Preventing Accidents and Injuries in the MRI Suite

What are the potential safety hazards associated with the magnetic resonance imaging (MRI) scanning
process?

While the capabilities of the MRI scanner have been well recognized for over 30 years, there are some inherent dangers in its use. The following types of injuries can and have occurred during the MRI scanning process:

• “Missile effect” or “projectile” injury in which ferromagnetic objects (those having magnetic properties) such as ink pens, wheelchairs, and oxygen canisters are pulled into the MRI scanner at rapid velocity.
• Injury related to dislodged ferromagnetic implants such as aneurysm clips, pins in joints, and drug infusion devices.
• Burns from objects that may heat during the MRI process, such as wires (including lead wires for both implants and external devices) and surgical staples, or from the patient’s body touching the inside walls (the bore) of the MRI scanner during the scan.
• Injury or complication related to equipment or device malfunction or failure caused by the magnetic field. For example, battery-powered devices (laryngoscopes, micro infusion pumps, monitors, and so forth) can suddenly fail to operate; some programmable infusion pumps may perform erratically; and pacemakers and implantable defibrillators may not perform as programmed.
• Injury or complication due to failure to attend to patient support systems during the MRI. This is especially true for patient sedation or anesthesia in MRI arenas. For example, oxygen canisters or infusion pumps run out and staff must either leave the MRI area to retrieve a replacement or move the patient to an area where a replacement can be found.
• Acoustic injury from the loud knocking noise that the MRI scanner makes.
• Adverse events related to the administration of MRI contrast agents.
• Adverse events related to cryogen handling, storage, or inadvertent release in superconducting MRI system sites.

The Joint Commission recommends that health care organizations take the following steps to reduce the risk for MRI injuries to patients:

• Restrict access to all MRI sites by creating safe zones recommended by the American College of Radiology (ACR);
• Use trained screeners to perform double checks of patients for items such as metal objects, implanted or other devices, drug delivery patches and tattoos;
• Ensure that the MRI technologist has the patient’s complete and accurate medical history to ensure that the patient can be safely scanned;
• Have a specially trained staff person accompany any patients, visitors and staff into the MRI suite at all times;
• Annually educate all medical and ancillary staff who may accompany patients into the MRI suite about the risk of accidents;
• Take precautions to prevent patient burns during scanning;
• Only use fire extinguishers, oxygen tanks and other equipment that have been tested and approved for use during MRI scans (equipment that will not be attracted to the magnet);
• Manage critically ill patients who require monitoring and life-sustaining drugs to assure that their care needs are continuously met while in the MRI suite;
• Provide all MRI patients with ear plugs to diminish the loud “knocking” noise emanating from the equipment; and
• Never run a cardio-pulmonary arrest code or resuscitate a patient in the MRI room.

While millions of MRI scans are performed each year and most cause no harm, the inherent dangers of the process need to be better known. The most common types of injuries are burns, while many accidents are caused by common objects that become missiles when brought into the MRI scanner’s magnetic field. Hopefully, by implementing the recommendations listed above, risks of injury can be significantly reduced.