Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : TC01 - TC04 Full Version

Respirators and Surgical Masks Artefacts on Phantom using Magnetic Resonance Imaging during COVID-19: A Cross-sectional Study

Published: March 1, 2022 | DOI:
Shashi Kumar Shetty, MM Jaseemudheen, U Raghuraj, R Kayalvizhi

1. Assistant Professor, Department of Radiodiagnosis, KS Hegde Medical Academy, NITTE Deemed to be University, Mangalore, Karnataka, India. 2. Assistant Professor, Department of Radiodiagnosis, KS Hegde Medical Academy, NITTE Deemed to be University, Mangalore, Karnataka, India. 3. Professor, Department of Radiodiagnosis, KS Hegde Medical Academy, NITTE Deemed to be University, Mangalore, Karnataka, India. 4. Assistant Professor, Department of Radiodiagnosis, KS Hegde Medical Academy, NITTE Deemed to be University, Mangalore, Karnataka, India.

Correspondence Address :
Mr. MM Jaseemudheen,
Assistant Professor, Department of Radiodiagnosis, KS Hegde Medical Academy, NITTE Deemed to be University, Mangalore, Karnataka, India.


Introduction: It is suitable for a patient to wear a respirator or face mask during any radiological investigation during Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic. Some face masks may have nanoparticles, or antimicrobial coating, which may comprise metal to help shape the mask according to user face shape. This kind of ferromagnetic substances can cause artefacts in the image.

Aim: To detect and compare the artefacts while using different types of respirators and surgical masks in the Magnetic Resonance Imaging (MRI) phantom images.

Materials and Methods: This was a prospective cross-sectional study which was conducted from July 2021-September 2021. Two not resistant to oil-based aerosols with 95% efficiency to airborne particles (N95) respirators and two types of 3-ply surgical disposable masks with a metal and plastic nose holder were used. The N95 respirators were of Halo N95 Filtering Facepiece 2 Particulate Matter (FFP2) PM 2.5 and Suchi N95 S-7400, while the surgical masks were from Venus 3-ply V-1010 with a metal nose holder and the Thea Tex Filtra 3-ply with plastic nose holder. A polymethyl methacrylate plastic phantom was used with 1.5 Tesla (Siemens Magnetom Avanto) MRI scanner for imaging.

Results: When exposed to the metal detector both N95 respirators and one of the surgical masks with a metal nose clip showed strong ferromagnetic attraction. Both respirators and a surgical mask with a metal nasal holder showed magnetic susceptibility artefacts. The signal loss is caused by dephasing of spins from metal strip on the image.

Conclusion: All the patients must have a recognised MR safe masks prior to an MRI investigation. When this is not possible to follow, metallic components from the face mask should be removed before the patient’s arrival at the MR room. After removing the metal strip from the mask, the paper tape may be applied across the nasal bridge region for adequate transmission control and to maintain the intended function of the mask. The mask with a plastic nasal holder was ideal to use in an MR environment since it doesn’t have any distortion in the image.


Metal, Nanoparticles, Pandemic, Severe acute respiratory syndrome coronavirus 2

Since the first case of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was reported in Wuhan city, China in December 2019, it has spread worldwide, and the World Health Organisation (WHO) has declared it as a pandemic on 11th March 2020 (1). The SARS-CoV-2 is transmitted through droplets from the affected individuals. The viral Ribonucleic Acid (RNA) has been seen in air sampling in numerous studies (2),(3). Worldwide, all medical professionals and public are affected by the Coronavirus Disease-2019 (COVID-19) infection, which predominantly affects respiratory system. Every hospital and healthcare centres across the world had to adapt and equip themselves to handle the prevalence of the infection depending on their specific characteristics by implementing governments’ recommendations and preventative medical measures.

The practice of health service was swamped and had to face up to the new circumstances by radiology department (4). The MRI scans during the COVID-19 pandemic are a big challenge in the radiology department. Radiology departments across the world had to implement several new recommendations to handle the overwhelming health crisis (5),(6),(7). Performing MRI scan despite the pandemic situation, subject to a risk/benefit analysis. In case of non-critical investigations, the recommendation has been to postpone them and establish levels of priority (8),(9),(10). To detect potential cases, screening questionnaires have been carried out through telephonic conversation before the arrival of patient (11). Social distancing has been imposed in waiting rooms, and masks made mandatory for all patients and public coming to radiology department (12).

