MRI Safety in 2019

8 Experts share their predictions of the top trends to watch out for in 2019

MRI Safety in 2019

8 Experts share their predictions of the top trends to watch out for in 2019

What will be the key trends in MRI Safety in 2019?

Last year we asked several leading MRI safety experts to predict what they thought would be the key trends in MRI safety. Following the success of that article we’ve once again asked the experts for their predictions for 2019.

Below you’ll find their responses, published in full, which show the many and varied challenges and opportunities that those working in MRI will face in coming months. The word cloud image below shows some of the key topics mentioned:

MRI Safety word cloud image

A consistent topic raised by most contributors this year is the continued increase in demand for MRI safety education and training around the world. At Metrasens we’re committed to helping raise awareness of MRI Safety best practices. We regularly produce a range of useful resources and training materials to help achieve this, including webinars and free guides. Visit our MRI Safety Resource Center to access these.

Take a read through what the experts think but we’re also keen to hear your views. Send your predictions to us via our website or on Twitter, Facebook or LinkedIn.

This year’s contributors include:

  • Barbara Nugent
  • Bill Faulkner & Kristan Harrington
  • Dr. Emanuel Kanal
  • John Posh
  • Dr. Mark Keene
  • Tobias Gilk
  • Vera Kimbrell

The views expressed in this article are those of the individual contributors and not of Metrasens.

Barbara Nugent

“Following the 2018 tragedy, I predict the call for MRI safety education and tools to help units detect forgotten ferrous items will be greater now”

Barbara Nugent  BSc(Hons), PgC(MRI), DCR(R), MRI/CT Radiographer, MRI Safety Matters® Consultant Radiographer, Lecturer, Edinburgh, Scotland, UK

Sadly, as predicted, projectile incidents continued in 2018. The greatest MRI tragedy came early in the year as someone paid the ultimate price for human error. To lose one’s life due to entering an MRI scan room with a ferromagnetic cylinder is horrific. Such a scenario could have always been predicted though, but crucially and, agonisingly, could have always be prevented. This is not the first death our profession has witnessed due to a ferrous cylinder, although the first, as far as we know, of a hospital visitor. So why do such incidents keep happening and why are we not learning from such horror?

Ferrous MRI incidents happen. I predict again, that 2019 will be no different. In order to get safety right, we need to compensate for the human element, where every possible safety scenario and contingency must be considered and addressed. It’s only by designing MRI units well, and educating MRI staff well, that the battle for ensuring safety can start from neutral ground.

The clamour for safety education was evidenced at MRI Safety Matters® events with Dr Shellock, in 2017 and Dr Kanal, in 2018. Predicting ongoing safety education needs, means that Kanal’s MRSO/MRMD course is now coming to London. In a European first, plans to administer the qualifying exams are underway too. I predict, therefore, that we will have MRI safety-accredited individuals in the UK for the first time and that this will result in enormous benefits for MRI patients, staff and visitors alike.

Following the 2018 tragedy, I predict the call for MRI safety education and tools to help units detect forgotten ferrous items will be greater now. Knowing and learning about such a terrible accident should enable us to compensate for the human factor in all accidents and help to focus our minds to try to ensure this never happens again. It may be the only fitting memorial for the individual who was killed.

“We have seen, and continue to see increasing demand for MR safety education and training.”

Bill Faulkner & Kristan Harrington of William Faulkner & Associates, LLC

We believe this coming year will see more MR personnel looking to receive certification as an MR Safety Officer (MRSO), MR Medical Director (MRMD) or MR Safety Expert (MRSE) through the American Board of Magnetic Resonance Safety. We have seen, and continue to see increasing demand for MR safety education and training.

We have worked with several sites who have either begun to move, or have moved to a ferrous-free MR environment. We believe this trend will continue as it can be shown to greatly reduce the number of incidents and near-incidents in the MRI environment.

As more implants and devices are introduced with MR Conditional labeling, MR equipment vendors will continue to develop user interface improvements to make it simpler for MR users to maintain conditions of use. There are already some MR systems with interface options allowing the operator to enter maximum values for scan parameters such as SAR, B1+rms, Slew Rate, etc., based on the device labeling.

