Download Magnetic Resonance Imaging (MRI) Safety Training

MCMH
Magnetic Resonance Imaging (MRI)
Safety Training
Developed 8.14
“ Six Year-Old Patient Fatally Injured Following Tragic
Accident in Medical Center’s MRI Suite”.
Albany, September 28, 2001- The New York State Health
Department today announced that Westchester Medical
Center (WMC) in Valhalla, New York will be fined $22,000
for its failure to ensure patient safety during MRI procedures.
The State Health Department cited WMC for eleven
violations that occurred on July 27, 2001, leading to the
tragic death off a sedated six-year-old patient. The child
sustained fatal injuries after being struck in the head by a
ferrous oxygen canister that was pulled into the MRI
scanner.
New York State Dept of Health 2001
Press Release
“ Death Linked to Hospital Scan”
Melbourne, Australia- The Alfred Hospital
has announced a review of its safety
procedures after the death of a man whose
pacemaker malfunctioned during a MRI
scan. Hospital spokesman David Faktor
admitted safety procedures were not
properly followed when an elderly man
died during MRI treatment on April 1.
The Herald Sun
By Jeremy Calvert and Tanya Taylor
Thursday April 13 2000-04-13
News Corporation Melbourne Australia
“ U.S. Warns of Injuries From
Implanted Stimulators”
Washington (Reuters)- People with implanted
nerve stimulators to treat brain, spinal or
other disorders may risk comas, serious injury
or death if they undergo MRI scans, U.S.
regulators warned on Tuesday. The Food and
Drug Administration said it had received
several reports of serious injuries, including
comas and permanent neurological
impairment, in patients with the stimulators
who underwent MRIs.
Reuters Health, May 11, 2005
MCMH Goals and Objectives
Goal- This training will enable the staff to provide a safe
environment for patients and other staff who are in the
presence of the MRI scanner.
Objectives:
1.
2.
3.
4.
Describe the basic knowledge of magnetic fields
and their influence on objects near them.
Describe the importance of safety when working
around the MRI scanner.
Identify precautions that should be taken to avoid
accidents when working near the MRI scanner.
Identify precautions that should be taken when
patients have implantable devices or metallic
foreign bodies.
The MRI Magnet
Magnetic resonance imaging
(MRI) is a non-invasive, painless
medical test that helps
physicians diagnose and treat
medical conditions by providing
views of the inside of the
human body.
MR imaging uses a powerful
magnetic field, radio waves and
a computer to produce
detailed 3 dimensional pictures
of internal body structures.
The MRI Magnet continued

The MRI scanner is a large magnet
(10,000 pounds) with a
tremendously strong magnetic pull.

The magnet in the scanner creates
a force field which can affect objects
that are close to it. As you
approach the MRI scanner, the
attractive force field increases
rapidly.

This strong magnetic field can have
adverse effects on patients and staff
who are within the scanner’s
magnetic force field.
Magnetic Field Hazards

All MRI magnets have a magnetic field that
extends into the exam room.

Anyone entering the MRI scanner room will be
exposed to the magnetic attraction of the
scanner. The closer you get to the scanner, the
stronger the magnetic pull.

Any ferromagnetic object (an object that is
attracted by a magnet and which can become
magnetized itself) brought into the MRI scanner
room will become magnetized and can become a
dangerous projectile.
Magnetic Fields continued
The Missile Effect
The “missile effect” refers to the capability of the MRI
magnetic field to attract a ferromagnetic object
into the scanner with considerable force.

This can pose a significant risk to a patient in the
scanner and to anyone who is in the path of the
attracted object.
Metal objects can become dangerous projectiles if
they are taken in the scan room.
Magnetic Field Hazards
Results of the Missile Effect…
Magnetic Field Hazards continued
Results of the Missile Effect…
Magnetic Field Hazards continued
Results of the Missile Effect…
Magnetic Hazards (examples)
Ferromagnetic metal alloys usually contain iron, nickel or cobalt.
These elements are found in most metal objects.
Magnetic Field Hazards continued
Results of the Missile Effect:

Delayed patient care- it takes 4 days to
remove the object and to re-power the
scanner.

Possible injury to the patient or staff.

Possible damage to the MRI scanner.

Approximate cost due to each missile effect
incident; $250,000.
Guess What?
Our MRI Magnet is ALWAYS on!
The definition of ALWAYS:
◦ At all times; on all occasions.
◦ Throughout a long period.
◦ Evermore - Constantly – Forever
Magnetic Field Hazards continued

Displacement and heating of surgical
implants:
◦
◦
◦
◦
◦
◦
Cardiac pacemakers
Neurostimulators
Pain Control Pumps
Penile Implants
Cochlear Implants
Stents and Aneurysm Clips
Displacement and heating of these implants may
cause a life-threatening situation.
Magnetic Field Hazards continued

Electromagnetic interference with
electronic devises:
◦ Mechanically or electrically activated implants may stop
or malfunction in the presence of the MRI magnetic
field.
◦ Patients with pacemakers have died during or shortly
after MRI exams due to disruption of pacemaker
function by the MRI system.
◦ Hospital staff with pacemakers or other implanted
electronic devices could also be affected if they come
within the strong magnetic field.
Magnetic Field Hazards continued

