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Head examinations are often the most claustrophobic for patients. When a patient feels anxious or restless, even minimal nodding or turning can produce motion artefacts. In addition, some head coils are very tight, leaving little space for headphones or earplugs; if the plugs fall out it quickly becomes very loud inside the bore. To minimise motion and to give the patient a feeling of security, Dorina recommends the MULTIPAD inflatable pads. These pads are placed between the head and the coil and inflated with a hand pump until they gently touch the sides of the coil. Because they adapt to the patient’s anatomy, they immobilise the head without any pressure points and also support earplugs so that they stay in place. A PearlFit Wedge under the knees relieves tension in the lower back and makes lying still easier.
Another problem in head MRI is patients touching the inner bore of the scanner. Larger or obese patients can inadvertently rest their shoulders or arms against the gantry, which may lead to RF-induced burns. A slim MR Safety Angel Pad placed under the table mat folds up automatically when the table moves into the gantry. It creates a soft barrier without extra work and protects the patient from direct contact. Patients frequently comment that they would like to take the large white wedge home after the exam because it adapts to their body without pressure points.
Products used: MULTIPAD, PearlFit Wedge, MR Safety Angel Pad
Wrist examinations are technically demanding because the anatomy is small and easily affected by movement. Patients lie in the prone “superman” position: they rest on their abdomen, stretching the arm forwards into the coil while the rest of the body remains on the table. This posture quickly leads to shoulder strain, and motion artefacts or fat‑saturation problems are common. A PearlFit Cushion placed under the feet allows the patient to shift weight away from the toes and reduces pressure on the chest. A small ProFoam Wedge or PearlFit Cushion under the shoulder and forearm brings the elbow and wrist to the same height as the coil and prevents the fingers from moving. Inflatable MULTIPADs placed inside the coil gently secure the hand and fingers without squeezing them.
With the help of these wedges and cushions, the entire forearm can be aligned horizontally with minimal effort. Dorina also recommends placing another PearlFit Cushion under the feet so that the patient’s heels do not dig into the end of the table – an often forgotten comfort measure when the table is moved to the very end of its range.
Products used: PearlFit Cushion, ProFoam Wedge, MULTIPAD.
Examinations of the elbow are usually carried out in the prone or “Superman” position. Dorina prefers to position the patient slightly on the side so that an external rotation of the elbow is easier. It is important that the shoulders and feet are well padded with PearlFit Cushions so that no pressure points or additional tension occur. For flex coils, the coil itself must be placed very close to the joint; Velcro‑free ProBelt straps of different widths are ideal for fixing the coil snugly without sticking to gowns or skin. In this set‑up, the ProBelt acts as a fixation strap around the coil. Additional PearlFit Cushions under the feet help the patient maintain the position comfortably for the duration of the scan.
Sandbags can help patients avoid moving their fingers during imaging or procedures. However, it is important to consider that if the sandbags are too heavy, they may cause the hand and fingers to go numb. For this reason, patients should always be asked whether the sandbag feels comfortable.
If a dedicated elbow coil is not available, the knee coil can be used as an alternative. The patient again lies in the prone position, but the arm is slid sideways into the knee coil. For patients who are not too obese, this technique is well accepted and has been used successfully for years. The elbow must be isocentric within the coil, especially along the vertical axis (y‑axis), so the armpits and body should be padded to maintain the correct height.
Some patients cannot bend their head far enough to clear the gantry; therefore a low pillow is placed under the forehead and additional cushions around the head and shoulder prevent pressure points. Inflatable pads (the Multipad) immobilise the elbow in the iso‑centre, while PearlFit Cushions provide support around the head and shoulder.
For prone elbow or hand scans that require patient cooperation (for example when music is needed to calm the patient), the PearlFit Forehead cushion is a valuable accessory. This two‑piece headrest allows patients to lie prone or laterally while wearing headphones. The opening in the centre permits unobstructed breathing, and the shape prevents pressure from building up on the ears. Patients appreciate the possibility of listening to music without the headphones pressing against the table.
Products used: PearlFit Forehead
The shoulder is one of the most frequently scanned joints in MRI. Ideally, the patient’s arm should be positioned in supination, which is challenging for many people. Dorina’s approach is to tilt the contralateral side slightly upwards using a wedge and to stabilise the arm with a sandbag. Patients should always be asked if the sandbag is comfortable; if it is too heavy the hand can go numb. Respiration can introduce movement artefacts in shoulder imaging, so placing inflatable pads inside the coil reduces the relative motion between the chest and the coil. Additional cushions and wedges under the elbow and legs provide comfort and help maintain the supinated position.
