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.

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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.

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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.

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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.

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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.

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Possible injury to the patient or staff.

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Possible damage to the MRI scanner.

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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.

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All ancillary staff entering the MRI Scanner must verbally be screened by the MRI technologist.

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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.

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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!

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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