Magnetic Resonance Imaging (MRI) and Tattooing

Magnetic Resonance Imaging (MRI) is a fairly new type of simple, painless examination.MRI uses magnetic fields and radio waves to “see” internal organs and soft tissue without the use of x-rays. Both safe and painless, MRI has no known side effects. MRI combines the “knowledge” of a computer with safe magnetic and radio waves to create extremely detailed images of areas of your body. The strong magnetic field created by the MRI machine is used to prepare the body to emit radio “signals.”

There is no special diet, medication or fasting required before an MRI examination. Since these machines use a magnet, the results can be altered by the presence of metal in the exam room. Jewelry, keys, zippers, snaps and other metallic items must be removed prior to the exam.

Prior to undergoing a MRI the patient should be asked if he or she has ever had any type of permanent coloring technique (i.e., tattooing) applied to any part of the body. This includes eyeliner, decorative designs, or other similar applications. This question is necessary because of the associated imaging artifacts and, more importantly, because a small number of patients (less than 10 total people) have experienced transient skin irritation or cutaneous swelling in association with MRI procedures. More recently, there has been one anecdotal report of a patient undergoing MRI who complained of a burning sensation at the site where he had a large black tattoo applied to his arm. When one considers the many millions of MRI procedures that have been conducted in patients over the past twelve years, obviously this problem has an extremely low rate of occurrence.

Recently, conflicting reports about not being able to have an MRI performed after a permanent cosmetic procedure (due to the iron in the skin), have surfaced. Iron oxide is a metallic substance found in some pigments used for Permanent Cosmetics (P.C.) It is also an ingredient found in various substances including eye shadow, blush, powder and foundation.

Metallic substances can interface with the eletromagnetic fields used in MRI procedures. Any types of metal such as pins, plates, IUD’s, pacemakers and amalgam fillings could theoretically create a safety issue and a potential diagnostic problem. According to Dr. Shellock, author of Magnetic Resonance: Bioeffects, Safety and Patient Management,  “of the thousands of patients who have undergone MRI tests, only a handful have reported redness around the eye area.”  The redness and resulting edema in the eye area does recede, and will not cause permanent damage.  He emphasizes there has been no reported problems with the eyebrows or lips areas.  Test studies have confirmed that the “iron” particles in pigment are too microscopic in size to react as true metal “pieces” (fragments from welding, etc.) but rather are more accurately compared to iron and other “metals” which already exist microscopically in our body.

In speaking with various imaging centers, and radiologists at different Scripps Hospitals, most pre-procedure reports do not list permanent cosmetics. According to Elaine Gagermeier, B.A., C.N.M.T., Chief Technologist and Manager of the MRI Center at Kettering Medical Center and Dr. Robert Tyrell, M.D. of MRI Consortium in Dayton, Ohio, any potential problem can be minimized through the use of proper protocol.

Safety is not a major concern with P.C.,” states Elaine Gagermeier. Although there have been a few cases of first degree burns, typical of a sunburn, the accompanying symptoms of localized swelling, redness, irritation are transient and subside after a few hours. The burning is caused by the heating produced during the MRI exam. Technologists at the Kettering MRI Center have goggles to cover the area of pigmentation.  As an added precaution, patients are instructed to inform the technologist if they feel excessive heating so that the procedure can be suspended.

Accuracy of the MRI in clients, with permanent makeup, has been met with controversy. “Due to the low concentration of iron oxide and the small areas with pigmentation, the possibility of a diagnostic problem is remote,” . says Dr. Tyrell. In the rare cases where a problem should occur, there are variables such as sequencing that can be controlled. One type of sequencing, called a fast-spin echo, can help minimize distortion.

In summary, a client with Permanent Cosmetics can have an MRI done safely and effectively with no ill side effects or diagnostic problems. The practitioner plays a key role in prevention by informing the client as to the nature of the MRI and its alternatives. It is important that the client inform the physician they have permanent makeup. In addition, the patient should advise the MRI operator regarding any unusual sensations felt at the site of the tattoo during the MRI examination.

The Society of Permanent Cosmetic Professionals was instrumental in funding and participating in research on tattoos and possible MRI interaction. This project, by Whitney Tope M.D. showed that any risks were negligible to the client and non-existent to the special equipment employed during the procedure.

It is important that clients feel assured of the safety of their permanent cosmetics. Permanent Cosmetics have become a fashionable and necessary alternative for many people. Busy women, women with allergies to regular make-up, women who have poor eyesight, and women who just want to find a convenient way to look their best, are considering the possibilities of permanent cosmetics. It is important that the public know that these procedures are safe and that they are not a contraindication to having an MRI.