NHSL Policy:
If the patient answers ‘yes’ to “have you ever had an eye injury involving metal” or if you cannot establish the injury was non-penetrating or was definitely not caused by a ferromagnetic object, then you must regard the patient as possibly having a penetrating injury to the eye from a metal object. You should then:
· Check RIS and National PACS for evidence of a previous MRI since the incident.
· Check National PACS for imaging of the head (e.g. skull or facial bones x-ray or CT brain) post incident. Please note: only a radiologist may check CT/other images for evidence of a metallic IOFB.
· If an x-ray is required ensure the orbital x-ray request is made by an appropriate referrer on RIS i.e. Medical Practitioner or MRI radiographer with authorisation from medical director.
· X-ray performed – A slit OM view with eyes looking UP should be performed initially (the petrous ridge should appear just below the lower orbital ridge).
· X-ray will be checked by a radiologist or competent IOFB Reporting Radiographer.
· If the patient is deemed safe to scan, the radiologist/radiographer will note this on the screening form and sign the ‘safe to scan’ section at the bottom of the form and the scan will proceed.
Note:
At UHW the IOFB reporting radiographer will issue an initial report on RIS and ‘sign 1’ this report to the duty radiologist for formal reporting of any other abnormalities present.
At UHH + UHM the IOFB reporting radiographer will add comments to RIS for orbital x-ray stating ‘No metallic IOFB identified, safe to scan’. Image will be formally reported by a radiologist.