ThermaCare HeatWrap Products Contain Iron And May Be Drawn Into MRI Scanners

According to the report, this patient was not injured and the MR staff was able to successfully remove the wrap from the MRI magnet. But any time you have ferromagnetic materials flying through the air near patients and staff, there is the very real risk of injury. Not only to people, but also to a million-dollar MRI scanner!

And assuming that it didn’t go flying, if there’s enough iron in this product that there’s that possibility, there’s likely enough iron to create some significant spatial distortions in the general vicinity of the wrap. And if the little iron ‘nuggets’ were to escape the wrap material and get under the covers to the bore of the magnet, you could wind up with shim problems that require a service call to correct.

According to the ThermaCare website:

“Protected inside ThermaCare^® HeatWraps are air-activated heat discs made of heat-generating materials (iron, charcoal, table salt and water).”

We’re in the process of testing the capabilities of the SAFESCAN® ferromagnetic detectors to detect these materials and I hope to have an update for you on this very soon.

In the meantime, whether you have the SAFESCAN® ferromagnetic screening products or not, please add these types of wraps to your ‘watch list’ of potentially dangerous materials to be kept out of your MRI suites.

Click here for Tobias’ Twitter Profile

One of the most effective means of screening for external ferromagnetic materials, particularly those that may be integrated with non-ferromagnetic MR Conditional objects or devices, is through the use of a ferromagnetic only detection system.

Halo vests are just one of huge number of potential ferromagnetic threats which endanger MRI patients, visitors and staff. Effective pre-screening for these risks should include the appropriate use of ferromagnetic detection systems, and this is more than my personal opinion.

To date, the ACR, JCAHO, the Department of Veterans Affairs and many MRI safety experts have called for the use of ferromagnetic screening to help mitigate just this sort of hazard.

Halo vests are just one of the innumerable objects that can pose grave threats to patients, staff, and MRI equipment if brought within the MRI scanner room. To protect people and scanner up-time, ferromagnetic detection is a wise investment.

]]> http://mrimetaldetector.com/blog/2009/12/rsna-aapm-identify-halo-ferromagnetic-risks/feed/ 2 http://mrimetaldetector.com/blog/2009/05/is-ferromagnetic-ferrous-detection-cost-effective/ http://mrimetaldetector.com/blog/2009/05/is-ferromagnetic-ferrous-detection-cost-effective/#comments Fri, 22 May 2009 16:19:48 +0000 Tobias Gilk http://mrimetaldetector.com/blog/?p=477 In a word, ‘Yes,’ but not by the conventional ways that imaging providers are accustomed to...

Would using ferromagnetic detection (FMD), to add a new and effective layer of pre-MRI screening, be reimbursed? What I mean is, is there a CPT code to get paid back for providing this additional service?

No, but the lack of a CPT code has little to do with the fact that using FMD can contribute, directly, to an MRI provider’s bottom-line. In fact, there are two concrete ways, off of the top of my head, that I know have provided financial ‘payback’ to users of ferromagnetic detection systems.

First, the indirect. If you owned a million-dollar house on the Florida coast, don’t you think you’d spring for hurricane insurance? What if there was an insurance policy that didn’t pay you back a proportion of your loss, leaving you to start all over, but instead offered the promise of making it less likely that the hurricane would even hit you in the first place?

This is what ferromagnetic detection does… when used correctly it reduces the risks of unplanned maintenance for shim disturbances, interrupted throughput for incomplete patient screenings, downtime associated with extracting cell phones, jewelry, furniture, etc… from the bore, or worse, damage to your MRI system.

What is this preventative effect worth? Well, the Veterans Administration published their average cost for an MRI projectile accident at $43,172 per incident. This average included a number of lesser projectile accidents, such as cell phones, indicating that some of these accidents are likely into the 6-figure range. Plus, because the VA doesn’t operate on a per-procedure reimbursement rate, the $43,172 cost does not include lost patient revenue.

The published VA data does not give frequency information, so if we turn to the only peer reviewed publication that does (Chaljub, Cramer, et. al.), and extrapolate the frequency they give for only medical gas cylinder accidents and assume that the same frequency of once every 6 years applies to all projectile events, even the smaller projectiles (it would, in reality, be far more frequent), the annualized cost of projectile accidents is roughly $7,200 (this is the VA’s $43,172 cost per projectile accident, divided by the Chaljub frequency determination of 1 medical gas cylinder accident every 6 years of MRI operation).

This is a hyper-conservative number, given that it doesn’t include lost scan-time reimbursement from projectile accidents, is based on data that is approaching 10 years old (indications are that accident rates have been on a steady increase year-over-year), and doesn’t include smaller projectiles in the frequency determination. The above figure also doesn’t take into account unplanned shim-correction or lost throughput from patient re-screening. Based on expert information from a former co-director of the VA’s National Center for Patient Safety, the annualized cost of projectile accidents exceeds $20,000 per year per MRI.

