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.

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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.

1. Resistance, or “What the [bleep] is this thing and who’s making me use it?”

One of the first steps in the path to embracing ferromagnetic detection is often resistance. Some MR staffers assume that the presence of a ferromagnetic screener demonstrates an implicit lack of faith in their ability to screen patients. This couldn’t be further from the truth!

The problem with effective patient screening has always been with the patient. At UPMC, where the Technologists work with the MR-safety-minded Dr. Emanuel Kanal, they found that 44% of all patients that had professed to be free of ferromagnetic material were, in fact, just about to walk into the MRI scanner room with some type of ferromagnetic material on them! That’s almost half the patients at one of the most MRI safety conscious sites in the whole world!

Ferromagnetic screening tools aren’t an indication that administration doesn’t have faith in the Techs, they’re protection for the Techs because it’s patient compliance that we don’t have faith in.

In fact, even with ferromagnetic detection we depend on the conscientious screening and observation of patients by skilled MR Technologists. No technology, not even ferromagnetic detection, is 100% foolproof, but this additional layer of protection has helped Techs to find threats that would have otherwise slipped past.

2 Annoyance, or “Why the [bleep] is this thing alarming on these subjects?”

One of the first thing that sites that ‘plug in’ ferromagnetic detection into their existing protocols find is just how poor patient compliance really is! We thought we did a great job of getting patients to follow our instructions… that is until there was a tool that could actually help measure patient compliance. Without that alarm, the person would more than likely have sauntered into the MR scanner room with whatever we didn’t know about in their pocket. Often, the bits of ferromagnetic-contraband that patients sneak in with wouldn’t cause any harm and can be rationalized-away, but that’s not always the case. Sometimes what get’s missed in conventional screening and access protocols is big, ugly, and scary…

3. Utter surprise, or “How the [bleep] did that get past screening!?”

This might not happen for the first hundred or more patients, but sooner or later you’re likely to be stunned by something identified by the detector that would have been very dangerous if it made it into the scanner room.

What sorts of things? Toolboxes, conventional wheelchairs, steel IV poles, medication pumps, knives, weights, gas cylinders, and the list goes on, and on… These are precisely the sorts of things that ferromagnetic detectors find at facilities across the country. They’re the things that aren’t supposed to be there in the first place, or, if they are there, are supposed to be immediately ID’d by the staff and kept way-far away from the magnet room. But all procedures break down at some point, and the maintenance contractor, or the new person in transport, may not know about your policies.

4. Gratitude, or “Thank goodness this got found!”

It only takes one or two rude awakenings to things that were about to enter the magnet room to change one’s entire outlook on ferromagnetic detection. Imagine the potential damage from that found oxygen cylinder, or the injury that might have resulted from the non-MR infusion pump that nearly made it into the room, and all of the sudden any alerts from the detector become music to Technologists’ ears because they’re the warning for the accident that hasn’t yet happened (and may now, for the first time, be caught before it does).

5. Reliance, or “I couldn’t imagine not doing this for a patient now.”

Some people are unduly concerned about MR staffers jumping right to this final stage and that the Techs will think that ferromagnetic detection technology is going to absolve them of of patient screening responsibility. Personally, I’ve seen many ferromagnetic detection installations and have yet to witness anything like this. The greater concern is that sites give-up trying before step 3 and fail to realize the tremendous benefits to patient safety that ferromagnetic detection provides.

We have clients who tell us about what their SAFESCAN® detector has found on ‘cleared’ patients, or on doctors or nurses who have come down from the floors with a patient. If you found the objects that many of our clients have found (and they generally tend to run top-notch MRI centers, so it’s not as if they need ferromagnetic detection more than anyone else), you’d be instantly convinced of the value, too.

It is worth noting that no technology is 100% foolproof, not even ferromagnetic detection. It’s a tool, and a tremendously helpful one at that, but it has limitations. But just because it can’t do everything isn’t a reason to not use it.

If you’re blindfolded at the edge of a cliff, you don’t know how much that first wrong-step is going to hurt, and hurt badly. And if you don’t know what patients and staff have been carrying into the MRI suite, risking their lives (and perhaps yours), you have no reason to be concerned. But as soon as you begin quantifying how much dangerous material is trying to get into your MRI room, you, like our clients, will never again want to go without the protection of a ferromagnetic screening!

Honestly, most materials made with the purpose of being brought into the MRI room are mostly made up of aluminum, plastics, titanium, brass and other non-magnetic materials. Were a MRI facility to use one of the conventional ‘airport-style’ metal detectors, it’d go off on just about everything that was brought to the room. Talk about annoying! Metal is everywhere, from the rivets in your blue jeans [Beeep] or shoe-lace grommets [Beeep], the clasp or underwire in bras [Beeep], reinforced toes or lugs in shoes [Beeep], gold jewelry [Beeep], stainless steel braces [Beeep] and dental work [Beeep], hair pins [Beeep] and a menagerie of other common, everyday non-magnetic items. If the plain-old metal detector alarms on everyone and everything brought through it, what help is it, really?

But it’s crucial to improve screening and keep the magnetic metals out of the MRI room. If the plain-old metal detector can’t help differentiate between those metals that are meant to be in the MRI room and those that are supposed to be kept out, what does?

Ferromagnetic detectors, such as the Mednovus SAFESCAN™ products, are designed to help MRI providers find magnetic materials to keep them away from the MRI magnet. Whether a hand-held ferromagnetic detector (FMD) such as the Target Scanner™ or pass-through systems such as the Sentinel® 2.0, these products can dramatically improve the quality of the safety screening for patients, visitors and equipment brought to the MRI room.

So, despite the name of this blog, those looking to improve the safety of patients and staff in MRI, as well as enhance the protection of millions of dollars of capital investment in the MRI itself, should NOT be using plain-old metal detection. For MRI screening, providers should be using ferromagnetic detection.