The Firing Line Forums - View Single Post - Long term lead shot vs steel shot in tissue?

Odd Job · September 15, 2009, 05:58 PM

Lead from bullets can be dissolved by synovial fluid in the body. This means that if the lead shot, bullet or fragment thereof is anywhere in a joint or an intervertebral disc, then plumbism can occur (lead poisoning). The effects may only be evident years later.

Any steel projectile is a ferrous hazard for MRI. Lead and steel shotgun pellets can usually be identified on X-ray because the steel ones are less prone to deformation and fragmentation. The likelihood is that a guy with multiple steel shotgun pellets in his body, will be refused an MRI on safety grounds.
If it is one or two steel pellets or a single unknown bullet or fragment thereof in a non-critical area, the radiographers might try advancing the patient slowly into the bore of the MRI scanner and asking the patient if there are any unusual sensations such as pulling in that area. It might well be that a guy with an embedded steel pellet in the thigh may still be able to have his brain MRI if there is no untoward motion of that foreign body.

I doubt that rusting pellets are an issue. If ferrous foreign bodies were prone to causing rust-related injuries to patients we would have found this out a long time ago with common workshop and vehicle-related injuries.

In terms of infection, you have the same chance of being infected by a steel or a lead projectile. Projectiles are not rendered sterile after firing, and bacteria have been successfully cultured from the surfaces of fired bullets. Generally the surgeons won't go for a retrieval of a projectile at the time of surgery unless they happen to find it during their work. Only if the projectile poses a mechanical hazard they may make it a priority to retrieve, eg if it is in a joint or has occluded a vessel. If it can't be proved that the projectile is not lead and the projectile has access to synovial fluid, they will probably go for a retrieval to prevent plumbism. This should be the action taken even if the bullet appears to have a smooth outline (appears to have an intact jacket) because you cannot tell if the base is exposed lead, and indeed the X-rays cannot be used to prove that the jacket is intact all the way around the surface of the bullet.

Bullets with lead cores constitute ferrous hazards if there is mild steel in the jacket. Radiologically, torn jacket fragments cannot be identified / excluded as being ferrous on the X-ray image. A piece of jacketing left in the wound must be assumed to be a ferrous hazard (even if no core is found, or a lead core is found in the clothing).

Lastly, all jacket fragments are sharps hazards, and care must be taken during surgery not to rummage in the patient's insides carelessly if jacketing is known to be in the area.

September 15, 2009, 05:58 PM	#7
Odd Job Senior Member Join Date: January 2, 2006 Location: London (ex SA) Posts: 476	Lead from bullets can be dissolved by synovial fluid in the body. This means that if the lead shot, bullet or fragment thereof is anywhere in a joint or an intervertebral disc, then plumbism can occur (lead poisoning). The effects may only be evident years later. Any steel projectile is a ferrous hazard for MRI. Lead and steel shotgun pellets can usually be identified on X-ray because the steel ones are less prone to deformation and fragmentation. The likelihood is that a guy with multiple steel shotgun pellets in his body, will be refused an MRI on safety grounds. If it is one or two steel pellets or a single unknown bullet or fragment thereof in a non-critical area, the radiographers might try advancing the patient slowly into the bore of the MRI scanner and asking the patient if there are any unusual sensations such as pulling in that area. It might well be that a guy with an embedded steel pellet in the thigh may still be able to have his brain MRI if there is no untoward motion of that foreign body. I doubt that rusting pellets are an issue. If ferrous foreign bodies were prone to causing rust-related injuries to patients we would have found this out a long time ago with common workshop and vehicle-related injuries. In terms of infection, you have the same chance of being infected by a steel or a lead projectile. Projectiles are not rendered sterile after firing, and bacteria have been successfully cultured from the surfaces of fired bullets. Generally the surgeons won't go for a retrieval of a projectile at the time of surgery unless they happen to find it during their work. Only if the projectile poses a mechanical hazard they may make it a priority to retrieve, eg if it is in a joint or has occluded a vessel. If it can't be proved that the projectile is not lead and the projectile has access to synovial fluid, they will probably go for a retrieval to prevent plumbism. This should be the action taken even if the bullet appears to have a smooth outline (appears to have an intact jacket) because you cannot tell if the base is exposed lead, and indeed the X-rays cannot be used to prove that the jacket is intact all the way around the surface of the bullet. Bullets with lead cores constitute ferrous hazards if there is mild steel in the jacket. Radiologically, torn jacket fragments cannot be identified / excluded as being ferrous on the X-ray image. A piece of jacketing left in the wound must be assumed to be a ferrous hazard (even if no core is found, or a lead core is found in the clothing). Lastly, all jacket fragments are sharps hazards, and care must be taken during surgery not to rummage in the patient's insides carelessly if jacketing is known to be in the area.