Anybody who claims to be able to drive that cost to $0 is selling snake oil. Accidents will continue to happen because MRI is just too dynamic and complicated an environment to assure 100% effectiveness in managing all the variables, all the time. But what if ferromagnetic detection could help cut that cost in half? What if we could help slash that annualized cost to just 10% of what it was, would that be worthwhile?

The second way that I know of that FMD has paid for itself is through a reduction in linen costs. One of Mednovus’ clients went from requiring all outpatients to gown (at a laundry cost of about $3 per patient) to only having about 1/4 of their patients gown (who was gowned was a function of the type of exam and the degree to which the staff felt comfortable with the patient’s ability to comply with screening instructions). All patients were screened with a hand-held ferromagnetic detector. This client reduced ongoing laundry costs, reduced average patient prep time, and improved screening effectiveness.

In a way, this provider found a way to get automatic reimbursement for using ferromagnetic detection pre-screening. It isn’t a CPT code, but the savings for linen service drops to the bottom line, just as a per-procedure reimbursement would.

So if we set aside the entire question of safety for patients and staff in the MRI environment and look at ferromagnetic detection solely though a lens of cost effectiveness, smartly deployed FMD systems can have very rapid return on investment (ROI) periods, in some cases only a matter of months!

Whether you look at ferromagnetic detection systems as something of a risk-management ‘insurance policy’, or a throughput management tool, or cost-containment for laundry services, or any of the other creative and constructive ‘revenue-positive’ solutions, a serious look comes away with the assessment that, “Yes, ferromagnetic detection is cost effective.”

And this is just the financial aspect, we haven’t even touched on the safety, best practice and accreditation parts of the equation…

As far as the MRI machine is concerned, there are two different types of metal, ferromagnetic and non-ferromagnetic. You may remember back to high school chemistry and the periodic table of elements where many of us learned (and then promptly forgot) that Fe is the symbol for iron.

Fe - Iron from the Periodic Table

“Fe”, the symbol, is derived from ferrum, the Latin word for iron. Ferromagnetic does not mean that a metal contains iron, but rather that the material has magnetic properties as iron can.

Ferromagnetic metals are iron, cobalt and nickel. These raw ingredients are common in many, many things made from metal, including (likely) the steel grommets in your shoes, to the zipper in your pants, to components in your wristwatch. Another common area to find these metals is in batteries, such as those found in your hearing aid, cell phone and iPod. There are a few non-metal ferromagnetic materials, but these are not very common.

Alright, alright, already… enough chemistry. What does this mean?

When exposed to magnetic fields, ferromagnetic materials become magnets themselves. You can prove this yourself with a fridge-door magnet and a few paper clips. You’ll probably find that paper clips right out of the box aren’t capable of magnetically ‘sticking’ to one another. If you stick one to a chunky fridge-door magnet, however, that paper clip is now magnetized and will likely be able to magnetically ‘stick’ to another paper clip. The length of the magnetic chain of paper clips you can create is a function of how strong the fridge-door magnet is and the magnetic properties of the paper clip steel.

Now, the exact same thing happens with ferromagnetic metals approaching the MRI, but a crucial difference is the distance at which the materials get attracted. With your fridge-door magnet test, the paper clip needs to be touching (or very nearly so) the magnet before the attractive effects are felt. MRI’s, by virtue of the fact that they’re both 1,000′s of time stronger and larger than your fridge-door magnet, can exert profound attractive force at a good distance away from the magnet.

The size and strength of MRI magnets is so great that people have been trapped, injured, and even killed by the force of ferromagnetic objects attracted to the MRI. From concealed roller-skate tennis shoes, to steel-reinforced furniture, to conventional hospital wheelchairs and gurneys, to steel oxygen cylinders, all of these normally harmless (outside the MRI suite) items become life-threatening when subjected to the enormous pull of the MRI’s magnet.

Not all metals are ferromagnetic. In fact, in an MRI suite a concerted effort is usually made to rid the area of ferromagnetic materials and use non-ferromagnetic replacements whenever possible. Non-ferromagnetic metals include aluminum, titanium, brass, copper, and many others. These (and other) non-ferromagnetic metals can present other problems and hazards during MRI imaging, but that’s a topic for another day.

It is almost impossible to determine whether a material is ferromagnetic just by looking at it. In fact, even sometimes when you know what an object is made of, it still isn’t enough to know whether it’s ferromagnetic or not. Stainless steel, is one of these examples.