A recent paper published in Radiology entitled “Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates” very clearly describes the need for specific types of research and the related challenges regarding research into gadolinium retention. This area is one all of us in MRI will be watching closely in the coming year.

“Certification for MR safety practitioners has been long overdue, but is now finally here and here to stay.”

Dr. Emanuel Kanal MD, FACR, FISMRM, MRMD, MRSE, AANG

Founder and Past Chair, American Board of MR Safety (ABMRS); Developer/Author, MagnetVision™ MR Safety app; Chief, Division of Emergency Radiology and Teleradiology; Director, Magnetic Resonance Services; Professor of Radiology and Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center.

1. Certification for MR safety practitioners has been long overdue, but is now finally here and here to stay. The interest in such certification has grown internationally, and American Board of MR Safety (ABMRS) examinations are now scheduled to be administered not only in the US but in the UK and the Australia/New Zealand regions of the world.

2. The burgeoning interest in standardization in MR safety will help re-define HOW we practice in this field. With advances in AI and technological capabilities, we will see increasing roles for software assisting with clinical decision making, teaching/learning tools, and risk management assessment specific to MR safety. And as penetration of such decision support tools increases throughout our MR industry, increasing standardization in our approach to MR safety practices will de facto follow.

3. The interest in gadolinium retention and safety will continue to pressure our industry to use lowest possible doses and to ensure that gadolinium administration is required prior to its administration. 2019 may yet bring with it official acknowledgement of the role of the radiologist in affirming the administration of GBCA, no longer permitting GBCA administration to be performed solely on the request of a referring physician.

“I think social media will continue to be very important as a venue for discussing and promoting MRI safety”

John Posh R.T.(R)(MR), Metrasens’ Director of Education, MRI Safety Officer

My predictions for 2019 are:

1. The ACR has re-formed the MRI safety committee. We anticipated an updated Guidance Document in 2018 but the release has been pushed so we now anticipate something from them in Q1-2 2019. I believe that the new version will be amendment heavy with stronger language for screening and patient prep, including the recommendation for increased use of ferromagnetic detection systems, staffing (maintaining two trained staff at all times), and overall recommendations for MRI safety.

2. I see the MRI Safety Officer Accreditation continuing its steep growth trend including a larger expansion into the global market. Last year I predicted that we would see a cottage industry of review and prep courses. That prediction has come true and these entities will likely expand to include the MRSE exam in 2019.

3. I believe the Joint Commission will continue to evolve with respect to MRI Safety. While slow initially, they seem to have developed a small measure of focus and I believe that trend will continue through 2019.

4. I think social media will continue to be very important as a venue for discussing and promoting MRI safety. There are several MRI centric boards on Facebook and discussions are frequently heated debates on how the industry is responding to safety changes. The MRI Safety Board has exceeded 20,000 members which makes it the highest density of like-minded MRI professionals and industry partners on the planet.

5. I think 2019 will see a much-needed surge in MRI Safety articles and white papers focusing on Hybrid MRI systems and the newly approved (relatively speaking) 7T scanners. These resources will fill the gap that seems to exist between product launch and available safety information, outside the manufacturers Instructions for Use.

6. I see a steep uptick in the use of implanted pulse generators for a variety of neuromodulation indications. While this has been happening for a few years, I see no signs it will slow soon and will in fact expand laterally into areas where drugs have been the historical treatment of choice.

“I would like to see safety as a key criterion during the planning and design stages of facilities – in all cases”

Dr. Mark Keene Metrasens’ Chief Technology Officer

Last year I had the privilege of assisting with the safety processes surrounding the first few adoptions of clinically approved 7T scanners in the US. The projectile risks for 7T MRI systems are higher in both likelihood and potential severity than for other systems. It is an easy prediction to say that an increasing number of 7T systems will be commissioned during 2019. However, alongside this the safety that is associated with 7T needs to mature considerably. There should occur a careful consideration of labelling, training, workflow, safety device technology and processes as these will be necessarily different to 3T (and lower strength) systems in many cases.

Much of this is also common to multi-modal, inter-operative and interventional suites, that I have also been fortunate to help with. Although these use conventional strength magnets, it is the complexity of the environment that is an issue. The wider range of equipment and the more diverse staff, (in terms of job function and safety training level), leads to this extra complexity over regular clinical MRI from the safety point of view. I would therefore like to think that the safely processes surrounding these suites will also mature during 2019.

