Question 1
When inpatients are brought to the MRI department, who is responsible for the patient in the MRI department, if the patient is monitored or not monitored?

If the patient is being monitored, at the request or actions of the referring ward, then the responsibility for monitoring the inpatient is delegated, by the referrer, to the appropriate ward staff/anaesthetic staff/referring doctor. Only staff who are trained in monitoring should be responsible for monitoring patients. If the patient is being monitored there is the expectation that whoever is given the responsibility for monitoring would know how to react to any monitoring issues, in the best interest of the patient, and so need to be well trained in this. Some MR units may have nurses specially trained to monitor and may be given this task as they are able to respond to any such situation.

MR radiographers/technologists would ensure, during all the usual screening processes, that the monitoring equipment was, of course, MR Conditional before allowing it into the scan room but should not normally be expected to be responsible for monitoring the equipment readings. Radiographers would also ensure that any monitoring cables/wires etc. were appropriately padded and positioned on the patient to prevent any potential heating. As radiographers have the responsibility for scanning the monitored patient and supervising them while they are in the Controlled Access Area/MR unit it would be very unusual and potentially hazardous to expect the radiographer to be responsible for reading and responding to the monitoring equipment too.

Delegated monitoring staff may or may not stay in the scan room with the patient. They may be required to, depending on the circumstances, for example, if the patient needs to be closely monitored within the scan room or the patient is anxious, and having an escort ensures compliance. Radiographers are responsible for the safety of everyone in the scan room whether inpatient, outpatient, staff or escort. To expect the radiographer, to scan, read monitor equipment and react to monitoring concerns is, however, unrealistic and impractical and not in the best interest of the patient or staff.

If the inpatient is not being monitored, the inpatient should still always have a member of ward staff escorting them in the MR unit who is responsible for them while the inpatient is out of their ward.

Question 2
Do you have a policy for scanning MR Conditional ICD’s and do you have cardiology to monitor?

I can source a typical local policy for scanning implantable cardiac devices which will be posted on this website and yes, in such cases, cardiology staff monitor the patient. For implantable cardiac devices, usually a senior cardiology technician or cardiology registrar is present to monitor the ECG during the scan. For MR Conditional pacemakers, cardiology technicians are present at the start and at the end of the scan for setting/resetting the pacemaker. Trained nursing staff are also available to monitor ECG and SP02 monitoring of the patients from a general health perspective. There is always a Radiologist available for these lists too.

Question 3
Our management is trying to make MRI rotational, how can we fight against this?

You can tell management that there is evidence that non-core, rotational MRI staff potentially introduce an inherent danger when working in MRI. Such staff are often not MRI-safety focussed in the same way that core, MRI staff are. This can be due to a lack of familiarity and less automatic safety responses when working in this high-risk environment. Staff who work in MRI only, are more likely to check themselves and others more thoroughly and behave in a more MRI safety conscious manner than staff who may routinely be working elsewhere, in other modalities, such as CT. This is evidenced by the responses to the research I performed where MR radiographers stated they felt that having rotational staff through MRI made their job more difficult and dangerous at times and brought an extra risk to the department.

Question 4
Are Insulin Sensors MR Safe?

The insulin pump, transmitter, and glucose sensor must be removed prior to entering the scan room/MR Environment as they are MRUnsafe.

Question 4
Many new sports clothing items have antibacterial properties, with internal silver fibers – sports bras, underwear, etc. Have you started to having patients remove all such clothing?

Yes, if the patient is wearing this type of clothing it must be removed as the metallic fibres can burn the patient. It’s also a good idea to have such a question on the screening form and inform patients about such clothing in any departmental information.

Question 5
Should all medication patches be removed for all scans?

Yes, metallic/foil backed patches can heat up and drug patches such as fentanyl can administer an incorrect drug dose to the patient if left on during the MRI scan. Best to mention this beforehand in departmental information and the screening questionnaire so that the patient or ward staff are aware and can source additional patches, if required.

Question 6
Is it safe to scan a patient with a rectal sensor probe? If yes what needs to be done with it before scanning? Does it need to be covered or not covered; I mean wrapped. If wrapped should the probe be wrapped straight or bent?

I have no experience of this, so sorry, I cannot comment

Question 7
How should a patient walk through a full body MRI metal detector column before walking into scan room?

The correct method of using ferromagnetic detectors should be described by the manufacturer and will vary depending on the make and model and their advice should be strictly followed.

Question 8
Can you scan a patient with an implant but with no documentation of the implant?

If there is no documentation or way of identifying the implant, the patient should not be scanned as the safety of scanning the implant or the conditions under which it could be safely scanned is unknown.

Question 9
How should potential metal in eyes be dealt with?

If the patient has had a history of metal in their eye but confirms that it has been removed by a physician/ophthalmologist, then the patient may be scanned, if the patient is giving informed consent for their MRI scan. This means that the patient fully understands the implications of a potential metallic foreign object in their eyes and has confirmed that they have no metal in their eyes. If there is any question that there may be metal in the eyes, the patient’s orbits should be further examined, as per the local policy, and confirmed usually by X-ray.

Question 10
Patients are complaining that Technologists are telling them on the intercom to stop moving. They feel intimidating when they hear that. Some hospitals are insisting Techs do not tell Patients to -stop moving anymore. So what should Tech tell patients who is moving during scanning?

Patients should never feel intimidated by the technologist speaking to them over the intercom. The patient needs to know that the technologist is always available, to speak to, and to hear them. Sometimes it’s essential to remind the patient to keep still but this should always be done in a kind and calm way. Perhaps saying something like:

“I noticed you were moving a little, is there anything we can do to help to make you feel more comfortable?”

Or

“Sorry, but there was just a little bit of movement on that scan, so I just need to repeat it. I want to make this as quick a scan as possible for you, so is there anything I can do to help you to stay still?”

Often pausing the scan and going into the scan room to reassure the patient and to ask them directly if they need any more padding or anything else can help with compliance.

If management have an issue with the tech speaking to their patient, then the management culture needs to be addressed in the first instance as this is preventing the tech from doing their job. If there is evidence that speaking to the patient and asking them to keep still is causing the patient any distress, then an analysis of the intercom system, working environment and communication skills should be investigated.

Question 11
How do you address patients with dermal piercing’s, we are seeing more of this

I know that some units scan them but there is the danger that they could burn the patient because the part under, and in contact with the skin could heat up. It’s also difficult to know what the metal part under the skin is made of. As dermal piercings cannot be removed easily, or at all, without surgical intervention, caution is warranted, and a local policy should be decided upon before agreeing to scan such patients.

Question 12
Where should near misses be reported in the US?

In the first instance, report any near-miss to your local/hospital incident reporting centre, as per any incident. Your incident reporting managers are unlikely though to report near misses to an outside organisation for further analysis. You could, therefore, also report the near miss (this can be anonymous) to the FDA’s MAUDE database.

Speaker: 

Barbara NugentBarbara Nugent BSc (Hons) DCR(R) PgC (MRI)

The “Danger of Projectiles” poster, designed by Sarah-Jane Sellwood and Barbara Nugent is freely available as a pdf. Click Here to download a copy.

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