“Hey! You got your chocolate in my peanut butter…”
I mean really, what could MRI accidents have to do with unprotected sex? Well, apart from the MR coital anatomic imaging (honestly, I couldn’t make this up), I mean this as an allegory…
Work with me now. Were someone to have unprotected sex and have the good fortune to not wind up with a sexually-transmitted disease or unintended pregnancy, there are three possible responses that might be typical…
One: “Oh man, what are you so worried about… you know you can only get AIDS from hemophiliac IV drug users in sub-Saharan Africa… and we were clearly smack-dab in the middle of the Sahara. Dude, you are so harshing my mellow. That kind of bad stuff would never happen to me.”
Two: “Did I really just take that kind of risk!? I mean, I could have just messed everything up! I really dodged a bullet and I’m going to make sure that I never – and I mean never – put us in that kind of jeopardy again!”
Three: “Jeesh, all that risk stuff is all just conspiracy theory-hype, only spouted by public-health wackos as cover for a repressive puritanical social agenda. I’ve done exactly the same thing as last night at least 10 times before and nothing bad has ever come of it. That proves that it’s not unsafe. Oh, by the way, I’ve been invited to this wild party in a hemophiliac commune of recovering IV drug users in sub-Saharan Africa. They don’t get out much so it’ll be crazy. Wanna come with me?”
If we distill the first and the last, they are (1) yeah, bad things happen, but they couldn’t happen here, and (3) I know that the risks are overblown because I’ve done stupid things and nothing bad has [yet] happened as a consequence.
Clearly, you can guess that the middle option, above, of thanking your lucky stars and mending your errant ways (should you even have errant ways) is what I would hope would happen, but the bookending options are, unfortunately, the more common responses to MRI safety.
I have a smoke alarm in my house (actually, I’ve got several plus carbon monoxide detectors), but I’d never be foolish enough to point at one as a demonstration that there could never be a fire. At many facilities I’ve heard phrases such as “oh, ____ could never happen here because we have ______” in response to the multitude of risks, as if the steel oxygen cylinder in the control room cares one whit about the paragraph in the procedure manual that says all cylinders must be verified before being brought into the magnet room.
The ‘it couldn’t happen here’ mindset is perhaps the most dangerous threat in all of MRI. It probably means that way too much faith has been placed in easily-foiled safety mechanisms and that other, pervasive risks haven’t been adequately addressed.
The other thing that is often heard in MRI is the rationale of “I had an MRI at [insert name of competitor] last year and they didn’t have a problem with my implant / shrapnel / dubious medical history.” If you’ve ever acquiesced to this kind of pressure before, consider the patient who, after getting the MR that the Technologist was reluctant to approve, said, “Man, that was a lot louder and longer than my last exam. That last one didn’t make that banging noise, and the tube was so short it was more like a ring, and it only made a soft whirring / spinning noise. And my wife, they made her wear a silly apron when she wanted to sit next to me.”
And even if the patient did get a prior MR instead of a CT, do you really want to vouch for the effectiveness of the other Tech’s thoroughness in screening that patient? Do you really want to assume best-case scenario for everything that has happened to that patient since the prior MR? And do you want to assume that the MR conditions of whatever that prior exam were are going to be equal or less to the risks presented by your intended exam? If the other imaging provider did such a good job of screening and imaging the patient before, why are they at your doorstep today?
At some level, unprotected sex, a failure to follow MRI safe practices, and roulette are all the same: they’re all functions of probability, just with different stakes. The odds aren’t less simply because you’ve not ever seen a ’00′ come up on the roulette wheel… they are what they are. As long as you’re in the MRI game, you can’t eliminate possibility of an accident, you can only reduce it. If you really want to more effectively prevent accidents, anticipate the multiple pathways that they can take and build barriers at each. And lastly, don’t be lulled into a false sense of security simply because prior acts of ignorance didn’t immediately come back to bite you in the butt.Tobias Gilk, President & MRI Safety Director Mednovus, Inc. Tobias.Gilk@Mednovus.com www.MEDNOVUS.com