During COVID-19 pandemic, the usage of masks or various medical devices, like ventilators, in radiology departments becomes inevitable. It is essential to make sure that they are compatible to the MRI atmosphere for safety purposes while ensuring no compromises to the image quality (12),(13),(14),(15). Facemasks by some manufacturers integrate metallic fibres or metallic nanoparticles to improve antimicrobial properties. These metal strips can heat up during MRI and pose a risk of burn to the patients (13). Furthermore, these metal strips may produce artefacts degrading the image quality. The MR staff members and the patients wearing respirators and facemasks may not be aware of MRI safety of it (16). However, using face masks in the MR environment are expected to provide some level of protection by reducing the spread of COVID-19 infection to MR personnel and the patients (17),(18). As pandemic changed people’s lives, wearing masks has become essential and there is an information gap on how it will affect MR image quality and their safety in MR environment. This study will help to bridge this information gap by detecting and comparing the artefacts in different types of respirators and surgical masks. This will help in analysing their MR safety and their effect on image quality during investigations.

Material and Methods

This was prospective cross-sectional quality-improvement study approved by the Institutional Ethics Committee (IEC) (Reg. No. EC/NEW/INST/2020/834). The study was conducted from July 2021-September 2021 with the use of 1.5 Tesla MRI scanner (Siemens Magnetom Avanto TIM + DOT system) in the Department of Radiodiagnosis and Imaging, KS Hegde Hospital, Mangalore, Karnataka, India. Four types of face masks were included, two N95 respirators from different companies (HALO N95 FFP2 PM 2.5 and Suchi N95 S-7400) and two types of 3-ply surgical disposable masks, VENUS 3-ply V-1010 with a metal nose holder and the Thea Tex Filtra 3-ply surgical mask with a plastic nose holder. No specific exclusion criteria was there as there was no patient involvement in this study. All four face masks were first exposed under X-ray to assess their radiopacity. Also, they were screened using metal detector to detect the presence of metal in nose bridge strips of the respirators and face masks.

A standard cylindrical water phantom made of polymethyl methacrylate plastic with dimensions of 12×24 cm (diameter×height), where the head of a hypothetical patient would be positioned. Further, each mask was placed on the MR phantom were imaged individually with a MR head coil with three routine brain spin echo sequences including Fluid Attenuated Inversion Recovery (FLAIR), T2 axial Turbo Spin Echo (TSE) and T1 sagittal TSE was performed (Table/Fig 1).


When all the four respirator masks were exposed to X-ray, all showed radiopacity with least opacity from Thea Tex Filtra 3-ply surgical mask. They were screened with the metal detector, both N95 respirators (HALO N95 FFP2 PM 2.5 and Suchi N95 S-7400) and VENUS 3-ply V-1010 surgical mask indicated the presence of metal in the nose bridge strips, unlike Thea Tex Filtra 3-ply surgical mask. Additionally, when assessed under MRI, except Thea Tex Filtra 3-ply surgical mask, other three masks underwent considerable translational/torque forces when kept close to the MRI magnet and completely lost contact with the phantom. They were held in place using ear loops around the water phantom. There was a significant susceptibility artefact on spin echo imaging for both N95 respirators (Table/Fig 2), (Table/Fig 3).

Furthermore, the VENUS 3-ply V-1010 surgical mask had a metal strip in the mask which acts as the nose bridge. This nose bridge strip produced substantial local susceptibility artefact on Spin-echo imaging with no obvious heating (Table/Fig 4).

The Thea Tex Filtra 3-ply surgical mask did not show any evidence of ferromagnetism to the metal detector or when resting on the phantom on the MRI table since it doesn’t contain any metal strip. There was no artefact on Spin-echo imaging (Table/Fig 5).


The MRI provides excellent soft-tissue contrast and allows the evaluation of specific tissue components in different sequences. Given these strengths, MRI has shown diagnostic superiority over Computed Tomography (CT) techniques in various soft tissue associated pathologies in the head and neck region (19). The use of spin echo sequences over gradient echo sequences was preferred due to their inherent ability to be less Susceptible to the metal-induced artefacts (20). It is suitable for a patient to wear a face mask for an MRI during the COVID-19 pandemic. The two N95 respirators and a surgical mask with metal strip were used for the current study and shows susceptibility artefact in the anterior aspect of the phantom. In addition, the study conducted by the Murray OM et al., used two types of masks, one of which had nasal bridge metal holder and the other had bilateral ferromagnetic staples, shown susceptibility artefact on anterior and lateral respectively (21). Before MRI begins, MR technologists should check the face mask for metal. Some face masks may have nanoparticles, or antimicrobial coating, which may be made up of metal to help shape the mask according to user’s face shape. This metal can cause in Radio Frequency (RF)-induced heating (22). The induced heating can be influenced by the magnetic field strength or use of higher Specific Absorption Rate (SAR) sequences (23). This may signify a hazard for patients during MRI in COVID-19 pandemic. The magnetic field disparities cause large resonant frequency variations, resulting in a variety of artefacts in MRI. When the field changes quickly with position, there is substantial dephasing of the signal, and subsequent signal loss (24).

