AHRA: ICDs are 'huge success story;' room for improvement remains

ORLANDO, Fla.—When it comes to MRI safety, the risks involved with imaging patients who have implantable cardiac defibrillators or other implants are often discussed. However, statistics show that incidents involving implants are the fifth most common type of accident, with other issues deserving more attention, according to a presentation Aug. 12 at the 40th annual meeting of AHRA: the Association for Medical Imaging Management.

It’s not that incidents involving implants aren’t serious, said Rob Junk, president of RAD-Planning in Kansas City, Mo. In fact, the attention paid to protecting patients with implants has resulted in what he called a “huge success story” as only 2 percent of MRI accidents involve implants. Now radiology needs to focus on the other common accident types, he said.

Junk pointed out the top four types of incidents involving MRI are:

• Burns (69 percent of all accidents)
• Projectiles (12 percent)
• Hearing damage (11 percent)
• Cryogen injury (3 percent)

All of these accidents are prevented fairly easily, said Junk, who offered tips on curbing the number of incidents for each  top accident type. By focusing on burns, projectiles and hearing damage, more than 90 percent of MRI accidents can be avoided, he said. Those tips were:

Burns

• Maintain 1 cm of an air gap or padding between patients and active radiofrequency (RF) elements.

• Remove extra, unneeded items from the table or patient that could conduct RF energy.

• Make sure any objects or leads that remain are properly insulated.

Projectiles

• Use the four-zone screening model from the American College of Radiology (ACR). This screening should be conducted on everyone who enters the MRI scanner room, including patients, relatives of patients, physicians and other staff.

• Test and label all MRI suite equipment for safety limitation and conditions.

• Even after screening according to ACR’s guidelines, use a ferromagnetic detector to screen patients and equipment entering the scanner room. “The ferromagnetic detectors are there as a second line of defense for those things that get missed, for those patients that tell you, ‘Yes, I’ve taken everything out,’” said Junk.

Hearing damage

• Require all persons remaining in MRI scanner room to use hearing protection.

• Instruct patients on proper placement of hearing protection, particularly molded ear plugs.

• Provide alternative means of hearing protection for patients unable to use ear plugs.