Escher KB, Shellock FG. Evaluation of MRI artifacts at 3-Tesla for 38

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1 Magnetic Resonance Imaging 31 (2013) 778782 Contents lists available at SciVerse ScienceDirect Magnetic Resonance Imaging journal homepage: www.mrijournal.com Evaluation of MRI artifacts at 3 Tesla for 38 commonly used cosmetics Kirin Escher a, Frank G. Shellock b, a Biology Department, Loyola Marymount University, Los Angeles, CA, USA b University of Southern California, Los Angeles and Institute for Magnetic Resonance Safety, Education, and Research, Los Angeles, CA 90045, USA a r t i c l e i n f o a b s t r a c t Article history: Purpose: To evaluate MRI artifacts at 3-Tesla for 38 commonly used cosmetics. Received 16 July 2012 Materials and Methods: Thirty-eight cosmetics (16, nail polishes; 5, eyeliners; 3, mascaras; 10, eye shadows; Accepted 4 November 2012 1, lip gloss; 1, body lotion; 1, body glitter, and 1, hair loss concealer) underwent evaluation for MRI artifacts at 3-Tesla. The cosmetics were applied a copper-sulfate-lled, phantom and initially assessed using a Keywords: screening gradient echo (GRE) pulse sequence. Of the 38 different cosmetics, 14 (37%) exhibited artifacts. Magnetic resonance imaging For these 14 cosmetics, additional characterization of artifacts was performed using a GRE pulse sequence. MRI artifacts MRI screening A qualitative scale was applied to characterize the artifact size. Results: Artifacts were observed, as follows: 2, nail polishes; 5, eyeliners; 3, mascaras; 3, eye shadows; 1, hair loss concealer. Artifact size ranged from small (eye shadow) to very large (hair loss concealer) and tended to be associated with the presence of iron oxide or other metal-based ingredient. Conclusions: Commonly used cosmetics caused artifacts that may create issues if the area of interest is the same as where the cosmetic was applied or if its presence was unknown, thus, potentially causing it to be construed as pathology. Therefore, these ndings have important implications for patients referred for MRI examinations. 2013 Elsevier Inc. All rights reserved. 1. Introduction 2. Materials and methods Cosmetics, including eye makeup, nail polishes, body lotions, 2.1. Cosmetics samples hair loss concealers and others, are frequently used to improve or enhance the appearance of the human body, without altering or Thirty-eight commonly used cosmetics were selected for affecting the body's structure or function [1]. Several reports have evaluation in this study. Table 1 summarizes the information indicated that certain cosmetics, especially those containing iron (cosmetic type, name, brand, etc.) for the cosmetics that under- oxide or heavy metal particles, can produce unwanted artifacts went assessment for artifacts, which included: 16, nail polishes; 5, on magnetic resonance (MR) images [25]. Unfortunately, this eyeliners; 3, mascaras; 10, eye shadows; and 4, miscellaneous information has been limited to eye makeup (e.g., mascara, eye items (lip gloss, body lotion, body glitter, and hair loss concealer). shadow, and eye liner) and restricted to MR systems operating at An effort was made to select those readily available items that 1.5 Tesla or less. Many other types of cosmetics may contain appeared to have metal-related components or glitter (22/38, ingredients that cause artifacts on MR images and it is well known 58%; Table 1). For example, of the sixteen nail polishes that that artifacts are inherently larger in association with 3-Tesla MR underwent testing, 13 (81%) contained glitter. For the 10 eye systems [610]. Artifacts may create issues if the area of interest is shadows, 7 (70%) contained glitter. Both the body lotion and body the same as where the cosmetic was applied or if its presence was glitter contained glitter. unknown to the interpreting radiologist, thus, potentially causing it to be construed as pathology [6,7]. Therefore, the purpose of this 2.2. Sample preparation investigation was to evaluate MRI artifacts at 3 Tesla for a variety of commonly used cosmetics. Since each cosmetic that underwent testing is used on the surface of the body, this evaluation of artifacts involved applying a sample of each item to the surface of a copper-sulfate-lled phantom. Each nail Corresponding author. Tel.: +1 310 670 7095. polish was applied twice to a 2.54-cm 2.54-cm removable adhesive E-mail address: [email protected] (F.G. Shellock). square (Scotch Wallsaver Removable Mounting Square; 3M, St. Paul, 0730-725X/$ see front matter 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.mri.2012.11.002

