Just a few months ago a service engineer was replacing a fan-blower assembly in an MRI unit (a part that is notoriously ferromagnetic). Working alone in the suite in the evening, after the regular staff had left, the engineer had finished early… or that’s what the security guard thought when he called to her and got no reply.

Turns out that she had been struck and pinned to the MR scanner by the blower assembly, and was unconscious, if not already dead, when the guard checked to see if she was still there.

This tragic story is something of a departure from my typical mantra of patient and staff safety. Yes, this was a trained individual who knew about the risks of the MR environment and materials she was working with. And yes, this was a vendor, and not a hospital worker or patient. But this is a repeatable condition, and an accident which, because there have been MRI accidents involving such a tremendous variety of ferromagnetic materials, deserves a little analysis for a ‘lessons-learned’ output.

One of the (theorized) main contributing factors to this accident is the design of the magnet room. Since the advent of active shielding, we’ve seen MRI rooms go from the size of racquetball courts to office cubicles. In this case, the clearances around the magnet were uncomfortably tight, and what space there was between the magnet and the walls of the suite was purportedly infringed by shelves, storage and clutter.

By failing to provide an appropriately-sized room to accommodate not only the MRI unit itself, but also the service and storage needs, the layout may have substantially increased the likelihood of an accident.

And while conventional screening methodologies wouldn’t have helped in this particular scenario (the object already in the MRI room), it’s not like this is the only strange thing that has been brought into a MRI room to be ‘sucked’ into the scanner. Yes, we all know about oxygen tanks (well, apparently we don’t, as there was another one reported recently, here), but they aren’t all!

Personal computers, iPods, filing cabinets, desk chairs, anesthesia machines, cribs, gurneys, wheelchairs, dollies, staplers, power tools, axes, roller skates, ‘sand’ bags, hampers, mop-buckets, and the list goes on, and on, and on… All of these, and many, many more objects have found their way into MRI scanner rooms. Sometimes the people involved, like in the circumstances surrounding the recent fatality, know that they’re taking a risk. But at least as often the accident occurs because the person is unaware of what they’re doing.

The magnets don’t take vacations. They’re not on just when ‘taking the picture’. They’re not turned off for the night when the last patient is done for the day. The risks are omnipresent, which demands that we are equally vigilant about providing the appropriate protections for everyone and everything that approaches the MRI room.

In the weeks ahead, I hope to have information for you about some of the efforts in the works that may help codify some of these expectations at the point of care. Suffice it to say that right now, for the first time in the U.S., substantive consideration is being given to explicit MRI safety requirements at the point of care. This is still all in the formative stages, and lots of work remains to be done. But perhaps when it is, there’s an umbrella drink and sandy beach with my name on them.

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Much to my surprise (and delight), this is happening with the new Guidelines for Design and Construction of Health Care Facilities (or Guidelines, for short). Though the 2010 edition of Guidelines has only been published for about a month (and the publisher has been struggling to catch up on back-ordered copies), two states have already adopted the 2010 edition as their requirements for licensure.

That’s right, in less than a month, the states of New Jersey and Georgia have already moved to the new 2010 edition of Guidelines, complete with its wholly rewritten section on MRI suite design and safety. What does this lightning-fast adoption of the new edition of Guidelines foretell for the other states and authorities (like the Joint Commission) that use Guidelines for their standard?

"As go Georgia and New Jersey, so goes the rest of the nation..."

“If the Guidelines code is updated every 3 – 4 years, why is this update so significant for MRI suite safety and design?”

Excellent question. The answer lies in what hasn’t been in the past 25-years worth of Guidelines, and that is any sort of design standard pertaining to safety for the MRI suite. Clinical MRI has been around that long, and yet the last edition of the standard (released in 2006) had nothing about MRI safety. If you just compared the number of words in that prior edition, there was nearly 5 times as much guidance for laundry facilities as there was for MRI.

And though it may not be significant from an MRI safety standpoint, a number of authorities – the Joint Commission among them – still reference the 2003 edition of Guidelines! Given the pace of healthcare developments, it’s hard to imagine anything remaining unchanged over a 7-year period. Georgia and New Jersey are just the first in what appears to be a multi-jurisdiction sprint to the new standards (some just staying current, others playing ‘catch-up’).

