Def.  Hyperbolic:  Rhetorical exaggeration or diminishing beyond the fact; exceeding the truth; as, an hyperbolical expression.

I have this sense that some feel that virtually all talk of MRI accidents is hyperbolic, or exaggeration. To those who believe this, I say there is a truth buried in this thought, but it’s not what they may think…

Flash back to high school when I simultaneously learned the alternate definitions for hyperbole. Mrs. Mayer, my English composition teacher taught that it was taking a truth and exaggerating it to just this side of the breaking point. Ms. Bohne, my geometry teacher, taught that the same word was used to describe mathematical curves which, as an example, were revealed in the cross-section of conical structures.

To those who feel that talk of the risks and costs of accidents in the MRI suite are exaggerated, I offer you Ms. Bohne’s hyperbola in response, as provided by the FDA’s accident data.

MRI Accident Rates As Reported To The FDA

The trend in these reports of accidents is both a marked increase over the last 4 years, as well as a marked acceleration in the growth rate.

It would be worrisome enough if this were just a straight-line function, exceeding as it does any rational explanation for ‘natural’ growth in accidents resulting from increased MRI utilization, but the fact that the year-over-year rate of accidents is accelerating should have the radiology and patient safety realms in an uproar.

The above graph may look familiar to you, as I’ve published prior versions of it before the 2008 data was available. The acceleration pattern was strongly suggested in last year’s numbers, but appears confirmed in the full 2008 figures.

What do these numbers mean? They mean that we’re unnecessarily injuring a significantly greater proportion of MRI patients today than we were just a few years ago.

I say ‘unnecessarily’ because we know the causes of the most prevalent MRI accidents (projectiles, device interference, burns, tinnitus) and we know how to dramatically attenuate the risks (ferromagnetic detectors, thorough screenings, effective patient positioning, hearing protection).

If the MRI industry were to follow the best-practice standards outlined in the ACR Guidance Document for Safe MR Practices, I would expect that the rates of MRI accidents would take a dramatic nose-dive. Nearly every accident in the FDA’s 2008 record might have been avoided through the proper use of the four interventions listed above.

Concern about MRI accidents can not possibly be hyperbole when the growth in accidents appears hyperbolic.

To view the FDA’s own sloppy data, click here to go to the MAUDE database and type in product code ‘LNH’ (minus the quotes) to review the numbers of accidents and specific incidents.

Now, for the entirety of 2008, there are only 148 reports. But if expert opinions are to be trusted (and I think they are) these 148 reports probably represent around 14,800 real-world accidents (40 accidents every calendar day of the year, or roughly 57 per day if you take weekends off).

Some point, justifiably, at the abyssmal reporting rates (as exemplified by my correction of two orders of magnitude, above) and suggest that these radical increases in the rates of accidents are really only an indication of marginal improvement in accident reporting (after all, if you’re only reporting 1/2 of 1% of all the accidents, and you increase reporting by a meager 1/2 of 1%, you’ve doubled the reporting rate). But I don’t support this contention.

First, technical, clinical, operational, and financial risk factors have all compounded over the last several years. Each risk ‘domain’ has increased on its own, but when taken together these incremental increases are multiplied. These ratcheting-up risk factors have not been attenuated by any safety-supportive changes in regulation, accreditation, or payor credentialling.

At the same time that the risk factors have been growing, there have been no initiatives from the states, accrediting bodies, or federal regulatory authorities to increase end-user reporting of adverse events.

In short, I see many reasons why MRI accident rates would be going up, but not a single reason why the proportion of accidents that get reported would also increase.

So I’m left with this gnawing feeling in the pit of my stomach. I look at the data and the crystal clear trend that it’s describing and I know full well what is at the end of this parabolic curve… Obituaries of more MRI accident victims.