“Getting You Back
®
in the Game! ”
Capital Orthopaedics MRI
12499 University Avenue, Suite 110
Clive, Iowa 50325
515-440-2663 (BONE)
Fax: 515-267-9988
www.dsmcapitalortho.com
Patient Checklist for MRI
Prior to your exam, please review the following checklist:
• Please arrive 15 minutes prior to your exam time to check in. This
will allow time for you to complete your patient registration and final
MRI screening forms then dress for your MRI appointment. Your MRI
examination will take approximately 45 minutes to complete so plan
on being at the MRI imaging center for approximately 1 hr. for your
appointment.
• You will change into a patient gown and/or shorts for your MRI
examination. Clothing with metal zippers/snaps/buckles or fasteners
will not be allowed into the MRI scanner. Athletic clothing such as
anti-perspiration/self wicking fabrics and synthetics cannot be worn as
they may contain metal fibers within the materials that can interfere with
your MRI testing. You will also need to remove certain jewelry and other
personal devices such as cell phones, wallets and purses before entering
the MRI scanner. A locker will be provided to store your valuables.
• For most exams, it isn’t necessary to refrain from eating and drinking.
Some MRI exams may require a lab test prior to your testing. The
MRI scheduler will advise you of any restrictions and provide you with
instructions if a lab test is indicated for your exam.
• You CAN take any medication you may currently be taking. It is not
necessary to stop taking it prior to the exam. Pain medication should
also be taken as prescribed. In fact, the exam will be much more
comfortable if you continue to take your medication as scheduled.
Please Note: Medication patches such as pain or nicotine patches
must be removed from your skin prior to the MRI testing, however, as
they can heat up and cause skin irritation when worn during an MRI
examination
• You CANNOT have the examination if you have the following:
–– Certain cerebral aneurysm clips (magnetic)
–– Pacemakers and implanted heart defibrillators
–– You are pregnant
–– In the case of mechanical heart valves, cochlear implants or other
electronic implanted medical devices such as an insulin pump, your
medical history will be checked for MRI safety and compatibility prior
to your MRI test.
• The MRI testing is done with a strong magnet and radio frequency. You
will be asked a series of questions regarding your surgical and medical
background prior to your MRI testing and entering the magnetic field.
Certain implants in your body (electronic or metal) will need to be
checked and documented from your medical/surgical records to verify
MRI compatibility to ensure your safety undergoing an MRI. If you
have had an injury to your eye(s) where metal was removed and you
were treated by a physician, preliminary x-rays of your eyes may be
necessary before your MRI test. An MRI staff member will contact you if
any preliminary x-rays or additional medical history is needed from you
prior to your testing.
• If you think you may be claustrophobic, ask your doctor to prescribe
medication prior to the exam. If you do receive medication, please bring
someone with you that will be able to drive you home because you will
not be able to drive yourself.
Relax and do not worry about the exam! We will make sure that you
receive the quality, professional care that you deserve.
Hitachi EchelonTM1.5T MRI (High Field/Short Bore)
Diagnostic Imaging
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Ankle
Elbow
Foot
Hand
Hip
Knee
Shoulder
Wrist
Brain
Brain/with Orbits
Brain/with Inner Auditory Canal
Cervical Spine
Neck (Soft Tissue)
Lumbar Spine
Thoracic Spine
APPOINTMENT:
DATE:
TIME:
:
AM
PM
Please arrive 15 minutes prior to your exam time to check in. This will allow
time for you to complete your patient registration and final MRI screening
forms then dress for your MRI appointment. Your MRI examination will
take approximately 45 minutes to complete so plan on being at the MRI
imaging center for approximately 1 hr. for your appointment.
12499 University Avenue, Suite 110
Clive, Iowa 50325
515-440-2663 (BONE)
Fax: 515-267-9988
Parking
Parking
Parking
Mercy Sleep
Center
YMCA Healthy
Living Center
Mercy Home
Respiratory
Care Center
N
12499 University Ave.
Suite 210
Parking Lot
The Other
Place
123TH STR
Clive
Tower
Walgreens
Granite
City
EET
Mercy
Cancer
Center
Lakeview
Medical Park
Biaggi’s
Veridian
59th PLACE
60th STREET
Lakeview
Surgery Center
I-80 / I-35
UNIVERSITY AVENUE
Iowa Heart
Center
and
Vein Center
Iowa Clinic
515-440-COSM (2676)
www.dsmcapitalortho.com
Methodist
West
Mercy West
Lakes Hospital
WESTOWN PARKWAY
WILLIAM R. BOULDEN, M.D.
WILLIAM C. JACOBSON, M.D.
TERI S. FORMANEK, M.D.
GREGORY J. YANISH, M.D.
BRIAN M. CRITES, M.D.
MARK D. FISH, D.O.
DONNA J. BAHLS, M.D.
JILL A. FRERICHS, D.P.M.
MICHAEL S. LEE, D.P.M.
MATT DANILSON, PA-C