on May 8, 2012 [1 favorite]
Wouldn't it fall of as the inverse cube, being a dipole field and all?
Yes, of course, thank you.
posted by Nomyte at 8:58 PM on May 8, 2012
Yes, of course, thank you.
posted by Nomyte at 8:58 PM on May 8, 2012
I wear a cochlear implant so can't have MRIs. I wear a medic alert bracelet for this reason (I know it's unlikely I'll be shoved in an MRI unconscious but I don't want to take that chance).
posted by prettypretty at 11:12 PM on May 8, 2012
posted by prettypretty at 11:12 PM on May 8, 2012
Also worth noting is this accident wherein an MRI machine snagged an oxygen canister and propelled it like a guided missile straight into the mouth of the machine where it killed the child being examined.
And from that same article:
"Shellock and Chaljub both say that implants in the body pose a greater danger for MRI accidents than do potential projectiles. For example, Chaljub says that a woman who had an aneurysm clip in her brain died after undergoing an MRI and "a welder who had a piece of metal imbedded in his eye was blinded in that eye.""
So yeah, I would definitely take pains to ensure that people know about your needle fragment before taking you anywhere near a 3 Tesla strength magnetic field.
posted by barc0001 at 11:26 PM on May 8, 2012
And from that same article:
"Shellock and Chaljub both say that implants in the body pose a greater danger for MRI accidents than do potential projectiles. For example, Chaljub says that a woman who had an aneurysm clip in her brain died after undergoing an MRI and "a welder who had a piece of metal imbedded in his eye was blinded in that eye.""
So yeah, I would definitely take pains to ensure that people know about your needle fragment before taking you anywhere near a 3 Tesla strength magnetic field.
posted by barc0001 at 11:26 PM on May 8, 2012
The metal in the eyes is a real thing and will show up on orbital films. Newer vascular clips are non-magnetic but older ones can be, so it kind of depends. I'm a doctor but not a radiologist and I order 3T MRIs a few times a week. A sewing needle lodged in a bone would not be a contraindication to getting a study done.
posted by karlos at 9:37 AM on May 9, 2012
posted by karlos at 9:37 AM on May 9, 2012
Response by poster: Thanks for all the answers y'all. I'm going to have a chat with podiatrist and make sure my PCP has all the info I need, and then go get a PENICILLIN ALLERGY alert pendant 'cuz that one actually matters.
posted by beefetish at 2:54 PM on May 10, 2012
posted by beefetish at 2:54 PM on May 10, 2012
This thread is closed to new comments.
posted by karlos at 4:18 PM on May 8, 2012