2 K. Escher, F.G. Shellock / Magnetic Resonance Imaging 31 (2013) 778782 779 Table 1 Thirty-eight commonly used cosmetics that underwent evaluation for artifacts at 3 Tesla. No. Cosmetic type Name Brand, company Color Ingredients Artifact results Nail Polish 1 Nail Polish Revlon Color Stay Revlon Coastal Surf Aluminum calcium sodium silicate, Calcium None New York, NY (170) Aluminum. May contain: iron oxide, Revlon.com titanium dioxide, ferric ferrocyanide 2 Nail Polish Revlon Color Stay Revlon Fall Mood (140) Aluminum calcium sodium silicate, Calcium None New York, NY Aluminum. May contain: iron oxide, Revlon.com titanium dioxide, ferric ferrocyanide 3 Nail Polish (glitter) Revlon Color Stay Revlon Amethyst (240) Aluminum calcium sodium silicate, Calcium None (Revlon, Revlon.com) New York, NY Aluminum. May contain: iron oxide, Revlon.com titanium dioxide, ferric ferrocyanide 4 Nail Polish (glitter) Revlon Top Speed Revlon Glitz and Glam Ethyl Acetate, Butyl Acetate, Silica, None New York, NY (530) Dimethicone, and others. May contain: Revlon.com Mica, Titanium Dioxide, Iron Oxides 5 Nail Polish Shatter by OPI O.P.I. Products, Inc. Red Shatter Glycol/Trimellitic anhydride copolymer, None North Hollywood, CA silica 6 Nail Polish (glitter) Confetti: Long Wearing Confetti Tahitian Turquoise Ethyl Tosylamide. May contain: tin oxide, None Nail Color MBA Beauty Inc. Stuart, FL (065) titanium oxide, black iron oxide, red iron oxide, red #34 Calcium Lake, aluminum powder, yellow #5 Aluminum Lake 7 Nail Polish (glitter) Milani: Jewel FX Milani Cosmetics, USA Lavender (581) Glycol/Trimellitic anhydride copolymer, None silica. May contain: ferric ferrocyanide, iron oxide, titanium dioxide, aluminum powder 8 Nail Polish (glitter) O.P.I Nail Lacquer O.P.I Products Inc. North Lemonade Stand By Glycol/Trimellitic anhydride copolymer, None Hollywood, CA Your Man (NL D22) silica 9 Nail Polish (glitter) Layla Magneffect Layla Cosmetics Milano, Italy Blue Grey Flow (03) Glycol/Trimellitic anhydride. May contain: Moderate iron powder, parafnum liquidum, iron oxides, titanium dioxide 10 Nail Polish (glitter) O.P.I Nail Lacquer O.P.I Products Inc. Rainbow Glycol/Trimellitic anhydride copolymer, None OPI Products, Inc. North Hollywood, CA Connection (HL silica, triphenyl phosphate C09) 11 Nail Polish (glitter) Confetti: Long Wearing Confetti Ice Ice Baby (005) Glycol/Trimellitic anhydride copolymer, None Nail Color MBA Beauty Inc. Stuart, FL triphenyl phosphate. May contain: tin oxide, titanium oxide, black iron oxide, red iron oxide, red #34 Calcium Lake, aluminum powder, yellow #5 Aluminum Lake 12 Nail Polish (glitter) Layla Mageneffect Layla Cosmetics Milano, Italy Silver Galaxy Glycol/Trimellitic anhydride. May contain: Large [11] iron powder, parafnum liquidum, iron oxides, titanium dioxide 13 Nail Polish (glitter) Revlon Revlon Radiant (441) Aluminum calcium sodium silicate. None New York, NY May contain: iron oxide, titanium Revlon.com dioxide, ferric ferrocyanide 14 Nail Polish (glitter) SensatioNAIL Gel Nail Nailene Espresso Bean Trimethylbenzoyl diphenylphosphine None Polish Pacic World Corp. Lake (71595) oxide, carbon black, dimethacrylate Forest, CA 15 Nail Polish (glitter) SensatioNAIL Gel Nail Nailene Purple Orchid Trimethylbenzoyl diphenylphosphine None Polish Pacic World Corp. Lake (71597) oxide, carbon black, dimethacrylate Forest, CA 16 Nail Polish (glitter) Sally Hansen: GEM Sally Hansen Cha-Ching (02) Glycol/Trimellitic anhydride, triphenyl None Crush Coty US LLC New York, NY phosphate Eye Liner 1 Eyeliner- pencil Line Express Eyeliner Maybelline LLC New York, NY Ebony Black (901) Methyl methacrylate crosspolymer, silica. Large May contain: iron oxides, titanium dioxide, ferric ammonium ferrocyanide 2 Eyeliner- crayon Perfect Point Plus eye Covergirl Black Onyx (200) Iron