Let’s Start With Reviewing What An MRI Is.
MRI stands for Magnetic Resonance Imaging. It is a medical imaging technique that utilizes strong magnetic fields, radio waves, and computer technology to generate detailed images of the body’s interior. MRIs are non-invasive: no surgery or cutting is involved, and no ionizing radiation is used, unlike X-rays and CT scans. The high-resolution images are especially useful for soft tissues, such as the brain, muscle, and organs. That being said, some of the common uses for an MRI are diagnosing brain and spinal cord conditions, detecting tumors and cancers, evaluating joint injuries, monitoring heart and blood vessel health, and examining internal organs (e.g., liver, kidneys, uterus).
Considering the recent adverse MRI events that have been in the newspapers, it is essential to remember that an MRI can cause injury and death if safety principles are not put in place and followed. Here are general safety guidelines to follow when working with an MRI to prevent harm to patients, staff, and visitors.
General Safety Principles
- MRI uses strong magnetic fields and radio waves. All metallic objects must be removed before entering the scan room.
- Patients must be screened for implants, devices, or foreign bodies that may pose a risk in the magnetic field.
MR Safety Zones
MRI safety zones are a standardized system used to control access and ensure safety around MRI scanners. These zones are defined by the American College of Radiology (ACR) and help prevent accidents involving the powerful magnetic field.
- Zone I – General Public Area
- Access: Unrestricted.
- Who: Anyone can enter—patients, visitors, staff.
- Location: Outside the MRI environment (e.g., hospital lobby, waiting rooms).
- Purpose: No magnetic field exposure; no special precautions needed.
- Zone II – Controlled Access Area
- Access: Supervised by MRI personnel.
- Who: Patients are greeted, screened, and prepared here.
- Location: Transition area between public and restricted zones.
- Purpose: Initial safety screening for implants, metal, or contraindications.
- Zone III – Restricted Access Area
- Access: Strictly controlled; only trained MRI personnel and screened individuals allowed.
- Who: MRI technologists, cleared patients, and staff.
- Location: Close to the MRI scanner room.
- Risks: Exposure to fringe magnetic fields; ferromagnetic objects can become projectiles.
- Security: Locked doors, badge access, or intercom systems are common.
- Zone IV – MRI Scanner Room
- Access: Most restricted.
- Who: Only fully screened and approved individuals.
- Location: Contains the active MRI magnet.
- Risks: Highest—strong magnetic field is always on.
- Precautions: No metal objects, emergency protocols in place (e.g., quench button).
Personnel Classification
The American College of Radiology (ACR) classifies MRI personnel into specific roles to ensure safety and accountability within the MRI environment. These roles are part of a structured safety framework outlined in the ACR Manual on MR Safety. These classifications help ensure that only properly trained individuals interact with the MRI environment, reducing the risk of accidents and improving patient safety.
MR Medical Director (MRMD)
- Role: Oversees the entire MRI safety program.
- Responsibilities:
- Approves safety policies and procedures.
- Ensures compliance with safety standards.
- Makes final decisions on safety-related issues (e.g., implant scanning).
- Qualifications: Typically a radiologist or physician with MRI expertise.
MR Safety Officer (MRSO)
- Role: Operational lead for MRI safety.
- Responsibilities:
- Implements safety protocols.
- Conducts staff training and education.
- Manages incident reporting and investigations.
- Qualifications: Often an MRI technologist or physicist with formal safety training.
MR Safety Expert (MRSE)
- Role: Provides technical and scientific guidance.
- Responsibilities:
- Advises on complex safety issues (e.g., device compatibility).
- Supports MRMD and MRSO with evidence-based recommendations.
- Qualifications: Typically a medical physicist or engineer with advanced MRI safety knowledge.
RI staff are also categorized based on their level of safety training:
Level 1 Personnel
- Definition: Individuals who have received basic MRI safety training.
- Examples: Receptionists, transport staff, housekeeping.
- Access: May enter Zone III under supervision but not Zone IV.
Level 2 Personnel
- Definition: Individuals with advanced MRI safety training.
- Examples: MRI technologists, radiologists, MRSOs.
- Access: Authorized to independently enter Zones III and IV.
Screening Protocols
- All patients and accompanying individuals must complete a comprehensive MR safety screening form.
- Screening includes questions about pacemakers, aneurysm clips, cochlear implants, and prior surgeries.
Emergency Procedures
- Quench button should only be used in life-threatening emergencies due to risk of asphyxiation and frostbite.
- In case of fire, evacuate the patient and call for emergency support—do not bring ferromagnetic equipment into Zone IV. All equipment must be MRI safe per the manufacturer’s instructions.
Contrast Agent Safety
- Gadolinium-based contrast agents are generally safe but require renal function screening to avoid nephrogenic systemic fibrosis.
What Patients Should Know To Prevent An Adverse Event From Happening
Before the Scan
- Screening is essential: Inform your healthcare provider about any implants (e.g., pacemakers, cochlear implants, metal clips), prior surgeries, or metal in your body.
- Remove all metal: Jewelry, watches, hairpins, and clothing with metallic threads or fasteners must be removed.
- Disclose medical conditions: Let staff know if you have kidney issues, are pregnant, or have allergies to contrast agents.
During the Scan
- Expect loud noises: You’ll hear knocking or buzzing sounds—ear protection will be provided.
- Stay still: Movement can blur images and may require a repeat scan.
- Communicate: You’ll have a call button to alert staff if you feel uncomfortable.
If Contrast Is Used
- Gadolinium-based contrast may be injected to enhance images.
- Tell staff if you’ve had reactions to contrast agents before or have kidney problems.
What to Avoid
- Entering the MRI room with metal: Even small items like pens or coins can become dangerous projectiles.
- Wearing makeup or lotions: Some contain metallic particles that can heat up during the scan.
In summary
MRI Safety is essential in preventing adverse events from happening. Policies and protocols must be adhered to, and continuing education must be provided to anyone entering the MRI Suite. Anyone entering the MRI Suite should be scanned and only patients allowed in the scanning area.
References
For questions or to learn more contact the C&A team at 704-573-4535 or email us at info@courtemanche-assocs.com.
