Tag Archives: Guidance Document

Breaking Up Is Hard To Do…

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… Click Here For The Rest Of The Story…

MRI Safety Planning Season

Ahh the four seasons… Winter, Spring, Summer, and MRI Safety Planning.

What, you’ve only heard it referred to as ‘Autumn‘ before? Well, that’s not terribly surprising. We’re so inundated with honorary days, weeks, and even months, that the season of MRI Safety Planning fails to get its fair share of media time. But here’s why MRI Safety Planning season should be tops on your list right now.

First, while there is a growing awareness of MRI Safety Week, a single week doesn’t really afford the time needed to plan for improvements to MRI safety. Real improvements come from refinements in operations and process, coupled with effective tools and training. That sort of interdisciplinary approach often requires more than a couple days to put together.

Second, MRI Safety Week falls in the middle of summer when budget-wrangling loses the attention-span battle to thoughts of barbecues and coco-butter suntan lotion. It is precisely now, when so many organizations are hammering out their financial priorities for next year’s budget, that MRI safety planning should be in full-swing.

By combining the operations planning with the budgeting, you can reap some real multi-task benefits from these synergistic efforts, and – buoyed by the support of our whole Mednovus organization – I’m here to help you make it as productive as possible.

When making your MRI safety plans, it’s important to know what new criteria are going to be expected of your facility. Accrediting bodies are all looking at MRI safety in a new way, and this is starting with the Joint Commission’s Environment of Care requirements, effective January of 2009.

There is also the flurry of recent MRI safety Best-Practice recommendations from a number of documents, all of which should be part of the Administrator / Technologist library of reference materials. One common element to the Joint Commission’s Sentinel Event Alert #38, the ACR’s Guidance Document for Safe MR Practices, and the recent Veterans Administration MRI Design Guide, is the recommendation for the use of ferromagnetic detection (see below).

While ferromagnetic detection systems can be readily incorporated into both new and operational MRI facilities with minimal muss & fuss, even the most easily-installed and cost-effective systems typically require advanced budgetary planning.

The upshot? Please start thinking today about your planned MRI safety improvements for 2009 and budget accordingly.

Whether you’re considering the newly-released Mednovus Sentinel® GS 2.0 portals (both the 24-inch Patient Sentinel® GS 2.0 and the 48-inch Entry Sentinel® GS 2.0) or our SAFESCAN® hand-held Target Scanner™ (or the optimal combination of both), it would be a privilege to be at your service.

We at Mednovus are delighted to announce our new association with Siemens Medical Solutions, a world leader in MR imaging, and we encourage you to contact your local Siemens sales rep to get product quotes for your budgeting purposes. Alternatively, simply let us know where you are located, and we will put you in touch with the appropriate Mednovus product expert from Siemens’ national accessories division. Contact us soon so that we can arm you with the information you need to secure MRI safety improvements in next year’s budget.

Yes! Please put me in touch with the right Siemens’ accessories product expert!

By reviewing your current MRI safety protocols against published best-practices, and soon-to-be accreditation standards, you can prioritize the areas for improvement in 2009. In many cases, no-cost operational changes will help you achieve your goals, but whether it’s a new MRI-friendly infusion pump, improved signage, or the thrice-recommended ferromagnetic detector, you will probably need to have a few MRI safety line-items in next year’s budget.

Please contact us if we can be of any assistance in helping you with your observances of MRI Safety Planning season.

Tobias Gilk, President & MRI Safety Director
Mednovus, Inc.
Tobias.Gilk@Mednovus.com
www.MEDNOVUS.com

New Joint Commission Environment of Care (EC) Requirements

Starting in January of 2009, the drought of MRI safety regulation will begin to end.

It surprises many that the Joint Commission has no specific MRI safety accreditation standards. Surveys of accredited MRI providers have, over the past many years, focused largely on general safety standards, adapted for the MRI environment. Historically, a surveyor’s check for a non-magnetic portable fire extinguisher was the only MRI-specific safety check provided by the Joint Commission.

Despite the fact that many MRI-specific safety articles, recommendations, and, most recently, Sentinel Event #38 have been offered by the Joint Commission and its allied Joint Commission Resources educational arm, there have not previously been specific MRI safety standards for accreditation, and it is only through the new Environment of Care requirements that MRI safety will become an implicit standard for Joint Commission accredited facilities.

Starting this coming January 2009, inpatient and outpatient accredited facilities will need to abide by the new Risk Management provisions of the Joint Commission Environment of Care standard. The Standards Improvement Initiative will require facilities to prospectively define the physical hazards within the facility and develop specific responses to manage and mitigate those hazards.

