Magnetic resonance imaging (MRI) has the ability to see it through bone
and to delineate fluid-filled soft tissue in great detail and produces images of
organs and vessels in motion. In this noninvasive procedure, the patient is
placed in a magnetic field into which a radiofrequency beam is introduced.
Resulting energy changes are measured and used by the MRI computer to
generate images on a monitor. Cross-sectional images of the anatomy are
viewed in multiple planes and recorded for the permanent record.
Because the magnetic fields and radiofrequency waves used are imperceptible
by the patient, no harmful effects have been documented. Research continues
on the optimal magnetic fields and radiofrequency waves for various tissue
types.
Procedure
The protocol and procedure for magnetic resonance imaging (MRI) differs per
area but generally, the following steps are followed.
1. If indicated, an IV line is started to administer a contrast medium
before the procedure begins.
2. The patient is placed in a supine position on a narrow, padded,
nonmetallic bed that slides to the desired position inside the
scanner.
3. The patient is asked to remain still.
4. Radiofrequency energy is directed at the area being tested. The
radiologist may vary the waves and use the computer to
manipulate and enhance the images.
5. The resulting images are displayed on a monitor and recorded on
film or magnetic tape for permanent storage.
6. The patient is advised to keep his eyes closed to promote
relaxation and prevent a closed-in-feeling.
7. If nausea occurs because of claustrophobia, the patient is
encouraged to take deep breaths.
8. If the test is prolonged with the patient lying flat, monitor him for
orthostatic hypotension.
Types
The following are the different types of magnetic resonance imaging (MRI):
Abdominal and pelvic
Indication Abnormal Results
Neoplasms
Visualize the liver, pancreas, adrenals, spleen, Renal implant
kidneys, blood vessels, and reproductive organsStage abnormalities
uterine, vulvar, and cervical carcinoma, and Retroperitoneal
prostate cancer structural
abnormalities
Blood Vessels (magnetic resonance angiography)
Indication Abnormal Results
Aneurysms
Atherosclerosis
Detect, diagnose, and assists in the
Disease in the aorta and in blood
treatment of heart disorders, stroke, and
vessels supplying the
blood vessels diseases
kidneys, lungs, and legs
Screen for familial tendency for an
Graft patency
arterial aneurysm
Occlusions
Stenosis
Breast
Indication Abnormal Results
Detect breast tumors in a woman with
implants
Benign and malignant breast
Visualize complex breast lesions
tumors
Differentiate between benign and malignant
Complex breast lesion
breast tumors
Stage breast cancer
Cardiac
Indication Abnormal Results
Visualize cardiac structures, valves, and Cardiac ischemia
coronary arteries Aortic dissection
Evaluate cardiac wall motion Aortic aneurysm
Thrombic clotting disorders
Congenital heart disorders
Pericarditis
Abnormal heart chamber
size
Intracranial
Indication Abnormal Results
Aneurysms
Arnold-Chiari
malformations
Cerebral edema
Demyelinating disease
Edematous fluids
Helps diagnose intracranial and spinal lesions and Hydrocephalus
soft- tissue abnormalities Ischemia
Stroke
Tumors
Multiple sclerosis (MS)
lesions
Pontine and cerebral
tumors
Musculoskeletal
Indication Abnormal Results
Changes in bone marrow
Delineate bones, muscles, and ligaments
composition
Contrast body tissues and sharply define healthy,
Spinal disorders
benign, and malignant tissues
Bony and soft-tissue
Identify primary and metastatic bone tumors
tumors
Spinal
Indication Abnormal Results
Congenital abnormalitie
Assess for spinal infection or tumors that arise in,
Primary and metastatic
or have spread to the spine
neoplasms
Detect a bulging, degenerated, or herniated
Demyelinating disease
intervertebral disk
(MS)
Visualize disease of the spinal canal and cord
Disk herniation
Help visualize needle placement for steroids to
Disk degeneration
relieve spinal pain
Inflammatory disease
Urinary tract
Indication Abnormal Results
Abscess
Bleeding
Hemorrhage
Edema
Detect prostate stones and cysts Fluid
Detect cancer invasion into seminal vesicles and collection
pelvic lymph nodes Inflammation
Evaluate genitourinary tumors and abdominal or pelvic Stenosis
masses Strictures
Tumors
Malformations
Organ atrophy
Thrombosis
Contraindication of MRI
Magnetic resonance imaging is contraindicated in:
Patients with severe obesity (usually more than 300 pounds)
Patients with claustrophobia
Patients who are confused or agitated
Patients who are unstable and require continuous life-support
equipment, because most monitoring equipment cannot be used
inside the scanner room. Magnet adaptive equipment is
becoming available for use in the MRI scanner room.
