Emergence Teleradiology Metal or Shrapnel Protocol

Orbits:

  • If history of metal grinding, welding, sheet metal work, or possible metal flakes or fragments to the eyes then recommend single view x ray of the orbits plain film exam.
  • If metal is viewed over orbits on single view and suspect could be lodged in bone then obtain second lateral view x ray to confirm metal is located within bone.
  • If metal fragment is located within bone, check with magnetic ferromagnetic wand, then ask radiologist to review x rays and consider performing MRI, on low field strength open MRI only.
  • If fragment is in soft tissues then patient is not to have MRI

Body:

  • If metal fragment anywhere in body then obtain 2 view x rays to determine if fragment is in soft tissues or lodged in bone.
  • If lodged in bone then ask radiologist to review x rays, check with magnetic ferromagnetic wand,  and consider performing MRI, on low field strength MRI only.
  • If metal in soft tissues and don’t know type of metal then patient is not to have MRI.
  • If metal in superficial soft tissues (<2cm deep) check with magnetic ferromagnetic wand, consult radiologist if no reaction to wand.

Shrapnel:

  • The acceptable shrapnel or bullet fragments include only copper, brass, aluminum. 
  • If patient knows that it is pure copper, copper, or brass then they can sign metal consent form stating they understand risk and accept risk. Then perform exam on low field strength open MRI.
  • If not sure of type of metal or metal is seen to be in soft tissues by x ray exam then patient is not to have MRI.
  • If metal in superficial soft tissues (<2cm deep) check with magnetic ferromagnetic wand, consult radiologist if no reaction to wand.

Special Items:

  • After coil embolization or vascular stenting patient needs to wait 6 weeks prior to MRI.
  • Non ferromagnetic metals include copper, aluminum, titanium, brass
  • Ferromagnetic metals include iron, cobalt, nickel, and steel

***IF DERTERMINED METAL DENSITY IS SAFE THEN ALL MRI PERFORMED ON OPEN LOW FIELD MRI ONLY***