Magnetic Resonance Imaging (MRI) is widely available throughout the world. MRI has been making headlines around the world for its dramatic accidents (1,2,3). Leaders in MRI have been working hard to formulate an effective organizational design that promotes safety. Several white papers have been written on general MRI safety that include everything from physical layout of the MRI suite to screening procedures (4,5). However, in a busy MRI department, it takes a diverse, well-educated team of people to implement safety policies effectively. Radiology nurses are increasingly performing vital roles in MRI procedures and need to become better educated on MRI safety in order to be an effective member of the team. Advances in medical technology have resulted in the increased availability and use of minimally-invasive therapies that insert implantable devices, many of which have very strict guidelines for MRI, or are high risk for movement, heating, or alteration during an MRI exam. Providing anesthesia for both children and adults is becoming more common. Plus, MRI is now being used in conjunction with therapy such as MR Guided Focused Ultrasound procedures.
Purpose:
Adverse events and accidents in the MRI environment typically happen because of failures in proper MRI safety procedures and screening, inadequate education/training, inappropriate use of equipment, and/or lack of appropriate supervision of the MRI suite. The main risks for MRI relate to the magnetic field, switching gradient fields and application of radiofrequency waves. The goal of this abstract is to help facilities set up proper MRI safety programs that will help providers utilize MRI in a safe manner for our patients and the staff working in the MRI suites. National and international safety guidelines can be implemented to provide a safety framework. An assessment of the MR safety incidents can help find sources of error in your institution and help to minimize further adverse events.
Main Teaching Points:
MR safety is essential in an MRI suite. An MR safety team is recommended and must include personnel educated in MR safety principles and be knowledgeable on how to best look up manufacturer and/or regulatory information on implantable devices, properly evaluate them for MRI scanning and in some cases modify the MRI scanning protocols to minimize patient risk (5). Annual safety training to all staff, including nurses and anesthesiologists working in the MRI suites is essential as recommended by the American College of Radiology (ACR) and The Joint Commission (TJC) (5,6). The physical environment should follow the ACR four zone system with signs, education and physical security to help prevent accidents.
MR Technologists are the final line of defense and must review paperwork and interview patients prior to the MRI exam, so it is essential that nurses communicate well with the MR techs they are working with in order to maximize patient care. MR technologists must document devices implanted inside a person and follow safety procedures specific to the device. Active implanted devices such as pacemaker and neurostimulators require additional safety features such as programming, interrogation, special monitoring, etc. as outlined by the US Food and Drug Administration (FDA). Implanted electronic devices are a growing concern as they are becoming more common. Patients with implanted electronic devices are carefully screened for MRI as they have special restrictions that must be followed for the patient to undergo an MRI safely (5,7). For example, MRI conditional pacemakers require a verification check of the pacemaker system, an ECG, special programming, constant monitoring while the patient is in the scanner by specially trained personnel, and then reprogramming and an ECG after the MRI in order to keep the patient and the device safe. Educating nurses on monitoring patients in the MRI environment help give nurses more confidence caring for patients in the MRI suite as the equipment and the physiologic readings available in MRI can vary from other patient care areas.
MRI suites must have standard procedures to ensure that non-MRI personnel be constantly supervised by MRI personnel for safety while in the MRI suite. Radiology nurses are often a part of the MR team, but nurses from the units need to be considered non-MRI personnel just as anesthesiologists are not considered MR personnel either. This distinction in roles is important because occasionally non-MRI personnel forget or simply don’t understand the safety requirements for MRI and have been known to accidently carry metallic pens, stethoscopes, pagers and other items into the MRI scanner room that could and have become projectiles. Certain objects like oxygen canisters are notorious for being potentially deadly in the MRI scanner room. Recently, at least two people worldwide have died from oxygen tank accidents (2,3).
MR safety time outs are essential prior to starting procedures (8). Nurse are well accustomed to procedural time outs and thus can be leaders in helping MRI adopt the time out as a routine part of patient care. Sedated or anesthetized patients in MRI are especially vulnerable for adverse events as they are unable to respond to sensations such as pain or heat during the MRI study. MR safety checks prior to starting these procedures is essential in preventing adverse events. Careful screening and team communication is required to keep these patients safe.
Summary:
Every MRI suite must have a safety program. A system of safety checks and documentation can help to minimize problems of missed devices and remind non-MR staff in the MRI suite about safety. Personnel from nursing, pediatric sedation, anesthesia teams and device interrogation specialists for cardiovascular support devices need MRI specific training and they must use specialized MRI anesthesia machines, medication infusion pumps, and monitoring equipment. MR safety is a team effort. Creating a safety program emphasizing communication across disciplines that provides MR safety training to all groups, minimizes risk to patients and staff.
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