1. Introduction This course is designed to inform individuals of the necessity of Magnetic Resonance Imaging (MRI) safety. Any individuals that are in contact with an MRI environment and have knowledge of MRI techniques would greatly benefit from this lesson. Click the right arrow to advance slides, and the left arrow to go back to the previous slide

2. MRI Safety © Tiffany Heider, 2005 It could mean the difference between life and death!

3. What is MRI? Magnetic Resonance Imaging (MRI) is becoming very popular within the world of medical diagnosis and research. MRI is a technique that uses a magnetic field and pulses of radio wave energy to provide pictures of organs and structures inside the body. For an MRI procedure, the area of the body being studied is positioned inside a strong magnetic field. The MRI can detect changes in the normal structure and characteristics of organs or other tissues. Due to the strong magnetic field, there are many safety issues to consider with this type of testing. Inadequate knowledge can result in serious injury and possible death.

4. Who gets MRIs? Everyday individuals, such as you, could one day have an MRI. As well as your family pet, or a sick zoo animal. Their safety depends on your knowledge.

5. Magnetic Fields There are 2 Types of magnetic fields Main magnetic field-responsible for the alignment of nuclei. -always on -the middle of the magnet (inside the bore)

6. Fringe or static field- stray magnet field outside the bore of the magnet -always on -No respect for confines of walls or doors, floor or ceilings -MRI room is shielded to confine the fringe field to inside the room Types of magnets, cont.

7. Why do I need to be safe? Patients lives are in your hands and they trust that you do not abuse that. Patient screening, in-depth knowledge, and proper precautions are expected of you.

8. MRI safety precautions Patient and personnel screening is the most effective way to avoid potential safety hazards. Patients or personnel with metallic implants should be examined. Screening forms should be filled out by anyone entering the MRI exam room. Screening forms should be filled out completely and correctly. Patients unable to fill out a screening form must have a family member fill it out for them.

9. Biological Effects No radiation is used in MRI, MRI is based on the transmission of radio waves. No biological or adverse effects No biological or adverse effects to fetus or pregnant women. -because of cell division during the first trimester it is recommended by the FDA that women do not have an MRI in the first trimester unless medically necessary.

10. Projectiles Ferromagnetic metal objects can become airborne. - small objects (paper clips, hairpins) can reach the velocity 40 mph Surgical tools such as hemostats,scissors, and clamps. Even ones made of surgical stainless steel can be highly magnetic. O2 tanks -All objects tested with hand- held bar magnet first.

11. Projectiles, cont. Janitors and cleaning crew must also be aware of MRI precautions. Buffers and cleaning tools can be attracted by a magnet. Vendors working on MRI equipment must also be trained and have the proper MRI tools that are nonmagnetic. It is the departments responsibility to assure no unauthorized persons are to entire a scan room.

12. Implants/Prostheses Metallic implants in patients or employees must be identified before entering room. Heating and Torque can occur-can cause serious effects Metal Implants can also cause artifacts on the films

13. Contraindications A factor that renders the administration of a drug or the carrying out of a medical procedure inadvisable.

14. Intra Cranial Vascular Clips Absolute contraindications, under no condition may that person enter the MRI room. Motion of the clip may damage the vessel resulting in hemorrhage or even death.

15. Intra Vascular and Extra Cranial Coils, Filters, Stents Intra Vascular coils, filters, and stints - 8 weeks post surgical, check with the technologist prior to the exam. Extra Cranial vascular clips -4-6 weeks after implantation-also check with technologist prior to exam

16. Vascular Access Ports and Heart valve implants Vascular access ports are MRI compatible Heart valves are usually compatible, however the type and model number is required to be checked prior to the test. -Usually safe after 8 weeks post implantation and scar tissue has formed around the implant.

17. Ontological or Ear and Ocular or Eye Implants Cochlear implants- all contrainindicated Ocular implants-some are ferromagnetic-all patients need to be screened thoroughly. Intra ocular foreign body- metal in the eye. -all patients who work or grind metal need to have an x ray before having an MRI. -Metal in the eye could could heat up or move causing blindness.

18. Contrainindications for MRI Cardiac Pacemakers Cochlear Implants Tissue Expanders Ocular Prosthesis Neurostimulators Bone growth stimulators Defibrillators Drug Infusion pumps Intracranial Vascular Clips-i.e. aneurysm clips

19. Claustrophobia Claustrophobia- the fear of being in enclosed spaces. Many people suffer from this and some patients may need to be sedated before having an MRI. Proper sedation monitoring must be used.

