Ready? OK…

Let’s start at the very beginning (“what a very good place to start”). Back in the 80′s, when GE was seeking FDA approval for their new-fangled ‘nuclear magnetic resonance’ scanner, they were keenly aware of the risks of things going flying into the giant magnet. It turns out to be extremely difficult to have a giant, super-powerful electromagnet (one that doesn’t have an on/off switch) that doesn’t draw in every conventional ferromagnetic wheelchair, oxygen tank, gurney, mop bucket, rolling cart, etc… that comes near.

New Ferromagnetic Detector Requirement to Mitigate Magnetic Projectiles Risks In MRI Suites

In an effort to help identify these threats before they were brought into the room, the GE application to the FDA called for mandatory metal detectors for screening patients and equipment as a part of each and every MRI installation.

Well, it turns out that this well-intentioned gesture was not very practical. As sites that have foolheartedly ventured down this path can tell you, darn near everything that is brought to the MRI suite has metal in it. This means that darn near everything, including objects that are at no risk of flying into the MRI, will set off the conventional metal detector. If the objective is to find only those things that would like to go flying into the MRI scanner, your conventional ‘airport style’ metal detector is of no use.

In the 1980′s there weren’t alternative means of detecting only ferromagnetic materials (those that become magnetized and get drawn to the MRI scanner), so the GE requirement for metal detection atrophied to nothing, becoming a forgotten (well-intended) bad idea.

Fast-forward about 20 years. At this point MRI technology is ubiquitous at hospitals (those with at least a couple hundred beds) across the country. Estimates were that there were somewhere around 8,000 MRI scanners in the US, and that most of them were GE products.

Concurrent with the growth in numbers of MRI scanners were increases in the magnetic strength and improvements to the ‘active shielding’ systems. Each of these enhancements had the coincidental effect of increasing the forces that draw magnetic materials into the scanner. When coupled, these factors actually multiplied the attractive force applied to magnetic objects, meaning that the risks associated with magnetic-projectiles flying into MRI scanners increased dramatically as the imaging technology advanced.

There have been magnetic-projectile accidents that jeopardize patients and staff in the MRI suite as long as there have been MRI scanners. The overwhelming majority of these remain ‘under the radar’ of safety, regulatory and accreditation bodies. One event occurred in the summer of 2001, however, that exploded through the veil of embarrassment that typically keeps these types of accidents secret.

In 2001, a young boy was anesthetized for an MRI scan and required oxygen during the exam. When the wall-outlet O2 didn’t work, the anesthesiologist called for oxygen. The technologists administering the exam left the control room to try and fix the oxygen supply problem and, while they were out, a nurse entered and told the anesthesiologist that there were oxygen tanks right there in the control room. Immediately upon bringing one of the portable tanks into the MRI scanner room, the magnetic field of the MRI ‘grabbed’ the tank and pulled it into the center of the doughnut-shaped scanner, where it struck the boy.

That six-year-old boy, Michael Colombini, died from the injuries a couple days later.

Splashed across the media and throughout radiology journals & trade publications, this event reignited the interest in metal detectors, many of the lessons learned from the prior experiments with ‘airport style’ detectors having been forgotten.

“If only there was a metal detector that only alarmed on magnetic materials,” was a common refrain. In 2001, there wasn’t (at least not an effective commercial product for pre-MRI screening). Ever the ‘mother of invention,’ the necessity for a magnetic-projectile screening tool prompted several companies, including Mednovus, to develop ferromagnetic only detection systems.

These products started becoming commercially available just a few years after the 2001 Colombini tragedy, and initially struggled to differentiate themselves from the failed legacy of’ ‘airport style’ detectors. In the years since, however, ferromagnetic detectors have become viewed as a valuable tool for safety in the MRI suite.

Would GE have mandated ferromagnetic detection (instead of the ‘airport style’ metal detectors) with their FDA application if the products had been available 20 years ago? Since the stated intention was to prevent projectile accidents, it would seem logical that they would have. They’re not the only MRI manufacturer to have indicated that choice, either.

In a 2008 interview with the Israeli business publication, Globes, Walter Marzendorfer, CEO of Siemens Medical Systems’ MRI Business Unit, was quoted as saying, “[t]he main safety issue where MRI is involved is the fact that it is a magnet. Accidents happen when a doctor enters the MRI room with a scalpel in his pocket and bends over the patient. People forget. There must be metal detectors at the entrance to every room with a MRI device.”