“What does this mean for MRI suites and the hospitals and imaging centers that build them?”

Among other things, it means that the verbatim cut-and-paste templates from the MRI equipment vendors are now insufficient for state licensure approval (I contend that they, alone, have been insufficient on many levels, but until now state licensure hasn’t been one of them). MRI suites will now have to be designed to respond to the new line-of-sight, access-controls, and ferromagnetic screening requirements in the 2010 edition of Guidelines.

Architects, engineers, equipment planners and facility managers are all having the performance bar raised relative to MRI safety design provisions. Here’s just one section of the new requirements for MRI suite design in the 2010 edition of Guidelines:

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

While I was expecting the roll-call of states adopting the contemporary 2010 edition of Guidelines to begin late this spring, or even this summer, I’m very pleased that this has bested my expectations. This means that as of right now, the new MRI safety standards are already required at the state level in Georgia and New Jersey… months ahead of schedule. We may actually see a very sizable number of authorities moved to the current version by this summer, the time I had expected the first adopters to announce.

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Our company, Mednovus, is making the annual pilgrimage to Chicago after Thanksgiving for the biggest of all radiology trade shows, the Radiological Society of North America (RSNA) annual meeting. In my original post I indicated why I thought MRI safety would be a ‘hot topic’ at this year’s RSNA, and gave an itinerary for the North Hall (the Philips Hall) for stops at relevant vendors, including our company, Mednovus (booth #7801). Then I followed up with an itinerary for the Lakeside Center, and just a couple days ago, I provided half of the South Hall.

Continuing on that theme, and to facilitate your review of MRI safety products and vendors, I’d like to suggest an itinerary for visiting the remaining select group of exhibitors from Exhibit Hall A, the South Hall, where the GE mega-booth is located…

The South Exhibit Hall (Hall A) includes exhibitors with booth numbers from 2500 – 6632. And while I won’t pretend to know what each exhibitor offers (so, clearly I won’t be able to identify all relevant MR safety products that might be featured at each exhibitor, please forgive any oversights), I would like to provide you with a short-list of stops that I recommend that you make.

Some of these are on my list because I know and recommend their products (look for the •), others are there because they’re new (to me at least) and I’m curious to learn more about them.

5449 Joint Commission – JCAHO is really only just coming into their own with respect to MRI safety. With the Sentinel Event Alert #38 last year, and next year’s code changes… the future promises that they’ll be more than just a paper tiger for MR.

5800 Sentinelle – Interventional MR is one of the real growth opportunities for the industry, and Sentinelle makes one of the most popular breast coil / biopsy products available.

6403 • American College of Radiology – The College’s MR Safety Committee (which I had the privilege to serve) will be coming out with a new joint statement on Gadolinium in the months ahead, and a revised version of the ‘Guidance Document’ in 2010. If you have a chance, thank them for their leading work in this area.

As before, there are likely vendors not on this list because (1) I either forgot or didn’t know about their product offerings, (2) they’re ‘old standby’s’ that I’m already familiar with, or (3) they’re in a different exhibit hall.

Which segues, nicely, into my (repeated) disclaimer that the above list is just for the second half of the South Hall (Hall ‘A’). If you’d like to read my proposed itinerary for the North Hall B, please click here, or if you’d like to read the MR safety stops for the Lakeside Center, please click here, or if you missed my previous post with recommended stops for the first half of the South Hall, please click here.

Now, if I had to say, it really appears to me as if the South Hall, despite its overall size, is pretty darn light on MR safety vendors that I would recommend you visit. Based only on the number of recommendations against the total number of booths in a given hall, you’re better off dedicating your MR safety time to the North Hall, or Lakeside Center.

If you’d like to conduct your own virtual tour of the RSNA exhibit halls, they offer a wonderful interactive floor plan of the exhibit halls online. You can see which booths I failed to mention (and add your suggestions in the comment field, below), or plan your own itinerary for all three Halls.

