Vigilance in the MRI environment
Lauren Madoff, MD and Lynne G. Maxwell, MD
Screening for ferromagnetic objects is of utmost importance to ensure the safety of all patients and staff within the magnetic resonance (MR) environment. Despite awareness of this danger to patients and staff, incidents continue to occur. Today’s PAAD highlights a letter to the editor by Sandridge et al that highlights some important practice changes implemented at their institution to prevent magnetic objects from entering the MRI scanner. Some of the checkpoints that have improved safety include 1) having patients change from their clothing into MRI-safe gowns prior to entering Zone 3, 2) screening all patients with both written forms and verbal confirmation, 3) using ferromagnetic detection devices on all patients and staff, and 4) using MRI compatible monitors on all patients.1 To discuss this important issue, we have invited Lauren Madoff, MD from Boston Children's Hospital, where she is a leader in MRI anesthesia.
Original Article
Sandridge B, Palazzolo M, Faulk D, Mandler T. Improving ferromagnetic screenings before MRI in pediatric patients. Paediatr Anaesth. 2023 Oct;33(10):872-873. doi: 10.1111/pan.14701. Epub 2023 May 23. PMID: 37218450
In addition to these measures, our institution (LM) utilizes several other safety measures for pediatric patients receiving anesthesia for MRI. Our process begins as soon as an order is placed for a sedated MRI. When scheduling sedated MRIs, our scheduler reviews a series of screening questions with the family. Any response flagged as safety concern, such as an implanted device, is investigated by an MR technologist prior to the scan date. Similarly, if there is a concern for contrast administration that is found on the screening form, a nurse reviews the case. All concerns are sent to either the safety or contrast queues and MR compatibility is determined prior to their scan dates. Patients are also screened for PICA (ingestion of non-food material). If PICA films are deemed necessary, patients are scheduled for x-rays prior to the MRI.
At the beginning of each day, the attending anesthesiologists, attending radiologists, charge nurse and MRI technologist in charge participate in a team huddle. All scheduled and add-on patients for the day are reviewed. Any safety concerns, such as the presence of an implanted device or a tracheostomy tube, are brought to the attention of the entire team caring for the patient and everyone is made aware of the plan for safely bringing the patient into the MR scanner.
All patients are anesthetized outside of the MR scanner in a separate induction space in Zone 3. Parents, caregivers, nurses, etc. can be present for the induction of anesthesia without entering Zone 4 and potentially carrying ferromagnetic objects. Patients can be visually scanned for any medication patches and non-MRI compatible monitoring devices. This practice also provides a separate space to perform the procedure time out and to use ferromagnetic detection devices prior to entering Zone 4.
One of the most important points to highlight from the communication of Sandridge et al is that the MR environment is always changing. Frequent turnover of new staff, trainees, as well as patients and caregivers, means that everyone involved must be constantly vigilant for potential hazards. Anesthesiologists can play a pivotal role in enhancing and ensuring MR safety.
Does your institution have enhanced screening practices for patients and staff prior to entering the MRI environment? Are they followed? Has your institution experienced any breaches? Please send your thoughts and comments to Lynne (lynne.maxwell@gmail.com) and we will post them in a reader response.
1. Sandridge, B., Palazzolo, M., Faulk, D. and Mandler, T. (2023), Improving ferromagnetic screenings before MRI in pediatric patients. Pediatr Anaesth, 33: 872-873