Overall for both of the above, I would like to see safety as a key criterion during the planning and design stages of such facilities – in all cases. It is better and less expensive to do this than to retro-fit safety to suites where this has not happened.

“I see 2019 as the first of several years of MRI safety silo-busting.”

Tobias Gilk M.Arch., MRSO, MRSE (MRSC™), Founding Principal, Gilk Radiology Consultants and Consultant to Metrasens

Last year I offered three predictions, two out of three of which held true. We did see a new FGI design standard for hospitals and imaging centers that clarified MR safety best practices for bricks-and-mortar. We did see large growth in the ABMRS and their MR Safety Certified™ Board Certified MRMDs, MRSOs, and MRSEs. I had also predicted that the ACR’s Guidance Document on MR Safe Practices would see a major update in 2018… that one, however, will have to wait a little longer for before it’s fully realized.

For 2019, I think we’re in store for the following…

1. I think we may see another incremental bump in MRI safety accreditation requirements. It’s been a few years since either ACR or TJC have moved to close the gap between their accreditation requirements and recognized best practices. I think it’s about time that we saw forward motion on MRI safety requirements from one or both of them.

2. I think this will be the year that we begin to coalesce, worldwide, around notions of core competencies for MR Safety Officers (MRSOs) and MR Medical Directors (MRMDs), making such role certifications even more attractive and sought after.

3. Lastly, I see 2019 as the first of several years of MRI safety silo-busting. For too long the MR system manufacturers didn’t have many conversations across interest groups with implant vendors and together with their end users, or with regulators, about what the practical MR safety struggles were. Each special interest has been somewhat blinkered from the big-picture view of MRI safety. I think a realization is settling-in that the same amount of effort would produce better results if it was applied in collaboration with other industry partners. Don’t break out the sheet music for Kumbaya just yet, but I think a new enlightened-self-interest openness to collaboration will take hold this year.

“Most sites now are turning to ferromagnetic detection systems to assist with the screening process.”

Vera Kimbrell BSRT R MR FSMRT, SMRT Safety Committee Chair

As I reviewed the contributions from last year it seems everyone was very intuitive! The MR safety teams had a very big year. We have new social media sites that link us worldwide and more workshops are available to help busy technologists and radiographers keep up with conditional information. Here’s what I think 2019 will bring:

Faster scans and shorter scan slots

As technology improves the average scan times are shrinking. We find ourselves moving at warp speed throughout the day with little time to research implants. With this kind of workload it is more important than ever to brush up those policies and ensure two methods of screening take place prior to the patient going into Zone 4. Frequent staff training and improved workflow can help us prevent accidents and scan our patients safely.

Large increase in implanted devices

We are seeing a large uptick of patients with active and passive implanted devices. Technology continues to improve and the shear number of patients who have some form of implant has grown astronomically. With that come scanning conditions that are more difficult to implement, making our lives stressful at times. Education is the key here. Regular updates and hands-on learning opportunities with our fellow technologists can improve the workflow and lessen the confusion.

Ferromagnetic Detection Systems (FMDS) as adjuncts to screening workflow

Most sites now are turning to FMDS to assist with the screening process. Patients and ancillary staff often are forgetful and these devices help us keep ferrous metal out of the scan room. Nothing can replace a verbal and written patient screening but the use of these devices has been proven to improve your ability to prevent projectile incidents. It takes a little work to set-up, make and follow policy but if implemented correctly can really save time and prevent serious accidents.

High Field and Hybrid Systems

We will see more 7T and higher systems as research pushes the envelope of what is possible in MRI. These scanners of course provide us with new safety decisions and untested devices. The bigger issue for the future however may be in hybrid workflow and niche scanners. New lower field permanent systems are going in NICU departments with markedly different safety parameters. Radiation Oncology is moving into MR with MR linear accelerators and MR simulators. These unique devices join MR PET and OR scanners in combining modalities not typically restricted to MR safety zones. A whole new frontier of safety issues is opening.

We have a lot of work in 2019 but it’s exciting and challenging work. With careful thought, good policies and proper training we can navigate the minefields of MR safely.