I will, of course, be doing some duty in the Mednovus booth, 7801 (just inside the North Hall B entrance that is NOT right next to Starbucks), and I hope that you’ll stop in and say ‘hi’ to me or my colleagues. Depending upon how ensconced I get in those conversations, this list may turn out to be a bigger proportion of my RSNA experience than actually getting to the other exhibits!

Our company, Mednovus, is making the annual pilgrimage to Chicago after Thanksgiving for the biggest of all radiology trade shows, the Radiological Society of North America (RSNA) annual meeting. In my original post I indicated why I thought MRI safety would be a ‘hot topic’ at this year’s RSNA, and gave an itinerary for the North Hall (the Philips Hall) for stops at relevant vendors, including our company, Mednovus (booth #7801). Then I followed up with an itinerary for the Lakeside Center.

Continuing on that theme, and to facilitate your review of MRI safety products and vendors, I’d like to suggest an itinerary for visiting a select group of exhibitors, this time in Exhibit Hall A, the South Hall, where the GE mega-booth is located…

The South Exhibit Hall (Hall A) includes exhibitors with booth numbers from 2500 – 6632. And while I won’t pretend to know what each exhibitor offers (so, clearly I won’t be able to identify all relevant MR safety products that might be featured at each exhibitor, please forgive any oversights), I would like to provide you with a short-list of stops that I recommend that you make.

Some of these are on my list because I know and recommend their products (look for the •), others are there because they’re new (to me at least) and I’m curious to learn more about them.

2517 Department of Veteran Affairs – OK, not really MRI safety, per se, but I have to take this opportunity to give props for their development of the MRI Design Guide. If you’re in the neighborhood, stop by and thank them for it.

2812 • ProScan – This booth is really here at RSNA to tout ProScan’s education and telerad services, but ProScan is one of the industry leaders in MRI safety. Stop by and ask them what they’re doing with ferromagnetic detection at all of their corporate-owned imaging centers. They’re really establishing a benchmark.

3237 CFI Medical Solutions – Manufacturers of radio-lucent and non-metallic patient positioning aids. They’re on my list because I’d like to learn more about them.

3242 Aadco – They offer a clever ceiling suspension system for MRI support equipment, as well a a number of accessories, such as procedure lights and injector arms, to go with the ceiling. I dislike that they trademarked “MRI Safe”, but I do want to learn more about their MRI products.

3407 Schiller – A Swiss company that offers MR patient monitoring solutions.

3800 Magnacoustics – Magnacoustics makes audio systems for MRI.

4029 • GE Healthcare – GE has been one of the industry leaders in MRI safety, which makes it all the more inexplicable as to why they sell plain-old metal detectors (specifically recommended against) as MR accessories, but don’t make available recommended ferromagnetic detectors. Can you find out why?

4209 Medrad – Medrad offers a number of MR patient monitoring / medication delivery products and is undoubtedly on your ‘short list’ of MR accessory vendors.

4604 • Iradimed – Makers of the MRIdium infusion pump system, which is damn nifty, what with it’s wireless operation and readout. How does that work through an RF shield?

4605 Creative Foam Medical Systems – Is it just me, or do there seem to be quite a number of patient positioning vendors at RSNA this year? Here’s another one I am hoping to check out.

Now, because the South Hall is the biggest of the three, I’m actually going to break here and will have the remainder of my noteworthy MRI safety vendor list for the South Hall in a follow-up entry, coming very soon.

As before, there are likely vendors not on this list because (1) I either forgot or didn’t know about their product offerings, (2) they’re ‘old standby’s’ that I’m already familiar with, or (3) they’re in a different exhibit hall.

Which segues, nicely, into my (repeated) disclaimer that the above list is just for the first half of the South Hall (Hall ‘A’). If you’d like to read my proposed itinerary for the North Hall B, please click here, or if you’d like to read the MR safety stops for the Lakeside Center, please click here.

If you’d like to conduct your own virtual tour of the RSNA exhibit halls, they offer a wonderful interactive floor plan of the exhibit halls online. You can see which booths I failed to mention (and add your suggestions in the comment field, below), or plan your own itinerary for all three Halls.

