MRI Safety This slide show will educate all healthcare providers about the safe delivery of care in the magnetic resonance (MR) environment.

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MRI Safety This slide show will educate all
healthcare providers about the safe delivery of
care in the magnetic resonance (MR) environment.

• This slide presentation has been adapted for
  Nursing from an original presentation compiled
  by
• Deborah Schwengel, M.D.
• Christopher Pressley, M.D.
• Kaadze Wright, M.D.
• Robert W. Evers, BSRT, MR, CV

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THE MAGNETIC FIELD IS AT FULL POWER ALWAYS .IT
IS ALWAYS ON.
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EMPLOYEE SAFETY

• ALL EMPLOYEES MUST BE SCREENED TO WORK IN A
  MAGNETIC FIELD ENVIRONMENT JUST LIKE THE
  PATIENTS.
• NO EXCEPTIONS.

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MRI PROCEDURE SCREENING FORM To ensure patient
safety, completion of the MRI screening form is
required prior to every MRI scan. Units can
assist expedite the MRI's triage process by
completing this form in advance and faxing to
2-8582.
This form is located online at
http//www.rad.jhmi.edu/requisitions.htm
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MRI Screening Sheet
All Patients will need this form filled
out before an MRI can be done.
Ideally, the form should be filled out by a.
The Patient If the patient cannot fill it
out b. Family Members If there are no family
members c. Referring MD
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What to do in an Emergency

• If there is a Patient Emergency in MRI
• GET THE PATIENT OUT OF THE ROOM
• NO CODE OR CODE LIKE PROCEDURES WILL BE RUN IN
  THE MRI ROOM.

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BURNS

• It is possible for patients to get 1st, 2nd, or
  even 3rd degree burns in an MRI if items such as
  ECG cables are looped and are touching the
  patients skin (even if these devices are MRI
  compatible).
• All cables should not touch the patients skin
  directly, and should NOT be in a LOOPED
  configuration.

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What can you take into a magnetic field?

• ONLY ITEMS THAT ARE MRI COMPATIBLE. Such as
• Brass
• Aluminum
• Plastic
• IF YOU ARE NOT SURE IF AN OBJECT IS MRI
  SAFEDONT TAKE IT INTO THE ROOM. ASK A
  TECHNOLOGIST!!!!!!!!

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Magnetic Field

• What objects can you take into a magnetic field?

Anything that doesnt contain iron. To be
safeTAKE NOTHING INTO A MAGNETIC FIELD. Work
closely with the Technologist who works in that
type of environment each day. Question
Everything.
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Site Access Restriction Screening

• All patients presenting for a non emergent scan
  must be screened by two MR personnel, including
  one with level 2 qualifications.
• A detailed history on possible implants or
  metallic objects must be obtained in writing and
  signed by appropriate medical licensed personnel.
  
• Do not rely on verbal history alone.

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Characteristics of the Magnetic Field

• the force of the field is measured in tesla (T)
  a typical scanner is approximately 1.5- 3.0 tesla
  
• the force of the field is greatest at the
  periphery of the magnet. This FORCE INCREASES as
  you move closer to the magnet.
• NOT ALL MAGNETS ARE THE SAME FIELD STRENGTH, THUS
  THEIR ATTRACTIVE FORCES WILL BE DIFFERENT.

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Biologic Effects of the Static Magnetic Field on
Persons in its Proximityquestions to consider

• does the field have long term deleterious effects
  such as increasing the risk of neoplasm?
• does the field have effects on the patient which
  alter our monitoring?
• does the field have effects on implanted medical
  devices which are non-ferromagnetic and MR
  safe?

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To date there is no clear and convincing evidence
that exposure to high magnetic forces in the MR
environment increases the risk of cancer.
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Effects of the Static Magnetic Field on Implanted
Medical Devices

• Although certain devices such as implanted pumps
  may be MR compatible, there are still important
  considerations in this patient population.

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Determining if a medical device is safe in the
MRI environment

• The MRI staff are always equipped with the latest
  information on device safety.
• Questions should be directed to the chief MRI
  technologist.

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Pacemakers

• There several reports in the literature
  describing the occurrence of sudden death in the
  MR for patients with implanted (but MR
  compatible) pacers. To date the mechanism of
  these fatalities is unclear but is thought to be
  secondary to the induction of fatal arrythmias.
  Therefore pacemakers are currently a
  contraindication to MR scanning.

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Forces in the MR Environment

• Magnetic field
• missile effect TRANSLATION
• rotational effect ROTATION/TORQUE

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Translational Force

• this term describes the force which attracts
  ferrous objects to the center of the magnetic
  field
• may act to transform ferrous objects into
  missiles as they accelerate toward the magnet
• the force is greatest when the difference in
  field strength across the object is greatest
  where delta T or difference in field strength
  from point A to point B is maximized

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Rotational Force

• this force relates to the North - South
  orientation of the scanners magnetic field
• ferrous objects will attempt to align their long
  axes with this orientation
• this force will rotate objects until they are
  aligned and is greatest at the very center of the
  field (unlike the translational force which is
  greatest where the difference in magnetic field
  across the object is greatest)

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Another danger in MRI -QUENCH!

• MR scanners are supercooled with inert gases such
  as helium.
• If these cryogens BOIL OFF either intentionally
  or unintentionally, a quench has occurred. THIS
  IS EXTREMELY BAD.
• An INTENTIONAL quench is done in an emergency to
  run the magnetic field to ZERO in order to remove
  a projectile/patient from the scanner in extreme
  emergencies.
• If a quench occurs, remove all staff from the
  room immediately

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Another danger in MRI -QUENCH!

• THE WORRY WITH A QUENCH IS THE POTENTIAL FOR
  ASPHIXIATION AND FROST-BITE TO THE HEALTH CARE
  WORKER AND PATIENT.

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Pregnant Patients or Personnel

• Pregnant patients regardless of trimester are
  only scanned if the results of the study will
  change the care of the patient.
• Pregnant MR personnel are encouraged not to stay
  in the room during the scanning process.

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Introduction to the zone system for maintaining
safety in the MRI suite
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Site Access Restriction

• All personnel with access to MR must have either
  level 1 or level 2 qualifications.
• Level 1 personnel are minimally trained in MR
  safety and can ensure their own safety and the
  safety of a patient in the MR environment.
• All JHH anesthesiologists must have level 1
  qualifications.

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Site Access Restriction

• Level 2 personnel are extensively knowledgeable
  about the MR environment, the potential hazards
  of the agents and equipment used, and MR safety
  precautions.
• The MR safety director, and all MR radiology
  technologists are level 2 personnel.

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Safety Zones

• Zone 1 This is a public access area with no
  restrictions.
• Zone 2 This is a semi restricted area where
  patients and hospital staff can interact.
• Zone 3 This area is completely physically
  restricted from non MR personnel especially the
  general public.

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Remember this mnemonicMRI Metal Results (in)
Injury
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The End