Tag Archives: Mednovus

2014 – A Brave New Year

Every New Year holds great promise… this one perhaps more than most.

First, I want to share with you that my direct employment with Mednovus has ended. The relationship with the founders and principals of the company is as strong as ever, and I owe them a huge debt of gratitude for allowing me to do so much ‘extracurricular’ work to further MRI safety. I will continue to work with them on a consulting basis, indefinitely. Which is a great segue into my new venture… Continue reading

Colombini, Codes, Metal Detectors And MRI Safety

Go grab yourself a cup of coffee before you continue… this is going to be a long (for me, anyway) rant.

Ready? OK…

Let’s start at the very beginning (“what a very good place to start”). Click To Read The Whole Story…

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…

AHRA – Attendance Down (a bit), Interest Up (a lot).

Concerned about a dramatic drop in attendance, the AHRA annual meeting in Las Vegas was rescued from the brink of dissapointing participation by a swell of last-minute and onsite registrations. Overall, the attendance numbers were flat from last year, but the level of interest in MR safety issues was way up! I noticed three separate areas where this was demonstrated…

Click Here To Read The Three Ways…

AHRA 09 – You’re Cordially Invited To 2½ Special Events

As if you needed a personal invitation from me, here it is nonetheless. Please join me (and a several thousand of your colleagues) at the American Hot Rod Association [ahem] American Healthcare Radiology Administrators annual meeting in August. And though it may not really be my place to invite you to the conference, I do want to extend to you a personal invitation to 2½ special events that will happen during that week.

Click Here To Learn About Your Special 2½ Invitations…

MRI Safety Week – Free Training Downloads

Once again, we’re approaching the anniversary date of the most infamous MRI fatality and the corresponding MRI Safety Week. This year, through the in-kind support of my employer, Mednovus, I’m able to make available a MRI safety quiz (actually, it’s two quizzes, one for radiology / MR staff and one for the MRI layperson).

Click HERE To Get To The Downloads…

“Pardon me, but could you spare $43,172?”

No, this isn’t about federal banking bail-outs or corporate welfare. This is the cost, in real-world dollars, of an average single MRI projectile accident in the VA Healthcare system.

Click to read more about the costs of MRI missile accidents…

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.

MRI Patient Pre-Screening

Ferromagnetic detection is a vital part of the pre-screening for persons about to enter the MRI magnet room, but it’s only one part of the overall sequence.

First, before we jump into the issue of where in the sequence ferromagnetic detection is best deployed, it’s important to break pre-MRI screening into its two constituent parts: clinical screening and physical screening.

Clinical Screening:

Before being brought to the MRI magnet, everyone (and this means patients, visitors and staff) needs to be screened for contraindications. Most often we think of pacemakers, but other contraindications include nerve stimulators, insulin pumps, prosthetics, halo vests, and a number of other objects. The screening is typically accomplished through the use of forms to help the subject identify any clinical risks for the MRI provider. The screening form is then to be reviewed between the patient and the MRI Technologist.

Once clinically cleared of contraindications for the MRI exam, then the subject should proceed to the next step…

Physical Screening:

Contrasted with the widespread uniformity of the clinical screening, the physical screening takes very different forms at different provider. However, all have the same objective, namely, to remove ferromagnetic materials from the subject and keep them away from the MRI scanner. Even small quantities of ferromagnetic material can cause artifacts in the MRI scan when near the imaging volume. Small ferromagnetic items, such as bobby pins and nail clippers, have caused serious harm when propelled by the magnetic force of an MRI magnet. And obviously, large items such as oxygen cylinders and floor polishers can have catastrophic consequences if brought to the MRI room.

Some MRI providers have outpatients simply empty their pockets, others provide gowns or scrubs for MR patients to change into, and all should use ferromagnetic screening to help verify patients’ compliance with screening instructions.

When performed in the above order, providers avoid gowning patients only to find out that the patient can’t receive the MR exam. Additionally, when clinical screening is accurately completed first, the Technologist has done everything within his or her human capabilities to mitigate the contraindication risks associated with exposure to magnetic fields. Although it is impossible to completely eliminate the chances of accidents, by following the recommended industry-standard procedures of  conscientious clinical and physical screenings followed by properly-performed ferromagnetic detection, the safety of your MRI center has been significantly enhanced.

Some of the most sensitive ferromagnetic detectors currently available use passive magnetic fields to improve sensitivity. These GS (Greater Sensitivity) detectors use a localized DC field (i.e. stronger versions of a similar type of the permanent magnet that holds your notes on your refrigerator door). While the magnetic field strength very close to the GS detector can exceed the 5-gauss threshold, that limit is for persons who haven’t been successfully cleared for MRI contraindications (a step which was just completed if the pre-MRI screening was conducted in the proper order).