More practical advice on shoulder positioning can be found in Dorina’s detailed article on MRI of the shoulder.
Products used: Sandbag, MULTIPAD, PearlFit Cushion, PearlFit Wedge.
Where available, a dedicated ankle coil is the easiest way to achieve good image quality. The patient lies supine with both legs extended; inflatable MULTIPADs inside the coil fill the space around the foot and immobilise the ankle. A PearlFit Cushion or PearlFit Wedge under the non‑examined leg keeps the pelvis level and prevents rotation.
When a dedicated foot or ankle coil is not available, the head coil can serve as an alternative. The challenge is that the coil is large compared with the foot, so the ankle must be stabilised without allowing too much movement. Inflatable Multipads fill the empty space and support the foot.
A soft PearlFit Cushion or ProFoam Wedge is placed under the lower leg and knee to prevent pressure points and to maintain the correct angle. The leg can then be secured either with a ProBelt strap or with a sandbag. This arrangement helps to keep the foot centred and reduces motion artefacts.
In some cases Dorina adds a flex coil around the foot inside the head coil. This “flex reinforcement” improves fat saturation and signal‑to‑noise ratio and additionally stabilises the foot. The flex coil is wrapped snugly around the foot and secured with a ProBelt strap so that it does not slip. The rest of the positioning is similar to the head‑coil set‑up described above; the main difference is the added coil for improved image quality. A lightweight sandbag or strap over the coil ensures the patient does not move the flex coil during the scan.
Products used: MULTIPAD, PearlFit Cushion / Wedge, ProFoam Wedge, ProBelt, Sandbag.
For knee scans, the dedicated knee coil provides the best image quality. Inflatable Multipads are placed laterally and medially to immobilise the joint inside the coil. Dorina often uses a large PearlFit Wedge as a head pillow or to slightly lift the patient’s back; by elevating the upper body, patients experience less claustrophobia because they can see out of the bore. A small ProFoam Plate under the elbow prevents the arm from pressing against the table or creating conductive loops. The non‑examined leg rests on a PearlFit Cushion so that the pelvis remains level.
If a patient is too large for the knee coil, the flex coil is an excellent alternative. Position the patient in the same way as for the dedicated coil: supine with the leg extended. Wrap the flex coil tightly around the knee and secure it with a ProBelt strap. A small sandbag on top of the coil can reassure patients and reduce movement. The white PearlFit Cushion under the knee provides gentle support, and another cushion under the head keeps the cervical spine in a comfortable neutral position.
Products used: MULTIPAD, PearlFit Cushion / Wedge, ProFoam Plate, ProBelt, Sandbag.
When imaging the hips, patients can be positioned head‑first or feet‑first in supine position. Dorina prefers to stabilise the feet with a short strap to prevent external rotation; a ProBelt with buttons or a simple tourniquet works well. Placing a small PearlFit Cushion under the knees relaxes the hip flexors and flattens the lumbar spine against the table.
For larger patients or examinations near the gantry wall, an MR Safety Pad is placed around the body to avoid RF-induced burns. This arrangement improves comfort and image quality because the coil fits snugly without compressing soft tissue.
Products used: PearlFit Cushion, ProBelt, MR Safety Pad / ProFoam.
For examinations in the abdominal area – whether you are imaging the cardio‑thoracic region, liver, spleen, intestines, aorta or plexus – patient positioning is almost identical. Dorina likes to have patients raise their arms above the head. This stretched position lengthens the torso, reduces phase‑wrap and aliasing artefacts and frees up space for the coil. Patients can also hold their breath longer when the chest is opened; it is similar to an athlete raising their arms after a sprint to breathe deeply.
A large PearlFit Wedge placed under the upper body adapts to the shape of the arms and cushions them without creating pressure points. A ProBelt strap around the coil stabilises the set‑up, and a small PearlFit Cushion under the knees relaxes the lumbar spine and prevents the legs from sliding. For obese patients, Dorina uses the MR Safety Angel Pad as a protective mat around the patient; this avoids points of contact with the bore and lowers the risk of RF-induced burns for obese patients.
Products used: PearlFit Wedge, ProBelt, PearlFit Cushion, MR Safety Angel Pad
Good positioning is not just about image quality; it is about the patient experience. When patients feel comfortable and secure, they are more cooperative and less likely to move. Dorina Petersen’s tips show how simple aids – inflatable pads, cushions, wedges, straps and sandbags – can be combined creatively to suit any anatomy. Pearltec’s positioning products are designed for hygienic use in MRI and CT and are available in many sizes. By investing a few minutes in proper set‑up, you can avoid artefacts, improve throughput and make every exam a success.