Tag Archives: Sentinel Event

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.

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.

“Ferromagnetic Detection? Yeah, Who Says So?”

For those in the unenviable role of having to make tough decisions about which safety features to invest in and which to forgo, one key factor to these decisions is compliance.

For those administrators stuck between ‘legal liability’ and ‘budgetary constraints’, sometimes the decision of which safety improvement to invest in has a lot to do with who recommends (expects) it. Regulatory compliance is an imperfect litmus test of safety, to be sure, but like it or not, when the accrediting bodies speak, people listen. In the past year there has been a growing chorus of accrediting and regulating bodies that have all called for ferromagnetic detection in MRI patient screening.

Let’s start at the very beginning (“What a very good place to start.”), with last summer’s publication of the ACR Guidance Document for Safe MR Practices: 2007…

“[F]erromagnetic detection systems are currently available that are simple to operate, capable of detecting even very small ferromagnetic objects external to the patient, and now, for the first time, differentiating between ferromagnetic and nonferromagnetic materials. While the use of conventional metal detectors is not recommended, the use of ferromagnetic detection systems is recommended as an adjunct to thorough and conscientious screening of persons and devices approaching Zone IV.” [Emphasis mine.]

Just a few months later, the UK’s MHRA released their 2007 MHRA Device Bulletin – Safety Guidelines for Magnetic Resonance Imaging Equipment, which included ferromagnetic detection in the document’s MR Suite Recommendations section. In the MHRA document, a two-stage ferromagnetic screening process is recommended, one near the door to the MRI room for large threats and a patient screening, capable of finding even smaller threats…

“As well as reducing the likelihood of small projectile incidents, the systems are designed to reduce the likelihood of an MRI scan having to be repeated e.g. due to the presence of an object distorting the MRI scan image.”

In February of 2008 the Joint Commission added their thoughts with something of an omnibus MRI safety Sentinel Event Alert (their highest patient safety alert). The top recommendations of the SEA included access controls and enhanced screening for threats…

“Use trained personnel to screen all non-emergent patients twice, providing two separate opportunities for them to answer questions about any metal objects they may have on them, any implanted devices, drug delivery patches, tattoos, and any electrically, magnetically, or mechanically activated devices they may have… [U]se other means to determine if the patient has implants or other devices that could be negatively affected by the MRI scan (e.g., look for scars or deformities, scrutinize the patient’s history, use plain-film radiography, use ferromagnetic detectors to assist in the screening process, etc.).” [Emphasis mine.]

And most recently, earlier in July of this year, the US Veterans Administration released a sweeping revision to their MRI Design Guide which offers design input on technical, operational and safety factors for MRI suites. The new MRI Design Guide covers a LOT of material, but included in its provisions is the use of ferromagnetic detection screening for all persons approaching the MRI magnet…

It is recommended that MRI facilities install ferromagnetic detection systems for use in screening persons and equipment entering Zones III and IV to interdict potential threat objects.” [Emphasis mine.]

For the moment, this chorus of official recommendations are not yet requirements, but that is about to change. The Joint Commission is said to be implementing a new risk-management requirement for accredited facilities which will demand that Joint Commission accredited facilities perform their own risk analysis using, as one of the criteria, the Joint Commission’s own Sentinel Event Alerts. Accredited MRI providers will need to demonstrate how it is that they provide quality-control review and redundancy of their MRI screenings.

The ACR’s MR Accreditation Committee is also entertaining a formal request to incorporate safety provisions of the ACR’s Guidance Document as a part of ACR MR Accreditation. Both the form and timeline of any changes in ACR accreditation are, as yet, unknown, but the current chair of the MR Accreditation Committee, Dr. A. Joseph Borelli, believes strongly in the principles of the Guidance Document.

So if the decision to embrace ferromagnetic detection or postpone it is influenced by what the regulatory / accrediting bodies think of it, the message is quite clear… ferromagnetic detection helps make a positive impact on patient safety and its use, at least among these four agencies, is universally called for.

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