Read 2018's predictions here
Read 2018's predictions here

Barbara Nugent BSc(Hons), PgC (MRI), DCR(R), Radiographer, Lecturer, MRI Safety Project lead for NHS National Education for Scotland and MRI Safety Matters™ Consultant, Edinburgh, UK

My predictions for 2018 are:

1. While MRI radiographers/technologists appreciate the wonders of new technology, such as pill-sized endoscopy cameras, they need to recognise them as a huge risk to the patient undergoing an MRI scan. However, referrers are unlikely to have the appropriate education to alert radiographers to this hazard when requesting a scan. Patients will forget to tell us if they have ingested but not passed these capsules. Therefore, such wonderful electronic wizardry, designed to help, will hinder safety in an MRI unit. Education can help but humans are forgetful creatures. We need tools to detect such items.

2. That more patients will undergo permanent cosmetic surgery. However, their beauticians will be highly unlikely to know the fact that such ferrous cosmetics can potentially burn their clients if they undergo an MRI scan. MRI screening forms need to include this question.

3. That countless MRI projectile incidents will continue to occur across the globe. Each of them could be prevented from happening by a zero tolerance of ferrous items, complemented by having ferrous detection systems and minimum standards of MRI safety education.

 

Bill Faulkner & Kristan Harrington of William Faulkner & Associates, LLC

From our clients at William Faulkner & Associates, we see a trend in the desire to create an effective culture of safety in MRI. Creating this culture requires a commitment from all parties. This means that administration, radiologists, MR technologists and support personnel are committed to working together to create and maintain an effective MR safety program.

Technologists shouldn’t be the only line of defense

Although the FDA’s MAUDE database is not an accurate reflection of the number of MR safety incidents, over the last year, there were multiple projectile incidents reported. Several of these incidents resulted in staff and/or patient injuries.

It’s still not uncommon, however, to hear technologists attending our MR Safety Officer (MRSO) courses state they feel like they are alone in trying to keep the patients and staff safe. Technologists are indeed the last line of defense when it comes to MRI safety. However, significant problems exist when they are the only line of defense.

“FMDS are sometimes not effectively utilized”

There is a significant difference between simply “checking boxes” and building an effective culture of safety. For example, we have performed several MRI safety audits and risk assessments surveys in facilities with Ferromagnetic Detection Systems (FMDS) installed.

However, the FMDS are sometimes not effectively utilized. For example, if an FMD alarms constantly because the staff does not dress in a ferrous-free fashion, alarm fatigue sets in and all alarms are eventually ignored. At one facility we visited, ineffective FMD utilization had resulted in a near-fatal incident for a technologist. Since that incident, however, significant changes have been made to the sites safety practices. We hope the trend of building an effective MR safety culture continues to be proactive rather than reactive.

Increased funding for training

Over the last year, we have seen larger institutions finance extensive MR safety training for their staff. We have personally participated in several MR Safety Officer / MR Medical Director courses presented solely for the MR personnel at those institutions. One large organization, which operates and/or manages over 150 magnets nation-wide has had us provide an MRSO/MRMD course for the past 2 years in a row. We believe this is due to the growing interest in the MR safety credentialing made available through the American Board of Magnetic Resonance Safety (ABMRS).

Finally, the number of clothing items with embedded metallic fibers is increasing. It is therefore critical that all patients be changed from street clothes into MR-appropriate attire prior to an MR exam.

 

Dr. Emanuel Kanal MD, FACR, FISMRM, MRMD, MRSE, AANG

Founder and Past Chair, American Board of MR Safety (ABMRS); Developer/Author, MagnetVision™ MR Safety app; Director, Magnetic Resonance Services; Professor of Radiology and Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center.

Since roughly 2014 there has been a substantial global awakening of interest in all matters pertaining to MR safety by predominantly the practitioners of MRI, namely, MR technologists/radiographers. As a result, we will likely see the following activities in MR safety in 2018:

1. An increased focus of MR safety on the part of radiologists and perhaps even MR physicists, largely as a result of the continued increased focus and attention on this topic by MR technologists/radiographers who continue to lead the drive for professional growth and focus on this topic.

