Presentation
Out of hospital ventricular fibrillation collapse, non-smoker, non-alcoholic. Current intensive care unit (ICU) admission, chest imaging to check for central venous catheter placement.
Patient Data
This case depicts what happens when a magnet meant for inhibiting the discharging of an implantable cardiac defibrillator (ICD) interferes with a digital x-ray detector.
Linear streaks are noted running down the radiograph's vertical plane, a result of a magnet-related detector artifact.
The donut-shaped magnet is slightly seen lateral to the ICD on the annotated image below. It had been placed intentionally to inhibit discharging whilst the patient's condition was being managed by other machines in the ICU.
Annotated images are seen outlining the external casing of the magnet (in yellow) and inner magnetic core (in red) on a magnified and cropped version of the initial frontal chest radiograph.
A donut-shaped white magnet meant for use with implanted pacemakers or cardiac defibrillators is depicted next to a ballpoint pen for size comparison.
Photo by Stefan Bellini, CC0, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Pacemaker_magnet.JPG
After noticing the multiple, consistent linear artifacts, the radiographer was able to troubleshoot the issue by removing the magnet and repeating imaging again. A diagnostic image (see x-ray below) was achieved the second time; readers will be able to appreciate the absence of the multiple linear artifacts (seen better on the frontal magnified image).
Interval insertion of a right-sided central venous catheter with its tip in the superior vena cava is noted. There is an endotracheal tube seen with its tip measuring 4.9 cm from the carina. A feeding tube is seen traversing the diaphragm with its tip beyond the inferior border of this radiograph. An implantable cardiac device is noted in-situ with its tips intact.
There is mild interval improvement of the bilateral patchy airspace opacities (worst in the right upper to mid zones). Mild blunting of the left costophrenic angle may be due to a small pleural effusion.
Case Discussion
This case teaches radiographers to recognize detector-failure artifacts and the appearance of an ICD magnet.
The radiographer had failed to recognize the disc-like structure over the patient's left upper chest as an ICD magnet, hence resulting in interference during image acquisition. Given the importance of the ALARA principle, all removable items should always be eliminated to prevent unwanted artifacts and unnecessary/additional irradiation to patients.
Interestingly, patients themselves must be educated on the possibility of any other devices (i.e. e-cigarettes) they may possess that might result in unintentional inhibition of their ICD 1.
Note: The removal of a magnet that is inhibiting an ICD's discharge function should only be performed in the presence of a trained personnel (i.e. cardiac technologist, specialized nurse).
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