oxides. May contain: titanium Large pencil Proctor and Gamble Hunt dioxide, chromium hydroxide and oxide, Valley, MD ferric ferrocyanide 3 Eyeliner- crayon Extra-Intense liquid L'Oreal Paris Carbon Black (799) May contain: iron oxides Large pencil eyeliner L'Oreal USA Inc. New York, NY 4 Eyeliner- pencil Brow and Eyemakers Covergirl Midnight black Silica, iron oxides. May contain titanium Moderate Proctor and Gamble Hunt (500) dioxide, ferric ammonium ferrocyanide, Valley, MD chromium oxide greens 5 Eyeliner- liquid Ultra Liner, Liquid Liner Maybelline LLC New York, NY Black (301) May contain: iron oxides, titanium dioxides, Moderate (waterproof) chromium oxide greens, chromium oxide Mascara 1 Mascara XXL Pro by EyeSTUDIO: Maybelline LLC New York, NY Very Black (581) Silica. May contain: iron oxides, titanium Large 24 Hour Bold Intensite dioxides, chromium oxide, ferric ferrocyanide 2 Mascara The Colossal Volum Maybelline LLC New York, NY Glam Black (240) Silica. May contain: iron oxides, titanium Large Express dioxides, chromium oxide, ferric ferrocyanide (continued on next page)

3 780 K. Escher, F.G. Shellock / Magnetic Resonance Imaging 31 (2013) 778782 Table 1 (continued) No. Cosmetic type Name Brand, company Color Ingredients Artifact results 3 Mascara Organic Wear Jumbo Organic Wear Black Organics Iron oxide, magnesium aluminum Moderate Lash Mascara Physician's Formula Inc. Azusa, CA (7353) silicate Eye Shadow 1 Eye Shadow NYX Glitter Cream NYX Sweet Chocolate Acrylic copolymer, aluminum, None (glitter) Pallet Los Angeles, Inc. Los Angeles, CA Browns (09) amorphous silica. May contain: iron oxide yellow, iron oxide red, ferric ammonium ferrocyanide, manganese violet, titanium dioxide, chrome oxide green, iron oxide black 2 Eye Shadow NYX Glitter Cream NYX Royal Violets (07) Acrylic copolymer, aluminum, None (glitter) Pallet Los Angeles, Inc. Los Angeles, CA amorphous silica. May contain: iron oxide yellow, iron oxide red, ferric ammonium ferrocyanide, manganese violet, titanium dioxide, chrome oxide green, iron oxide black 3 Eye Shadow NYX Glitter Cream NYX Fresh Greens (08) Acrylic copolymer, aluminum, None (glitter) Pallet Los Angeles, Inc. Los Angeles, CA amorphous silica. May contain: iron oxide yellow, iron oxide red, ferric ammonium ferrocyanide, manganese violet, titanium dioxide, chrome oxide green, iron oxide black 4 Eye Shadow e.l.f.: eye lips face. e.l.f. Cosmetics Dist. By JA Multiple Talc, zinc stearate, kaolin, parafnium None (glitter) Glitter eye Cosmetics New York, NY liquidum. May contain: iron oxides, manganese violet, titanium oxide 5 Eye Shadow Expert Wear: Maybelline Charcoal Smokes Magnesium stearate, calcium sodium None (glitter) Maybelline NY New York, NY (04Q) borosilicate, calcium aluminum borosilicate, tin oxide. May contain: titanium oxide, iron oxides, manganese violet, chromium hydroxide green, aluminum powder, bronze powder, ferric ammonium ferrocyanide 6 Eye Shadow EyeSTUDIO Maybelline Maybelline LLC New York, NY Blue Blowout (20) Magnesium stearate, calcium aluminum None (glitter) New York borosilicate, parafnum liquidum, aluminum hydroxide, tin oxide. May contain: iron dioxides, titanium dioxides, manganese violet, chromium oxide green, aluminum powder, copper powder, bronze powder 7 Eye Revlon Perle Revlon Black Galaxy (045) Boron nitride, ploymethyl methacrylate, Large Shadow(glitter) New York, NY zinc stearate, silica. May contain: titanium dioxide, chromium oxide green, manganese violet 8 Eye Shadow- eye Medusa's Make-up Medusa's Make Up Penny Wise Titanium dioxide Small dust Chicago, IL 9 Eye Shadow- eye Medusa's Make-up Medusa's Make Up Silverado Titanium dioxide Small dust Chicago, IL 10 Eye Shadow- liquid Milani: Crystal Eyez. Milani Dist.Los Angeles, CA Beautifully Brilliant May contain: titanium dioxide, iron None Sparkling Eye Shadow (02) oxides, chromium oxides green, chromium hydroxides green, aluminum powder, ferric ferrocyanide Miscellaneous 1 Lip Gloss ShineSensational: Lip Maybelline LLCNew York, NY Cocoa Fever (50) Unknown None gloss/Brilliant 2 Body Lotion Pure and Basic: Glitter- Pure and Basics Products Opalescent Glitter Titanium Dioxide None (glitter) Up Body Lotion Carson, CA 3 Body Glitter Zinc