American Academy of Micropigmentation
 

MRI SAFETY

 

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Tattoos, Permanent Cosmetics, and Eye Makeup

Before undergoing an MR procedure, the patient should be asked if he or she has ever had any type of permanent coloring technique (i.e., tattooing) applied to any part of the body. This includes cosmetic applications such as eyeliner, lip-liner, lip coloring, as well as decorative designs.

This question is necessary because of the associated imaging artifacts and, more importantly, because a small number of patients (fewer than 10) have experienced transient skin irritation, cutaneous swelling, or heating sensations at the site of the permanent colorings in association with MR procedures. More recently, there has been one anecdotal report of a patient undergoing MR imaging who complained of a burning sensation at the site where a large tattoo had been applied on his arm using a black pigment.

Investigation of the incidents related to patients experiencing problems in relation to the presence of tattoos revealed that there was a tendency for the problem to occur whenever pigments that contained iron oxide or other similar ferromagnetic substance(s) were used. This includes those pigments that are especially black or blue in color.

Supposedly, certain ferrous pigments used for the tattooing process can interact with the electromagnetic fields used for MR procedures, producing the reported problems

A recent case report indicated that 24 year old patient experienced a sudden burning pain at the site of a decorative tattoo while undergoing an MR procedure on the lumbar spine using a 1.5 T MR system. Swelling and erythema was resolved within 12 hours, with no evident permanent sequela. To permit completion of the MR examination, an excision of the tattoed skin with primary closure of the site was performed. Apparently, the tattoo pigment used in this case was ferromagnetic, accounting for the symptoms experienced by the patient.

Of note is that the authors of this report wrote, "Theoretically, the application of a pressure dressing of the tattoo may prevent any tissue distortion due to ferromagnetic pull." However, there was not attempted for this patient. They also indicated, "In some cases, removal of the tattoo may be the most practical means of allowing MRI."

Kanal and Shellock commented on this report in a letter to the editor, suggesting that the events were "rather aggressive". Clearly the trauma, expense, and morbidity associated with excision of the tattoo far exceed those which may be associated with ferromagnetic tattoo interactions.

The demonstration of grossly detectable ferromagnetic characteristics of a tattoo is not new and has been well-known for over a decade. Certainly, the painful sensation experienced by the patient could not be considered a serious adverse event nor warrant the excision of the tattoo. Particularly in consideration of the existence of other imaging modalities that could be used to assess the lumbar spine (computed tomography, myelography, etc.).

Kanal and Shellock recommended the following procedures to prevent potential problems associated with a similar incident: (1) bandage the area with a pressure dressing and immobilize the tattooed skin with sufficient force to prevent motion of the skin upon exposure to the static magnetic field of the MR system; and (2) in the very rare instance where a patient reports ferromagnetic discomfort or pain, have the patient approach the MR system in a manner to minimize both translational and rotational forces by orienting the patient's tattoo parallel to the magnetic lines of force associated with the MR system.

When one considers the many millions of clinical MR procedures that have been conducted in patients over the past 15 years and that only a few individuals have had a minor, short-term difficulty related to the presence of permanent coloring, it is apparent that this problem has an extremely low rate of occurrence and relatively insignificant consequences.

Any problem performing an MR procedure in a patient that has a tattoo is unlikely to prevent the examination, since the important diagnostic information that is provided by this imaging modality is typically critical to the care of the patient.

If a patient with a tattoo requires an MR procedure, the individual should be informed of the relatively minor risk associated with the site of the permanent coloring application. In addition, the patient should be requested to advise the MR operator regarding any unusual sensations felt at the site of the tattoo during the MR examination.

Patients with tattoos located on extremities or peripheral sites should be positioned in the MR system to avoid direct contact with the body coil or surface coils (e.g., foam rubber pads may be placed in between the site of the tattoo and the coil) to minimize the potential problem. Similar to other patients undergoing MR procedures, patients with tattoos should be closely monitored using visual and auditory means throughout the entire operation of the MR system to ensure their safety.

With respect to eye makeup, there has been a report of a patient that developed eye irritation when her makeup, which contained ferromagnetic particles, became displaced from her eyelid into her eye during exposure to the MR system. Therefore, it is necessary to inform individuals with certain types of eye makeup about the potential problems related to the presence of eye makeup and request that they remove it (if appropriate) before undergoing the MR procedure.

Tattoos, Permanent Cosmetics, and Eye Makeup References

Jackson JG, Acker JD. Permanent eyeliner and MR imaging. Am J Roentgenol 1987;49:1080.

Kanal E, Shellock FG. MRI interaction with tattoo pigments. Plastic and Reconstructive Surgery 1998;101:1150-1151.

Kreidstein ML, Giguere D, Friedberg A. MRI interaction with tattoo pigments: Case report, pathophysiology, and management. Plastic and Reconstructive Surgery 1997;99:1717-1720.

Lund G, Nelson JD, Wirtschafter JD, Williams PA. Tattooing of eyelids: magnetic resonance imaging artifacts. Ophthalmic Surgery 1986;17:550-553.

Sacco D, et al. Artifacts caused by cosmetics in MR imaging of the head. Am J Roentgenol 1987;148:1001-1004.

Shellock FG. Guide to MR Procedures and Metallic Objects: Update 1999. Fifth Edition, Lippincott Williams & Wilkins Healthcare, Philadelphia, 1999.

Shellock FG, Kanal E. Magnetic Resonance: Bioeffects, Safety, and Patient Management. Second Edition, Lippincott-Raven Press, New York, 1996.


(c) 2001 by Shellock R & D Services, Inc. and Frank G. Shellock, Ph.D. All Rights Reserved. All copyrights and pertinent trademarks are owned by Shellock R & D Services, Inc. and Frank G. Shellock, Ph.D. No part of the MRIsafety.com web site may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, physical, electronic or otherwise, without the prior written permission of Shellock R & D Services, Inc. or Frank G. Shellock, Ph. D.

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