Screening Forms for Patients for MR Procedures and Individuals for the MR Environment

Abstract

This appendix presents the screening forms that are to be filled by the patient prior to being scanned. Completion of these screening forms is also required for any person accompanying the patient into the magnet room. There are certain answers that will absolutely contraindicate the patient being scanned (e.g., if the patient has a cardiac pacemaker or ferromagnetic implant) while other questions are more designed to evaluate the patient's tolerance (such as whether they are claustrophobic). Other questions (such as those relating to renal disease) will determine if it is safe to use a contrast agent and make the physician aware of the medical status of the patient.