I will, of course, be doing some duty in the Mednovus booth, 7801 (just inside the North Hall B entrance that is NOT right next to Starbucks), and I hope that you’ll stop in and say ‘hi’ to me or my colleagues. Depending upon how ensconced I get in those conversations, this list may turn out to be a bigger proportion of my RSNA experience than actually getting to the other exhibits!

Link

Our company, Mednovus, is making the annual pilgrimage to Chicago after Thanksgiving for the biggest of all radiology trade shows, the Radiological Society of North America (RSNA) annual meeting. In my prior post I indicated why I thought MRI safety would be a ‘hot topic’ at this year’s RSNA, and gave an itinerary for the North Hall (the Philips Hall) for stops at relevant vendors.

Continuing on that original theme, and to facilitate your review of MRI safety products and vendors, I’d like to suggest an itinerary for visiting a select group of exhibitors, this time in Lakeside Center (Exhibit Hall D)…

Lakeside Center includes exhibitors with booth numbers from 100 – 2225. And while I won’t pretend to know what each exhibitor offers (so, clearly I won’t be able to identify all relevant MR safety products that might be featured at each exhibitor, please forgive any oversights), I would like to provide you with a short-list of stops that I recommend that you make.

Some of these are on my list because I know and recommend their products (look for the •), others are there because they’re new (to me at least) and I’m curious to learn more about them.

108 Polyform – With RF burns being one of the fastest-growing sources of MRI patient injury, positioning / insulating pads have recently become far more important. I’m interested to see what this vendor has to offer.

115 Advanced Imaging Research – A specialty RF coil manufacturer with pediatric and cardiac coils. They also offer non-magnetic accessories.

124 LMT Lammers – Manufacturers of special infant / neonatal MR imaging devices, an MR-friendly incubator.

803 • West Physics Consulting – More than just a ‘necessary evil’ for accreditation, a good physicist can help extend the life of your MR system and improve clinical image quality. West is one of the top providers out there.

820 IMRIS – OK, not specifically about safety, but how neat is an MRI that travels into the operating room!

825 • Siemens – Siemens is now offering not only the Mednovus ferromagnetic detectors (see Mednovus at booth 7801 in the North Hall), but MR safety packages of support equipment! Seek out Siemens’ accessories representatives and ask them.

1202 Optoacoustics – Manufacturers of fiberoptic video and audio systems for the MRI environment.

1209 American Association of Physicists in Medicine – Let’s start a groundswell. AAPM published a guide on MRI siting and safety about 25 years ago, back when we still called it nMRI. Let’s get 100 people to ask them when they’re updating that publication (publication #20)!

1213C • SMRT – For MR Technologists, this is THE organization. Great educational opportunities, and one of our industry’s very few concerted efforts at advancing MRI safety.

1213E • AHRA – For radiology or MR managers, this is on-par with what SMRT is for Techs. (note: if you’re a lead-tech with one foot on either side of that line, get involved in both organizations!)

1213L AIA-AAH – The Architectural profession’s healthcare group really needs our help with regard to radiology. I’ll give you a dollar if you simply go up and ask them what the AIA’s position on the designer’s role in addressing a 277% increase in MRI accidents!

1302 Nova Biomedical – Offers a point-of-care blood tester for calculating eGFR for Gadolinium contrast safety screening. I’d like to see it.

1409 Brainlab – Like IMRIS, I just love the idea of intraoperative MR. I don’t know if they’re doing as much about intraoperative MR safety as I know IMRIS is doing. But I’ve gotta look at their latest toys.

1632E NORAS MRI Products – In RSNA’s ‘Germantown’ NORAS offers a number of specialty MR coils and support products.

As before, there are likely vendors not on this list because (1) I either forgot or didn’t know about their product offerings, (2) they’re ‘old standby’s’ that I’m already familiar with, or (3) they’re in a different exhibit hall.

Which segues, nicely, into my (repeated) disclaimer that the above list is just for the Lakeside Center, Hall D. If you’d like to read my proposed itinerary for the North Hall B, please click here. Time permitting, I’ll do the same for the South Exhibit Hall A (the GE Hall), though making that list will require reviewing the largest number of vendors thus far.