Stainless steel is not a metal, but rather a family of recipes for metal. Some stainless steel ‘recipes’ (alloys) call for ingredients with ferromagnetic properties. Others which include ferromagnetic ingredients are specially formulated to change the structure of magnetic materials into non-magnetic versions of the material. These special ‘de-magnetized’ stainless steels can become ferromagnetic if the steel is manipulated (shaped, bent, heated, or stressed), so even magnetically ‘safe’ stainless steels can become ‘unsafe’ under certain circumstances (a change that isn’t observable to the eye).

It is remarkably difficult to distinguish magnetically ‘safe’ metals from magnetically ‘unsafe’ metals, either by simply looking at them or, sometimes, even if you know what the metal is. As a result, MRI facilities must assume all metals to be magnetically unsafe unless and until they’ve been verified to be non-magnetic.

So, how do MRI facilities distinguish magnet-unsafe metals? They can use magnets, which shouldn’t be used on patients or sensitive equipment, limiting their applicability. The safer option (and arguably more effective, to boot) is to use a ferromagnetic detector, at least on patients and sensitive equipment.

Ferromagnetic detection instruments, such as the Mednovus products, should be used to help identify magnetically-unsafe materials. This is the standard established by the American College of Radiology, the VA’s MRI Design Guide, and even recommended by the Joint Commission in Sentinel Event Alert #38.

As a patient, it is vital to take seriously the admonitions against wearing or carrying metal into the MRI suite. If you have shrapnel, penetrating metal injuries (particularly in the eye), or any surgeries, implants or prosthetics, it’s critical to have the full information on each to share with your MRI provider. Metal inside the body may not fly across the MRI room like a loose oxygen cylinder (don’t believe what you see on House), but the twisting an pulling that the magnet will exert on an internal ferromagnetic object can be just as dangerous. Active implanted devices, such as pacemakers or nerve stimulators, present particular problems because of both the magnetic attraction and potential interference with the normal function of the device.

Patients should also actively seek out MRI providers that conform with the contemporary safety recommendations, including the use of ferromagnetic detection. You can even contact Mednovus when you want to find providers near you who have this technology available.

Providers of MRI services should make sure that the pre-screening and safety services they provide are in accord with the contemporary best practices, including the use of ferromagnetic detection. With available ferromagnetic detection products equal in cost to only a few hours worth of technical revenue, there’s no financial rationale for not providing this valuable safety benefit to patients and staff. Plus, when weighed against the costs of ferromagnetic object accidents, these instruments of safety are clearly effective risk-management investments.

In all cases, metal brought to the MRI suite (either inside or outside the body of the visitor) should be scrutinized by a trained MRI staff person. This investigation should be aided through the use of ferromagnetic detectors, both to help characterize the hazards of any particular object and to help find ferromagnetic materials that weren’t caught in the prior screening process.

‘Employees will be required to park in “Lot K” beginning on September 1st.’

‘The company has switched health insurance providers and you will receive your new card in the mail in 4 – 6 weeks.’

‘All persons entering the MRI scanner room must successfully clear a ferromagnetic screening.’

Except that sometimes, things that don’t appear to be in our best interests in fact are to our personal benefit, and ferromagnetic detection is one of them.

First, let’s dispel the myth that ferromagnetic detection is somehow there to ‘grade’ the screening effectiveness of the Technologist. The fact is that most of the time when ferromagnetic material makes it through the screening process it is because the person bringing it failed to comply with instructions that they’d been given!

Yes, there are differences among Technologists and some are more thorough than others, going beyond the standard screening forms. But time and time again we find that projectile accidents are compliance lapses on the part of patients, visitors, contractors, transport, housekeeping, anesthesiology and the myriad of others who come to the MRI suite.

If you had a tool to verify that patients complied with your critical safety instructions, wouldn’t you want to use it?

So, ferromagnetic detection is – first and foremost – present to make sure that patients, staff and visitors comply with the MR Technologist’s instruction. An alarm on your ferromagnetic detector should be viewed as a patient compliance issue.

Second, ferromagnetic detectors help to protect Technologists (and medical directors, and radiology administrators) from liability. The civil lawsuit resulting from the death of the young boy in a 2001 MRI accident personally names the two Technologists and the medical director for the MRI provider. Even if they aren’t found to have any individual civil liability in the trial, they’ve already had a multi-million dollar lawsuit hanging over their heads for the last 6 years or so.

While the presence of a ferromagnetic detector won’t transform an MRI provider into a guaranteed accident-free site, when used effectively these instruments can dramatically improve compliance with the Technologist’s instructions and help reduce the likelihood of future ferromagnetic projectile / missile accidents.

Maybe there’s a silver lining to having to walk the extra two blocks from the newly designated employee parking lot or switching healthcare insurance companies (then again, maybe there isn’t), but there should be no question that ferromagnetic detectors are definitely in the best interests of Technologists, radiology administrators, and MRI medical directors.