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Incidence of Adverse Events Related to Ballistic Fragments in Patients Undergoing MRI at a Large Urban Health System:
Paul M Armenta1, Adam Siegel2, Russel R Fullerton3
1Department of Radiology, Montefiore Medical Center, Bronx, New York. Electronic address: https://twitter.com/paulmarmenta.
Background:
Patients with retained ballistic fragments commonly require MRI. Very few studies have reported MRI-related adverse events in patients with retained bullet or shrapnel fragments. Current ACR recommendations suggest caution when scanning patients with retained fragments but offer limited concrete guidance to assist MRI personnel with safety determinations.
Purpose:
To assess the incidence of retained bullet or shrapnel fragments in patients undergoing MRI and of associated adverse events, in the context of an existing screening policy.
Material And Methods:
The Montage search feature of the PS360 reporting system for radiological examinations was used to identify, for the years 2010-2023, all patients who underwent radiographic examinations demonstrating retained bullet or shrapnel fragments, who underwent a subsequent MRI examination. Medical record review was used to assess the occurrence of adverse events related to the MRI examination.
Results:
In all, 220 patients with evidence of a retained bullet or shrapnel fragment who underwent subsequent MRI were identified from 6,143 positive radiographs. Four of 220 patients (1.8%) reported transient localized burning or discomfort during the MRI examination. In each of the four patients, the retained bullet or shrapnel fragments were in the superficial soft tissues. No medical treatment was required, and no serious adverse events or persistent symptoms were reported.
Conclusion:
There is a low incidence of adverse events in patients with known bullet or shrapnel fragments undergoing MRI in the context of the local screening policy. An effective screening paradigm likely plays a role in minimizing adverse events.
Insights
Patients with retained bullet fragments undergoing MRI have a low incidence of adverse events. A robust screening policy helps minimize risks during magnetic resonance imaging (MRI) for individuals with metallic fragments.
Area of Science:
- Radiology and Medical Imaging
- Patient Safety in Medical Procedures
- Biomedical Engineering
Background:
- Magnetic resonance imaging (MRI) is frequently required for patients with retained ballistic fragments.
- Limited data exists on MRI-related adverse events in patients with bullet or shrapnel fragments.
- Current American College of Radiology (ACR) guidelines offer general caution but lack specific safety determination protocols for MRI personnel.
Purpose of the Study:
- To determine the incidence of retained bullet or shrapnel fragments in patients undergoing MRI.
- To assess the occurrence of MRI-related adverse events in this patient population.
- To evaluate these findings within the framework of an established institutional screening policy.
Main Methods:
- Utilized the Montage search feature of the PS360 reporting system to identify patients with retained fragments who subsequently underwent MRI between 2010 and 2023.
- Reviewed medical records to meticulously assess for any adverse events linked to the MRI examinations.
- Included patients who had prior radiographic evidence of bullet or shrapnel fragments.
Main Results:
- Identified 220 patients with retained fragments who underwent MRI from 6,143 positive radiographs.
- Four out of 220 patients (1.8%) reported transient, localized burning or discomfort during MRI.
- All reported events involved superficial soft tissue fragments; no serious adverse events or need for medical treatment occurred.
Conclusions:
- The incidence of adverse events in patients with known bullet or shrapnel fragments undergoing MRI is low under a defined screening policy.
- An effective screening paradigm appears crucial in mitigating potential risks and ensuring patient safety during MRI.
- These findings support the safety of MRI in selected patients with retained fragments when appropriate screening measures are in place.
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