Color Multi Zinc Color 3D Silver Unknown None (glitter) Purpose Glitter (Unknown city and state) 4 Hair Loss Concealer Top Coverage Plus Bald TC Plus Black Copolymer, iron dioxides, silica Large Spot Eraser Liminova Inc. Rancho Santa Fe, CA Cosmetic ingredient information that states May contain does not provide information regarding the specic ingredients that are listed. MN) and attached to the surface of the phantom for the assessment 2.3. Determination of artifacts of artifacts. The mascara, eye liner, eye shadow, lip gloss, body lotion, and body glitter were applied to a 2.54-cm 2.54-cm square area of In order to efciently determine which of the 38 cosmetic paper tape (Micropore Tape; 3M, St. Paul, MN) and attached to the samples created an artifact at 3-Tesla, the cosmetics were initially surface of the same copper sulfate-lled phantom, as indicated assessed using a screening gradient echo pulse sequence. The above. The hair loss concealer was sprayed on a 5-cm 5-cm piece following parameters were used, based on previous publications of white printing paper and allowed to dry for 4 hours. This paper and the artifact document issued by the American Society for was then attached to the surface of a copper-sulfate-lled phantom Testing and Materials (ASTM) International [811]: gradient echo for the assessment of artifacts. (GRE) pulse sequence; repetition time, 100-msec; echo time, 15-

4 K. Escher, F.G. Shellock / Magnetic Resonance Imaging 31 (2013) 778782 781 msec; ip angle 30 o; matrix size, 256 256; section thickness, 10 mm; eld of view, number of excitations, 2; bandwidth, 16 kHz. The GRE pulse sequence was selected for this project because it tends to have a great degree of artifact associated with it when MRI is performed on a metallic object and, thus, it represents an extreme MR imaging condition [811]. Section locations were obtained through each cosmetic that were selected from multiple scout MR images to identify possible artifacts as they were presented in the largest or worst case situation. For the cosmetics that showed artifacts, MRI was repeated using the same pulse sequence as before (GRE; repetition time, 100 msec; echo time, 15 msec; ip angle 30 o; matrix size, 256 256; section thickness, 10-mm; number of excitations, 2; bandwidth, 16 kHz) with the addition of selecting section locations through each cos- metic from multiple scout MR images to show the largest or worst-case artifact size. The imaging planes were oriented to encompass the long axis and short axis of each sample. The frequency encoding direction was parallel to the plane of imaging. Fig. 2. Artifacts associated with eyeliners (numbers correspond to the information in Table 1)(bottom row, left to right): #5, artifact size, moderate; #4 artifact size, The transmit/receive body RF coil (30-cm eld of view) was utilized moderate; #3, artifact size, large; #2, artifact size, large; and #1 artifact size, large. for these MRI artifact assessments, with the exception of the hair Artifacts associated with mascaras (top row, left to right): #3, artifact size, moderate; loss concealer, which used the transmit/receive head RF coil (26-cm #2, artifact size, large; and #1, artifact size large. eld of view). The transmit/receive head coil was used for the hair loss concealer in order to simulate the conditions used if a patient with this cosmetic was undergoing an MRI examination of the brain. cosmetics, as follows: 2, nail polishes (one with glitter); 5, eyeliners; The image display parameters (i.e., window and level settings, 3, mascaras; 3, eye shadows (three with glitter); and 1, hair loss magnication, etc.) were carefully selected and used in a consistent concealer. Artifacts tended to be associated with the presence of iron manner to provide valid representations of the artifact sizes [810]. oxide or other metal-based ingredient. The artifact size ranged from While it is acknowledged that there are many possible MRI small (two eye shadows) to very large (baldness concealer). Figs. 1 parameters that may be used to evaluate artifacts, this particu- and 2 show examples of MR images of the artifacts for the nail lar methodology has been utilized in many previous reports in- polishes, eyeliners, and