Medical Imaging and Radiotherapy Journal (MITRJ) 37 (1) 11
 
Case report
TWO CASES OF MRI-INDUCED SKIN BURNS
PRIMERA OPEKLIN NA KOŽI PRI MAGNETNO RESONANČNEM SLIKANJU
Gašper Podobnik
Institute of Oncology Ljubljana, Radiology department, Zaloška ulica 2, 1000 Ljubljana
*Corresponding author: gpodobnik@onko-i.si
Received: 1. 8. 2019
Accepted: 8. 4. 2020
https://doi.org/10.47724/MIRTJ.2020.i01.a002
ABSTRACT
Purpose: The purpose of this paper is to present two cases of 
MRI-induced skin burns.
Materials and methods: Both cases were imaged using a GE 
Optima™ MR450w 1.5T scanner. A combination of anterior and 
posterior arrays were used. In both cases, patients were placed 
in the headfi rst prone position.
Results and discussion: In the fi rst case, there was a red area 
on the skin and a white blister appeared after 15 minutes. A 
closed conducting loop was created in the patient’s body, 
which caused increased local temperature at the junction of 
her thighs. We could prevent this by using insulation, such 
as foam pads, which is one of eight steps for preventing MRI-
induced skin burns. In the second case, there were red spots 
on the skin of the left and right thighs at the contact of the 
scrotum where a white blister appeared after 15 minutes. This 
could not have been prevented, even if we considered all the 
steps for preventing MRI-induced skin burns.
Conclusion: I reported a case of burns on a small area of skin 
at the junction of the patient’s thighs, which we could have 
prevented by using insulation pads, and a case of burns on the 
skin at the contact of the scrotum, which we could not have 
prevented, even if we considered all the steps for preventing 
MRI-induced skin burns. However, we could have stopped the 
increase in the degree of the burn by recognising early signs. 
Key words: MR imaging, burns, safety, radiofrequency waves, 
heating
IZVLEČEK
Namen: Namen tega članka je predstaviti dva primera opeklin, 
ki sta nastala pri MR slikanju.
Metode in materiali: Oba primera smo slikali z 
magnetnoresonančnim tomografom GE Optima 450w 1,5T. 
Uporabili smo sprejemno tuljavo za trup (ang. anterior array) 
in hrbtenico (ang. posterior array). Oba pacienta sta ležala na 
hrbtu z glavo proti tomografu.
Rezultati in razprava: V prvem primeru se je med slikanjem 
pojavila rdečina, na kateri je čez 15 minut nastal še bel mehur. 
V pacientkinem telesu se je ustvarila prevodna zanka, ki je 
povzročila lokalno segrevanje na notranji strani stegen in 
posledično je na tem mestu nastala opeklina. Temu bi se lahko 
izognili z namestitvijo izolativne blazinice, kar je eden od 
osmih korakov, ki jih lahko upoštevamo za preprečitev opeklin 
med MR slikanjem. V drugem primeru sta se rdečini pojavili na 
koži levega in desnega stegna ob skrotumu, na katerih je čez 
nekaj minut nastal bel mehur. Temu bi se težko izognili, tudi če 
bi upoštevali ukrepe za preprečitev opeklin.
Zaključek: Predstavil sem primer opeklin, ki so nastale zaradi 
manjšega stika kože na stegnih, ki bi jih lahko preprečili z 
namestitvijo blazinice med stegni, ter primer opeklin na koži 
stegen ob skrotumu, ki ju ne bi mogli preprečiti, lahko pa bi, 
ob razumevanju mehanizma nastanka le-teh in v komunikaciji 
s pacientom, prepoznali zgodnje znake ter preprečili 
poglabljanje stopnje opekline. 
Ključne besede: MR slikanje, opekline, varnost, radiofrekvenčni 
pulzi, segrevanje
12 Medical Imaging and Radiotherapy Journal (MITRJ) 37 (1)
INTRODUCTION 
Since magnetic resonance imaging (MRI) has been used, there 
has not been any scientifi c proven cases of relevant long-term 
adverse eff ects on body cells or organisms (1).  
Modern magnetic resonance scanners, which are used for 
clinical purposes, use a very strong static-magnetic fi eld, 
additional gradient magnetic fi elds and short high-frequency 
waves from radiofrequency (RF) fi elds to excite protons. RF 
waves are transmitted by the coil/array that induces high-
frequency current in tissues (2). Using the energy from the 
impulses, the average magnetisation of proton is distorted. 
