MRI Safety 2015 Annual Staff Mandatory Training

MRI Safety • The MRI environment presents new safety concerns that you might not be familiar with. One must be constantly aware of their surroundings and all activities that take place in the department. Awareness is not only vital to the patient’s safety, but also for the safety of fellow staff members who may not be fully trained in MRI safety.

Course Objectives Upon completion of this course participants will be able to: • Identify potential hazards that exists in the MRI environment • Understand the aspects of MRI screening and the potential hazards • Discuss general characteristics of the magnet • Identify the zones areas, their approved occupants, and hazards • Explain emergency departmental protocols specific to the MRI suite • Discuss the most recent updates to ACR MRI safety standards

What You Need to Know About Magnet • The biggest and most important component in an MRI system is the magnet. The magnet in an MRI system is rated using a unit of measure known as a Tesla. Another unit of measure commonly used with magnets is the gauss • (1Tesla = 10,000 gauss). • The magnet in use today in MRI are in the 0.5-Tesla to 3.0 Tesla range or 5,000 to 30,000 gauss.

What You Need to Know About Magnet • Because of the power of these magnets the MRI suite can be a very dangerous place if strict precautions are not observed. Metal objects can become dangerous projectiles if they are taken into the scan room. For example paperclips, pens keys, scissors, hemostats, stethoscopes and any other small objects can be pulled out of pockets and off the body without warning at which point they fly toward the opening of the magnet (where the patient is placed) at very high speeds posing a threat to everyone in the room. Credit cards, bank cards and anything else with magnetic encoding will be erased by most MRI systems. • The members of the MRI staff are specially trained in MRI safety.

What You Need to Know About Magnet • Even when the control panel is dark and the scanner appears to be off the magnet is still energized. The only way to actually power down the magnet is through a process called quenching. REMEMBER: THE MAGNET IS ALWAYS ON!!!!

Quenching • This process releases the cryogens that cool the magnet into the atmosphere. This action should only take place under extreme emergency situations. The act of quenching the magnet is dangerous in itself.

Access Control • Access control is the responsibility of the MRI staff and Imaging leadership.

• Entrance to the area is controlled by: – A locking mechanism on the entrance doors to the suite – Video monitoring of any individual requesting access

Access Control • These two systems allow us to maintain a secure environment so that only those staff members or administrative personnel who have been properly screened and trained will have access to the area. These control measures also allow us to ensure that patients do not gain enter restricted zoned areas without proper screening or the presence of a staff member.

REMEMBER: THE MAGNET IS ALWAYS ON!!!!

The Zones The MRI environment is divided into 4 distinct zones with each zone being a higher risk environment then the previous one.

ZONE I Zone I Area/Hallways outside DTC104: • The MRI waiting area and any hallways outside MRI or DTC 104. No special screening and or training is required in this area.

ZONE II Zone II MRI waiting Area/ Receptionist Area • All outpatient screening is done in this area prior to the actual scan.

ZONE III Zone III MRI Holding Area • This area is considered any area beyond the restricted entrance points. This includes the holding area interior patient holding room and bathroom. It is the most dangerous area and most difficult to control. Therefore, only properly screened and trained staff members and key personnel may enter this area.

ZONE IV Zone IV Magnet Suite • Only MRI staff have access to this area. • No personnel under any circumstances shall enter this area unless they are instructed by a trained MRI staff. • Granting access to this area requires screening and supervision by a trained MRI staff.

Ferrous Materials Ferrous materials are any objects that contain a metal that is subject to a magnetic force. Some common ferrous materials found in our facility are: • • • • •

Oxygen Tanks Gurneys Cellular Phones Stethoscopes Crash Carts

• • • •

Wheelchairs IV Poles Pagers EKG Monitors

No crash carts of any kind may be taken into Zones 4. Only those objects that have been classified as being of a NON-FERROUS material may be taken into Zones 3 and 4.

WHO CANNOT ENER ZONE IV? Any patient, visitor or staff member who has ferrous or implanted material within their body, can not enter the magnet suite. Common implantables include: • Implanted Pacemaker • Aneurysm Clips • Retained foreign bodies i.e. bullet fragments or metal shavings in the eye, and others. • Left ventricular assist device (LVAD).

WHO CAN ENER THE MAGNET SUITE? • Trained MRI Staff • Properly Screened Patients

Emergency Situations If an emergency situation occurs while the patient is in the magnet suite (ZONE IV), the patient must be removed and immediately transferred to the MR holding area where the situation can be assessed. • Hands on only CPR can only be initiated in ZONE IV • No instruments, crash carts, or defibrillators are allowed in the magnet suite. The patient must be removed from the MR suite before any CPR intervention begins.

• Access will be controlled by MRI Staff on duty!!!

Other Protective Measures Ear Protection • The scanner is very loud during scanning sequences. As part of protective measures includes: – Earplugs will be supplied by the MRI department. – A call button is provided – Communication will be established by the staff at all times during the procedure

Summary • MRI safety is the responsibility of every staff member that works in the department. • Trained staff members must always be aware of their surroundings and identify any potential risk or hazards that could cause harm to patients or other staff members.

REMEMBER: THE MAGNET IS ALWAYS ON!!!!

References • •

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Kanal. E. et al. (2013). ACR guidance document on MRI safe practice. Journal of Magnetic Resonance Imaging, 37(3), 501-530. Shellock, F. (2014). Reference Manual for Magnetic Resonance Safety, Implants, and devices. Biomedical research publishing group: Los Angeles, California. Shellock, F. ( 2014). The institute for Magnetic Resonance Safety, Education and Safety: MRI Safety Guidelines. Retrieved from http://imrser.org/PaperPDFlist.asp?pgname=Guidelines. United States Food and Drug Administration (2014). Magnetic Resonance Imaging Safety. Retrieved from http://www.fda.gov/RadiationEmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/uc m200086.htm For more information please visit Patient Videos: What to expect at your MR Scan. Retrieved from http://www.acr.org/Quality-Safety/Radiology-Safety/MR-Safety

Education Development