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MRI of Bullet Fragments, Education Costs, and Vendor Earnings
August 18, 2025
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Together with
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“Declining reimbursements … raise concerns for potential recruitment of physicians and eventually access to care for patients.”
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Khosla P et al, in a JACR study on medical specialty education debt.
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Radiology has a renewed focus on MRI safety following the tragic death of a New York man in an MRI accident last month. With that in mind, a new JACR study looks at adverse MRI events caused by an uncommon but still important phenomenon: retained bullet fragments in patients getting scans.
MRI is radiology’s most powerful modality, but its strong magnetic fields can be hazardous – and on extremely rare occasions even fatal – for both patients and medical personnel.
- Patients are supposed to be screened for metallic implants, jewelry, and other contraindications, but how often do providers know to ask about retained bullet fragments?
Having a retained bullet fragment on its own isn’t a contraindication for MRI, but providers do need to know where fragments are located and how large they are.
- If pre-scan screening discovers a patient with a retained fragment, they typically receive X-rays of the involved area to determine location and size – scans should be aborted if the fragment is in a solid organ or within 5 mm of an important artery or vein.
If all these steps are taken and the scan goes ahead, how often do adverse MRI events occur?
- MGH researchers reviewed 6.1k X-ray reports that contained the terms “bullet” or “shrapnel” over 13 years, finding 284 patients who got an MRI scan after a retained fragment was found on radiography.
They found…
- Only four patients (1.8%) experienced symptoms during MRI scans.
- Each of the exams was terminated early due to patient discomfort, with three patients reporting burning and one general discomfort.
- None of the symptomatic exams had the bullet in the MRI field of view.
- No serious injury and no follow-up care was required.
The Takeaway
The new findings are encouraging by showing that with careful patient screening and monitoring, MRI scans can be performed on patients with retained bullet fragments. But as always, MRI operators must remain vigilant and adhere to published MRI safety guidelines.
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- Education Debt in Radiology: Radiology landed in the middle in terms of how much debt medical school graduates take on to pursue their specialty. In a JACR article, researchers surveyed 146.9k graduates, of whom 6.5k planned to enter radiology. As of 2024, 65% in radiology took on medical debt, higher than dermatology (59%) and ophthalmology (56%), but lower than anesthesia and psychiatry (both 69%), OB/GYN and emergency medicine (both 72%), and family medicine (75%). Radiology’s median debt load fell 19% compared to 2018 ($200k vs. $248k).
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