We can only achieve this if the frequency of radiofrequency 
waves is identical to the frequency of core precessing in 
the magnetic fi eld, and if these cores are perpendicular 
to the static-magnetic fi eld. We can control the angle of 
magnetisation through the appropriate power and duration 
of RF waves. In MRI, we most often angle the magnetisation of 
the cores to 90 degrees so that it precesses around the axis of 
the static-magnetic fi eld with Larmor frequency. That is how 
magnetic current in an RF array is adjusted and thus electrical 
voltage is induced. At 90 degrees, electrical voltage is at its 
highest, as it has the widest possible projection at the surface 
when it is perpendicular to the static-magnetic fi eld (3).
Most of the RF energy that is used for MRI is transformed into 
heat within the patient's tissue. Energy absorption in MRI is 
measured in specifi c absorption rate (SAR); it is the power 
absorbed per mass of tissue (W/kg). Higher body temperature 
of the patient due to RF wave exposure also depends on the 
patient’s thermoregulation system, the duration of exposure, 
the energy accumulation rate and the environment where the 
patient is during the imaging process (4).
Soon after MR was introduced for clinical purposes, the fi rst 
articles appeared on risks due to increased temperature in 
the imaging process (5, 6). It has been proven that the local 
temperature can increase and result in burns during MRI. Most 
injuries occur with patients who were attached to life function 
monitoring devices and whose skin was in contact with 
sensors or conductors (7). The human body is a conductor 
and therefore burns can occur even if there are no implants 
or active electrical devices. A closed conducting loop in the 
patient’s body can thus be created if a patient lies with his 
hands clasped or if a thumb is touching a thigh (8).
Organ shape and layers of insulating fat can have an impact 
on how the induced electrical voltage fl ows. This may lead 
to increased local temperature (9). Knopp et al. described a 
case in which a closed conducting loop was created through 
the torso and legs. The contact area between the calf 
muscles comprised two adjacent skin layers that consisted of 
approximately 2 mm of subcutaneous fat. They assessed that 
the average power absorbed in a layer of subcutaneous fat 
of 1 cm3 was 1.5 W, which was enough to cause RF-induced 
burns. In this area, the local temperature could reach up to 
43oC, which does not cause immediate pain, but is suffi  cient 
to induce tissue necrosis. Initially, third-degree burns are 
painless, as pain receptors under the skin are destroyed fi rst 
(10). Friedstad Jonathan et al. described an unusual case of 
two third-degree burns that occurred on the ring fi nger of the 
right hand and on the left forearm during MRI (11).
AIM 
The aim of this paper is to present two cases of MRI-induced 
skin burns, raise awareness and introduce measures to prevent 
such complications.
METHODS
Both cases were imaged using a GE Optima™ MR450w 1.5T 
scanner. A combination of anterior and posterior arrays was 
used.
Case 1: 
MRI of low-grade liposarcoma of an 82-year-old patient’s 
rectus femoris muscle.  We performed a protocol for soft tissue 
tumour that includes T1, T2, T2 pulse sequences with signal 
saturation from fat (FS) and a diff usion-weighted sequence in 
the axial plane and axial, coronal and sagittal T1 FS sequence 
after the application of a contrast agent. The patient was 
placed in the headfi rst prone position during the examination. 
The patient stated at the end of the process that she felt heat 
between the thighs.
Case 2:
MRI of the rectum of a 74-year-old patient. We performed a 
standard rectal protocol that comprised a T2 sagittal sequence, 
paraxial (imaging plane planned through the cancer-infected 
rectum area) and paracoronal (imaging plane perpendicular 
to the paraxial plane) plane, followed by a diff usion weighted 
sequence in the paraxial plane and a T2 sequence for lymph 
node display in the axial plane. The patient was placed in the 
headfi rst prone position during the examination. After the 
examination, the patient stated that he felt heat in the testicle 
area.
RESULTS AND DISCUSSION
Case 1:
There were no peculiarities during the examination, except 
at the end the patient complained about the increased 
temperature between her thighs. At the junction of her thighs, 
there was a red area on the skin and a white blister appeared 
after 15 minutes (Image 1). The female patient was referred to 
a surgeon who cared for the wound and provided her written 
instructions on how to care for the burn. 
Image 1: Photograph of the medial side of the thigh with burns on 
both sides
Podobnik G. / Two cases of MRI-induced skin burns
Medical Imaging and Radiotherapy Journal (MITRJ) 37 (1) 13
The MR images (Image 2) show that the local temperature 
increased and caused the burns at the junction of the patient’s 
thighs. It is stated in the results of the examination that, 
compared with the previous MR examination a subcutaneous 
fat oedema was evident, which probably contributed to the 
higher conductivity of this area.
