Magnetic resonance imaging (MRI) is a powerful and widely used diagnostic tool in modern medicine. This non-invasive imaging technique uses strong magnetic fields and radio waves to create detailed images of the body’s internal structures, allowing healthcare professionals to diagnose and monitor a wide range of conditions without ionising radiation1.
While MRI scans are generally considered safe and do not expose patients to harmful radiation, patients should be aware of potential risks and side effects.
Upon arrival for your MRI, you will need to check in and complete a screening form. This will allow you to confirm the presence of implants, allergies, and whether you might need any anxiety medication.
During the scan, you will lie down on a sliding table. A dedicated surface or phased-array coil is typically placed over the limb or region of interest2. The scan typically lasts 30-45 minutes of actual “table time”, during which the technician may acquire multiple sequences (settings).
You may be asked to hold your breath for short periods during the scan to minimise motion and improve image clarity. You’ll hear a series of loud knocking or tapping sounds as the MRI machine works. This is completely normal. The scan typically takes between 20 and 60 minutes, and you’ll be offered earplugs or headphones to make the experience more comfortable.
You’ll stay in touch with the team via a two-way intercom and a squeeze bulb, allowing you to communicate or pause the scan if needed. If contrast is required, it’s injected halfway through, possibly causing a brief cool sensation. After the final sequence, the coil is removed, and you’re free to go. The whole procedure is completely painless and radiation-free.
MRI scans utilise powerful magnetic fields, radiofrequency waves, and acoustic energy to produce detailed images of the body. Most side effects result from the loud noises generated, minor heating, or sensory factors, such as lying still in a confined space3. Psychological responses such as anxiety or discomfort are common, yet true physical risks are rare and usually mild.
MRI scanners routinely generate loud knocking or buzzing sounds, with measured sound pressure levels typically ranging from 110 dB(A) to 130 dB(A), depending on the imaging sequence4. One study found that 33 per cent of patients have specifically mentioned scanner noise as uncomfortable, 34 per cent of subjects experienced dizziness while moving into the scanner, and 30% while moving out5. In 11 per cent of cases, a metallic taste was reported. Claustrophobia during MRI affects approximately 2 per cent of patients (as evaluated in a study of 5798 MRI reports of 4821 patients)6.
Severe reactions, such as life-threatening allergies to contrast dye, are exceedingly uncommon. Acute adverse reactions to MRI contrast agents occur in 0.2 to 0.7 per cent of cases, and severe reactions are as infrequent as 0.04 per cent7. In patients with end-stage renal disease (ESRD), gadolinium-based agents can cause severe complications such as nephrogenic systemic fibrosis and, rarely, acute renal failure or pancreatitis8. This has led to restrictions on certain agents in high-risk groups.
MRI scanners come with different bore (opening) diameters, typically ranging from 60 cm in standard models to up to 80 cm in newer wide-bore units, which are more spacious and comfortable for larger or anxious patients9. Noise levels vary: traditional models can peak above 90 dB, while low-field open-bore scanners can be 5-10 dB quieter, though often at the expense of image sharpness10.
Image quality is generally superior in closed, high-field systems, but open and wide-bore options may be available at larger hospitals. Ask the scheduler about available scanner types if comfort is a priority.
Most MRI side effects are minor and affect the majority of patients, with estimates suggesting that up to 94 per cent notice at least one, such as noise or mild warmth11. These reactions are generally brief and can be effectively managed with simple interventions.
The gradient coils in MRI machines generate sound levels that can reach 110-120 dB, comparable to the sound levels of a rock concert. Standard foam earplugs or headphones lower patient noise exposure by about 25-30 dB, keeping it within safe limits. Occasionally, people may experience transient tinnitus or a sense of muffled hearing that resolves within a few hours12.
Radiofrequency (RF) pulses used during MRI can cause patients to experience mild scalp warmth or slight sweating, especially during longer scans13. Strict safety standards employ cooling fans and specific absorption rate (SAR) limits to maintain tissue temperatures below 39°C, thereby preventing dangerous heating.
Rapid changes in magnetic fields can stimulate peripheral nerves, causing a brief sensation of tingling, buzzing, or muscle twitching14. This effect is harmless, typically fleeting, and stops as soon as that imaging sequence ends.
