Synopsis
Screen patients and equipment for magnetic resonance hazards, interpret MR Conditional labelling exactly, and use gadolinium only when its added diagnostic value justifies agent-specific risk.
- MR Conditional means safe only when every stated condition is met for the exact device, scanner and protocol; it does not mean universally safe.
- Screen the patient, accompanying people and all equipment before each attendance, then resolve implants and foreign bodies before controlled-area access.
- In eGFR below 30 mL/min/1.73 m², use gadolinium only for compelling added value, choosing a lowest-NSF-risk macrocyclic agent at the smallest diagnostic dose.
Key red flags
An unidentified active implant, ferromagnetic foreign body or incomplete screening prevents routine entry to the controlled MR environment.
Acute airway, breathing or circulatory deterioration in the scanner requires rapid safe removal to the designated resuscitation area.
Pregnancy plus proposed gadolinium, or severe renal impairment plus gadolinium, needs an explicit senior benefit-risk decision.
Pain, heating, pulling, unexpected device behaviour or distress during scanning requires immediate communication and sequence cessation.
Sudden pain, heating, device symptoms, distress or physiological deterioration requires stopping acquisition and safely extracting the patient.
Reasoning priorities
Identify hazards from referral through final entry checks.
Repeat screening at each attendance and after transfers because devices, procedures, clothing or accompanying equipment may have changed.
Worked reasoning
A patient presents with a device card but the planned scan conditions remain unverified.
- Context: identify every generator, lead and component, the indication for MRI, dependency status and relevant device records.
- Reasoning: compare manufacturer conditions with scanner field strength, gradients, RF limits, anatomical restrictions and monitoring requirements.
- Outcome: scan only through the approved device pathway after programming and staffing requirements are satisfied, or choose an adequate alternative.
- Verification: document pre-scan checks, monitor as specified, restore device settings and complete post-scan assessment before discharge.