Image 2: Left, T1 image of a saturated signal from the adipose tissue 
after the application of the contrast agent in the axial plane. Right, T1 
image of a saturated signal from the adipose tissue after the applica-
tion of the contrast agent in the coronal plane.
During MRI, a conducting loop was created in the patient’s 
body, which is schematically presented in Image 3. As the 
result of magnetic induction in the body (Larray), an electric 
voltage, which is infl uenced by the resistance of the individual 
tissue (Rskin), fl ows through patient’s body. The entire resistance 
of the loop is presented with Rarray. In border areas between 
fat, skin and air, an electrical charge is created according 
to a similar principle as in an ordinary electric capacitor. 
Capacitance is dependent on a distance between the tissues 
and the ability to accumulate electrical charge in an individual 
tissue (Rskin). In our case, it is the border between the fat and 
the skin. A virtual capacitor with Cair is also created between 
the skin of left and right thighs. In the worst-case scenario, 
the capacitance is high enough to create an electrical current 
through every tissue, meaning it can increase the temperature 
in border areas and cause burns (8).
Image 3: Schematic diagram of a closed conduction loop that appea-
red in the patient’s body in the process of MRI. Loop induction (Larray), 
loop resistance (Rarray), skin resistance (Rskin), skin capacitance (Cskin), 
air capacitance (Cair)
We could prevent this by using insulation between the thighs, 
such as foam pads, at least 1 cm thick, which would prevent 
the creation of a closed conduction loop. 
With an increase in the number of MR examinations and 
better MR scanners there is also an increase in the number 
of burns reported. Skin damage is the most common reason 
for a report of an unwanted event (Hardy and Weil, 2010). For 
this reason, the ISMRM (International Society for Magnetic 
Resonance in Medicine) prepared a poster that everyone can 
print for free and hang in the MR diagnostic clinics and that 
systematically describes steps to prevent MR burns. 
1. We systematically check for implants or other metal objects 
in the patient’s body, and everything that is unknown to us 
is deemed MR Unsafe. 
2. We systematically check that every object that enters the MR 
space is MR Safe or MR Conditional; we always check that all 
conditions for MR safety have been met. All metals, including 
non-ferromagnetic metals, can heat up and cause burns. 
3. Before the examination, every patient strips down to their 
underwear and puts on a cotton hospital robe.
4. For examination, we prepare the patient so that there is no 
skin contact (hands on the hips, crossed arms or legs).
5. While preparing the patient, we use insulation foam pads 
on skin to skin contact spots, skin to conductors and skin 
to a scanner wall spots.
6. We prevent loops on array conductors and other medical 
devices. 
7. Imaging is done on a normal operative level, using the 
lowest possible SAR. 
8. We continuously observe and listen to patients to ensure 
that everything is all right. We are aware of any signs of 
increased temperature. Sedated patients are connected to a 
life function monitoring device that is MRI Conditional (12).
Case 2:
There were no peculiarities during the examination, except at 
the end the patient complained about increased temperature 
Image 4: Localiser in the coronal plane. The red line indicates the tra-
jectory of the closed conducting loop.
Podobnik G. / Two cases of MRI-induced skin burns
14 Medical Imaging and Radiotherapy Journal (MITRJ) 37 (1)
on the skin around his thighs, in the scrotum area. There 
were red spots on the skin of the left and right thighs at the 
contact of the scrotum where a white blister appeared after 
a few minutes. We cared for the wound and provided him 
instructions for cooling the wound.
This could not have been prevented, even if we considered 
all the steps for preventing MRI-induced skin burns. A similar 
case occurred in Sweden, but was not described in literature. 
The skin burn appeared under the breast where an air pocket 
formed in the inframammary fold and a closed conduction 
loop was created around it.
CONCLUSION
With an increase in the number of MR examinations and 
better MR scanners around the world, a growing number of 
cases of MRI-induced burns can be expected. The aim of this 
article is to present an example of burns on a small area of skin 
at the junction of the patient’s thighs, which we could have 
prevented by using insulation pads. Another example shows 
the occurrence of skin burns at the contact of the thighs and 
scrotum, which we could not have prevented. However, by 
communicating with patients, understanding the mechanism 
behind the burns and by recognising early signs, we could 
have stopped the increase in the degree of the burn. 
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Podobnik G. / Two cases of MRI-induced skin burns