Flatliners: The Real MRI Story

March 8, 2018March 2, 2018 / Jordyn Redwood / 3 Comments

As followers of this blog know, I did my own medical review of the recent movie version of Flatliners here and here. I thought there was something off about the MRI scenes, so I asked our resident radiology expert, Shannon Moore, to watch the film and give her thoughts.

Welcome back, Shannon.

I’m a huge fan of the 1990’s version of Flatliners. Kieffer Sutherland and Julia Roberts were brilliant outside of his Lost Boys role and her Pretty Woman phenomenon.

In 2017, an updated version of the Flatliner’s movie was released with Ellen Page. Of course, I had to watch and give my opinion. The movie was as enjoyable as the first one and held my interest and nerves through the entire film.

However, some flaws invaded the magnetic resonance imaging (MRI) scenes.

MRI Magnets

MRI machines contain a highly charged magnet thousands of times beyond the magnetic field of the earth. Metal objects become projectiles when they are close to the machine. Just to give an idea of this device’s strength, click on the link or search You Tube for MRI accidents after reading this post.

With a magnet so powerful, how can these students use a defibrillator right next to the scanner? The metal paddles, as well as other components in the device, would have become projectiles and caused damage not only to the equipment, but also to the people in the room standing next to the system. An MRI safe defibrillator is being explored, but so far not approved or on the market.

Even the argument they turned off the magnet is not logical. To “quench” or shut off an MRI magnet is not as simple as flipping a switch. In a hospital setting, MRI magnets are only “quenched” in case of a fire or if someone is pinned to the machine. Neither of these happen in this movie. The reason the magnets stay on constantly is because the shutdown process demands a release of helium and causes days of down time. The magnet could be damaged from the quenching process. Therefore, the magnet remains active on a daily basis or in this movie’s case, during their experiment.

The residents use the defibrillator to stop and restart the heart with the person on the MRI table. Real-life cardiac arrest procedures, with the patient in an MRI scanner, is to remove the patient from the scanner and place them on an MRI safe stretcher. They are removed from the room and provided life-saving measures.

Other metal objects in the movie’s experiment room are Courtney’s laptop computer, the heating blanket, laryngoscope, etc. – all containing metal objects and life-threatening projectiles.

MRI Images

When the residents are gathered in her apartment reviewing the images on a laptop, bolts of lightning or electrical currents appear on the scans—that is all Hollywood.

The type of scan they were showing on the screen was a Diffusion Tensor Imaging (DTI). This scan is a type of functional MRI that tracts the diffusion of water molecules in the white matter fibers of the brain. The colors in these images are assigned based on orientation. Front and back are usually blue, right to left are red and interior to exterior are green. Recorded electrical pulses are not shown on real MRI images. To be accurate the lightning bolts should not have been added and the actors could have pointed to the areas they were discussing.

MRI Brain Coils

The final inaccuracy is with the brain coil placed on the resident’s heads. It was dainty and petite showing the entire face of the actor.

Here is a real brain coil:

Quite a bit different from what was shown in the movie. In real life, there are a couple of coils to show the face, but they would have hindered the actor’s ability to intubate which again would not be done in an MRI Scan room because of the metal Laryngoscope used.

Overall, the movie was entertaining and interesting, but the MRI scenes need some resuscitation.
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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.

Medical Review of the Movie Flatliners 2/2

March 1, 2018February 21, 2018 / Jordyn Redwood / 7 Comments

I’m continuing my review of the movie Flatliners that released last year which is a reimagined redux of the original 1990 movie.

In the movie, a group of medical students intentionally put one another into cardiac arrest so they can have a near death experience (NDE). Let’s examine medically whether or not their method would work.

The plan is to anesthetize the inductee with Propofol (which is a short term anesthetic), cool their core body temperature, and then defribillate them with electricity causing them to flatline. Keep in mind, asystole means there is no electrical activity happening in the heart. You can read a post I did here on how electricity or defibrillation really works. Amazingly, in this medical center’s basement in another fully functional hospital with a very expensive MRI to be used during a disaster.

Issue #1: A medical center has a fully functional part of the hospital with an expensive MRI that is doesn’t use. Any empty, unused space in the hospital is a drain on the budget. Especially an expensive piece of radiology equipment. No sane hospital anywhere would be leaving that piece of equipment unused in a basement.

Issue #2: What they show is not an MRI. MRI scans take a long time and can never be done in 60 seconds.

Issue #3: Trusting a fellow medical student to resusciate you. Need I say more?

Issue #4: Knowing that they are going to put someone in cardiac arrest, no one really bothers to hook up a resuscitation bag.

