@article{ref1,
title="Imaging appearance of ballistic wounds predicts bullet composition: implications for MRI safety",
journal="AJR American journal of roentgenology",
year="2020",
author="Fountain, Arthur J. and Corey, Amanda and Malko, John A. and Strozier, Davian and Allen, Jason W.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVE. The purpose of this article was to determine whether the radiographic and  CT appearance of ballistic projectiles predicts their composition and to  characterize the translational, rotational, and temperature effects of a 1.5-T MRI  magnetic field on representative bullets. <br><br>MATERIALS AND METHODS. Commercially  available handgun and shotgun ammunition representing projectiles commonly  encountered in a clinical setting was fired into ballistic gelatin as a surrogate  for human tissue, and radiographs and CT images of these gelatin blocks were  obtained. MR images of unfired bullets suspended in gelatin blocks were also  obtained using T1- and T2-weighted sequences. Magnetic attractive force, rotational  torque, and heating effects of unfired bullets were assessed at 1.5 T. <br><br>RESULTS. Fired bullets were separated into ferromagnetic and nonferromagnetic groups based on  the presence of a debris trail and deformation of the primary projectile in the  gelatin blocks. Whereas ferromagnetic bullets showed mild torque forces and marked  imaging artifacts at 1.5 T, nonferromagnetic bullets did not have these effects. Heating above the Food and Drug Administration limit of 2°C was not observed in any  of the projectiles tested. <br><br>CONCLUSION. Patients with ballistic embedded fragments  are frequently denied MRI because the bullet composition cannot be determined  without shell casings. We found that radiography and CT can be used to identify  nonferromagnetic projectiles that are safe for MRI. We also present an algorithm for  determining the triage of patients with retained bullets.<p /> <p>Language: en</p>",
language="en",
issn="0361-803X",
doi="10.2214/AJR.20.23648",
url="http://dx.doi.org/10.2214/AJR.20.23648"
}