If you’d like to conduct your own virtual tour of the RSNA exhibit halls, they offer a wonderful interactive floor plan of the exhibit halls online. You can see which booths I failed to mention (and add your suggestions in the comment field, below), or plan your own itinerary for all three Halls.

I will, of course, be doing some duty in the Mednovus booth, 7801 (just inside the North Hall B entrance that is NOT right next to Starbucks), and I hope that you’ll stop in and say ‘hi’ to me or my colleagues. Depending upon how ensconced I get in those conversations, this list may turn out to be a bigger proportion of my RSNA experience than actually getting to the other exhibits!

To facilitate your review of safety features, I’d like to suggest an itinerary for visiting a select group of exhibitors, starting with North Exhibit Hall B (the Philips hall)…

North Hall B includes exhibitors with booth numbers from 7000 – 9550. And while I won’t pretend to know what each exhibitor offers (so, clearly I won’t be able to identify all relevant MR safety products that might be featured at each exhibitor, please forgive any oversights), I would like to provide you with a short-list of stops that I recommend that you make.

Some of these are on my list because I know and recommend their products (look for the •), others are there because they’re new (to me at least) and I’m curious to learn more about them.

7019 • MagResource – Offers the largest (that I know of) online database of medical devices tested for MR safety. Subscriptions are paid, but they do make available a free trial period.

7524 Resonance Technology – Offers special audio and video systems for MRI patients. Not specifically safety, but if you’re looking for A/V products for your MRI suite, best to get them from someone who knows.

7708 MR Instruments – Again, not quite a MR safety company, but they offer a variety of MR coils that may not have come with your vendor’s ‘standard package’ of coils.

7725 Philips – Word has it that Philips is expanding their accessories catalog to include additional MR safety products. Seek out their accessories reps and ask them what they have.

7801 • Mednovus / SAFESCAN® – Right near the entrance to the hall, you may want to visit us, first, on your way to others. We offer some of the most effective / cost-effective ferromagnetic screening systems available, plus expert consultation.

8810 Composites Horizons – Finding positioners that are suitable (non-metallic) to the MR environment is always a challenge. I plan on looking these people up to see the range of what they have.

8940 Imprex International – One of the largest manufacturers of non-magnetic tools and hardware specifically designed for safe use inside the MRI environment. Particularly as we’re putting more equipment alongside the MRI, this becomes more and more important!

9113 • Covidien – Most often thought of in terms of contrast media, Covidien also manufactures one of the leading MR-tested infusion pumps.

9522 • Ernie’s Welding – These guys get a lot of funny looks (‘are you sure you’re at the right conference?’), but Ernie’s is perhaps the nation’s expert in fabrication of cryogen vent exhaust systems. Conduct a check of your quench pipe before you leave for Chicago and visit the people at Ernie’s booth if you have any questions about what you found.

9529 Wardray Premise – An MR accessories products company (that I’m hoping to get familiar with) based in England.

There are vendors not on this list because (1) I either forgot or didn’t know about their product offerings, (2) they’re ‘old standby’s’ that I’m already familiar with, or (3) they’re in a different exhibit hall.

Which segues, nicely, into my disclaimer that the above list is just for the North Exhibit Hall B. Time permitting, I’ll do the same for the Lakeside Center D (the Siemens Hall), and then the South Exhibit Hall A (the GE Hall).

If you’d like to conduct your own virtual tour of the RSNA exhibit halls, they offer a wonderful interactive floor plan of the exhibit halls online. You can see which booths I failed to mention (and add your suggestions in the comment field, below), or preview what you think my recommendations might be for the other two Halls.

I will, of course, be doing some duty in the Mednovus booth, 7801 (just inside the North Hall entrance that is NOT right next to Starbucks), and I hope that you’ll stop in and say ‘hi’ to me or my colleagues. Depending upon how ensconced I get in those conversations, this list may turn out to be a bigger proportion of my RSNA experience than actually getting to the other exhibits!

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!