Issue #5: During one code that begins to run several minutes, one of the students orders another to put the cooling blanket back on because “she’s too warm”. This flies in the face of every resusciation protocol there is. There is a somewhat well used phrase that you must be “warm and dead”. Suboptimal body temperature makes resuscitation more difficult. They are only making their job harder.

Issue #6: Endotracheal tubes have a balloon on the end that must be inflated to stay in place and deflated to take out. No one seems very concerned about this.

Issue #7: You cannot deliver electricity over clothing. Bare skin only. Also, paddles are really not used any more for a variety of reasons. Most hospitals have transitioned to patches. The paddles are used as a back-up.

Issue #8: Propofol is a distinctive milky white substance. Seems easy enough to draw up some milk in your syringe for the movie to simulate this.

Issue #9: You cannot shock a heart that is in asystole into a normal rhythm. You can see my post above for that. Can you shock someone into asystole? There is a rare possibility that you can shock someone and stop their heart. However, the common rhythms a person would go into because of this is V-tach and V-fib and not asystole. The movie depending on this rare event for every flatline is unrealistic.

Issue #10: You can tell when a shock is delivered to a patient because generally they have quite a few muscles contract. Patients never come up off the bed as dramatically as on film or television. In fact, I’ve never seen a patient come up off the bed at all.

Have you seen Flatliners? What did you think of the medical aspects?

Medical Review of the Movie Flatliners 1/2

February 26, 2018February 21, 2018 / Jordyn Redwood / 4 Comments

Flatliners 2.0 released in October, 2017. If you haven’t seen the movie (or the original from 1990) then you may not want to read this post as there will be spoilers involved.

Flatliners centers around a group of medical students who become curious with the phenomenon of near death experiences (NDEs) to the point that they “flatline” one another so that they can purposefully have one.

This first post will deal with a medical scenario that happens in the first ten minutes of the film. We’ll look at two screenshots from the movie.

Here is the conversation among the medical students when their new patient arrives.

Paramedic: “Transfer from Holy Cross. Thirty-eight year old construction worker fell off a beam. Persistent coma. GCS 6.”

Marlo: “Standard procedure for a GCS 6 admit calls for 2 large bore IVs and diazepam on standby.”

Ray: “Seizure meds won’t do any good. Whatever is wrong is in his spinal column and not in his brain.”

Marlo: “And what medical protocol are you citing?”

Ray: “The protocol of actually living in the real world. Where guys with crappy HMO’s go undiagnosed with spinal injuries.”

Marlo: “Actually he’s on seizure meds which is a medical protocol of reading his chart.”

At this point an alarm sounds and the students begin to panic. This is the screen shot at the moment of panic. It shows the monitor. The patient’s heart rate is a nice steady 73. His oxygen level is 100%– can’t get any better than that. His respiratory rate is 19– the patient is on a ventilator. I don’t know– things looks pretty good to me for this patient.

An attending doctor arrives.

Attending: “What is it?”

Student: “Respiratory failure.” (Based on the screen shot, there is no basis for this. Also, nothing is quite hooked up correctly at the head of the bed for an ER.)

Attending: “He might be hemorrhaging. Page neurosurgery, call a code, and get CT on standby. Students, clear the room!”

They then show another monitor in the room which appears to show ventricular fibrillation (V-fib) which is a lethal, but shockable rhythm. Yet, no one starts CPR.

End Scene.

Issue #1: I’m not sure how a medical student within the first ten seconds of getting this patient can know if the problem is in the brain or the spinal cord. For me, the problem seems likely to BE in the brain considering his persistent vegetative state.

Issue #2: Because of the patient’s insurance, he didn’t receive an accurate diagnosis. Mmmm . . . I know this myth get’s perpetuated. You don’t necessarily need expensive tests ALL the time to get an accurate diagnosis. CT scans and MRI scans aren’t really seen as extreme measures anymore. Though they are expensive the cost has come down.

Issue #3: Nothing these medical people say makes any sense medically. What evidence is there that the patient is in respiratory failure? The photo of the first monitor doesn’t suggest that. What evidence is there that the patient is hemorrhaging into his brain? Fixed and dilated pupils? Unequal pupils? A worsening coma score? None of that is presented in the scene.

Issue #4: The one medical problem they seemingly show is the V-fib in the second screen shot. Good to call a code, but research has shown that early and effective CPR is the one thing that is best at bringing people back. The next is early defibrillation which no one seems to anxious to accomplish.

Is it that hard to find good medical consultants for movies?