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.

Bill

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

Kristan Square

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.

Dr Kanal BW

“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.

Josh Posh

“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.

Mark Keene

“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.

Toby Gilk

“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.

Vera Kimbrell

“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.

Register for our next MRI safety webinar

Jan 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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