2. With the recent CMS relaxation of reimbursement criteria for cardiovascular implanted electrical devices (CIED) there will be a notable surge in requests for MR scans of patients with various CIEDs that are not labeled for MR scanning. This will generate substantial pressures on radiology personnel to accept device patients for MRI scans – personnel who are not familiar with how to do so safely. This, in turn, will further increase awareness and interest in formal MR safety education and ABMRS credentialing among US radiologists and technologists alike.

3. On a similar note, I predict that 2018 will usher in a budding international interest in formal MR safety accreditation/certification for MR radiographers, which might even awaken interest in formal MR safety education and certification among radiologists and physicists worldwide.

4. With the explosion of new implantable medical and non-medical devices and implants there will be increasing demand for standardization in approaches to implant MR safety evaluation and assessment, as well as demand for more objective analysis and assessment of risk quantification. 2018 will see the introduction of new software tools that will propel the entire MR community worldwide into more standardized approaches to risk quantification, analysis, and clinical decision making for patients with implants, devices, and foreign bodies.

5. For better AND for worse, the public’s eye has now been sharply focused on gadolinium-based contrast agent safety and the topic of retained/residual gadolinium. The recent FDA meeting on this issue, the recent well-publicized activities and lawsuit by Chuck and Gena Norris, and the recent FDA announcements regarding mandatory patient education regarding residual gadolinium promise to make 2018 a year filled with questions from our patients regarding GBCA usage, type, and dosing. This, in turn, will stimulate more formal educational efforts for at least US radiologists regarding this topic, and significant new research in this field will doubtless be forthcoming during this year.

 

Dr. Frank G. Shellock Ph.D., FACR, FISMRM, FACC, FACSM

Frank is Adjunct Clinical Professor of Radiology and Medicine at Keck School of Medicine, University of Southern California; Director for MRI Studies of Biomimetic MicroElectronic Systems at National Science Foundation, Engineering Research Center, University of Southern California; and President, Shellock R & D Services, Inc. www.MRIsafety.com

My predictions for 2018 are:

1. More active implants that are used for important therapeutic applications will receive MR Conditional labeling, including additional cardiac devices, cochlear implants, neurostimulation systems, and others.

For those active devices that currently have limited MR Conditional labeling, updated labeling will involve fewer limitations as well as the use of 3-Tesla/128-MHz MR systems for clinical MRI exams. The requirements that must be followed to ensure patient safety will continue to be unique to each particular active device, presenting further challenges for MRI Technologists/Radiographers.

2. There will be a substantial increase in the number of investigations published in peer-reviewed journals that address the important topic of gadolinium deposition. The question of whether there are adverse clinical effects related to this phenomenon will remain unanswered.

3. A growing number of MRI facilities will become attentive to the topic of MRI safety, focusing on yearly, comprehensive training, updating their policies and procedures in consideration of the latest information, and encouraging their radiologists/supervising physicians to become more engaged.

 

Greg Brown MRSO, MRSE (MRSC™), FSMRT, Researcher & Lecturer, University of South Australia

The topic that I think will dominate attention, effort and discussion in the United States, and possibly elsewhere, is managing the public’s concerns over gadolinium accumulation.

In the USA in early 2018, the action of the FDA, and the “nothing to see here” attitude of radiology will really start to clash with public information. When all patients have to be given new drug information acknowledging the biochemical accumulation of gadolinium compounds in the bone, skin, and brain tissues occurring regardless of renal function, radiologists & staff needs to be ready to answer a wave of new questions accurately.

More to the point, the edict from the FDA following September 2017’s public and scientific hearings is that each patient will be required to read the new information before they are given any GBCA. I think the implications of that course of action can be huge.

More information needed on potential harm

The FDA has recognized a potential toxicity issue, recognized the concern and possible harm to the public, recognizes the potential benefits of GBCA when used judiciously, and recognizes that more information on potential harm is needed but will take a long time to obtain.

Their response, motivated perhaps by a duty to protect the public, is to require that before a gadolinium-based contrast agent is administered, the patient is informed that all GBCA leave trace amounts of GBCA in the body of all patients for the long term, (regardless of renal function), that some agents leave a lot more in the body than other. Now there’s a conversation starter…

Need to focus on the answers

Radiology will have to be ready for all the obvious questions that will follow: “Do you have the one that leaves the least gadolinium in me?”; “Is there something else we can use?”; “How toxic is this stuff? What can I do to get the gadolinium out of me? If it’s harmless how come Chuck Noriss’s wife is suing the companies?

