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Johns Hopkins Cochlear Implant MRI Protocol

What to do if you need a MRI at Johns Hopkins Hospital after you have had a cochlear implant:

  • You and the clinician ordering the MRI must determine if the benefit of having a MRI outweighs the risk to you and your cochlear implant.  Generally, you should avoid having an MRI unless your clinician has determined that the MRI is critical to a diagnosis that cannot be made using other imaging means. Your clinician should fax the order for the MRI and any authorization required by insurance to Johns Hopkins Radiology scheduling at fax # 443-451-6986. Once those documents have been received, you will be contacted with a time for the study. Failure to follow this approach will likely result in your MRI being cancelled.
  • MRIs to be done at Johns Hopkins Hospital for cochlear implant users must be scheduled when one of the Johns Hopkins Neurotology Fellows is available to apply a binding (head bandage) prior to the MRI. Time has been set aside for Monday through Friday mornings for the binding to be done between 7am and 9 am.  This was set up to minimize disruption in the surgical training of our fellows.  
  • You can reach Barbara Gottschalk by email at bgottsc1@jhmi.edu or by telephone at 410-955-6554 to discuss the MRI procedure if you still have questions after reading the information below.

To minimize confusion and delays on the day of the MRI, we strongly recommend that you:

  1. Ensure that you know the exact model of your cochlear implant(s), and bring documentation of that information on the day of the scan. What matters in this case is the model of the implant itself, not the external devices that are part of a cochlear implant system. All manufacturers recommend that all external parts of a user’s cochlear implant system be removed prior to entering an MRI suite.
  2. Review the relevant manufacturer website below before scheduling an MRI, and print a copy of the information there to give to the MRI technologist and/or radiologist on the day of your scan.
  3. Notify the MRI scheduling agent that you have a cochlear implant and ask that the agent specifically notify the MRI tech and radiologist that they should review the manufacturer’s website prior to the day of the planned MRI. You can suggest that they search “Johns Hopkins Cochlear Implant MRI” to reach our website, then follow the links to the manufacturer’s site.

Manufacturers

Advanced Bionics

https://advancedbionics.com/us/en/home/professionals/hires-ultra-3d-mri-safety.html

The Advanced Bionics HiRes Ultra3D requires no bandage; however, MRI technicians and radiologists may be unfamiliar with this device, so you should anticipate and try to minimize day-of-study confusion and delays by ensuring that the MRI facility reviews the website above before your MRI is performed. If your implant is this model and you have no other implants, then we suggest that you notify the MRI scheduling agent that you have an MRI-compatible cochlear implant and ask that the agent specifically notify the MRI tech and radiologist that they should review the above website prior to the day of the planned MRI. You should then print and bring a copy of the above website instructions and its attached documents to the MRI facility on the day of the study.

Despite similar names, the Advanced Bionics HiRes 90K, HiRes 90K Advantage, and HiRes Ultra are not the same as the HiRes Ultra3D. They all require bandaging and following the scheduling procedures described above.

MRI is contraindicated for the AB Clarion C1 and CII.

MedEl:

https://blog.medel.pro/mri-instructions-cochlear-implants/

Manual for the United States

The MedEl Synchrony (Mi1200) cochlear implant has a reorienting magnet that makes it more MRI-compatible than other MedEl implants (Concert Mi1000, Sonata, Pulsar, C40+) and all other cochlear implants other than the Advanced Bionics HiRes Ultra3D; however, Med-El recommends bandaging prior to MRI for all Med-El cochlear implants, including the Synchrony.

Cochlear Ltd:

https://www.cochlear.com/us/en/home/ongoing-care-and-support/device-support/mri-and-medical-considerations

Manual for the United States

Commonly Asked Questions About Cochlear Implant Binding

  • Why do I need to have cochlear implant binding (head wrap bandage placement) during the MRI? Your internal device contains a magnet that can interact with the magnetic field generated by the MRI. Binding helps decrease the risk of the implant magnet moving during the MRI.
  • What exactly is cochlear implant binding? Your medical professional will apply a small, firm, disc-shaped object over the site of your device magnet. This will be secured with a tight circumferential head wrap and tape. The binding is designed to limit movement of the magnet and implant within the magnetic field of the MRI. You can expect some discomfort from the tightness of the head wrap.
  • What can happen during the MRI? The interaction of the MRI with your device magnet may cause: pain, intolerance of imaging study, cochlear implant movement despite the binding, reversal of magnet polarity, magnet or device extrusion (coming out of the skin), device failure, need for additional surgery, possibly including replacement of the cochlear implant. Most of these risks are rare. More commonly, patients experience mild-moderate discomfort and warmth at the site of the device magnet.
  • What are the alternatives to having the MRI with the binding? MRI is presently the best technology for evaluation of many tumors and joint or soft tissue problems.While CT scans can be done in the presence of a cochlear implant, the information that they provide is very limited about soft tissue, and there are problems with the metal in the implant causing artifacts in the images.In some cases, the alternatives to MRI may only be observation or surgical exploration of the site in question.A very small number of cochlear implants are compatible with low-strength MRI, but these MRI scanners provide limited detail.
  • What about removing the magnet from the cochlear implant? If an MRI is required, the only alternative to binding for most cochlear implant models is to surgically remove the magnet from the cochlear implant.Magnet removal and replacement can be done as a sterile procedure in the clinic or operating room.However, every time this is done there is a risk of infection or failure of the skin to heal, and ultimately loss of the implant (we do not recommend this). We use the binding protocol to avoid these risks.
  • Is there anything I need to bring for the implant binding? If this is your first MRI with your cochlear implant in place, you will be provided a small disc for the binding. If you have had a previous MRI, please bring your disc(s) to future studies. For magnet localization, please bring your external processor. Remember that before entering the MRI suite, you will have to remove your external processor and leave it outside.
  • What if I can’t tolerate the MRI? Some patients are unable to tolerate the wrapping or imaging due to discomfort and/or claustrophobia. We recommend that patients take an over the counter analgesic like ibuprofen or acetaminophen to minimize any pain.  If you think you may require an anti-anxiety medication, you should obtain that in advance from the clinician/provider ordering the MRI scan. The otolaryngologist doing the binding will not be able to provide this prescription, and you may have to reschedule the study if you do not have the medication available.