The strong static magnetic field in MRI scanners can disturb the fluid in the inner ear, leading to vertigo or dizziness, often described as a sensation of a spinning room15. This sensation usually resolves on its own within minutes after the patient leaves the scanner’s magnet.
The combination of a narrow tube, loud noise, and enforced stillness can provoke anxiety or even panic in some people, occasionally causing a racing heart or shortness of breath16. Strategies to help included using mirror goggles for an open visual field, listening to music, using a call bell for reassurance, and, when necessary, administering mild oral sedatives, such as lorazepam, always under medical supervision.
Occasional side effects from MRI scans affect only a minority of patients. Clinicians are vigilant for such reactions but rarely need to interrupt the scan.
A headache after an MRI is reported by a small proportion of patients and can be triggered by multiple factors, including exposure to loud noise, mild RF heating, injection of contrast, or simply tenseness during the exam17. These headaches are usually mild and improve with rest, hydration, or over-the-counter pain relievers.
Approximately 10 per cent of MRI patients, particularly those at ultra-high field strengths, experience a brief metallic or “ozone” taste during scanning, especially when their head is positioned inside the magnet5. This is a harmless effect caused by electric currents that stimulate taste buds on the tongue, and it fades quickly after the exam.
Flashes of light, known as visual phosphenes or magnetospehens, may occur, particularly during scans that utilise fast gradient switching. This effect is more common in high-field MRI systems (up to 20 per cent at 7T), and in head-first exams conducted in darkness18. These flashes are brief, non-harmful, and resolve immediately once the scan is complete.
A minority of patients develop mild nausea or excessive sweating (diaphoresis), often related to vertigo from the strong static field, pre-scan fasting, or feelings of anxiety. Symptoms respond well to a cool airflow in the scanner room and slow, deep breathing; they rarely require the scan to be stopped19.
For individuals with pre-existing tinnitus, the loud MRI noise can cause a transient worsening that typically resolves within hours20. Good-quality earplugs or headphones can halve the likelihood or severity of this temporary spike.
Gadolinium-based contrast agents occasionally trigger mild reactions, such as itching, hives, or flushing, which occur in approximately 0.2 to 0.7 per cent of injections. These are usually managed with oral or intravenous antihistamines, and alternative contrast options can be discussed for future scans7.
In less than 0.05 per cent of MRI contrast injections, the gadolinium may accidentally leak into surrounding tissue if the IV needle becomes dislodged21. This results in swelling, tenderness, or mild ache at the site, which typically resolves with limb elevation, cooling packs, and observation for any rare complications.
Patients with magnets in cochlear implants or tissue expanders have a rare risk of experiencing pain from the movement of magnets during an MRI. Special “magnet-in MRI” safety protocols or temporarily removing the magnet under specialist care can help prevent this complication22.
Although serious MRI-related side effects are exceptionally rare, they demand careful consent, planning and prompt emergency response.
Patients with tattoos containing metallic pigments, or those with ECG leads arranged in loops, may experience RF burns during MRI3. These burns result from metals or cable loops acting as antennas, and occasional second-degree burns have been reported. Using non-ferrous inks, non-metallic cables, and placing ECG leads in straight lines can mitigate this risk.
Conductive leads from deep brain stimulators (DBS) or pacemakers can concentrate RF energy, causing local tissue heating and potentially damaging surrounding structures23,24. To prevent complications, only MR-conditional devices, implants specifically designed and tested for safety in MRI, are scanned, and only with strict manufacturer-prescribed settings and protocols.
Trace amounts of gadolinium can be deposited in the brain and bone after repeated use of gadolinium-based contrast agents. To date, there is no evidence of clinical toxicity; however, data are still being collected25. Macrocyclic agents are associated with lower tissue retention compared to linear agents; regulatory agencies continue to closely monitor the issue.
Macrocyclic GBCAs have a more stable, tightly chelating molecular structure, leading to less gadolinium release and tissue retention. As a result, macrocyclic agents are now the first-line choice in most centres, while linear chelates are reserved for specific medical needs26.
Patients with severe kidney dysfunction are at risk of developing NSF after exposure to gadolinium-based contrast agents27. This condition causes skin thickening, typically on the arms and legs, and potential internal organ involvement. In severe cases, it can be life-threatening.
