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The number of minimally invasive procedures and diagnostic imaging examinations requiring moderate sedation has increased greatly in the radiology department. Many procedures in radiology are performed with the use of iodinated contrast media, and safe use of contrast media is important to everyday radiology practice. Providing moderate sedation in the magnetic resonance imaging (MRI) suite presents both patient and environmental challenges. The most common need for moderate sedation in MRI arises from severe anxiety from claustrophobia while in the scanner. It is important to limit patient movement to acquire clear diagnostic images, and in some instances patients require deep sedation or general anesthesia administered by an anesthesiologist. The American College of Radiology and the Joint Commission have published safety guidelines and alerts, and all personnel working in the MRI environment must review these guidelines and receive facility-specific safety training and screening prior to caring for patients in the environment.
This chapter covers pre-screening, history and physical for evaluation of patients who are potential candidates for procedures under sedation, as well as instructions for patients. Patients for elective procedures may be referred by their primary care physician or may be self-referred. Screening, evaluation, and instruction of patients requires clinical experience, and clerical staff members should not be performing any more than simple initial screening or instructing patients as to time, location, and routine standard instructions. The scope of practice of the surgeon/practitioner/physician(s) involved and the individual facility determine the range of procedures possible. The setting may be quite flexible and general (an operating room) or very specifically designed and equipped. Procedures should be scheduled in locations equipped both for the procedure and for sedation and any contingencies that can be routinely expected as a result of either the procedure or the patient.