MRI Safety Starts Earlier Than You Think

  Clinically reviewed by Liz Marsh
  MRI Clinical Lead

MRI safety is often assumed to start and end with the radiology team at the point of scanning. However, by the time a patient has arrived for their MRI scan, key decisions that influence safety have already been made.

Your referral is actually the first safety checkpoint. The risks a patient may be facing are directly related to key information that should be considered at the point of referral.

Here, we will explore how unclear or incomplete referrals directly affect patient safety, workflow efficiency and the patient experience.

MRI isn’t ‘low-risk’, it’s information-dependent

Patients in need of an MRI scan are often already dealing with a certain level of anxiety due to unexplained symptoms. It is, therefore, understandable that MRI is often presented by clinicians as low risk due to the absence of radiation.

However, in reality, the risks are highly dependent on the circumstances of each individual, especially regarding their implant or device history.

Every medical implant or device needs to be assessed to determine if it is MRI safe, MRI conditional or MRI unsafe. Missing or incomplete information in a referral, particularly regarding implants and medical devices, is often the real source of risk.

The consequence of unclear referrals is often that no scan is possible. This leads to delays and rescheduling while essential information is sourced. Not only does this result in a poorer patient experience, but it also delays clinical insights.

What are the risks?

Risks of MRI for patients include those that are physical and biological. Almost all of these risks can be mitigated when the appropriate information is provided at referral and/or the patient is sufficiently educated regarding what to expect during their scan.

Physical risks include:

1. Projectiles — ferromagnetic objects, such as tools, oxygen cylinders, and personal items like keys or phones, can become dangerous projectiles in the magnetic field.
2. Implant and device interference — pacemakers, cochlear implants, neurostimulators, and aneurysm clips can malfunction, heat up or be dislodged.
3. Burns and thermal injuries — radiofrequency energy used during a scan can cause closed electrical pathways (conductive loops), for example, through skin to skin contact on a patient or contact with metal objects, leading to concentrated heating.
4. Acoustic noise — knocking and buzzing sounds produced by the MRI scanner can be greater than 100dB in volume, which can cause hearing damage without ear protection.

Biological risks include:

1. Peripheral nerve stimulation (PNS) — rapid gradient switching during a scan can stimulate nerves, causing tingling or muscle twitching.
2. Claustrophobia and anxiety — enclosed spaces can trigger anxiety and, in severe cases, panic attacks in certain patients.
3. Contrast agent — gadolinium contrast very rarely causes severe allergic reactions and is not known to lead to any long-term health problems; however, it is still advised that pregnant women do not have an MRI scan with gadolinium until after birth.

What are the common gaps in MRI referrals?

The most common gaps in MRI referrals occur in 3 key sections:

1. Clinical history

The absence of a clear surgical history means we cannot tailor the scan to the clinical indication and makes it more challenging for a radiologist to interpret scan images, increasing the likelihood of misdiagnosis.

2. Indication for the scan

Unclear clinical questions or indications make it more difficult to carry out a risk–benefit analysis to justify the scan. In a private healthcare setting, this can make it less likely that an insurer will cover the costs.

3. Presence of any implants

Missing implant details are a major roadblock to scanning due to serious safety issues that can result from the effects of MRI on implants (e.g. burns, implant movement and device failure).

Beyond the type of implant, referrers need to provide specifics such as the implant make and model, and the date implanted. If possible, implant cards and/or operation notes should also be provided to evidence the implant details.

You shape the patient experience

As a referrer, a patient’s scan journey starts with you. Patients can experience considerable uncertainty and anxiety over having an MRI scan. The clarity you provide at referral, both in terms of the questions you hope to answer with the scan and the safety risks as they relate to them personally, helps set and manage their expectations.

Better-informed patients are less likely to cancel their scans and more likely to benefit from a smoother care pathway.

You make the first safety decision

By the time the radiology team performs their routine safety checks, key decisions have already been influenced by the information provided in your referral.

Your referral is, therefore, not an administrative step along the scanning pathway, but the first active safety step.

The MHRA Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use published in July 2026 states that it is the responsibility of the referrer to identify patients with implants and/or contraindications before referral, making accurate clinical information essential to safe MRI practice. The MHRA recommend that all MR referring clinicians undertake MRI safety training for referrers. The NHS England e-Learning for Healthcare (e-LfH) Referrers Module 5 is specifically designed to fulfil this learning need. A better quality of referral has the power to improve patient safety, workflow efficiency and the patient experience.

At Vista Health, we support our referrers in delivering better quality referrals with our accessible referral portal for speedy, secure and comprehensive MRI referrals.