Life-threatening allergic reactions to GBCAs, such as laryngeal swelling and low blood pressure, occur in only 0.001 to 0.01 per cent of scans28. Immediate recognition and administration of epinephrine alongside rapid activation of the medical emergency team are crucial to patient survival.
Scans performed in ultra-high fields (≥7T) can produce strong vestibular stimulation, causing disorienting “barrel-roll” vertigo that may persist for hours29. Patients are advised to sit before standing after the scan to minimise the risk of falling.
Some individuals report clusters of symptoms, such as prolonged fatigue and bone pain, after undergoing a contrast MRI, although the underlying cause remains unclear25. This syndrome is under investigation and, if reported, is managed with supportive care.
Contrast-induced seizures remain extremely rare, primarily occurring in people with epilepsy. Prophylactic medication or switching to alternative imaging strategies are considered for patients with seizure risk25.
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During MRI scans, rapid switching of gradient coils in the presence of a strong static magnetic field creates Lorentz forces30. These forces cause mechanical vibrations in the coil assemblies, resulting in significant acoustic noise.
This noise originates directly from the vibration and stress within the MRI gantry, which explains why MRI procedures can be among the loudest in clinical medicine. Effective coil design and damping strategies are areas of ongoing research aimed at mitigating this effect.
The RF pulses used in MRI deposit energy into the patient’s tissues, quantified as the SAR. SAR is measured in watts per kilogram (W/kg), with regulatory limits typically set to 4W/kg for whole-body exposures in a clinical setting. Elevated SAR increases the risk of tissue heating, which may manifest as discomfort, warm sensations, or, in rare cases, mild burns31. Strict SAT monitoring is especially critical for patients with implants, as conductive devices can focus energy and exacerbate heating effects.
MRI involves both very strong static magnetic fields (1.5 T, 3T, or even 7T) and rapidly changing gradient fields. The rapid changes (quantified as dB/dt, or the magnetic field’s rate of change over time) can induce electrical currents in the body, potentially stimulating peripheral nerves or muscles32.
Higher magnetic field strengths enhance signal-to-noise ratio and image resolution, but also increase risks33. Machines at 3T and especially 7T generate louder acoustic noise, which can cause vertigo or dizziness, and heighten sensory symptoms during patient positioning and scanning. 7T scanners are associated with more frequent sensations of movement or spatial disorientation.
GBCAs are chelated to minimise toxicity and possess variable osmolality depending on the formulation. In patients with normal renal function, these agents are rapidly excreted, with clearance half-lives of approximately 1.5-2 hours34. In renal impairment, clearance is delayed, increasing the risk of gadolinium dissociation from its chelate and, in rare cases, NSF35.
MRI environments can be stressful, eliciting anxiety-driven elevations in cortisol and measurable changes in heart-rate variability (HRV)36. Factors such as noise, confined spaces, and anticipation of the procedure contribute to psychophysiologic stress. The individual’s cognitive framing, their interpretation and understanding of the situation, significantly influences stress responses and can modulate both endocrine and autonomic markers. Supportive communication and preparatory interventions have been shown to benefit patients by mitigating stress and enhancing their comfort during MRI examinations36.
Patients with significant renal impairment are at increased risk when exposed to certain GBCAs, particularly linear agents, as they face a greater chance of developing NSF37. Therefore, newer macrocyclic agents are preferred, and linear GBCAs should generally be avoided in this group.
Individuals with migraine disorders are also at heightened risk: studies have linked migraines to increased susceptibility to post-scan headaches and more frequent subclinical brain lesions observed on MRI, making them more sensitive to noise and sensory stimulation during scanning38.
Those with pre-existing vestibular disorders can be especially prone to vertigo or disequilibrium during MRI examinations due to effects of strong static and switching magnetic fields39.
Elderly patients require careful screening for joint replacements and other metallic implants before undergoing MRI, as these can cause imaging artefacts or pose safety considerations if not MRI-compatible40. Additionally, older adults have naturally slower thermoregulatory responses; this means their bodies dissipate heat less efficiently, making them more prone to temperature increases or discomfort related to RF-induced tissue heating, especially at higher field strengths41,42.
MRI radiographers and other personnel regularly exposed to high-field environments can experience cumulative symptoms, such as vertigo, headache, metallic taste, and imbalance, due to occupational exposure to static magnetic fields and gradient switching39,43. These effects are generally mild and transient but may become more notable with repeated or prolonged exposure.
