If you’ve ever been on an email mailing list for the ACR, then you’ve probably received a few of these in the last few months… emails imploring you to contact your Senators and Representatives to urge them to support the Diagnostic Imaging Services Access Protection Act (HR 3269). So far I’ve received three or four of them, and for the ones I’d received previously, I replied, agreeing to contact my elected officials on their behalf, but on one condition…
Ambivalence is rampant with respect to MRI safety. “It hasn’t happened to us (so therefore the risk is just theoretical)”, or “MRI is the safe modality”, or “our last license or accreditation surveyor didn’t say anything, so we must be good.” In large part, I understand this let-sleeping-dogs-lie attitude (I don’t agree with it, but I can understand where it comes from). What I can’t abide, however, is hypocrisy with regard to MRI safety as typified by one entity’s ‘we’re the greatest thing for MRI safety since sliced bread’ PR.
Yes, I’m talking about the ACR…
Ironically, those two words – so similar on the surface – often turn out to be antonyms. Today I’m going to attempt to provide you with some transparency relative to a recent disappearance here on this site.
One can only presume that this is the commentary that US States and radiology accreditation agencies have to offer on the contemporary state of MRI safety. After all, there’s been nothing more than navel-gazing when it comes to measurable changes in standards for MRI providers. Let’s break it down…
I’m not big on New Years’ resolutions. In fact, I’ve previously resolved to not resolve… but today I’m breaking that vow (or would that be a ‘disavow’?). This year there are just too many things precariously poised — that could fall our way or not — that I can’t help but to resolve to rededicate myself to making substantive changes to industry standards and practices for MR safety, and here’s how I’m going to do it…
This past weekend I was invited to present the findings of a study I did with my friend and colleague, Emanuel Kanal. Among his many accolades and credentials, Manny Kanal is the Chair of the ACR MR Safety Committee, a fellow of the ACR and ISMRM, and a neuroradiologist at the University of Pittsburgh Medical Center. The study had a two-part mission, first to review and categorize 18 months of the FDA’s MRI accident data, and second to compare each of these adverse events against existing best-practice standards for MRI safety. The results of the analysis were both stunning, and disheartening…
This, in essence, is the entirety of point-of-care safety standards for MRI.
“Hey, you, MR technologist! Make sure you know what you’re supposed to know to keep people safe around MRI.“
Make no mistake, as someone who spent a decade in college (which included a Masters degree and about half of a 2nd Bachelors), I’m a huge fan of education. What I’m adamantly opposed to – when it comes to MRI safety – is education without any standards or benchmarks, which is precisely where we find ourselves today.
Here we sit, on the cusp of mandatory accreditation for ‘Advanced Imaging’ modalities at outpatient providers (these are CT, MRI and PET), and a series of articles on medical radiation exposure splashes across the New York Times.
In nearly concurrent moves, the Joint Commission (JC) unveils their just-developed Advanced Imaging (AI) accreditation program, the FDA is clamoring for new authority to regulate medical device safety (or gearing-up to use authority that it’s been hiding for safe-keeping, that isn’t exactly clear to me), the US Congress whips together a set of hearings on the issue, and, at those hearings, the American College of Radiology (ACR) recommends that the Feds expand the scope of the AI accreditation requirement to include radiation therapy and to apply the expanded accreditation requirements to hospitals, too.
Whew, that’s a lot of ground covered for radiology in just the last few weeks! Wait a minute… who is that sitting in the backseat? Who has been drug through all of the hullabaloo about radiation exposure and patient safety without once having been considered, individually? MRI, that’s who.
A few weeks ago the announcements came down, CMS had ‘deemed’ three organizations to accredit the new classification of Advanced Imaging in order to be eligible for Medicare & Medicaid reimbursement: the American College of Radiology (ACR), the Intersocietal Commission, and the Joint Commission (TJC).
The other two have had modality-specific accreditation programs for years, so what was the TJC going to do? Well, they’ve released their accreditation criteria, and one of the most wonderful surprises is that MRI safety is more prominent than it is in either of the other two ‘imaging’ accrediting bodies!
And what’s even more alarming is that 20% of those implant patients that get MRIs experience some sort of device malfunction afterward! And yet, the dangers of imaging these patients are not well known by the doctors who prescribe these imaging studies.