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MRI safety

MRI safety. Zulmarie Roig , MD Chief of MRI, NSMC Courtesy of Stacy Kimball RTR(MR), MM. Courtesy of Stacy Kimball RTR(MR), MM. DANGER!!!!! The Magnet is ALWAYS ON !. Courtesy of Stacy Kimball RTR(MR), MM. FDA.

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MRI safety

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  1. MRI safety ZulmarieRoig, MD Chief of MRI, NSMC Courtesy of Stacy Kimball RTR(MR), MM

  2. Courtesy of Stacy Kimball RTR(MR), MM

  3. DANGER!!!!!The Magnet is ALWAYS ON ! Courtesy of Stacy Kimball RTR(MR), MM

  4. FDA According to the Alert, the Food and Drug Administration (FDA) has received nearly 400 reports of MRI-related accidents over the past decade. More than 70 percent of accidents were burns, while 10 percent of injuries occurred when metal objects such as ink pens, cleaning equipment and oxygen canisters have become "missiles" when pulled into the magnetic field of the scanner. Courtesy of Stacy Kimball RTR(MR), MM

  5. Outcome of Missile Effect Courtesy of Stacy Kimball RTR(MR), MM

  6. Other Accidents Stacy Kimball RTR(MR), MM

  7. Accidents Stacy Kimball RTR(MR), MM

  8. MRI safety zones • Zone 1: General Public: Front reception area • Zone 2: Unscreened MRI patients: Front reception area, where unscreened MRI patients wait for their examinations. • Zone 3: Screened MRI patients, visitors, and personnel: Screened by a technologist, technologist aide, or MRI nurse prior to entering this zone. Zone is secured by a door which only MRI staff members can let patients and visitors through. • Zone 4: Screened MRI patients under constant direct supervision of trained MRI personnel: Is the magnet room. All patients, escorts, and visitors must pass the MRI screening. Anyone who enters Zone 4 must be escorted by an MRI Technologist, MRI Nurse or Technologist Aide.

  9. Implants and metallic devices will not enter the magnetic field strength area beyond Safety Zone III • Pacemakers • Implantable defibrillators • Magnetic sphincters • Implantable neuro-stimulators • McGee Stapedectomy piston prosthesis • Intraocular foreign body. • Metallic devices: Infusion pumps • Metallic Heart Valve • Retained Internal Pacing Wires (post cardiac surgery) • External fixators orthopedic hardware • Endoscopy video capsules

  10. Researched and documented before qualifying for and MRI • Stents/Filters/Coils and Vascular Grafts Renal Transplant Clips • Cerebral aneurysm clips • Certain dental implants • Certain ocular implants • Vascular Clips (endoscopy clips) • Middle Ear Prosthesis • Cochlear Implants • Accident involving metal in the eye • Intra-uterine devices, IUD. • Transdermal patches

  11. Ferromagnetic Objects must NEVER enter the MRI scan room Buffing machines Chest Tube stands Clipboards or patient charts Gurneys Hairpins Hearing Aides ID badges Key Medical Gas cylinders Mops Nail Clippers of files Oxygen Cylinders Pulse oximeters Pace makers HugsTags Medication patches Pagers Paper clips Pens and Pencils IV pumps IV poles Prosthetic Limbs Shrapnel Sandbags (with metal filings) Steel shoes Stethoscopes Scissors Staples Tools Vacuum cleaners Watches Wheel chairs Chairs

  12. Before undergoing an MR procedure must remove: • all removable metallic personal belongings and devices on or in them (e.g., watches, jewelry, pagers, cell phones, body piercings [if removable], contraceptive diaphragms, metallic drug delivery patches, cosmetics containing metallic particles [such as eye make-up], and clothing items that may contain metallic fasteners, hooks, zippers, loose metallic components, or metallic threads). • Patients are required to wear a gown without metal fasteners/hospital gowns without snaps.

  13. Scan room • Hearing protection • Ocular screening(implants, metallic FB)

  14. Acoustic Injury Ear Protection

  15. Oxygen Tanks GREEN oxygen tanks are NOTMRI compatible NEVERbring a GREEN tank into a MRI room or near the MRI machine under ANY circumstance. SILVER oxygen tanks ARE MRI compatible

  16. Equipment for MRI All equipment for MRI is labeled “MRI Compatible”. This SPECIFIC equipment can go into the MRI room. The technologist will decide what can go into the room.

  17. Burns Objects can HEAT during a MRI Scan Surgical staples Lead wires Implants External devices Patient touching the bore of the magnet with bare skin

  18. Example of a Patient Burn

  19. What is Nephrogenic systemic fibrosis (NSF)? .

  20. Nephrogenic systemic fibrosis • Rare and serious syndrome that involves fibrosis of skin, joints, eyes, and internal organs. • The first cases were identified in 1997. • Cause is not fully understood. • Evidence to suggest that it is associated with exposure to gadolinium (with gadolinium-based MRI contrast agents being frequently used as contrast agents for magnetic resonance imaging) in patients with severe kidney failure.

  21. How can we help prevent this disease? Asking these patients the following questions both when scheduling and screening patients.

  22. ACR recommendationsNew recommendations for screening These are the questions which need to be asked to EVERY patient. • Patients over the age of 60 • History of renal disease (including one kidney, kidney transplant, kidney tumor or kidney mass). • History of “Hypertension” (if patient is undergoing treatment for hypertension). • History of diabetes mellitus: type I and type II • If the patient receiving dialysis? Proceed with the Policy : MRI Exams for DIALYSIS Patients. • Patients in Acute Renal Failure/Insufficiency, peritoneal dialysis or severe liver failure/pre/post liver transplant will NOT receive a contrast MRI regardless of GFR value. These patients will be decided on a case by case basis by the Radiologist.

  23. Questions for you?? Are Ferromagnetic objects MRI compatible? T or F If I have a pacemaker I can enter the MRI scan room. T or F Green oxygen tanks are MRI compatible? T or F I have to wear hearing protection in the MRI scan room. T or F What kind of wheelchair or stretcher can enter the MRI room?___________ . Codes are performed outside the MRI suite. T or F I will be screened before entering the MRI suite T or F

  24. Contact Stacy Kimball – Chief MRI Technologist Office 978-573-3136 Partners Page 73742 SLKIMBALL@PARTNERS.ORG Site Leaders Lennie Chasse- Salem Campus 978-573-3151

  25. Video http://www.imrser.org/

  26. Reference Manual for Magnetic Resonance Safety, Implants, and Devices yearly edition is located in each control room for reference, and for online support MRISAFETY.com • Mag Resource (http://www.doctordoctor.biz/search/Login.aspx) or within a Partners approved implant search list.

  27. References References: http://www.mrisafety.com/ http://www.imrser.org/ Pictures from GE medical and Google.com

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