The N95 respirators are specifically designed to protect users from small airborne particles, including aerosols. Asadi S et al., found that surgical masks and unventilated KN95 respirators reduced the emission rate of outward particles by an average of 90% and 74% during talking and coughing, respectively (25). Suspected or proven COVID-19 pneumonia in whom MRI is required should wear a surgical facemask (26). The current study shows a susceptibility artefact on the image with one of the surgical face masks which was scanned with a nasal bridge metal strip. Similarly, other studies has shown commercially available masks contain ferromagnetic components and are thus regarded as “MRI unsafe” (16),(18).

The current study also shows an artefact-free image with a surgical face mask with a nasal bridge plastic strip. As suggested by the American College of Radiology, MRI technologists need to be aware of MR unsafe issues. They are advised to test any respirator used locally with a strong >1,000 gauss hand-held metal detector before MRI scan (16). Therefore, a surgical mask is a safe alternative for MR staff than the use of respirators in an MRI environment. The WHO recommendation has been adopted locally (27). Although several metals are believed to be MR safe, they can significantly hide information during imaging for several reasons. This was in contrast to X-ray images in which radiopaque metal looks bright. If there is no MRI signal from the metal, the metal is dark on MR images (28). These field variations depend on the shape, size and type of metal and orientation in the magnetic field (24). One case study, described metallic artefacts in the frontal region induced by the metal strip in the face mask covering the nasal bridge region (29). The metal strip in masks can cause an inhomogeneous static magnetic field, large variation in the precession frequency across the object. The predominant issues arising in imaging are signal loss due to dephasing, failure of fat suppression, and displacement artefacts (24).

The Dahlhausen surgical mask’s metal nosepiece made of aluminium caused minimal artefact in gradient echo pulse sequences (21). Therefore, removal of the nosepiece or facemask may not be necessary before entering the MRI scanner. Indeed, removing the nosepiece would reduce the seal at the nose bridge and risk patient exposure to COVID-19. While visiting outpatient imaging department, many patients will opt to wear face coverings during the COVID-19 pandemic situation. These masks tend to create artefacts more extensive than that induced by cosmetic or dental implantation (30). Present study comprehended the need for a local risk-benefit analysis to be carried out by MRI technologists, infection control experts and the clinical team regarding imaging parameters and facemask availability.

The purpose of present study was to familiarise the radiologist/technologist with the appearance of the susceptibility related artefacts generated by the N95 respirator or surgical masks. As can be appreciated in present study, the artefacts have a characteristic appearance on phantom MRI.


Since present study was not an in-vivo experiment, the artefacts in this study may be different from those obtained in the human body. Also, this study did not explore the effects of different MR sequences other than routine sequences. In addition, the number of respirators and surgical masks assessed in this study were limited, due to their strained availability during an ongoing pandemic. Future studies can explore different types of respirators available globally and their effects on MRI.


Most of the currently available N95 respirators and surgical masks contain metal strips producing susceptibility artefact and tend to heat up during MRI investigations. Hence, it is important for the patients to use MR safe masks which does not compromise image quality. On other hand, when this is not possible to follow, metallic components from the face mask should be removed before the patient’s arrival to the MR room. After removing of the metal strip from the mask, paper tape may be applied across the nasal bridge region for adequate transmission control and to maintain the intended function of the mask. MRI examinations with metal containing face masks is strongly discouraged.


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DOI and Others

DOI: 10.7860/JCDR/2022/52429.16140

Date of Submission: Sep 16, 2021
Date of Peer Review: Dec 16, 2021
Date of Acceptance: Jan 06, 2022
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Sep 17, 2021
• Manual Googling: Jan 01, 2022
• iThenticate Software: Jan 06, 2022 (22%)

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