It would seem that Siemens has exactly the same take on the necessity for projectile safety in the MRI environment that GE had, namely that there should be some form of automated screening. I’ll chalk-up the use of the term “metal detector,” instead of the projectile-specific screening provided by a ferromagnetic detector, to the multiple languages likely involved in ultimately arriving at an English text. Both GE and Siemens have stated the necessity for some form of automated projectile screening, but it doesn’t end with the equipment manufacturers.

GE and Siemens aren’t alone in the calls for some form of  requisite screening for projectile risks…

• In 2007, the ACR Guidance Document for Safe MR Practices amended language from prior publications which recommended against ‘airport style’ detectors to include the explicit recommendation for using ferromagnetic detection systems.
• In 2008, the US Department of Veterans Affairs (VA) MRI Design Guide echoed this recommendation.
• In 2008, the Joint Commission’s Sentinel Event Alert #38 offered ferromagnetic detection systems as an example of a conformance tool for their objective of verified patient screening.
• In 2009, the American Society of Healthcare Engineering (ASHE) published a monograph entitled Designing and Engineering MRI Safety which explicitly called for ferromagnetic screening.
• In 2009, ECRI Institute published their Top-10 Medical Technology Hazards watch-list for 2010. On that list is MRI projectiles and among the ECRI Institute’s recommendations are ferromagnetic detection systems.

There are others, but you get the gist. The technology of the ferromagnetic detector answers the need for MRI projectile protection which was identified nearly 30 years ago. It fits precisely with the intention of GE’s original FDA application for approval of MRI as a clinical device, and with the much more recent statement by Siemens’ top MRI guy. It has been recommended by major institutional standards and both professional and accrediting bodies, so it must be a ‘done deal,’ right?

Unfortunately, there has been one missing element… a requirement for MRI projectile safety protections.

It turns out that ‘perfect fits’ with manufacturers’ intentions and a ‘who’s who’ list of recommending bodies wasn’t enough. Yes, there have been many adopters of ferromagnetic screening tools, but estimates are that most of the MRI providers in the US still don’t use ferromagnetic screening for people entering the MRI suite. If they’ve been waiting for a requirement, that wait is just about over.

42 of the 50 US states, the Joint Commission, and many, many other health regulatory bodies around the world, use the Guidelines for Design and Construction of Health Care Facilities, originally jointly produced by the American Institute of Architects (AIA) and the US department of Health and Human Services (HHS). With updates to the standard published every 3 to 4 years, Guidelines is, in effect, the building code that governs most licensed and accredited MRI providers in the US. The 2010 edition of Guidelines just came out last month.

In the 2010 edition, for the very first time, Guidelines includes MRI safety protection requirements in the design criteria. Here’s one excerpt from the new code:

2.2-3.4.4.2 Design configuration of the MRI suite

(1) Suites for MRI equipment shall be planned to conform to the four-zone screening and access control protocols identified in the American College of Radiology’s “Guidance Document for Safe MR Practices.”

(2) The layout shall include provisions for the following functions:

(a) Patient interviews and clinical screening
(b) Physical screening and changing areas (as indicated)
(c) Siting of ferromagnetic detection systems
(d) Access control
(e) Accommodation of site-specific clinical and operational requirements

That’s right, the inclusion of ferromagnetic detection systems is a requisite element of MRI suite design in the 2010 Guidelines!

Since the 2010 edition of Guidelines has only just been published, it hasn’t (as of this writing) yet been adopted by the various authorities that use Guidelines, but that’s only a question of time.

And while the Guidelines, as a building code, might only apply to new MRI facilities and newly-sited MRI equipment, it appears that this may be just the first requirement-domino to fall.

In 2006 (yes, four years ago), the ACR’s MR Safety Committee issued a formal request to the ACR’s MR Accreditation Committee, include the Safety Committee’s Guidance Document principles as requirements for MR site accreditation. The MR Accreditation Committee has agreed that it will do something relative to MR safety in the accreditation process, but has yet to specify what this will be. It makes sense to me that the ACR MR Accreditation Committee would (minimally) appropriate existing physical safety requirements put forward by other entities (preserving the ability to deflect criticism with, ‘it’s not our standard, it’s just one that many of our accredited providers will be held to by other agencies and we felt it prudent to include it in our accreditation standards to make sure that they weren’t otherwise caught unaware.”).

