tgilk

Having already stipulated to the fact that there aren't enormous numbers of MRI patient injuries, I would also say that the numbers of close-call and minor-injury events is far from rare. Here's a blog post identifying a few of the most egregious MRI accidents from the first 3/4 of 2009, as reported to the FDA (Can We Still Call Them MRI Metal Detector Blog). It should be noted that most MRI accidents occur because the machine is working properly (generating massive magnetic fields and washing patients in large amounts of RF energy). As long as the device is working as designed and approved by the FDA, as a medical device contemporary law provides some very substantial protections to the manufacturer of the MRI. As such any standards that the manufacturers wish to put forward are (a) voluntary on their part, and (b) without any means of enforcement. It is estimated that thousands, perhaps 10's of thousands, of MRI accidents and near-misses occur annually in the US. The vast, VAST, majority of these are 'pilot error' which could be avoided had someone, anyone, required that industry best practices be followed. For all the regulation, licensure and accreditation oversight for ionizing radiation modalities, there has not been a single physical environment safety requirement for MRI at any level. It is only by grace or luck that we've failed to seriously injure more people, though the trends suggest that 'injuring more people' is the direction MRI is currently headed ( MRI Metal Detector Blog). I won't dispute that a 95% handwashing rate, as an example, would do more to save lives than an MRI Sentinel Event Alert, but through just a handful of changes to MRI safety, bringing contemporary expectations in-line with best practices, we could virtually exterminate some of the most common forms of MRI injury.

Interesting timing for your post. Bob Wachter just posted a piece about how he felt that TJC was becoming significantly more relevant with some contemporary changes... The Health Care Blog: The New Joint Commission And while I don't dispute your underlying point (quality and safety both being intimately tied to nursing care), I think the MRI sentinel event alert is a poor target. Yes, MRI deaths are less than those caused by people tipping vending machines over themselves to get that stuck bag of chips... but the MRI environment is one where the fundamental laws of physics change imperceptibly and normally-harmless objects can become lethal just by moving them a foot one way or the other. These sorts of risks are wholly unknown by the non-MR public, so there is a unique duty of the provider to make sure that they have protections that conform to industry best practices. John Q. Public knows the risks of tipping that big machine towards him to get an extra Snickers bar (even if he misjudges what the risks are). The same person is largely 100% unaware that failing to disclose the aneurysm clip or relinquish the 'lucky pocketknife' could result in someone getting killed in the MRI suite. We're not talking raw-denominator numbers here, we're talking about a duty to manage unknown (to patients and visitors) risks that they have no awareness of / control over. Tobias Gilk

This is a very 'sticky-wicket' from the practical standpoint. I agree that telling the tech that (s)he is forbidden from using their portable pump is a bad decision for anyone to make, particularly a healthcare provider, but I would be even more determined to prevent anyone carrying ferrous material, even as a part of their job... such as a tool belt, to circulate within the MRI suite without appropriate protections. Given the typical workloads and throughput pressures common to most MRI facilities, it borders on fantasy to think that techs would be willing to both turn away from patient care at the same time several times per day for one to repeatedly screen the other. Current technology and best practices, however, might provide a solution that would also enhance the safety of ALL persons entering the MRI scanner room. The 2007 ACR Guidance Document and the recent Joint Commission Sentinel Event both suggest the use of ferromagnetic detection (FMD) devices as an adjunct to conventional screening. This diabetic tech's pump, if it is ferromagnetic enough to go flying into the bore, is likely ferromagnetic enough to light up a ferromagnetic detector like a Christmas tree. While most facilities might be reluctant to take such steps for an issue raised by one tech, if the FMD was positioned in the path of everyone entering the MRI suite, it could provide redundant screening for everyone, not just the one tech. I served on the ACR's MR Safety Committee and am a contributing author to the Guidance Document. While today I work for a company that manufactures FMD (full disclosure), the proposal to include the recommendation for the use of FMD screening in the Guidance Document was that of Dr. Emanuel Kanal, noted guru of MRI safety issues. I'd hate to see a trained and talented technologist be forced to choose between the career that they've chosen and effective management of their health, particularly when there are options out there that might allow both options to coexist and provide safety benefits to everyone else in the MRI suite, too. Tobias Gilk