Effective MRI Screening Protocol for Ballistic Fragment History

Background: The decision on how to proceed with an MRI ordered for a patient with a history of a bullet or shrapnel injury is challenging. Typically, x-rays are performed to assess the fragments, which could lead to harm with the MRI magnetic properties. However, reliable criteria of this pre-MRI imaging assessment to allow safe proceeding with the MRI examination are uncertain. Objective: To assess the incidence of retained bullet or shrapnel fragments in patients undergoing MRI and of associated adverse events, in the context of an existing screening policy. Design: Retrospective review. Participants: Patients who underwent MR imaging from 2020 to 2023 and had reported a prior bullet or shrapnel injury were reviewed. The patient records were searched for x-ray reports for a "retained bullet or shrapnel" obtained prior to MRI, and who subsequently underwent MRI. Methods: The authors implemented an MRI screening protocol with criteria for the pre-MRI findings related to the assessmen more...