20. SUMMARY  MRI suites are a valuable but potentially dangerous medical tool.  MRI magnets are always on.  The smallest metallic object can be attracted into a MRI magnet.  Patients must be screened prior to examination.  Any individual entering the MRI scan room must be properly trained on the hazards.  Patient and employee safety must always come first.

21. ASSESMENT Next you will be asked a series of questions testing your knowledge on the given material. You will be given a question/scenario and a choice of answers. Choose the best answer and click to the next slide to see an explanation of answers. This is for your benefit so please so looking ahead at the answers.

22. Question 1 Who are MRIs designed for? 1. Very sick individuals 2. Individuals with trauma or physical injury 3. Individuals with experimental consent 4. Animals 5. All of the Above

23. Question 1 Answers The correct answer is #5 All of the above. MRIs do not treat just deathly ill individuals, or individuals with recent trauma. An MRI can diagnosis all kinds of diseases or injuries in all people as well as animals.

24. Question 2 Sally is an MRI technician. They are not in the middle of a scan and she wants to get the scan room organized. Since there are no scans going on it is okay for Sally to take her cell phone into the room with her. 1. True 2. False

25. Question 2 Answer The correct answer is #2 False. MRI magnetic fields are always active regardless if there is a scan going on. As long as the machine has power the magnetic field is present in the room.

26. Question 3 Mark is an MRI supervisor. His department has gotten backed up with patients and they are running behind. He knows the next patient has an accurate health history and tells his technician to skip the screening form. Is Mark’s decision the correct one? 1. Yes, he is the supervisor. 2. No, the form should be filled out.

27. Question 3 Answer The correct answer is #2 No. Even though the patient has a complete health record and Mark is the supervisor, safety should never be disregarded. The patient could have implants or other metallic objects that could be attracted to the magnet. These objects could result in patient injury or death. The screening form must be complete.

28. Question 4 Which of the following are NOT a MRI safety hazard. 1. Medical scissors 2. Patient oxygen tank 3. Radiation 4. Hair pins 5. Metal implants

29. Question 4 Answer The correct answer is #3 Radiation. A MRI suite does not use radiation as in CT suites. A MRI machine uses magnetic fields and radio waves rather than radiation waves. However any material made of metal that is not non-magnetic may be attracted into the magnet.

30. Question 5 A patient states that they have a metallic implant. However, they also inform you that they have had an MRI before, and it will not attract to the magnet. If the patient says it will not attract, then you should: 1. Continue with the exam. 2. Advise that the exam cannot be completed. 3. Have the patient sign a waiver.

31. Question 5 Answer The correct answer is #2 Advise that the exam cannot be done. If you were to scan that patient and something were to happen, then you would be responsible. It is better to notify your superiors and the patient rather than be liable for an injury or death that could result in a lawsuit and personal emotional stress.

32. Question 6 A vendor comes in to work on your MRI injector. You are headed out to lunch, but want the work to get done. What do you do to accommodate both of you? 1. Give him the keys to the room and go to lunch 2. Tell him to come back 3. Ask him if he is MRI safe before allowing him into the room while you are gone 4. Ask him to pull the unit out of the room before you go to lunch and work on it outside the room.

33. Question 6 Answer The correct answer is #4. Ask the vendor if he can work on the unit outside of the MRI scan room. This allows you to observe the individual while in the room, lock the room once he is done, and be sure that no magnetic tools enter the room. If he is unable to pull the unit out ask him to come back or have a collegue supervisor the MRI room.

34. Question 7 True or False A patient informs you that he/she gets nervous in tight spaces. Since this is the case, you cannot perform an MRI on this individual.

35. Question 7 Answer The correct answer is false. Many individuals have Claustrophobia. The MRI bore is a very tight fit, but a patient can be sedated. However, there must be a nurse there to perform the sedation and a qualified individual to monitor MRI compatible monitoring equipment.

36. CONGRATULATIONS YOU HAVE COMPLETED THE MRI SAFETY ASSESMENT. I HOPE YOU HAVE RECEIVED A LOT OF VALUABLE INFORMATION AND USE IT IN YOUR DAY TO DAY CAREER.

37. Reference Westbrook, C. Kaut, C.(1998). MRI in Practice. MRI Safety, chp 10. Blackwell Science.ltd. The American Heritage Dictionary of the English Language, Forth edition.(2000).Houghton Mifflin Company