Body Piercing Jewelry- Risks
 Discomfort or painful sensations due to possible
displacement (movement) of the jewelry.
 Patient burns due to heat generated from the
interaction between the jewelry and the
electromagnetic fields.
All patients with body piercing jewelry must be screened
for jewelry removal before they have their MRI scan!
Magnetic Field Hazards continued

Transdermal Patches
◦ Some patients wear transdermal patches for
medication delivery.
◦ Many of these patches contain aluminum foil or
other metallic components which can cause
excessive heating, leading to burns in patients
undergoing a MRI scan.
All patients with transdermal patches must be screened
for patch removal before they have their MRI scan!
Magnetic Field Hazards continued

Tattoos
◦ Many patients scheduled for a MRI scan will present
with tattoos.
◦ These tattoos will be either cosmetic or decorative and
can be located anywhere on the body.
◦ Some of these tattoos will contain ferromagnetic
material which can cause heating, swelling, or burning at
the tattoo site.
All patients with tattoos must be screened before they have
their MRI scan!
Magnetic Field Hazards continued

Pregnancy
◦ MR imaging is recognized as a beneficial diagnostic tool
to assess a wide range of diseases and conditions that
affect pregnant women and their fetuses.
◦ MR imaging in pregnant women should only be
performed in cases where the referring physician and
radiologist agree that the findings of the MRI has the
potential to change or alter the care of the mother or
fetus and that the benefit outweighs the risk.
Screening Protocols

All patients and any family members
entering the MRI Scanner must be screened
by the MRI technologist.

All ancillary staff entering the MRI Scanner
must verbally be screened by the MRI
technologist.

All patients must complete the Magnetic
Resonance Imaging Information Form
before they have a MRI scan.
MCMH Screening Forms

MCMH has a screening form available on
Forms On Line as well as a form that
pops up when ordering a MRI scan.

The following are images of the screening
forms.
Screening of Patients

Patients with Metallic Foreign Bodies:
◦ All patients with a history of injury by a metallic foreign
body must be screened and evaluated before being
placed in the magnetic field of a MRI scanner.
◦ Examples of metallic foreign bodies:






BBs
Bullets
Pellets
Shrapnel
Buckshot
Eye or body metal fragments
Screening of Patients continued

Patients with Implants:
◦ Information that must be supplied by the patient, a
family member, or by hospital staff for a patient with an
implant includes:
 Make and model of implant
 Manufacturer of implant
 Date of implant insertion
◦ Medical Alert Cards- most people who get an implant
receive a medical alert card stating whether or not the
implant is MRI compatible. These cards should be
checked by the MRI technologist.
Restrictions to Access
The Joint Commission offers the following recommendations
and strategies to health care organizations for reducing
MRI accidents and injuries.
4 Zone Concept
Zone 1: General public
 Zone 2: Unscreened MRI patients
 Zone 3: Screened MRI patients and personnel
under supervision of Level 1 or level 2 personnel.
 Zone 4: Screened MRI patients under constant,
direct supervision of level 2 trained MR personnel

MR Personnel Levels

Non-MR Personnel –
Employees who have not been trained or
screened or patients who have not been screened
to enter the MR area.
Restricted to Zone 1 & 2.
MR Personnel Levels

Level 1 MR Personnel –
Employees who have passed minimal safety
training to ensure their own safety*.
* Level 1 MR personnel may not accompany patients
into Zone 4.
MR Personnel Levels

Level 2 MR Personnel –
Employees who have had more extensive safety
training in the broader aspects of MR safety issues.
MR Personnel Level Training

Level 1 Requirements:
 Completion of this annual education module.
 Attendance at the annual skills fair to
complete the annual screening requirements.
Who Should Be Level 1 Trained?
Hospital Nursing staff (RN, LPN, CNAs)
 All members of the hospital code team.
 Maintenance/Security Staff
 Environmental Services Staff
 Radiology Staff

MR Personnel Level Training

Level 2 Requirements:
 Completion of this annual education module.
 Viewing the Philips MRI Safety video that
includes RF, Magnet and Gradient Safety
modules.
 Completion of Personal MCMH safety
Screening Form.
 Identified by the MR Medical Director as
having qualified as Level 2 MR personnel.
Who Should Be Level 2 Trained?
Attending Radiologists
 MRI Technologists
 MRI Office Staff and Assistants

MR Safety Training

All Level 1 and Level 2 MR Personnel
should be documented as having
successfully completed MR safety education.
This education must be done annually!

Level 1 and Level 2 Personnel who do not
maintain their annual education every 12
months will be considered non-MR
Personnel.
In Case You Forgot
Our MRI Magnet is ALWAYS on!
The definition of ALWAYS:
◦ At all times; on all occasions.
◦ Throughout a long period.
◦ Evermore - Constantly – Forever
Questions?

Please contact:
◦
◦
◦
◦
Dr. Brian Ewy, MR Medical Director
Jewel Brown, Medical Imaging Supervisor
Natalie Stanley, Medical Imaging Department
Roy Burlingame, MRI Department