MRI Safety
MRI Safety
Definitions:
MRI – magnetic resonance imaging
Adverse Event – any unexpected or dangerous reaction to treatment/drug/procedure
Serious Adverse Events - any event which causes death, permanent damage, or requires hospitalization
Ferromagnetic Object – object with magnetic properties
There are Potential Risks in the MRI Environment for:
Patients
Accompanying family members
Accompanying health care professionals
Security
Housekeeping personnel
Firefighters/Police/Prison Guards
What Makes the MRI Environment so Hazardous?
Large invisible magnetic fields that extend in 3 dimensions
It is impossible to tell by looking at an MRI system whether it is “ON” or not
Many objects that don’t appear to contain ferromagnetic/hazardous material
1 For example, sandbags – some contain ferrous materials even though one would not think so.
Labeling on devices or in documentation can be confusing
1 “MR safe” and “MR compatible” are specific to a particular MR environment. The terms are not intended to be used without further specifying the particular MR environment where the devices have been tested and found safe and compatible for
2 “MR safe” and “MR compatible” may not be with more powerful MRIs
Combination of complacency, work-arounds for speed, and diffuse responsibility
Equipment and consumables that are “safe” 99% of the time become “unsafe” near MRI
People and equipment who are “new” to MRI suite (more interventions and surgeries)
Ferromagnetic Objects Include:
Buffing machines
Chest tube stands
Clipboards (patient charts)
Gurneys
Hairpins
Hearing aids
Identification badges
Insulin pumps
Keys
Medical gas cylinders
Mops
Nail clippers and nail files
Oxygen cylinders
Pulse oximeters
Steel shoes
Stethoscopes
Scissors
Staples
Vacuum cleaners
Watches
Wheelchairs
Types of MRI Hazards
• Projectile effect (ferromagnetic material pulled toward the magnet bore) - Oxygen bottles, scissors, IV poles, patient lifts, traction weights, pens, stethoscopes, and hair barrettes
Hairpins near a MR magnet can reach speeds of 40mph
• Twisting (magnetic objects aligning parallel with the field – torque)
• Magnetic cochlear implants & cerebral aneurysm clips twist within the body causing damage
• Magnetic components rip loose from their foundation on equipment causing device failure or patient injury
Burns from objects that may heat during the MRI process
1 Looped ECG leads, pulse oximeter cables, & MR accessories (e.g., RF coil leads) in contact with
3 a patient under sedation can cause full thickness burns
4 While rare in occurrence, tattoos or tattooed eye-liner containing iron oxide have heated to cause minor burns
5 Skin burns at the sites where the pulse oximeter sensor touches and ECG electrode sites
6 Skin burns from contacting the bore of the magnet
7 Inadvertent overly high settings for extremity exams have caused ignition of special cuffs/sleeves
Device malfunction (electronics or mechanics affected)
1 Devices with analog gauges, electric motors, transformers, relays, & switches can be affected by the static magnetic field
2 Devices that use magnetization to attach to a patient (e.g., some dental devices) and some implants that are electrically, magnetically, or mechanically activated can be affected by the static magnetic field
9 Battery-powered devices (laryngoscopes, monitors, etc.,) can suddenly fail to operate
10 Some programmable infusion pumps may perform erratically. A PCA pump reversed flow, despite presenting normal displays to the user – a one-way valve stopped flow blood into the IV bag. A similar incident occurred with an insulin infusion pump
1 A ventilator delivered inadequate inspiratory pressure
2 Pacemakers can pace at the wrong point in the cycle & rapid pacing can occur due to RF field interactions
3 ECG waveforms can be distorted (e.g., increased T-wave or ST segment) due to the static magnetic field interactions, & ECG signals can be misinterpreted (e.g., missed complexes) due to the gradient magnetic field interactions
Acoustic injury from the loud knocking noise that the MRI scanner makes
Adverse events related to the administration of MRI contrast agents
Nursing Staff, for Your Own safety
You must not accompany a patient into the MRI chamber if you are wearing any clothing containing metal
You must not accompany a patient into the MRI chamber if you are wearing dentures, hearing aids, hairpins, artificial prosthesis, jewelry, TENS unit, stimulators, support braces, makeup, holter monitor
You must not accompany a patient into the MRI chamber if you have had any surgery or trauma which has resulted in shrapnel or welding wounds
For your own safety you must not accompany a patient into the MRI chamber if you have any of the following:
Cardiac valve prosthesis
Cardiac pacemaker or pacer wire implant
Intracranial aneurysm
IUD
Cochlear implants
Joint replacements
Metal plates or pins
If you are pregnant
Remember
The magnets in the MRI scanner are always “on” and that turning them “off” (quenching) is an expensive and potentially dangerous undertaking
Many of the objects pulled into the MRI scanner are cleaning equipment or tools taken into the MRI suite by housekeeping staff or maintenance workers
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