Similarly, the Joint Commission (TJC), having just received ‘deemed status’ and the ability to accredit advanced imaging providers (CT, MRI, PET) for the 2012 Medicare requirements, is purportedly working on imaging-specific patient safety standards. While TJC will adopt the 2010 Guidelines as their physical facility standard, that may also provide them with the ability to develop their own MR safety specific accreditation standards. I would expect to see a flurry of imaging-specific guidance and standards coming from TJC starting this summer / fall.

What does this all mean if you’re an MRI provider? One of the things it means is that if you don’t already have a ferromagnetic detection system, you should get one, and get it soon. Setting aside the ‘best practice’ standards, loss-reduction, safety improvement, and throughput benefits, ferromagnetic detectors will be requirements of accreditation and licensure.

If I can be of any assistance to you, navigating the new requirements or addressing questions about ferromagnetic detection, please do contact me.

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Let’s look at the circular path it took to arrive here…

• In 2002, when the first ACR ‘White Paper on MR Safety’ came out, I was an architect working on an MRI suite renovation and wound up calling Dr. Kanal several times to try and better understand the 4-zone concept.
• I gave him enough grief about the importance of architectural design, that he incorporated a few of my suggestions (and a big disclaimer about seeking knowledgeable design professionals) in the 2004 edition of the ‘White Paper.’
• During this  time, as an architect I became more and more involved in what designers could do to build suites that enhanced safety, and became an ardent supporter of ferromagnetic detection technologies as a part of enhanced MRI safety.
• In 2006, at the request of Dr. Kanal, I was invited to serve on the ACR’s MR Safety committee, where I helped with the addition of what became the MRI safety facility design appendix and was a co-author for the 2007 ‘Guidance Document.’
• In 2008, my experiences and commitment to MRI safety led me to join Mednovus, a company that manufactures and sells ferromagnetic detection systems for pre-MRI screening. I had long-since endorsed the technology and working for Mednovus afforded me the opportunity to work full time on the safety issues that gratified me so much.
• In 2009, Dr. Kanal invited me to again serve the ACR MR Safety committee for a scheduled 2010 revision, during the process of which I disclosed any and all potential conflicts. It was determined by the ACR, based on the fact that Mednovus cited the ACR’s endorsement of ferromagnetic detectors in marketing materials, that there was too much of a potential perception of conflict, and the ACR exercised its veto power for my appointment to the MR Safety committee.

I fully understand the necessity of the ACR to protect both the organization, and the work that it publishes, against diminished importance because of the appearance of personal bias. I find it a little ironic, however, in light of the ACR’s published statement disavowing the institutional weight of this committee’s work (appearing in a letter alongside the original publication of the 2007 ‘Guidance Document).

When I got the ‘Dear John’ letter, I was upset. I briefly thought to fight the decision. Though ultimately I think I saw the issue from something close to the ACR’s perspective, and understood their decision.

So, now off of the committee, I have no voice in MRI safety, right?

Wrong.

The ACR MR Safety committee will again accept comments from the professional community, and I’ve got a raft of them, waiting for the appropriate time. I also have friends on the committee and, thought I can’t argue my points in person, I’m certain that my suggestions will get a fair hearing. That’s all I would have been assured had I been on the committee.

There are also uses for ferromagnetic detection which I think are justified and wise that I wouldn’t have put forward as a member of the committee out of a concern that the ideas would have been perceived as having selfish motivation. Just like all of the legacy MR-dangerous implants and devices, even when 4-zone becomes a requirement for new MRI suites, how do we provide protections for those patients and staff when the MR room door opens into the public corridor? Ferromagnetic detection? Yes, I think so.

I also believe that, as an architect serving on a committee of the radiology professional association, my ‘insider’ status wasn’t nearly what it was cracked-up to be. Perhaps my greatest asset with respect to the work I can do in MR safety is the fact that I am, to a large degree, an outsider. I’m not beholden to Radiology, an MRI scanner manufacturer, Technologists, the FDA or any of the players that have been linchpins in our MR safety culture in the last 30 years.

Do I wish I was still on the committee? Yes, today I do. I am terribly proud of the honor and opportunity I was given to help shape the industry’s standard of care for MRI safety. I would gladly continue to serve the committee, but I’m realizing that not being on the committee has its benefits, too.

Breaking up is hard, but there are changes that I can help effect independent of my role on the ACR committee. I won’t tip my hand just yet, but there are a number of alphabet soup-named organizations that I am working with / on to bring about greater change for the benefit of the MRI profession.

