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To help simplify
the registration process we have posted the question you will be
asked by our staff.
For more information about the process of MRI
scanning click here.
Contact information
- Name/Address
- Date of birth
- Referring Doctor
If any of the next 4 questions
are answered YES the MRI can not be
performed.
- Do you have, or have you ever
had a heart pacemaker?
- Do you have any electrodes
implanted in your body?
- Do you have cochlear implants?
- Do you have aneurysm clips in your head or neck?
The following-questions are extremely
important. There is a significant risk of permanent eye damage for
patients who might possibly have gotten metal in their eyes.
- Did you ever have an object
that may have been metal strike your eye?
- Did you need to get medical
attention at the time?
If both of the above are
answered Yes the patient must obtain
X-rays of the eyes to screen for metal objects.
- Have you had surgery in the
past week?
- Do you have a history of
cancer?
- Do you have kidney disease?
- Are you on dialysis? If yes,
patient must be dialyzed as soon as possible following
Gadolinium injection.
- Is there a chance that you are
pregnant?
- Are you breast feeding?
- Have you had brain surgery?
- Do you have an artificial heart
valve? What type?
- Do you have any metal,
electronic implants, or prostheses in your body?
- Have you had any other
operations?
- Do you have a problem with
claustrophobia?
- For hospital inpatients only:
Is the patient DNR? Who answered the questions? Patient,
Other.
- Do you have sickle cell anemia?
If yes, no gadolinium injection.
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