mascaras. Fig. 3 displays the MR image of the volving the characterization of artifacts for implants, devices, and artifact for the hair loss concealer, which exhibited the greatest materials [710]. artifact size (i.e., very large) for the cosmetics that underwent A qualitative scale was applied to characterize the size of the testing. artifact associated with each cosmetic using a careful visual inspec- tion by the investigator, as follows: (a) None, no artifact; (b) Small, the artifact area was smaller than or the same size and shape of the sample; (c) Moderate, the artifact area was 25 to 75% larger than 4. Discussion the size and shape of the sample; (d) Large, the artifact area was 76 to 100% larger than the size and shape of the sample; and (e) Very Thirty-eight commonly used cosmetics were selected for evalu- Large, the artifact area was greater than 101% of the size and shape ation in this study. An effort was made to select specic items that of the sample. appeared to have metal-related components or glitter. Although, it should be noted that, glitter may be made from either small pieces of 3. Results metallic or nonmetallic materials including aluminum foil, iron oxides, bismuth oxychloride, copolymer plastics, and other types of Table 1 summarizes the artifact ndings for the cosmetics. materials. Interestingly, of the 22 cosmetics that contained glitter, Artifacts were observed as areas of signal loss for 14 of the 38 Fig. 1. Artifacts associated with nail polishes (numbers correspond to the information Fig. 3. Artifact associated with hair loss concealer: artifact size, very large. Note the in Table 1), #9 (right) artifact size, moderate and #12 (left) artifact size, large. substantial signal loss that exists below the surface of the copper-sulfate-lled phantom.

5 782 K. Escher, F.G. Shellock / Magnetic Resonance Imaging 31 (2013) 778782 only three (two nail polishes and one eye shadow) exhibited artifacts doubtedly be unwilling to divulge the use of this product and surely on MRI. not aware of the artifact issue. Accordingly, if an MRI technologist Unfortunately, the information presented in the labeling of the or radiologist observes a large signal void in a patient without a cosmetics with regard to the ingredients was somewhat problematic neurological metallic implant undergoing MRI of the brain, the insofar as there was often a statement that the particular makeup possibility of hair loss concealer as being responsible for the artifact May contain. certain compounds (e.g., iron oxide, iron dioxide, should be considered. titanium oxide, etc.) that may have been responsible for the artifacts seen on MRI (Table 1). While every one of the cosmetics that showed 5. Conclusions and recommendations artifacts had a metal-related ingredient listed, we were unable to obtain more accurate ingredient information that would have MRI testing performed on 38 commonly used cosmetics indicated otherwise permitted a prediction with regard to which cosmetic that artifacts can be associated with certain types of makeup was likely to cause artifacts. including nail polishes, eyeliners, mascaras, eye shadows, and even hair loss concealer. The extent of the artifact may impact the 4.1. Nail polishes diagnostic use of MRI if the area of interest is the same as where the cosmetic was applied or if its presence was unknown to the To our knowledge, this is the rst description of MRI artifacts interpreting radiologist, thus, potentially causing it to be construed found in association with nail polishes. Two out of 16 (12%) nail as pathology. Therefore, as part of the pre-MRI screening procedure, polishes demonstrated artifacts that were moderate and large, consideration should be given to patient management with regard to respectively. (Note: The nail polish that showed the large artifact this information and a procedure should be in place to prevent issues (Layla Magneffect) was designed to react to the magnet on the cap, related to cosmetics. This may include advising patients before they creating three-dimensional designs in seconds.) This information arrive for MRI exams to thoroughly remove all cosmetics. is interesting because 13 of these were glitter