First, I was asked to give a presentation on MR safety and legal responsibility two separate times during the conference. Both sessions were very well attended… the first one was standing room only! Lots of attendee feedback was along the lines of

‘I wish I could have bottled this message to take it back to my CEO,’ or

‘my lead MR tech was so jealous that I got to see this,’ or

‘this was the most important session of the whole conference.’

I am flattered and humbled by the responses to the presentation and excited about the growing interest in MR safety.

Second, though I didn’t get to sit-in on nearly as many of the other sessions as I would have liked, I was thrilled that conference participants were asking MR safety questions in other break-out groups. There were questions about MR safety in facility design, questions to the ACR representatives about accreditation standards, and others.

Third, the interest and responses from people I talked with, and others that our Mednovus team had conversations with, ferromagnetic detection has shifted from the popular sentiment of ‘why would I ever do that’ to ‘I know I need to do that… now it’s just making it a budgetary priority.’ For the first time, ever, this was a trade show where not one manager of an MR facility said, ‘oh, I know what that is but we don’t need it.’

As always, the AHRA annual meeting was exceptionally well planned and executed. And, also as always, it is a tremendous forum for getting a sense of the state of the industry with regards to attention to MRI safety. The results of that are crystal clear… there is a greater awareness of – and concern about – MR safety and, in particular, ferromagnetic detection.

The first special event is a presentation that AHRA invited me to give entitled ‘MRI Safety, Liability, and Best Practice.’ If you received the conference program mailers a few weeks ago that indicated that I am giving this presentation on that first Sunday of the conference, don’t believe it! I am not giving this presentation on Sunday, but I am giving it on Monday, August 10th, from 2:30 – 4:00. (They’ve done a little juggling that changed a few scheduled presentations.)

The program will touch on a number of the MR safety developments of the last several years, though even more from a management perspective than any of my prior presentations to AHRA.

This is the first special invitation and I would very much love for you to join me on Monday afternoon. There are lots of other great sessions, however, and I understand if you have your eyes on another program scheduled for the same slot. I’ll miss you though, and will stare wistfully at your empty chair in the presentation.

Which brings me to my ½-event invitation. It’s actually a full event. It’s 90-minutes long, just like my Monday presentation. In fact, it’s almost exactly like the 90-minute Monday presentation because AHRA has asked me to offer this program twice! If you can’t make Monday afternoon, please come by Tuesday morning, from 8:00 – 9:30, to see ‘MRI Safety, Liability, and Best Practice’. I’ll actually feel much better on Monday if you’re not there, since we have this opportunity to meet up on Tuesday. And if you’re a glutton for punishment, or if you just want to see what I do to mix it up from one day to the next, you’re welcome to attend both sessions.

The last special event to which this post invites you is actually a revolving, ongoing set of conversations that I would love to share with you. When I’m not on the podium in front of large audiences, I will be in the Mednovus booth on the exhibit hall floor (booth #828 / 830), having one-on-one and small group conversations. I invite you to come by and join in a personal conversation with me and my colleagues about how best to prepare your MRI facility for the rapid-fire changes that are in process.

Though it’s only 4 weeks until AHRA, the great people at Mednovus are diligently working on special announcements that will be released in the lead-up to the annual meeting. Please stay tuned to be among the first to learn of what’s going on.

I hope to have the chance to see you at the annual meeting. Please do join me in one (or both) of my presentations, and do visit with me and my colleagues in our booth. I’m really looking forward to it.

Eight years ago this month (July 27th, 2001, to be exact), young Michael Colombini was fatally injured in an MRI accident involving a portable oxygen cylinder. The week surrounding the date of that accident is set aside each year as MRI Safety Week. This year, 2009, it falls July 27th through August 2nd.

During MRI Safety Week, MRI providers are encouraged to provide additional emphasis on safety provisions, training, inspection and equipment. This could serve as the anniversary date for annual inspections (cryogen safety systems, infection control, etc…). It is sometimes the additional motivator for special projects like labeling all portable equipment with the contemporary MR Safe, MR Conditional, MR Unsafe labels and designations. And sometimes it can be an opportunity to reinforce safety training for our MR staff and share a little bit of our daily safety mission with those outside MRI.

To make this easier, I’m posting two free Jeopardy-styled MRI safety quizzes (in Power Point format) for you to use for your staff, or for those who may not be quite so familiar with MRI safety. These resources are available at my new MRI Safety Week webpage.