Proper preparation can minimise the risk of MRI side effects. Patients should stay well-hydrated and avoid excessive caffeine before their appointment, as dehydration and stimulants can increase discomfort or anxiety. Arriving in comfortable, metal-free clothing is advised, as all metal objects and jewellery must be removed before scanning to ensure safety and prevent image artefacts. It is essential to disclose all implants, medical devices, or other relevant health conditions to the healthcare team, as some implants may interfere with the scan or increase risk.
For patients with significant anxiety or claustrophobia, mild sedation may be used to facilitate a successful scan. Oral benzodiazepines (such as diazepam) taken 30–60 minutes before the MRI are commonly prescribed and have proven efficacy in reducing anxiety, allowing patients to remain calm throughout the procedure44. Anyone receiving sedation should arrange for an escort, as it is unsafe to drive or travel alone after the procedure.
Patient comfort during MRI is enhanced by several practical measures. The use of foam cushions or specialised supports helps minimise movement, reducing the risk of poor image quality and physical discomfort. A lightweight blanket can address chills from the often cool scan room. Listening to music via headphones, choosing a calming playlist, or wearing mirror or prism glasses to see outside the scanner can further alleviate anxiety and sensory stress. These options contribute to a more tolerable and positive scanning experience.
After the scan, patients are generally free to resume regular activities, except if sedation was used. Drinking water and having a light snack can help clear contrast agents and restore comfort. Mild headaches or muscle aches, common minor side effects, can typically be relieved with over-the-counter pain medications. It is essential for centres to provide 24-hour phone contact in case of persistent symptoms, allergic reactions, or delayed side effects that require medical attention.
Individuals with a history of migraines may benefit from specific strategies to prevent scan-triggered attacks. For those with predictable, scan-provoked headaches, a triptan taken about one hour before the MRI can reduce the likelihood of acute migraine onset. For more frequent migraines, a preventive regimen with beta-blockers (such as propranolol or metoprolol) or other established prophylactic agents may be appropriate, guided by the patient’s physician45.
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After an MRI, certain symptoms require prompt medical evaluation. Red-flag symptoms include wheezing or difficulty breathing, swelling of the lips or face, spreading rash, a severe headache that lasts more than 24 hours, and new limb weakness46. In rare cases, neurological symptoms like urinary retention, incontinence, saddle anaesthesia, or progressive limb weakness may signal urgent issues like cord compression or cauda equina syndrome, which merit immediate attention47.
If you experience symptoms suggestive of an allergic reaction, contact the radiology clinic or imaging centre immediately. Staff are trained to assess and respond to these events and will guide you on next steps. The clinic is also responsible for reporting adverse contrast reactions to regulatory bodies, such as through FDA MedWatch in the US or to the EMA in Europe, helping ensure patient safety and regulatory compliance.
MRI-related adverse events, particularly those associated with contrast agents, are systematically recorded and closely monitored. Hospitals maintain internal incident logs to track and analyse any complications. Reported events also enter national or institutional contrast registry databases, where they are categorised by severity and clinical features. Manufacturers of contrast agents have a legal obligation to conduct pharmacovigilance, tracking all serious or unexpected side effects globally. These layers of oversight help identify rare risks, inform safer clinical practices, and guide future regulatory recommendations.
MRI scans are considered safe during pregnancy and present no proven risk to the mother or unborn child, though gadolinium contrast is generally avoided unless essential.
MRI is safe for children, as it uses strong magnets instead of radiation; however, Ezra does not currently provide MRI scans for paediatric patients.
Most modern dental implants, such as those made of titanium or zirconia, are MRI-safe and do not significantly interfere with MRI procedures.
You can safely undergo an MRI with braces. Metal parts may cause minor image artefacts near the mouth, but they do not pose a health risk or prevent imaging in other regions.
MRI scans can reach noise levels of 103-123 dB, comparable to a rock concert (110 dB), but wearing earplugs drops sound exposure to approximately the level of a lawn mower.
Gadolinium contrast agents are generally considered safe for most people, but small amounts may remain in the body; the long-term risks are uncertain for healthy individuals, and people with kidney problems face greater risk.
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