While patients and caregivers should be concerned about exposing unscreened persons to the extraordinarily powerful magnetic fields around the MRI, momentary exposure of post-screened persons to the passive “fridge-door” magnetic fields of a GS ferromagnetic detector is very, very small on the relative risk-o-meter. And this minute risk comes with an enormous potential safety upside…

No ferromagnetic detection system on the market from any manufacturer is intended (or approved) for finding objects internal to the body of the patient. However as an incidental finding, ferromagnetic detectors have alarmed on the ferromagnetic content of implants (including pacemakers) that were disavowed by the patient in the clinical screening process. While ferromagnetic detection should never be used in lieu of conscientious clinical screening, they have helped to identify critical contraindications that may have otherwise jeopardized the safety of the MR patient — had they not been found by the ferromagnetic detector.

And the relative risk of being exposed to 5, 10 or even 100 gauss as a part of a physical pre-screen (particularly when already cleared of clinical contraindications) is microscopic, when compared to either the risk of the planned exposure to 15,000 / 30,000 gauss, or the potential benefit of identifying a contraindication that the patient themselves didn’t communicate.

The take-home messages from this are these:

  • MRI providers should provide as thorough and comprehensive clinical screening as humanly possible for everyone approaching the MRI.
  • Once the clinical screening is complete, the provider’s standard physical screening (emptying pockets, changing into scrubs, etc…) should be conducted as appropriate to the MR patient / visitor.
  • And following the clinical and physical screenings, patient / visitor compliance should be verified with a ferromagnetic detector.
  • If these industry-standard procedures are correctly followed, there should remain only minute (accepted) risks associated with exposure to any magnetic field, either the enormous field of the MR or the comparatively tiny field present in GS detectors.

Clearly, providers should feel free to use whatever ferromagnetic detection they wish – from their choice of manufacturer – in order to conform with ACR, VA and Joint Commission guidance, whether it be an instrument which relies on only the trace-magnetism of the Earth’s own magnetic field, or one in which the detection sensitivity has been enhanced through the use of a locally-provided, passive DC magnetic field as found in GS ferromagnetic detectors.

My recommendation is always to use a detector with the greatest possible sensitivity. Because, while they are wonderful instruments that can make a substantial improvement in a provider’s MR safety protocols, ferromagnetic detectors are dumb. They can’t differentiate ‘good’ ferromagnetic material from ‘bad’. These sorts of value judgments should be made by a trained MR technologist and not by a machine.

In my opinion, ferromagnetic detectors should be used to help find every piece of ferromagnetic material that they can, so that the Technologist knows what is about to enter their magnet room (and can make re-screening decisions as appropriate). The greater the sensitivity of the detector, the more informed those Technologist decisions will be.

Pass-through ferromagnetic detection systems, such as the newly released Mednovus Sentinel® GS 2.0 portals, also have user-adjustable sensitivity settings, so that the system can be ‘dialed back’ as needed for special circumstances, further supporting the concept of having the instrument with the greatest sensitivity, and tuning it to meet your specific needs.

As evidenced by repeated, and increasing MRI projectile accidents, there is enormous room for improvement from the prior standards. Effective pre-screening of MRI patients, including the use of ferromagnetic detection at the appropriate point, can make an significant difference in the safety of the MR exam. Providers should turn to the current best practice guidance and compare their pre-MRI screening processes, making any indicated changes to help assure the safety of their patients, visitors, and staff.

Tobias Gilk, President & MRI Safety Director
Mednovus, Inc.

Dr. Emanuel Kanal Recommends Ferromagnetic Detection

If you ever get a chance to hear Dr. Kanal speak, GO! Apart from being Director of MR Services for the University of Pittsburgh Medical Center, a Fellow of both the ISMRM and the ACR, Chair of the ACR’s MR Safety Committee and one of the world’s experts in instruction for the mind-boggling complexity of MR physics, you’ll also find him to be one of the most animated, enthusiastic and downright approachable speakers, ever.

That’s precisely what about 100 – 200 Radiology Administrators at the AHRA Annual Meeting, held just a couple weeks ago in Denver, found out in Dr. Kanal’s MRI Safety Update presentation.

His talk whisked through a number of topics in the brief hour that he had, but one of the chief subjects of his presentation was his enthusiastic support for the use of ferromagnetic detection (FMD) systems as a quality assurance step to assure patient compliance.

At his direction, the University of Pittsburgh Medical Center (UPMC) has purchased 20 Mednovus SAFESCAN® hand-held Target Scanners™, which are in use throughout the UPMC system. Dr. Kanal’s MRI suite is also the ‘proving grounds’ for ferromagnetic detectors from different vendors and he highlighted the use of the Mednovus Entry Sentinel® GS walk-through portal, which is currently being used in a trial to verify screening compliance.

In the coming days and weeks, I hope to share with you specific excerpts from Dr. Kanal’s presentation to the AHRA annual meeting. Suffice it to say that the world’s foremost authority on the breadth of MRI safety issues is a firm believer that MRI-projectile accidents are among the most common source of MRI-related injury – and that ferromagnetic detection can be a remarkably effective tool to help minimize these most frequent safety lapses.

Stay tuned for more information from Dr. Kanal’s presentation, coming soon.

Tobias Gilk, President & MRI Safety Director
Mednovus, Inc.