MRI CLINICALS

I had my first experience with a contrast reaction this week. Luckily it was not very severe, but it was still very scary. I had a patient in her early seventies for an ankle without and with contrast. I had to do several scans on her prior to contrast. I also had to do a GFR check on her to confirm her kidneys were function appropriately, and that she could have contrast. Her GFR came back within normal range. I injected 19cc of omniscan. During and immediately following the injection she stated she felt fine. I advanced her back into the scanner and left the scan room. After the first post contrast series ran, the patient squeezed the emergency ball. I asked her if she was alright, she said she was having trouble breathing and started coughing uncontrollably. I rushed into the room. I sent a co-worker to get out lead tech immediately. I brought the table to ground level and had to patient sit up. She said she felt her throat was swelling and she was having trouble breathing. At this time the lead tech, along with the other four techs in the building and the doctor entered the MRI area. The doctor said to bring the patient out of the scan room and he would evaluate her. He listened to her heart and breathing and said she was most likely having anxiety because she sounded fine. Even with this said we monitored her pulse and oxygen, and started an IV. We had oxygen ready next to her. The doctor administered 25mg of benadryl. The patient continued to feel swelling of her throat on and off. The radiologist reading the images was contacted because he was at a different center. He stated that he did not want us to finish the scan, he had adequate information to make a diagnosis. We continued to monitor the patient for 35 more minutes. We had her call a friend to drive her home and stay with her for several hours following her reaction. The patient felt fine but had slightly elevated blood pressure when we released her. I had to document everything as a patient incident report and send it to our HR department. While this was a minor reaction, it is very rare to even see a reaction in MRI. My lead tech has been scanning in MRI for over 10 years and this was only her second reaction she has seen. I hope that I will not see another one for at least 10 years, never again would be preferred.

MRI CLINICALS

I scanned a brachial plexus yesterday. The patient received contrast for this exam because he had a history of a tumor removed from the lateral axillary area one year ago. Because of the location of the area of interest we had to increase our field of view, change our centering to lower and more lateral, and also increase the slices of many of the series. Our routine brachial plexus has very long scans to begin with, so when we began changing parameters the scans became even longer, some over six minutes. The patient was very cooperative. After contrast we ran scans in all three plains with additional fat saturated images in the coronal plane. From what I could tell the tumor had not returned. This was a good learning experience because it was not a typical brachial plexus. I had to use critical thinking to modify the scans to meet the needs of the radiologist, so that he could give an accurate diagnosis.