Part 5 - Case Scenarios

The four case scenarios found in this section will help you examine your clinical skills and knowledge. Consider how you might approach each case as a practising Canadian magnetic resonance technologist.

Case Scenario 1

Mr. Patrick Lavigne, a 25 year old male, has come to the magnetic resonance imaging (MRI) department for an MRI of his brain. His clinical symptoms include numbness of the extremities, altered gait, and visual field disturbances. The technologist was performing the multiple sclerosis brain protocol and the following images were acquired.

Things to consider...

  • Do you understand the clinical history and reason for the exam?
  • Do the images acquired suggest the presence of multiple sclerosis?
  • Are additional images required? If so, which sequences should be done?
  • Will the patient require a contrast injection?
  • What factors need to be considered when giving MRI contrast?

Case Scenario 2

Mrs. Saniya Patel, a 65 year old woman with hypertrophic cardiomyopathy arrives in the MRI department in a wheelchair. Her past surgical history is extensive, including surgeries of her heart, abdomen and shoulder. Her referring physician has requested a cardiac MRI to evaluate the extent of the disease.

Things to consider...

  • Do patients with heart conditions require any special safety/screening procedures prior to their exam?
  • Do the surgeries listed raise any specific concerns in regards to MRI safety?
  • Do you understand the diagnosis?
  • Can the patient be safely transported in to the MRI scan room?
  • Are there any special considerations when preparing a patient for cardiac exams?
  • Should you change your sequences to deal with any potential hardware that may be surgically implanted?
  • Will this patient require a contrast injection for the exam?
  • What sequences are required to obtain the necessary information?

Case Scenario 3

Patty, a 10 year old girl, arrives in the MRI department with her mother for an MRI of her brain. She has headaches and has a family history of aneurysms. During the screening process she is very nervous and her mother states that she may be claustrophobic. The technologist tells Patty that the test will take approximately 20 minutes. They will do everything possible to help her complete the procedure successfully.

Things to consider...

  • Do you understand the diagnosis?
  • Did the patient bring any prescribed medications to help her through the exam?
  • Can Patty’s mother accompany her into the magnet room to help calm her down during the exam?
  • Will a mirror over her eyes, music or video help the patient to complete the exam?
  • Are some sequences more important for her diagnosis than others? Which sequence should be run first, if Patty is unable to complete the exam?
  • What parameters can the technologist change to shorten the sequences without compromising the quality of the images?

Case Scenario 4

Mr. Adam Majewski, a 45 year old male patient is in the ICU department. He requires an MRI of his brain and cervical spine. Upon arrival in the MRI department the technologist notices that he is in a cervical collar. The patient is semi conscious, uncooperative and will require full sedation.

Things to consider...

  • How do you successfully screen the patient to decide if he is safe to have an MRI scan?
  • Does the patient require monitoring? If so, how will this be accomplished?
  • Do you remove the cervical collar?
  • How will the patient be safely transferred to the MRI bed?
  • Is it necessary for any accompanying staff members, such as a nurse and a respiratory technologist, to enter the MRI magnet room?
  • Should the coil configuration be altered due to the patient’s condition?
  • Should the images be reviewed by a radiologist before the patient is removed from the magnet?