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"Failed standards"

About: Royal Free Hospital

I supposed to have a 20 minute MRI, 10 minutes without contrast and10 minutes with contrast, but due to my asthma I had an allergic reaction to the contrast. I usually have a mild allergic reaction to contrast, always within the first minute when the contrast agent spreads into my veins because it acts as a vasodilator and I have asthma. So it has nothing to do with the procedure or the closed scanning machine and I have had many different scans with contrast in the past and always the same reaction the first few seconds which last about 1 minute and then the feeling of warmth in my chest gradually disappears as the contrast spreads further into my veins. But this time my allergic reaction was more than mild, I couldn't breathe and the feeling of warmth in my chest was more concentrated, which fortunately gradually spread to my neck, stomach and head and disappeared. I had to press the button because the feeling of warmth in my chest was so strong that at one point I couldn't breathe. The radiologist continued scanning and said, “There’s no such thing.” Thankfully, the concentrated feeling of heat spread to other parts of my body and then it went away like it always does. When I pressed the button, it was unbearable and no one could have known it would go away. At one point, I was ready to pull myself out of the machine violently. After a minute, the scan stopped and the radiologist said, “Maybe it was anxiety.” To which I replied that I always have a reaction after a contrast injection and I don’t have any reactions when I do scans without contrast. Then the radiologist quickly said we were done and I could go home. So no ten-minute contrast scan.

The radiologist quickly sent me home without recording an allergic event in the system and no nurse to check me. There’s a protocol for that. I was sent home with dizziness, lightheadedness, headaches and palpitations that lasted about 2-3 hours and the next day I had an allergic reaction with a delayed onset of an hour of chest pain. I was not monitored nor did the nurse check my blood pressure or pulse, which is what the radiologist should have arranged. I was sent home with a moderate allergic reaction.

Moreover, the radiologist who interpreted the incomplete MRI scan wrote: "This is only seen on the sagittal sequence on the postcontrast study, not

seen on other sequences and therefore of uncertain significance."

How can someone interpret an incomplete MRI scan and make an oncological conclusion about a tumor where contrast images are very important, otherwise a small tumor is not visible? The radiologist should have ordered another MRI with contrast instead of making life-changing claims about the tumor.

Instead of a 10-minute scan with contrast, I only had 1 minute, which means the MRI images are not enough to check for a small tumor.

This just goes to show how saving money on patients and staff reputations seems to take precedence over the health, safety, and correct diagnosis of the patient.

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Responses

Response from Royal Free Hospital 7 months ago
Royal Free Hospital
Submitted on 16/12/2024 at 08:48
Published on nhs.uk at 08:48


Thank you for your feedback and I am sorry to read about your experience. If you have not already done so, I would recommend

contacting our colleagues in the Patient Advice and Liaison Service (PALS) for them to look into this further for you. They can be contacted either via email at rf.pals@nhs.net or on 020 7472 6446

With best wishes, the patient experience team

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