Radiology, and specifically Radiologists, will be judged on the answers they provide. I think a lot of conversations in 2018 will focus on what the answers will be. I hope we don’t continue to neglect the critical question that has been often passed over in the past decades: What medical benefit will this use, of this GBCA have for this patient, in this examination?

The answer to that question is the justification for the development of this class of drug. I hope that in 2018 this central justification is recognized directly and converts to practice.

Other safety issues

Scanning active implants and decisions around passive implants will continue to trouble MR practitioners. In 2018, I expect we will see the rollout of Siemens’ software to assist sites to keep scanner outputs within defined ranges. It has taken three years for any manufacturer to respond to Philips’ ScanWise, suggesting a reluctance to enter this arena.

We can expect to see the increasing prominence of RF measured in B1+ RMS on scanner consoles, and the appearance of the FPO mode. Active devices designed to work with that mode may still be a few years away.

Things I’d like to see in 2018

RF burns will continue to be the major mechanisms of injury in MRI, and sites will continue to be surprised by them. In 2018, any patient reporting heating after a scan, or the appearance of lesions must be referred to the radiologists and get some medical examination.

Hearing-related injuries will continue. The Quiet suites and SilentScan tool won’t have changed the noise exposure. In 2018, I want to see all patients receiving ear bud hearing protection, with supervised fitting and recognition that MR safety must be focused on patient and public safety in the context of medical benefits from the examinations.

I’d also like to see Radiologists stepping into the conversation about MR safety, by becoming better educated, by delegating responsibilities explicitly to well-educated staff, and by taking the central role on medical decisions and the balance of risk for benefits.

 

John Posh R.T.(R)(MR), Metrasens’ Director of Education, MRI Safety Officer

My predictions for 2018 are:

1. The ACR has re-formed the MRI safety committee and we will likely see an updated 2018 version of the ACR Guidance Document as a result. I believe that the new version will be amendment heavy with stronger language for screening, including the recommendation for increased use of ferromagnetic detection, staffing (maintaining 2 trained staff at all times), and overall recommendations for MRI safety.

2. I see the MRI Safety Officer Accreditation continuing to grow. There has been an increase in job postings specifically requesting this certification and I think that trend will increase in 2018. Additionally, I predict a cottage industry of review and prep courses to deploy in 2018.

3. I believe the Joint Commission will continue to evolve to become more granular with respect to MRI safety. There have been social media postings where they have dived down to the patient prep level to make recommendations regarding what the patients wear on their feet in the scan room. In my opinion, this portends an awakening on their part to the real dangers associated with MRI and it will be interesting to watch their reaction as the year progresses.

4. I see 2018 as a big year for the MRI Contrast industry. The European agencies are banning certain linear agents for all but limited and specialized use (intra-articular). In the US there will be a push for greater clinical review of patient need before administration as well as greater accountability for misuse. This largely stems from the recent high-profile case of Chuck Norris and his wife. That case will also cause a ripple into the radar of patients needing MRI who will be more cognizant of the fact that contrast can cause problems.

5. 2018 will be the first full year of the traveling roadshow for the ISMRM/SMRT’s Joint Safety Committee’s MRI safety Committee’s MRI Safety Day. I believe that the regional 1-day safety focused seminars will grow in popularity and that these will continue beyond 2018.

6. I think social media will continue to be very important as a venue for discussing and promoting MRI safety. There are several MRI centric boards on Facebook and discussions are frequently heated debates on how the industry is responding to safety changes.

7. I do not see 2018 as the year that the vendors do much in the way of MRI Safety initiatives. There has been some small movement by the vendors to improve safety for users of their equipment. Some vendors have been paying for customers to attend MRI Safety Certification classes and others have been developing products to help in that regard such as ScanWise from Philips. I think dedicated MRI safety inititives will continue to be a low priority for the vendors in 2018.

 

Dr. Mark Keene Metrasens’ Chief Technology Officer

Safety thinking around the increasing use of multi-modal assets, as well as inter-operable and interventional MRI, is still largely wooly without any accepted, defined or published ‘best practice.’ I believe that this year will see an increasing accident rate with such diagnostic assets. Along with this, will be progress toward defining best safety practices. Although these will have some level of commonality, there will be bespoke aspects for each type of asset.

