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General Questions and Answers For learning, sharing your experience, and exchanging information about Multiple Sclerosis. Please discuss medications in the Medications forum, and natural supplements in Tara's forum.

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  #16  
Old 03-02-2012, 11:22 AM
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Quote:
Originally Posted by cosake View Post
I understand that it is all about CYA for the tech, but the tech should have the form for people to sign -- not the doctor.
First off, there is no CYA element in any of this where the technologist is concerned. I don't get what you mean by this.

Also, what form do you have to get from a doctor? I've never seen a radiologist involved in handing out a patient screening form - that form is filled out before a patient is even brought back to the MRI area, so that nobody with a pacemaker or (most) aneurysm clips gets near the magnet. Clerical people give the patient the forms, and then we review them before getting the patient. I suppose some sites may have a radiologist present who obtains consent for the contrast injection, but I've never worked anywhere where this was so. Our patients are generally given the contrast consent form to read and sign in the waiting room, along with the other paperwork. I don't really like that procedure; I think a radiologist should explain the risks of gadolinium before a patient is asked to sign a consent form.

To be clear, there is no "consent form" for pregnancy. The consent form is for the gadolinium injection. Pregnancy status is just one part of the general patient screening form.


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  #17  
Old 03-02-2012, 11:28 AM
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Had that been me - assuming a different gender, of course - I would have peed on the floor and found a different diagnostic center...
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  #18  
Old 03-02-2012, 12:14 PM
cosake cosake is offline
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@ Rex -

I think I was not clear - I meant CYA for the tech as in following what he has been told is policy so that he doesn't lose his job.

And I guess what I was trying to say is that the form for consent for the contrast should be where the patient can easily sign it -- not in an office on the other side of the hospital and NOT a form that is going to take 2 hours to deliver to the patient when they are sitting there waiting for their MRI. I did not mean to indicate that the tech should be responsible for obtaining consent - it would just be the best place for a form like this to be in this particular situation.

I totally agree consent should be signed before patient leaves the office and that is always how it has been done for all of my MRIs. I get a clipboard with statements to check off and sign, and then I take it with me to MRI machine. Tech there reviews the questions with me again verbally to make sure that all answers match. Pregnancy is one of the questions.
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  #19  
Old 03-02-2012, 02:47 PM
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Originally Posted by cosake View Post
I totally agree consent should be signed before patient leaves the office and that is always how it has been done for all of my MRIs. I get a clipboard with statements to check off and sign, and then I take it with me to MRI machine. Tech there reviews the questions with me again verbally to make sure that all answers match. Pregnancy is one of the questions.
Actually, I think anything that requires "informed consent" - not the questionnaire with the checklist, but the contrast injection consent - should be obtained by someone who is in a position to inform the patient, or answer any questions before the patient is expected to sign. That is not something the imaging clerk can do. So, I think either the physician or technologist should do it. Of course, people stopped listening to me a long time ago, and I mean that seriously - it's very difficult to function as a person of principles and conscience in the health care field today, thanks to the corporate ownership of everything. Of course, the same holds true for Home Depot.


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  #20  
Old 03-02-2012, 06:56 PM
miknfs miknfs is offline
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Find another facility

In all my years as an mri tech we just had the patients fill out the form about surgeries,metel in the body and wheather or not they were pregnant and sign it. Now, if they wern't sure about being pregnant we sent them to the lab for a blood test. If the patient said no too pregnancy we would never make them take a pregnancy test,I dont understand why they would not believe you. Id find another facility.
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  #21  
Old 03-04-2012, 04:22 AM
Thinkimjob Thinkimjob is online now
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Catholic hospitals will make you take a pregnancy test before doing anything that might harm an embryo, foetus, or baby. (I'm not getting involved.) Fair enough, I suppose.

I thought you were looking for something in which to pee, in an emergency, when I read the post title. Sorry you've got the other problem.
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  #22  
Old 03-04-2012, 07:09 AM
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kingrex kingrex is offline
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Originally Posted by Thinkimjob View Post
Catholic hospitals will make you take a pregnancy test before doing anything that might harm an embryo, foetus, or baby. (I'm not getting involved.) Fair enough, I suppose.
All due respect, if that's true, I don't think it's fair at all. But really, I've never heard of that practice before.


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  #23  
Old 03-04-2012, 09:21 AM
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sexygatubela sexygatubela is offline
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Originally Posted by kingrex View Post
This is absolutely incorrect.

Gadolinium most definitely crosses the placenta and enters the body of the fetus, and studies of its effect upon the unborn fetus have been extremely limited. Therefore, no determination of the effects of gadolinium on the fetus has been made. If you doubt what I'm saying, Google this topic and you will see that medical centers in general do not inject pregnant women unless it is felt that the benefit outweighs the risk. My guess is that nobody regards the hunt for an active MS plaque as more important than the life of an unborn child. A brain tumor, OTOH, might be different.
No offense, but I certainly would believe my doctors more, my OB-GYN and neuro-opth on this subject, since they did their research and found no risk in doing an MRI with contrast at the time. I was right between my second and third trimester, so that might have been the trick. However, I do understand that all doctors pretty much will avoid anything unnecessary during the first trimester.

But, again, in most centers, a sign consent is sufficient and not a pregnancy test.
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  #24  
Old 03-04-2012, 12:56 PM
miknfs miknfs is offline
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[QUOTE=Thinkimjob;1351273]Catholic hospitals will make you take a pregnancy test before doing anything that might harm an embryo, foetus, or baby. (I'm not getting involved.) Fair enough, I suppose.

Not the two catholic hospitals I was an MR tech at, we believed the patient. If she said she wasn't pregnant that was that. Now if there was any doubt,off to the lab she went for the blood test. LOL
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  #25  
Old 03-04-2012, 01:14 PM
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Originally Posted by sexygatubela View Post
No offense, but I certainly would believe my doctors more, my OB-GYN and neuro-opth on this subject, since they did their research and found no risk in doing an MRI with contrast at the time.
When I say that there have been no studies done to adequately assess the impact of gadolinium compounds on an unborn child, don't feel as though you have to take my word for it - the manufacturers themselves will tell you the same thing. In fact, their own package inserts carry the same warning, like this one from the Prohance enclosure:

There are no adequate and well-controlled studies in pregnant women. ProHance (Gadoteridol) Injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

The trouble is, without knowing what the potential risk is, it's difficult to measure the risk vs. the benefit.

Here's what the doctors at UCSF think:

Intravenous gadolinium is contra-indicated in pregnancy, and should only be used if absolutely essential, and only after discussion of risks and benefits with the patient and referring clinician.


Again, without a body of knowledge with which to assess the risk, it's impossible to accurately measure the risk vs. the benefit. So, it's up to you and your doctor to determine what you're willing to do - but don't confuse your doctor's opinion with any scientific evidence that gadolinium has no effect on the fetus. Of course, this is a sort of Catch-22 - without the go-ahead, nobody wants to put their baby in jeopardy, thus there can't be any science done which might ultimately demonstrate the safety of gadolinium for unborn babies.

So, your doctors are making a presumption, one which may in fact be true. But it's a reach to say that they've done the research and there's no risk. Late-trimester is generally felt to be safer for everything, as a rule of thumb, because more structures are fully formed, but it's not a guarantee of safety.


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