The MRI Screening Form Prior to GBCA Administration
Having been the director of MR services for a major university medical center for 25 years, I am very familiar with the MRI Screening form, that all centers have patients complete prior to undergoing an MR exam.
From that perspective, combined with the wisdom that comes with experience and thoughtful reflection, it is somewhat humorous/sad to think what is in the form as important and what is lacking. The slings and arrows of what is asked, and what is not. As with most other things in life, there is a certain randomness, and that randomness is often based on the artifact of anecdotal experience or anecdotal awareness, and lack of broad awareness. For example, one of my pet peeves is the tremendous concern for metal fragments in the eyes. It is not rare to order plain x-rays of the orbits, and even CT scans of the orbits are done, and I have seen the latter at our own center (but not ordered by me) hunting for these elusive fragments. What is this based upon? Without scanning the literature again for any recent examples, but I am aware of one case report of someone with a sharp iron fragment imbedded in the retina which was torsed by the magnet field and caused a retinal hemorrhage, and blindness, I am not sure how complete; maybe 2 or 3 other cases? Likely millions of dollars are spent annually on trying to hunt down metal fragments in eyes. 700 million MR scan worldwide over the years (or more) - 1 case of partial blindness? Cost/benefit?
Our fervent tracking of cardiac pacemakers, probably also greatly overdone, as recent literature has shown.
Asking about metal in general and metal implants probably has been a very good idea. This will be especially true for 7 T MRI. My personal opinion is I am concerned of the safety aspects of 7T in general, and this would include all metals.
This has been a lengthy introduction to a topic which is important and is not yet present in the MRI Screening form, but should be there. I am writing this addition here first. It probably will eventually be part of the standard form, but for a variety of reasons, many I have discussed previously, this will take some time. And believe me, it is not for lack of interest on my part that there will be delay.
So here it is:
The following questions should be answered by persons who have undergone prior GBCA administrations for MRI.
After the previous injection of a GBCA, did you experience any of the following (check all that apply):
1. a persistent metallic taste, nasal sensation, or body odor that came on shortly after the injection, and had lasted for over 1 week.
2. development of mental confusion/brain fog that started within minutes or up to 1 month after the injection, and lasted for atleast 3 months.
3. development of burning skin or deep skin pain that started within minutes or up to 1 month after the injection, and lasted for atleast 3 months.
4. development of boring bone or bone and joint pain that started within minutes or up to 1 month after the injection, and lasted for atleast 3 months.
5. development of sharp pins and needles sensation in any body part but especially of the lower arms/hands and/or lower legs/feet that started within minutes or up to 1 month after the injection, and lasted for atleast 3 months.
6. development of changes of the lower arms/hands and lower legs/feet that include any of: pain, discoloration, skin thickening/doughiness.
6. development of dry eyes and/or vision changes that started within minutes or up to 1 month after the injection, and lasted for atleast 3 months.
7. development of head pain, that may be like a very tight strap placed around the top of your head, that started within minutes or up to 1 month after the injection, and lasted for atleast 3 months.
If you have answered yes to one or more of the above, make sure the technologist is aware of this. It may be advised that you not receive another GBCA injection.
This cluster of questions basically ask about the A symptoms of GDD. Until the time that the Radiology community is more aware of the condition, and this is formalized in the MR screening form, it falls upon you the patient to act as your own fiduciary. De-emphasize metal in eyes/ emphasize symptoms of GDD.
The simple awareness of the symptoms of GDD, and prevention of future GBCA injections in these patients, would avoid atleast 50% of the cases of significant GDD, preventing injury to likely tens of thousands of patients. This modification of the MR screening form would accomplish this goal.
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