Magnetic Resonance Imaging

What is an MRI scan?

• An MRI (magnetic resonance imaging)
scan is a safe and painless test that can
provide detailed pictures of the inside of
your body. It uses a strong magnetic
field and radio waves to create pictures,
on a computer, of tissues, organs and
other structures.
 What does the equipment look like?
• The traditional MRI unit is a large cylinder-
shaped tube surrounded by a circular
magnet. You will lie on a moveable
examination table that slides into the center
of the magnet.
• In some instances, a noniodinated venous
contrast is injected for better visualization of
anatomy. The most commonly used contrast
agents are gadolinium 50-DTPA, gadolinium
manganese, or iron, which has very low
toxicity and much fewer adverse effects than
iodine contrast agents.
What is gadolinium contrast medium?

• Gadolinium contrast media (sometimes

called a MRI contrast media, agents or ‘dyes’)
are chemical substances used in magnetic
resonance imaging (MRI) scans. When
injected into the body intravenously, it
enhances and improves the quality of the
MRI images. This allows the radiologist to
more accurately report on how your body is
working and whether there is any disease or
abnormality present.
 What are the risks of gadolinium
contrast medium injections?
• Gadolinium contrast medium is generally
very safe. Side effects or reactions are
uncommon, but can occur.
• The most common adverse reactions are
minimal: headache, nausea (feeling slightly
sick) and dizziness for a brief time after the
injection. A few patients will have a feeling of
coldness at the injection site.
 Indications
● to differentiate diseased tissue from healthy
tissue and study blood flow
● to evaluate multiple sclerosis, Alzheimer’s
disease, spine and cord abnormalities,
neoplasms throughout the body, joint
pathologies, cardiac function, and vascular
pathologies.
 Contraindications
There are a multitude of implants within patients that need
to be assessed as safe. Many are safe and will be reviewed
on the safety screening form before the scan.
These implants include, but are not restricted to:
• AAA stent
• stapes implant
• implanted drug infusion device
• neuro or bone growth stimulator
• surgical clips, wire sutures, screws or mesh
• ocular prosthesis
• penile prosthesis
• joint replacement or prosthesis
• other implants, in particular mechanical devices
 Other conditions can act as relative
contraindications for MRIs:
• Large patients might find it difficult to fit into the
bore of the MRI. Some MRI facilities have wider
bore magnets that can more easily accommodate
larger patients.
• Claustrophobic patients might require sedation.
This can be prescribed to be taken before the
procedure or intravenous sedation can be given in
the MRI department.
• Significant pain might limit a patient’s ability to lie
still. Movement degrades the images, limiting
interpretation and reducing the accuracy of the
report.
• Surgery in the previous 6 weeks.
 Nursing Responsibilities
Before the procedure
• Patient may be asked not to eat or drink
anything for 4 - 6 hours before the scan.
• Asked patient if they are afraid of close
spaces or claustrophobia and inform the
doctor. Patient may be given a medicine to
help them feel sleepy and less anxious, or the
doctor may suggest an "open" MRI, in which
the machine is not as close to the body.
 Nursing Responsibilities
• Asked the patient if they have implants
• Asked patients to remove the following:
 Items such as jewelry, watches, credit cards, and hearing
aids - may be damaged.
 Pens, pocketknives, and eyeglasses - may fly across the
room.
 Pins, hairpins, metal zippers, and similar metallic items - can
distort the images.
 Removable dental work should be taken out just before the
scan.
Because the MRI contains strong magnets, metal objects are
not allowed into the room with the MRI scanner, it is
important to inform the health care provider of any
pregnancy or suspected pregnancy prior to the procedure.
 Nursing Responsibilities
• Monitoring is indicated to patients who are
great potential for change in physiologic
status during the procedure or whenever a
patient requires observations of vital
physiologic parameters due to an underlying
health problem.
• Monitoring is imperative to patients who are
using sedative or anesthesia to ensure
patient safety.
 Nursing Responsibilities
During the procedure
• Patient will be asked to remain perfectly still
during the time the imaging takes place, but
between sequences some minor movement may
be allowed.
• When MRI procedure begins, patient may
breathe normally, however, for certain
examinations it may be necessary for you to
hold your breath for a short period of time.
• Some MRI exams require an injection of
intravenous MRI contrast.
 Patients that require monitoring
and support during MRI procedures
• Physically or mentally unstable patients.
• Patients with compromised physiologic functions.
• Patients who are unable to communicate.
• Neonatal and pediatric patients.
• Sedated or anesthetized patients.
• Patients undergoing MR-guided interventional
procedures.
• Patients who may have a reaction to an MRI
contrast agent.
• Critically ill or high-risk patients.
 After the procedure
• There is no recovery time, unless you were
given a medicine to relax. After an MRI scan,
you can resume your normal diet, activity,
and medications.
• If a dye injection is used, the IV is removed
from the arm before you go home.
 After the procedure
• Allergic reaction from gadolinium dye is
extremely rare. However, if you experience
symptoms such as rash, hives, or shortness of
breath, you should notify the technologist
immediately.
• In the event that sedation is needed you will
be sent home once awake and alert.
 If you are breastfeeding
• If you are breastfeeding, throw away your
milk for 24 hours after your MRI
examination.
Computed Tomography Scan
 What is a CT scan?
• A computerized tomography (CT) scan
combines a series of X-ray images
taken from different angles around
your body and uses computer
processing to create cross-sectional
images (slices) of the bones, blood
vessels and soft tissues inside your
body.
• The CT scanner looks like a giant thick
ring. Within the wall of the scanner
there is an X-ray source. Opposite the
X-ray source, on the other side of the
ring, are X-ray detectors.
 Why it's done?
Your doctor may recommend a CT scan to help:
• Diagnose muscle and bone disorders, such as
bone tumors and fractures
• Pinpoint the location of a tumor, infection or
blood clot
• Guide procedures such as surgery, biopsy and
radiation therapy
• Detect and monitor diseases and conditions
such as cancer, heart disease, lung nodules
and liver masses
• Monitor the effectiveness of certain
treatments, such as cancer treatment
• Detect internal injuries and internal bleeding
 Contraindications
Contraindications for the use of iodinated contrast media:
• Allergy to iodine
• Toxic goitre of the thyroid
• Planned radioiodine treatment of thyroid cancer
• Contraindications against the use of ion-based contrast media in
patients:
• Children below 2 years of age
• Pregnant women
• Persons over 60 years of age
• Persons with acute and chronic circulatory and respiratory failure
• Persons with hepatic and renal failure (also dialyzed patients)
• Persons with asthma and pulmonary edemas
• Persons with allergies
• Persons with insulin-dependent diabetes
• Persons with hypertension
• Persons with convulsions of cerebral etiology
• Persons with glaucoma
 How you prepare?
Depending on which part of your body is
being scanned, you may be asked to:
• Take off some or all of your clothing and
wear a hospital gown
• Remove metal objects, such as a belt,
jewelry, dentures and eyeglasses, which
might interfere with image results
• Refrain from eating or drinking for a few
hours before your scan
 How you prepare?
• Give medications up to 2 hours
before test.
• Assess for possible reaction to
iodine dye (by asking about allergy
to seafood). Document any allergy
and inform the physician and
radiology department.
• Remove metal hairpins, clips, and
earrings.
When and why we use intravenous
contrast?
• A special dye called contrast material
is needed for some CT scans to help
highlight the areas of your body being
examined. The contrast material
blocks X-rays and appears white on
images, which can help emphasize
blood vessels, intestines or other
structures.
 Contrast material might be given to you:

• By mouth. If your esophagus or stomach is being

scanned, you may need to swallow a liquid that
contains contrast material. This drink may taste
unpleasant.
• By injection. Contrast agents can be injected through a
vein in your arm to help your gallbladder, urinary tract,
liver or blood vessels stand out on the images. You
may experience a feeling of warmth during the
injection or a metallic taste in your mouth.
• By enema. A contrast material may be inserted in your
rectum to help visualize your intestines. This
procedure can make you feel bloated and
uncomfortable.
Preparing your child for a scan
• If your infant or toddler is having a CT
scan, the doctor may recommend a
sedative to keep your child calm and
still. Movement blurs the images and
may lead to inaccurate results.
 What you can expect?
• You can have a CT scan done in a
hospital or an outpatient facility. CT
scans are painless and, with newer
machines, take only a few minutes.
The whole procedure typically takes
about 30 minutes.
 During the procedure
• You lie on a narrow, motorized table that slides through
the opening into a tunnel. Straps and pillows may be used
to help you stay in position. During a head scan, the table
may be fitted with a special cradle that holds your head
still.
• While the table moves you into the scanner, detectors and
the X-ray tube rotate around you. Each rotation yields
several images of thin slices of your body. You may hear
buzzing and whirring noises.
• A technologist in a separate room can see and hear you.
You will be able to communicate with the technologist via
intercom. The technologist may ask you to hold your
breath at certain points to avoid blurring the images.
 After the procedure
• After the exam you can return to your
normal routine. If you were given
contrast material, you may receive
special instructions. In some cases, you
may be asked to wait for a short time
before leaving to ensure that you feel
well after the exam. After the scan,
you'll likely be told to drink lots of fluids
to help your kidneys remove the
contrast material from your body.
 Results
• CT images are stored as electronic data
files and are usually reviewed on a
computer screen. A radiologist
interprets these images and sends a
report to your doctor.
 Risks
• Radiation exposure
• Harm to unborn babies
• Reactions to contrast material- Most
reactions are mild and result in a rash
or itchiness. In rare instances, an
allergic reaction can be serious, even
life-threatening.
Symptoms you need to tell us about
immediately

