Journal of Trauma Nursing

Body piercing/tattooing and trauma diagnostic imaging: medical myths vs realities.(CLINICAL CARE)

In the emergency and trauma settings, diagnostic imaging has become an integral part of the trauma resuscitation process. A recent study of undergraduate college students found that 23% of students had tattoos and 51% had body piercings of their face, torso, abdomen, or genitalia. (1) As body piercing and tattooing are certainly on the rise, the medical implications of these body modifications are becoming more and more evident. (2-4) However, when it comes to diagnostic imaging and body jewelry, the motto of "when in doubt.., just take it out" is not always practical, reasonable, or even possible. This article will illustrate some of the controversies and medical realities of body modifications and emergency imaging.


What really happens when patients with tattoos and/or piercings undergo diagnostic imaging? Many healthcare providers fear that jewelry will fly across the room during a magnetic resonance (MR) scan and the imaging artifact from jewelry or tattoos will make computed tomography/MR studies unreadable, (5-10) However, the experiences of the authors and a review of the literature show that this is not accurate. Most published articles that address MR and piercings focus not on the potential artifact but on the safety of performing the procedure. Higher-quality body jewelry containing LVM 316 or 316L stainless steel, titanium, or niobium has been found to be safe even if worn during an MR examination. (5,10) Testing the jewelry before entering the MR suite with a handheld magnet, although not fail-safe, has been suggested as a rapid screen to determine ferromagnetism. (5-10)


There are many more published studies concerning computed tomography/MR studies and tattoos. Again, the concerns are artifact and patient safety. Even if a tattoo has been removed with lasers before the test, artifact can still be present and potentially confusing. (11) However, the larger concern is for patient safety) (11-9) Especially with older/larger tattoos, but also with recently placed ones, during the MR procedure, some inks that include small quantities of ferrous materials can potentially cause a visible burn to the patient. (19-21) However, there have been only 5 documented cases of this occurrence. (20-24)

Many pre-MR questionnaires ask specifically about tattoos and piercings, and if they are present, simply remind the patient to inform the technician immediately if an area feels warm at any point during the procedure. Taking that idea one step further, some authors have advocated placing a cold pack on the tattoo during the procedure as a precaution with positive past experiences. (10,23,25) With the introduction of permanent cosmetics, especially on the facial areas, the MR imaging-induced heating of ink has been noticed as well. …

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