The new standard specifically cites Sentinel Event Alerts as one external reference that must be considered in defining risks. For MRI, this automatically means Sentinel Event Alert #38. And since SEA #38 draws so heavily from the ACR Guidance Document for Safe MR Practices: 2007, it only follows that the ACR Guidance Document is the underlying industry standard document for defining MRI safety. Another external reference that specifically addresses MRI physical hazards which should be used as a basis for risk analysis is the VA MRI Design Guide.

What do Sentinel Event Alert #38, the ACR Guidance Document, and the VA MRI Design Guide all recommend? Well, lots of common elements, actually, but one of the key recommendations is for the use of ferromagnetic screening (click here to download a PDF document that outlines many of the recent recommendations for ferromagnetic detection).

While it is starting with the Joint Commission Environment of Care, my expectation is that MRI-specific patient safety requirements will spread to other accreditation requirements, building codes, and standards of practice. This will include not just recommendations, but requirements for the use of ferromagnetic detection for MRI pre-screening.

Over the next few months, all Joint Commission accredited MRI providers will need to review the standards of practice in the ACR Guidance Document for MR Safe Practices. Specific actions must be taken to identify, document, and respond to the unique hazards in the MR environment. One of those immediate actions should be planning for ferromagnetic detection at your MRI facility.

If you have any questions about the new MRI safety standards, the best-practice recommendations for ferromagnetic equipment siting, and incorporating these vital safety instruments in your MRI screening practices, I recommend that you heed the advice of the ACR Guidance Document, the VA MRI Design Guide, and other safety practice documents. If you still have questions about these standards, I invite you to contact me.

Tobias Gilk, President & MRI Safety Director
Mednovus, Inc.
Tobias.Gilk@Mednovus.com
www.MEDNOVUS.com

Do Hand-Held Magnets = Ferromagnetic Detection?

In short, no. Hand-held magnets do not do the same job that ferromagnetic detectors do.

In many MRI facilities, foreign materials brought by people to the MR suite are tested for magnetic field hazards with high strength hand-held magnets. Ones designed specifically for MRI screening are far stronger than the ones holding up my daughter’s artwork on my refrigerator. Some of these ‘test’ magnets can be 1 Tesla at the surface (10,000 gauss)!

Example of hand-held MRI test magnet

These extremely powerful hand-held magnets can help users differentiate between superficial materials that are, and are not, ferromagnetic, but the extraordinary strength of these magnets introduces a number of additional cautions which limit their use.

First, the key word in the paragraph above is ‘superficial.’ The magnetic field of all permanent magnets drops off precipitously (field strength drops with the cube of distance… double the distance and the magnetic field is cut to 1/8th the original value), so permanent magnets will be useful for distinguishing ferromagnetic materials only at or near the surface of an object. Ferromagnetic components below the surface may go undetected by a hand-held magnet, but rest assured that the MRI will find them if those objects make it into the scanner room!

Second, the potential forces exerted on a ferromagnetic body with magnetic field strengths of near 1 Tesla mean that shallow ferromagnetic material within the body of the patient could be moved, perhaps dangerously, by these very strong magnetic forces. But if the purpose of screening is to prevent accidents instead of preemptively causing them, hand-held magnets are poorly suited for patient screening.

Third, if screening medical equipment instead of patients, even some pieces of equipment designed for use in MRI scanner rooms have maximum allowable static and dynamic magnetic field values. Sticking a 1 Tesla magnet all over an anesthesia machine may wind up having some unintended consequences with regard to operation.

Lastly, 1-Tesla magnets stick hard to things. While the hand held magnets aren’t weighty, their magnetic force can require a bit of elbow-grease to get them separated from the cart or medical gas cylinder to which they got stuck. No, it’s not like it becomes epoxied on, but wielding one of these high strength permanent magnets is not a trivial affair.

Each ferromagnetic detection product has its own limitations, so I’m not attempting to state that FMD systems are the perfect solution to the hand-held magnet problem. Hand-held magnets can be useful, in a limited range of uses.

When it comes to the recommendations of the ACR Guidance Document for Safe MR Practices, or the Joint Commission Sentinel Event Alert (#38) on MRI Accidents and Injuries, or the U.S. Veterans Administration’s new MRI Design Guide, the experts all seem to have recognized the benefits of ferromagnetic detection and made a clear distinction between the new technology and the old custom of using permanent magnets to test for safety.

Tobias Gilk, President & MRI Safety Director
Mednovus, Inc.
Tobias.Gilk@Mednovus.com
www.MEDNOVUS.com