MRI Suite safety is not what an organization has, but what an organization does.

According to published data, there are approximately 20 – 30 million MRIs performed each year in the United States. Continually addressing the potential hazards of the MR procedure is critical to ensuring the safety of patients and staff alike.

Many different factors can affect the safety in an MRI suite – equipment, policies, etc. – but this month, we are focusing on the best ways to make your patients “MR Safe” before their procedures.

Zone Defense

The American College of Radiology (ACR) recommends dividing the MRI suite and screening process into 4 zones. The higher the zone number, the closer the patient is to the magnet. Based on the patient’s proximity to the MRI machine, the guidelines spell out which activities can be safely performed in that zone:

Zone 1: This includes all areas accessible to the general public (example: the hallway outside the MR department). This zone is a great first place to alert patients, personnel and staff that they are entering an MR zone.

Zone 2: There are typically two areas in Zone 2 – the reception area of the MR suite and the patient holding/exam area. At this point, patients and staff are under the supervision of MR personnel and are not permitted to roam freely. Zone 2 is where the patient interview and screening is conducted.

Zone 3: Zone 3 is typically the control room of the MR suite, and everyone needs to have been pre-screened to enter this area. Any ferromagnetic object or undetected implanted device may cause serious injury or death because of its close proximity to the magnet.

Zone 4: This area is usually the MR scanner room itself. It should be clearly marked as being potentially hazardous due to the presence of the strong magnetic fields, usually with a red light and signage saying “Magnet is Always On.” Anyone entering this area will be under constant direct supervision of trained MR personnel.

Before your patient even steps foot in the MRI suite, it’s best to identify and review the zones of magnetic strength around your area. In recent years, the demand for space is forcing facilities to place MRI systems in smaller spaces, thereby extending the reach of the magnet further into zones that, on paper, should not be affected by the magnet.

Your organization will have specific policies pertaining to the layout and access to your particular MR suite. Be sure to consult these policies on a regular basis to ensure your MR suite is meeting required standards.

Getting to Know You…

The patient interview and screening process is a thorough, and sometimes embarrasing, step before an MRI procedure. Here are some tips to get the information you need to ensure the safety of you and your patient.

• First and foremost, establish a good rapport with your patient. The more comfortable they are with you, the more information they will be willing to divulge.
• Patients are typically required to answer a multi-page questionnaire to determine if anything could impede the MRI scan or harm them. Although extremely important, the length of the document can be cumbersome, causing patients to incorrectly or inadequately answer questions. Take time to sit with the patient and review the completed questionnaire to clear up ambiguity and confirm answers.
• Have your department develop a “script” to get information that the questionnaire may not ask. For example, the screening form may ask if the patient has had any eye injuries from metallic shavings, a follow-up question could inquire about their lines of work. They may come in contact with shavings (tool and die work), but have never been injured.
• The face-to-face interview and ferromagnetic wand screening may be awkward for the patient. Devices such as “house arrest” ankle bracelets, body piercings and contraceptive devices may not be suitable for polite conversation, but can cause serious injury if it makes its way through to the MRI suite.
• Stumped as to how to easily work it into the conversation or screening? Injecting a bit of humor or light conversation during the process may put your patient at ease. Or, consult colleagues with more experience to learn what works best for them.
• As a courtesy, give your patient a heads up as to what to expect during the procedure. The small size of the bore, the loud knocking noise during the procedure, and the length of time they’ll be in the machine are all good things to go over.

It’s What’s Inside That Counts

Now that you’ve screened the patient properly, how can you tell if their implants or devices are MR safe?

The MRI safety status of medical implant devices can be much like searching for a needle in a haystack. Many manufacturers re-name their companies, sell their devices to other companies or discontinue their implant devices. To keep up with the ever-changing manufacturer landscape, there are valuable resources for professionals.

A good place to start is the internet. Simply type in “MRI Safe implants” in any search engine and you’ll come up with a multitude of websites that list devices and implants and their MRI safe properties. Some are paid/subscription sites, some are free. Typically, the paid sites will give you some value-added services, such as contacting the manufacturer directly with your question or researching unlisted devices for you.

Printed guides are available as well. They usually contain contact information for implant or device manufacturers, so you can contact them directly. Many guides are updated annually, but keep in mind that you may not have the most recent information on that particular device. Your best bet is to contact the manufacturer directly for the most up-to-date information.

Again, this is just one aspect of the multitude of precautions you’ll need to consider to ensure your environment is MR Safe. Consult your organizational guidelines to ensure your MR suite is meeting required safety standards.

Be sure to contact Cone Instruments for all your MRI Safe equipment needs, including: MRI procedure accessories, MRI-safe furniture, and patient transfer/transport supplies.

Sources:

American College of Radiology Guidance Document for MR Safe Practices: 2007, AJR:188, June 2007

Turner, B, Safety for the MRI Suite of the Future, September 2007

Preventing Accidents and Injuries in the MRI Suite, The Joint Commission, Issue 38, February 14, 2008