nail polishes or Alternatively, it may be necessary to have makeup removal items appeared to have a metallic appearance. Because the associated available at the MRI facility to take off different types of cosmetics artifact may disrupt the diagnostic use of MRI if the area of interest (e.g., nail polish remover). In the case of hair loss concealer, it is is where the nail polish was applied (e.g., nail polish applied to toes necessary for the patient to wash the area with shampoo in order and an MRI is needed to evaluate the neuropathic foot in diabetes to remove this product. Metal-based cosmetics may theoretically mellitus), it would be prudent to thoroughly remove this cosmetic cause issues for patients due to the potential for MRI-related prior to conducting the MRI examination. heating, however, that possible problem was not investigated during our study. 4.2. Eyeliners, mascaras, and eye shadows References In the present investigation, each eyeliner (5/5), each mascara (3/3), and three of the 10 eye shadows created artifacts at 3 Tesla. [1] Department of Health and Human Services, Ofce of Women's Health. http:// www.womenshealth.gov/publications/our-publications/fact-sheet/cosmetics- The sizes of the artifacts ranged from small to large, which may your-health.cfm#c. impact MRI of the orbital area but are unlikely to interfere with [2] Smith FW, Crosher GA. Mascaraan unsuspected cause of magnetic resonance routine head examinations because signal losses were localized to imaging artifact. Magn Reson Imaging 1985;3:287-9. the respective cosmetic's application area. In previous studies, [3] Weiss RA, Saint-Louis LA, Haik BG, McCord CD, Taveras JL. Mascara and eye- lining tattoos: MRI artifacts. Ann Ophthalmol 1989;21:129-31. various types of eye makeup were reported to pose issues related [4] Wright RM, Swietek PA, Simmons ML. Eye artifacts from mascara in MRI. AJNR to artifacts on MRI [25]. In some cases, as indicated by Weiss et al. Am J Neuroradiol 1985;6:652. [3], artifacts caused by eye makeup may mimic ocular disease such [5] Sacco D, Steiger DA, Bellon EM, Coleman PE, Haacke EM. Artifacts caused by cosmetics in MR imaging of the head. Am J Roentgenol 1987;148:1001-4. as ciliary body melanoma or cyst. Accordingly, a patient undergoing [6] Hargreaves BA, Worters PW, Pauly KB, Pauly JM, Kock KM, Gold GE. Metal- assessment of ocular or orbital regions should remove all forms of induced artifacts in MRI. AJR Am J Roentgenol 2011;197:547-55. eye makeup (eyeliner, mascara, and eye shadow) to prevent im- [7] Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices: 2012 Edition. Los Angeles: Biomedical Research Publishing Group; pairing the diagnostic use of MRI [25,12]. 2012. [8] Shellock FG, Bedwinek A, Oliver-Allen M, Wilson SF. Assessment of MRI issues for 4.3. Miscellaneous cosmetics a 3-Tesla immune programmable CSF shunt valve. AJNR Am J Neuroradiol 2011;197:202-7. [9] Weiland JD, Faraji B, Greenberg RJ, Humayun MS, Shellock FG. Assessment of For the miscellaneous cosmetics, only the hair loss concealer MRI issues for the Argus II retinal prosthesis. Magn Reson Imaging 2012;30: produced an artifact, which was scored as very large in relation to the 382-9. [10] Shellock FG, Valencerina S. In vitro evaluation of MR imaging issues at 3-T for size of the sample that was evaluated (Fig. 3). This unexpectedly aneurysm clips made from MP35N: ndings and information applied to 155 substantial artifact (probably related to the ingredients, iron di- additional aneurysm clips. AJNR Am J Neuroradiol 2010;31:615-9. oxides) could compromise an MRI procedure involving the brain [11] American Society for Testing and Materials (ASTM) International Designation: due to the depth of the associated signal loss. While it would F2119-07, Standard Test Method for Evaluation of MR Image Artifacts from Passive Implants. ASTM International, West Conshohocken, PA 2007. be benecial to identify a patient using this hair loss concealer [12] Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document for safe MR practices: before performing MRI of the brain, such a patient would un- 2007. AJR Am J Roentgenol 2007;188:1447-74.

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