More early adopters will install 7T magnets. A significant level increase in safety procedures around these will be required.

There seems to be a huge upsurge in imaging implanted patients. This will no doubt increase indefinitely. Data and advice for imaging assets to enable this is increasing and will take big leaps forward next year. Implant-present scanning will be conducted by increasing numbers of non-specialist facilities.

The implementation of ferromagnetic detection systems will also increase. In addition to warning people at the door, the most advanced entry control FMDS also collect and report statistical data on ferromagnetic materials entering Zone IV. This data will increasingly be used to manage the ferromagnetic safety levels in facilities, allowing controlled and measured reduction of unnecessarily ferrous material entering Zone IV.

 

Tobias Gilk M.Arch., MRSO, MRSE (MRSC™), Founding Principal, Gilk Radiology Consultants

MRI safety is now a rapidly evolving part of radiology. In just the past few years we’ve seen new safety accreditation requirements from both the Joint Commission (TJC) and the American College of Radiology (ACR). 2018 promises to bring us even more…

The ACR’s MRI Safety Committee has reconstituted and I expect that 2018 will see an updated version of the ACR Guidance Document on MR Safe Practices which will address some of the recent technical changes (hello, 7T), and changes in how MR is used, clinically (including interventional / intraoperative settings).

2018 will also see a new version of the Facilities Guidelines Institute (FGI) publication on design standards for healthcare facilities. While the clarifications on MR safety (including explicit language on the requirement for FMDS) will be limited, the structure of the design criteria for all of imaging (including MRI) will focus on patient acuity and level of intervention. It will also make clear that MRI safety standards should be applied to mobile (trailer based) settings, just as they are to permanent, brick-and-mortar, environments.

At the end of 2017 the American Board of Magnetic Resonance Safety (ABMRS) announced that they had surpassed 1,000 MR Safety Certified™ professionals. The number of certifications (for MRMD, MRSO, and MRSE) is likely to have passed a crucial ‘tipping point’ and 2018 is likely to be the year we see an explosion of individuals seeking accreditation, as well as job listings specifically requiring these credentials.

 

Vera Kimbrell BSRT R MR FSMRT, SMRT Safety Committee Chair

As we head into 2018, MR safety education has had a very good year. There are multiple seminars around the world and more hospitals are being proactive to get their staff trained. We still have a long way to go and we need to push hard to keep the momentum. Good quality education is the key to maintaining a safe MR environment for our staff and patients.

Better tools for researching implants

The implant world has exploded with so many new implants and devices that our heads spin! Most but not all have MR conditions and slowly those conditions are better written and more easily translated in “MR lingo”. The issue for sites now is the time it takes to screen, research and scan these appropriately. It’s become a full-time job in busy sites to do this work. My hope is that in 2018 we get better tools for researching implants.

MR scanners are getting “smarter” and have tools for MR safety now. Several of the manufacturers have stepped up to the plate with software that “limits” parameters, allowing us to stay within conditional guidelines. I believe this trend will continue with more companies taking this on and making their scanners with MR safety software.

High field MR safety issues

Higher field scanners are here to stay and soon to be used for clinical patients. We will see more implants tested and approved at 7 Tesla with new RF conditions. Words like Dual Transmit, Parallel transmit will become part of our lingo soon. There may be other MR safety issues with high field and we will watch and learn in the next couple years.

The push to go back and look at areas once thought to be Unsafe is gaining momentum. We may have to reevaluate our policies and learn how to scan devices that have less defined safety criteria. We need our MR MD’s to guide us thru this very stressful time when the old rules may be changing.

In general, I am very optimistic but we must never stop learning, questioning and educating. MR remains a modality that while safe for most can have fatal results.

 

Register for our next MRI safety webinar

MRI Accident Case Studies: learning from the FDA MAUDE Database

Join us at 11am CT on Wednesday 23 January for the first in a new series of webinars where MRI Safety experts John Posh and Tobias Gilk will be taking a closer look at recently reported MRI accidents to help you learn from the mistakes of others.

© 2019 Metrasens, All rights reserved.





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