But beyond sharing these resources with you, I am also offering for this to serve as a clearinghouse of MRI safety resources that you want to share with your colleagues. Drop me an email (my contact information is always at the foot of each post, or in the ‘about Tobias Gilk, editor’ in the box above and to the right) and we’ll see if we can share your posters, table-tents, questionnaires, articles, quizzes, or other downloadable resource with the broader MRI community.

This year, MRI Safety Week is more important than ever. The number of MRI exams continues to slowly climb, year-over-year, but rates of reported accidents are skyrocketing! We’ve seen nearly a 3-fold increase in the number of MRI accident reports to the FDA in just the last 4 years. Collectively, we have the opportunity to make a substantial impact in MRI safety.

Thanks to Mednovus for allowing me the time and resources to prepare these materials for you. But mostly, thank you for joining with me in again celebrating and promoting excellence in MRI safety through this special week.

The Department of Veterans Affairs has an amazing resource, the National Center for Patient Safety, which has access to detailed accident evaluations that, by law, are kept confidential within the VA. What NCPS has done over the years, however, is to evaluate and distil the data, providing useful pictures of complex risk profiles.

Late last year, the NCPS updated their previously published ‘MR Hazard Summary‘ in which they quantified, for the first time, the average cost of one MRI missile accident at $43,172.

What isn’t included in the VA’s cost average, because they don’t operate on a per procedure reimbursement rate, is the lost revenue from MRI downtime. This 5-figure cost average does include magnet system damage, cost of care for injury accidents, costs associated with farming-out MRI patients to other providers, but not the overhead expenses and lost revenue that would be critical components of commercial providers’ costs.

Even though revenue for an efficient MRI provider should be on the order of $1,000 per hour and overhead costs are several thousand dollars per business day, let’s assume, for the sake of argument, that the VA’s number is equally true for the per-procedure payees.

• If a box of donuts will entice staff to a lunch-hour meeting, you could provide over 19 years of daily MRI safety updates to your staff for the cost of a single accident.
• Or, if MRI safety conferences cost $2,000 to attend, $43,172 would provide for 21 conferences (plus a little extra for the bar tabs) for a site’s Technologists.
• Or, for less than half of the cost of a single accident you could buy, have installed, and provide regular training for a pass-through Mednovus MRI Sentinel® ferromagnetic detector.
• Or you could provide the hand-held Mednovus SAFESCAN Target Scanner™ and have more than $40,000 left over!

When people assert that ferromagnetic screening tools are simply ‘too expensive,’ it must be because nobody has shown them the real business costs of just a single MRI missile accident. It’s not ferromagnetic detection that’s expensive, it’s the accidents that they help prevent!

Yes, every business must balance their books and money doesn’t materialize in the bank account simply because there is a need. But when substantial help with MRI safety for patients and staff is so cost-effective as compared to projectile accidents, and the ROI requires only grade school math, why wouldn’t every MRI provider provide ferromagnetic detection screening for patients, staff and equipment?

So here’s your call to action… if you haven’t already done so, finagle ferromagnetic detection into this year’s budgetary priorities. Avoid the unplanned $40,000+ ‘hit’ with a fiscally-wise, planned deployment of a ferromagnetic screening system.

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.

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.

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.

So, it surprised me, more than a little, when I came across this gem…

“There must be metal detectors at the entrance to every room with a MRI device.”

Realizing that the speaker meant ferromagnetic detection, these words sound like ones that have passed my own lips, or those of noted MRI safety guru Dr. Emanuel Kanal. Imagine my surprise to learn that this statement was issued by none other than Walter Marzendorfer, CEO of Siemens’ MRI business unit.

The interview, which appears in the Israeli business publication ‘Globes’ [click here to go to the Globes interview], includes the statement about the magnetic field risks and the necessity of projectile detection to help mitigate the safety concerns.

“The main safety issue where MRI is involved is the fact that it is a magnet. Accidents happen when a doctor enters the MRI room with a scalpel in his pocket and bends over the patient. People forget. There must be metal detectors at the entrance to every room with a MRI device.”

–Walter Marzendorfer, CEO of Siemens’ MRI business unit

I believe that Siemens Medical worldwide views this statement with the same unequivocal eye with which I read it, and that ferromagnetic detection will be offered for Siemens MRI installations.

Stay tuned as the MRI vendor situation develops!