I’m not prepared to break out into song with ‘Hakuna Matata’ (at least, not yet), but the circular nature of things in life is unmistakable: ironically, the path that my commitment to MRI safety has taken has also produced the unintended consequence of getting me ‘uninvited’ from the ACR’s MR Safety committee.
Let’s look at the circular path it took to arrive here…
- In 2002, when the first ACR ‘White Paper on MR Safety’ came out, I was an architect working on an MRI suite renovation and wound up calling Dr. Kanal several times to try and better understand the 4-zone concept.
- I gave him enough grief about the importance of architectural design, that he incorporated a few of my suggestions (and a big disclaimer about seeking knowledgeable design professionals) in the 2004 edition of the ‘White Paper.’
- During this time, as an architect I became more and more involved in what designers could do to build suites that enhanced safety, and became an ardent supporter of ferromagnetic detection technologies as a part of enhanced MRI safety.
- In 2006, at the request of Dr. Kanal, I was invited to serve on the ACR’s MR Safety committee, where I helped with the addition of what became the MRI safety facility design appendix and was a co-author for the 2007 ‘Guidance Document.’
- In 2008, my experiences and commitment to MRI safety led me to join Mednovus, a company that manufactures and sells ferromagnetic detection systems for pre-MRI screening. I had long-since endorsed the technology and working for Mednovus afforded me the opportunity to work full time on the safety issues that gratified me so much.
- In 2009, Dr. Kanal invited me to again serve the ACR MR Safety committee for a scheduled 2010 revision, during the process of which I disclosed any and all potential conflicts. It was determined by the ACR, based on the fact that Mednovus cited the ACR’s endorsement of ferromagnetic detectors in marketing materials, that there was too much of a potential perception of conflict, and the ACR exercised its veto power for my appointment to the MR Safety committee.
I fully understand the necessity of the ACR to protect both the organization, and the work that it publishes, against diminished importance because of the appearance of personal bias. I find it a little ironic, however, in light of the ACR’s published statement disavowing the institutional weight of this committee’s work (appearing in a letter alongside the original publication of the 2007 ‘Guidance Document).
When I got the ‘Dear John’ letter, I was upset. I briefly thought to fight the decision. Though ultimately I think I saw the issue from something close to the ACR’s perspective, and understood their decision.
So, now off of the committee, I have no voice in MRI safety, right?
The ACR MR Safety committee will again accept comments from the professional community, and I’ve got a raft of them, waiting for the appropriate time. I also have friends on the committee and, thought I can’t argue my points in person, I’m certain that my suggestions will get a fair hearing. That’s all I would have been assured had I been on the committee.
There are also uses for ferromagnetic detection which I think are justified and wise that I wouldn’t have put forward as a member of the committee out of a concern that the ideas would have been perceived as having selfish motivation. Just like all of the legacy MR-dangerous implants and devices, even when 4-zone becomes a requirement for new MRI suites, how do we provide protections for those patients and staff when the MR room door opens into the public corridor? Ferromagnetic detection? Yes, I think so.
I also believe that, as an architect serving on a committee of the radiology professional association, my ‘insider’ status wasn’t nearly what it was cracked-up to be. Perhaps my greatest asset with respect to the work I can do in MR safety is the fact that I am, to a large degree, an outsider. I’m not beholden to Radiology, an MRI scanner manufacturer, Technologists, the FDA or any of the players that have been linchpins in our MR safety culture in the last 30 years.
Do I wish I was still on the committee? Yes, today I do. I am terribly proud of the honor and opportunity I was given to help shape the industry’s standard of care for MRI safety. I would gladly continue to serve the committee, but I’m realizing that not being on the committee has its benefits, too.
Breaking up is hard, but there are changes that I can help effect independent of my role on the ACR committee. I won’t tip my hand just yet, but there are a number of alphabet soup-named organizations that I am working with / on to bring about greater change for the benefit of the MRI profession.Tobias Gilk, President & MRI Safety Director Mednovus, Inc. Tobias.Gilk@Mednovus.com www.MEDNOVUS.com