• wheeziness, difficulty in breathing or

tightness or pain in the chest
• dizziness or feeling faint
• fever or high temperature
• an unexpected change in the amount of
urine produced and / or its appearance
• stinging pain at or near the injection site
immediately following the injection
• severe rash with peeling
Other symptoms and when you
should report
These are usually mild and don't last long.
• abdominal discomfort
• nausea and or vomiting
• swelling or tenderness of your salivary
glands on your throat
• pain during the injection
• low pulse and feeling faint
• skin rash, itchy spots or other allergic
symptoms
 What is an ultrasound?
• An ultrasound scan is a medical test that
uses high-frequency sound waves to
capture live images from the inside of your
body. It’s also known as sonography.
 What does the equipment look like?

• Ultrasound scanners consist of a console

containing a computer and electronics, a
video display screen and a transducer that is
used to do the scanning. The transducer is a
small hand-held device that resembles a
microphone, attached to the scanner by a
cord. Some exams may use different
transducers during a single exam. The
transducer sends out high-frequency sound
waves into the body and then listens for the
returning echoes from the tissues in the body.
 Why an ultrasound is performed?
• Most people associate ultrasound scans with
pregnancy. These scans can provide an
expectant mother with the first view of her
unborn child.
• Your doctor may order an ultrasound if you’re
having pain, swelling, or other symptoms that
require an internal view of your organs. An
ultrasound can provide a view of the bladder,
brain (in infants), eyes, gallbladder, kidneys,
liver, ovaries, pancreas, spleen, thyroid,
testicles, uterus, blood vessels
• Doppler ultrasound, also called color Doppler
ultrasonography, is a special ultrasound
technique that allows the physician to see and
evaluate blood flow through arteries and veins
in the abdomen, arms, legs, neck and/or or
within various body organs such as the liver or
kidneys.
There are three types of Doppler ultrasound:
• Color Doppler
• Power Doppler
• Spectral Doppler
 How to prepare for an ultrasound?
The steps you will take to prepare for an ultrasound will depend
on the area or organ that is being examined.
• Your doctor may tell you to fast for eight to 12 hours before
your ultrasound, especially if your abdomen is being examined
• For an examination of the gallbladder, liver, pancreas, or
spleen, you may be told to eat a fat-free meal the evening
before your test and then to fast until the procedure. However,
you can continue to drink water and take any medications as
instructed. For other examinations, you may be asked to drink
a lot of water and to hold your urine so that your bladder is full
and better visualized.
• Be sure to tell your doctor about any prescription drugs, over-
the-counter medications, or herbal supplements that you take
before the exam.
 How an ultrasound is performed
• Before the exam, you will change into a hospital gown.
You will most likely be lying down on a table with a
section of your body exposed for the test.
• An ultrasound technician, called a sonographer, will apply
a special lubricating jelly to your skin. The jelly also helps
transmit the sound waves.
• Depending on the area being examined, you may need to
change positions so the technician can have better access.
• After the procedure, the gel will be cleaned off of your
skin. The whole procedure typically lasts less than 30
minutes, depending on the area being examined.
• In some ultrasound studies, the transducer is
attached to a probe and inserted into a natural
opening in the body. These exams include:
• Transesophageal echocardiogram. The transducer
is inserted into the esophagus to obtain images of
the heart.
• Transrectal ultrasound. The transducer is inserted
into a man's rectum to view the prostate.
• Transvaginal ultrasound. The transducer is inserted
into a woman's vagina to view the uterus and
ovaries
What will I experience during and
after the procedure?
• Ultrasound examinations are painless and easily tolerated by
most patients.
• Ultrasound exams in which the transducer is inserted into an
opening of the body may produce minimal discomfort.
• If a Doppler ultrasound study is performed, you may actually
hear pulse-like sounds that change in pitch as the blood flow is
monitored and measured.
• Most ultrasound examinations are completed within 30
minutes, although more extensive exams may take up to an
hour.
• When the examination is complete, you may be asked to dress
and wait while the ultrasound images are reviewed.
• After an ultrasound examination, you should be able to
resume your normal activities immediately.
 Who interprets the results?

• A radiologist, a physician specifically trained

to supervise and interpret radiology
examinations, will analyze the images and
send a signed report to your primary care
physician, or to the physician or other
healthcare provider who requested the
exam.