Patients with implantable metal objects such as pacemakers,
infusion pumps, aneurysm clips, inner ear implants, and metal
fragments in one or both eyes, because the magnet may move
the object within the body and injure the patient.
Interfering Factors
Patients inability to remain still while the procedure is ongoing
Patients inability to fit into the scanner
The following are the medical assistanting interventions and medical
assistanting care considerations for a patient undergoing magnetic resonance
imaging:
Before the procedure
The following are the medical assistanting interventions before magnetic
resonance imaging:
Explain to the patient the purpose of the test. Tell him who will
perform the test and where it will take place.
Inform the patient that he’ll need to lie flat on a narrow bed,
which slides into a large cylinder that houses the MRI magnets.
Tell him that the scanner will make clicking, whirring, and
thumping noises as it moves inside its housing and that he may
receive earplugs.
Explain to the patient that MRI is painless and involves no
exposure to radiation from the scanner. A radioactive contrast dye
may be used, depending on the tissue being studied.
For MRI of the urinary tract, advise the patient to avoid alcohol,
caffeine-containing beverages, and smoking for at least 2 hours
and food for at least 1 hour before the test. Explain to the patient
that he can continue taking medications, except for iron, which
interferes with the imaging.
Advise the patient that he’ll have to remain still for the entire
procedure.
Explain to the patient who’s claustrophobic or anxious about the
test’s duration that he’ll receive a mild sedative to reduce
his anxiety or that he may need to be scanned in an open MRI
scanner, which may take longer but is less confining. Tell him that
he’ll be able to communicate with the technician at all times and
that the procedure will be stopped if he feels claustrophobic.
If contrast media will be used, obtain a history of allergies or
hypersensitivity to these agents. Mark any sensitivities on the
chart and notify the practitioner.
Instruct the patient to remove all metallic objects, including
jewelry, hairpins, and watches.
Ask the patient if he has any implanted metal devices or
prostheses, such as vascular clips, shrapnel, pacemakers, joint
implants, filters, and intrauterine devices. If so, the test may not
be able to be performed.
Make sure that the patient or a responsible family member has
signed an informed consent form.
Administer the prescribed sedative if ordered.
At the scanner room door, recheck the patient one last time for
metal objects.
Just before the procedure, have the patient urinate.
During the procedure
Remind the patient to remain still throughout the procedure.
Assess how the patient responds to the enclosed environment.
Provide reassurance if necessary.
Monitor the cardiac function for signs of ischemia (chest
pressure, shortness of breath, or changes in hemodynamic status).
If the patient is unstable, make sure an IV line with no metal
components is in place and that all equipment is compatible with
MRI. If necessary, monitor the patient’s oxygen saturation, cardiac
rhythm, and respiratory status during the test. An anesthesiologist
may be needed to monitor a heavily sedated patients.
After the procedure
The medical assistant should be aware of these post-procedure medical
assistanting interventions after magnetic resonance imaging:
Tell the patient that he may resume his usual activities as ordered.
If the test took a long time and the patient was lying flat for an
extended period, observe him for orthostatic hypotension.
Provide comfort measures and pain medication as needed and
ordered because of prolonged positioning the scanner.
Monitor the patient for the adverse reaction to the contrast
medium (flushing, nausea, urticaria, and sneezing).
Normal Results
The following are the expected normal results of magnetic resonance imaging:
Results dependent on the specific type of MRI
Structure and function of the studied organ within normal
parameters for the patient
