AJR 2001; 176:412
© American Roentgen Ray Society
Pocket Guide to MR Procedures and Metallic Objects
Update 2000
James R. Brookeman
University of Virginia School of Medicine Charlottesville, VA
22908
By Frank G. Shellock. Philadelphia: Lippincott Williams & Wilkins,
244 pp., 2000. $19.95
If you would like to review books for AJR, please send a cover
letter stating your interest with a current curriculum vitae to Assistant
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Winston-Salem, NC 27104.
This handy pocket-sized guide contains safety information for more than 700
objects in typical clinical use in the MR imaging environment today. This
updated version has been expanded to include more material, and the chapters
have been reorganized to be more user-friendly for the reader. After a brief
introduction is a series of minichapters, each with references, describing in
general terms the particular safety concerns of each area in which an implant
or device might pose a problem. These chapters cover such topics as aneurysm
clips, burns and prevention, cardiac pacemakers, coils, stents and filters,
hearing aids, pellets and bullets, pregnant patients and MR imaging, and
tattoos, permanent cosmetics, and eye makeup. After these 41 chapters is a
tabulated list that contains specific safety information in the MR environment
for more than 700 implants, devices, materials, and products. A useful feature
of this revised edition is a safety "status designation" for each
of the listed objects. This designation indicates whether the object is
"safe," "conditional," or "unsafe" and
thereby permits the user to make an informed assessment of the potential risks
of an MR imaging procedure for a patient with a particular implant or
device.
The author, Frank Shellock, has extensive experience in the area of MR
safety, having published numerous articles on the subject; he also maintains
an excellent up-to-date Web site at MRIsafety.com for further information. One
mild criticism of the Pocket Guide is that the title might lead the
reader to expect information about general patient procedures, whereas the
focus is almost entirely on procedures that include implants or devices. For
example, the book contains some information about pregnancy, but nothing on
precautions for patient limb positioning to avoid burns from radiofrequency
pick-up loops formed by the legs or arms. Also, the section on tattoos notes
that for "the past 15 years...only a very few individuals have had minor
difficulty" and therefore "this problem has an extremely low rate
of occurrence." Anyone who has observed the younger generation will know
that this rate will probably not remain low, but can be expected to increase
as this generation moves into the MR-imaged population. It is well worthwhile
to carefully check young patients referred for MR imaging, particularly
looking for tattoos that contain black pigments, which can be ferromagnetic or
conduct electricity.
In summary, I find the Pocket Guide to MR Procedures and Metallic
Objects an excellent revised edition of a useful pocket reference on MR
safety, and I recommend that every MR imaging site obtain a copy as a
comprehensive source of safety information. The Pocket Guide is a
valuable text for radiologists and technologists alike.
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