There is a lot of confusion about whether to scan patients with different types of metal in their bodies, to the extent that patients are often refused MRI scans. In order to assess the scope of the problem and allow targeted designing of educational programs, we conducted a survey on MRI safety amongst radiologists from varying geographies.
An anonymous questionnaire with 11 clinical situations was circulated digitally amongst ~5,000 radiologists. Questions comprised of MRI scanning dilemmas faced by us in real practice, where an MRI was eventually performed after extensive literature search. Situations included those related to total knee replacements (TKR), VP shunts, bullet injuries, shrapnel injuries, tattoos, baclofen pumps, intra-uterine devices (IUD), sternal wires, coronary stents and cardiac valves. Responses were scored and appropriate analysis performed.
206 radiologists, from 94 cities, with mean experience of 11.92 years (SD: 9.04; range 0 to 50), completed the survey. The average score was 6.53/11 (SD: 2.03, range 1 to 11), with 4 having perfect score. Radiologists performed worst in situations related to arms and explosives - bullet in close relation to vertebral canal (28%) and potentially pregnant woman with bomb shrapnel (29%), and best in situations with a child with an Omaya reservoir with VP shunt (88%) and woman with an IUD (76%). 70% radiologists were correct about baclofen pump, 65% about short-term (3 years) TKR, 60% about stents and sternal wires, 60% about valve replacement, 59% about shoulder gunshot, 52% about long-term, (10 years) TKR and 52% about tattoos. Interestingly, while, 18% radiologists suggest 'no MRI' for a patient with TKR done 10 years ago, 7% recommend 'no MRI' for a patient with TKR done 3 years ago. There was no correlation (R2=0.0004) between years of experience and total score.
We note a trend wherein radiologists seem to adopt a conservative approach and avoid MRI in situations where it can be safely performed, denying patients optimum care. Radiologists need to be systematically educated about situations where MRI can and cannot be done in a clinical setting - situational education being one approach. We demonstrate the need for conducting dedicated training programs on the safety of MRI for practicing radiologists. Many patients who are denied critical MRI scans can benefit from such programs.
Link to complete publication here: https://scholar.google.com/citations?view_op=view_citation&hl=en&user=dqpMNRUAAAAJ&cstart=20&pagesize=80&citation_for_view=dqpMNRUAAAAJ:Zph67rFs4hoC
