Undetected intraocular metallic foreign body causing hyphema in a patient undergoing MRI: a rare occurrence demonstrating the limitations of pre-MRI safety screening

Lawrence, David A.; Lipman, Adam; Gupta, Sushan; Nacey, Nicholas C.

doi:10.1016/j.mri.2014.12.009

Cited by 20 publications

(14 citation statements)

References 16 publications

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“…Despite this, there have been few cases of harm recorded as a result of undetected IOFB; a potential case of cataract formation resulting from fragment movement in 2001 which was missed on pre-screening radiographs, 18 and the most recent report of hyphema in 2015 following confirmed removal of IOFB and subsequent MRIs. 13 Other cases reported have shown that despite evidence of retained fragments detected on MRI, no harm has resulted. 19 Potential for harm, particularly from occupational injury, is further reduced these days as a result of tighter Health and Safety requirements around the use of Personal Protection Equipment, such as goggles 20 when performing tasks involving metal-working.…”

Section: Discussionmentioning

confidence: 97%

“…The lack of reported harm may also suggest that such instances are likely to occur unknowingly. 13 A review by Eshed 14 on retained metal fragments from combat and terrorist attacks showed that over a 10-year period there was no resultant harm to any patients undergoing an MRI. Precautions over size and location still need to be applied but this does demonstrate that the probability of harm is low.…”

Section: Discussionmentioning

confidence: 99%

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A 3-year review of MRI safety incidents within a UK independent sector provider of diagnostic services

Hudson

Jones²

2019

BJR|Open

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A review of MRI safety incidents conducted over a 3-year period for a large independent sector diagnostic imaging provider in the UK. The review took a systematic approach using reports logged on an internal incident reporting system that were then categorised and analysed for themes and trends. Notable cases and actions taken are also described from within the period. MRI safety-related events made up 7.5% of the total number of incident reports submitted and 15.5% of all MRI-related reports. The MR safety-related incidence report rate was 0.05% (1 per 1987 patients), which is relatively low considering the number of patients seen in our facilities each day. Internal MRI safety events indicated the main trends to be around referral of contraindicated devices (32% of reports) and failure in the screening process (21.5%—either due to unexpected implants or being unable to confirm safety). To improve practice and work to reduce incidents, advice and instructional materials were developed. The review suggests a potential approach to categorisation of MRI-related safety events which could allow comparisons to be made across organisations, helping to look for trends and guide learning. It also provides insight into the state of MRI safety within the organisation, a rationale for some of the interventions introduced to improve safety, and discussion around common issues arising in MRI safety.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

A 3-year review of MRI safety incidents within a UK independent sector provider of diagnostic services

Hudson

Jones²

2019

BJR|Open

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“…The first serious AE was presented by Kelly et al, where the MRI of a patient with a 2 x 3.5 mm intraorbital FMO resulted in unilateral blindness . Subsequent reports on AEs have been rare, and have not resulted in serious or permanent harm . One study reported that two patients with small (≤0.5 mm) intraorbital ferromagnetic FMOs did not experience any clinical consequence when scanned at 1.0T, but due to the limited number of human studies the authors suggested that a thorough screening be performed when there is suspicion of intraorbital FMOs.…”

Section: Discussionmentioning

confidence: 99%

MRI safety and devices: An update and expert consensus

Maralani

Schieda

Hecht

et al. 2019

Magnetic Resonance Imaging

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The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high‐volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi‐inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657–674.

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“…Radiographs and CT images can reveal the presence and location of a foreign body [ 9 ], but the physical properties remain undetermined [ 8 ]. Therefore, a system or apparatus by which unknown foreign bodies can be determined to be magnetic, in terms of MRI compatibility is necessary [ 8 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Ferromagnetic Foreign Body at the Lateral Aspect of the Mandibular Ramus in a Medically Compromised Patient

Yamamoto¹,

Nakayama²,

Yamamoto³

et al. 2016

TODENTJ

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A case of a ferromagnetic foreign body in a medically compromised patient was reported. The patient was a 45-year-old male who consulted our department complaining of a foreign body accidentally impacted in the right cheek. X-ray examination revealed a foreign body at the lateral aspect of the right mandibular ramus. The removal of the foreign body was scheduled, but the patient did not return for the procedure. After 8 years he revisited our department for the removal of the foreign body, because it had been found to be ferromagnetic and a barrier to MRI examination. X-ray examination confirmed the foreign body was located at the same site as 8 years prior. Although the patient was suffering from liver cirrhosis with thrombocytopenia and leukopenia, the foreign body was successfully removed under general anesthesia. The foreign body was 12 × 5 × 1 mm, weighed 0.48 g, and was ferromagnetic. The patient’s postoperative course was uneventful. X-ray examination confirmed the removal of the foreign body. Since the surgery, the patient has been in generally stable condition with no complications. This case was a rare example of a foreign body that needed to be removed for medical examination.

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Undetected intraocular metallic foreign body causing hyphema in a patient undergoing MRI: a rare occurrence demonstrating the limitations of pre-MRI safety screening

Cited by 20 publications

References 16 publications

A 3-year review of MRI safety incidents within a UK independent sector provider of diagnostic services

A 3-year review of MRI safety incidents within a UK independent sector provider of diagnostic services

MRI safety and devices: An update and expert consensus

A Ferromagnetic Foreign Body at the Lateral Aspect of the Mandibular Ramus in a Medically Compromised Patient

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