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INFORMATION FOR YOU: Ensuring Student Safety in Magnetic Resonance Educational Programs
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Loraine D. Zelna, MS, RT (R)(MR), serves as
faculty and department chairperson of the medical imaging department
for Misericordia University in Dallas, Pennsylvania. She also serves
on the JRCERT Board of Directors This article is based on content previously published by the American Society of Radiologic Technologists and is used with permission of the ASRT. |
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Conversations about magnetic resonance (MR) imaging will usually include discussions on safety because of potential risks in the MR environment. Since the magnetic fields utilized in MR imaging are, on average, 30,000 - 60,000 times more powerful than the earth’s magnetic field, this strong magnetic field creates a “projectile effect” by pulling any ferromagnetic material (material that has a high susceptibility to magnetization, such as iron) into the center of the magnet at extremely high speeds. The magnet is always on, and the magnetic field is invisible. The risks for harm created by the strength of the magnetic fields and the radiofrequency hazards extend to all who enter the scanner’s magnetic field. These risks include the possibility that an implanted device, such as a pacemaker, could cease working, the magnet could torque or create excessive heat within or around an implanted device, or a person could be struck by a projectile as it is pulled toward the magnet. These potential hazards have led to rigorous screening procedures aimed at reducing the risk of accidents involving healthcare providers, MR personnel, and support staff who routinely work in the MR environment, and patients. Previously, the clinical setting personnel might have been relied upon to inform students in radiography, radiation therapy, magnetic resonance imaging, and medical dosimetry programs about MR safety. In October 2014, the Joint Review Committee on Education in Radiologic Technology (JRCERT) Board of Directors adopted new interpretations to Standard Four to help ensure student safety in the MR environment.1 Incidents of Note During the October 2014 meeting of the JRCERT Board of Directors, the board confidentially discussed an experience a student had during an MR rotation. During this particular incident, the student apparently heard the MR technologist screening a patient before the examination. The student became concerned and informed the MR technologist that she had a pacemaker. The technologist had assumed the educational program had screened the student before assigning her to an MR rotation, and the program had assumed the MR technologist would screen the student. One of the most widely publicized MR safety incidents occurred in 2001 at a New York-area hospital. A 6-year-old boy died after having an MR exam when a ferromagnetic oxygen tank was brought into the MR suite by an individual who was not trained appropriately in MR safety procedures. The machine’s magnetic field propelled the oxygen tank across the room and into the magnet, crushing the child’s head 2. This tragedy highlighted the need to improve safety considerations in the MR environment and emphasized the unmistakable need to improve safety measures for students in educational programs. Promoting Safe Practices and Improved Accountability Reports of unsafe practices in the MR environment have pointed to a need for increased guidance on safety practices. The American College of Radiology (ACR) developed a guidance document to provide industry standards for safe and responsible practices in MR environments. The document is updated continually to reflect changes in MR imaging best practices. Emanuel Kanal, MD, FACR, FISMRM, MRMD, AANG, the lead author of the document, has developed an MR safety training course to promote the certification of MR safety officers.3 . In addition, the Joint Commission issued diagnostic imaging requirements that require organizations to manage safety and security risks in MR environments. These requirements include restricting access to MR areas, ensuring these areas are controlled by MR safety-trained individuals, and posting signage to indicate potentially dangerous magnetic fields (see Table).4 Furthermore, the Joint Commission requires facilities to document the ongoing education of MR personnel, including annual training on MR safe practices. Magnetic Resonance (MR) Safety Zones5
New Standards Interpretations In the JRCERT’s continual quest to promote quality and safety, the new interpretations for Standard Four of the JRCERT Standards, were adopted in October 2014. Since that time, the JRCERT requires MR programs to publish and provide information about the potential dangers of implants or foreign bodies in students to all students and the general public, as well as to establish a safety screening protocol for all students.1 To document compliance, the program must describe how it prepares students for MR safe practices and provide a copy of the screening form. A plethora of MR safety information and resources for programs to use is available (see Box).
As of the beginning of 2016, the JRCERT has accredited 10 MR programs, with several more in the accreditation process. All of these programs have published information about MR safety screening on their program’s Web site; whereas, an informal review of non-JRCERT accredited MR programs listed on the American Registry of Radiologic Technologists Educational Programs Web site revealed that only 1 of 4 MR programs have published information on their program’s Web site about MR safety screening.7 This indicates the need for, and value of, programmatic accreditation. Programmatic accreditation provides educational programs preparing new practitioners for the profession with an external benchmark to ensure they meet the minimum standards identified by the profession. These external benchmarks help to ensure that students are screened appropriately and educated in MR safety practices to provide safe, high quality diagnostic services to patients while maintaining their own safety.8 Conclusion MR safety will continue to be an area of concern for imaging professionals and educational programs preparing students to enter the profession. The risks can mean life or death; therefore, it is paramount to implement safe practice standards. The MR community and various organizations work diligently to improve MR safety education and provide additional educational resources. Technologists practicing in MR must remain current on new safety information and considerations and share their knowledge and expertise. Students are the future of the profession, and they need to be prepared in the fundamental principles of MR safety. JRCERT has developed standards that assist programs in promoting safety for students, patients, and the general public Furthermore, these standards demonstrate the JRCERT’s commitment to excellence in education and to the quality and safety of patient care through its accreditation of educational programs.9
References 1. Joint Review Committee on Education in Radiologic Technology. MR safety screening for all educational programs. http://www.jrcert.org/sites/jrcert/uploads/documents/October_2015_Newsletter_Final_11_04_15.pdf. Published 2014. Accessed February 26, 2016. 2. Spike in MR Imaging Accidents Underscores Need for Regulation. Radiological Society of North America Web site. http://www.rsna.org/NewsDetail.aspx?id=1621. Published October 1, 2010. Accessed February 26, 2016. 3. New MR safety certification focuses on radiologists, technologists, and physicists. Patient Safety & Quality Healthcare Web site. http://psqh.com/january-february-2015/news-new-mr-safety-certification-focuses-on-radiologists-technologists-and-physicists. Published February 3, 2015. Accessed December 3, 2015. 4. The Joint Commission. Diagnostic imaging requirements. http://www.jointcommission.org/assets/1/18/AHC_DiagImagingRpt_MK_20150806.pdf. Published August 10, 2015. Accessed December 2, 2015. 5. Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document on MR safe practices: 2013. J MagnRson Imaging. 2013;37(3):501-530. doi/10.1002/jmri.24011. 6. Joint Review Committee on Education in Radiologic Technology. 2014 JRCERT standards for an accredited educational program. http://www.jrcert.org/programs-faculty/jrcert-standards/. Published 2014. Accessed December 1, 2015. 7. American Registry of Radiologic Technologists. ARRT-Recognized Educational Programs-Magnetic Resonance Imaging. https://www.arrt.org/Education/Educational-Programs/Magnetic-Resonance-Imaging. Published 2016. Accessed February 29, 2016. 8. What is accreditation? [online module]. Joint Review Committee on Education in Radiologic Technology Web site. http://www.jrcert.org/students/what-is-accreditation/. Published 2014. Accessed December 3, 2015. 9. JRCERT mission, vision and core values. Joint Review Committee on Education in Radiologic Technology Web site. http://www.jrcert.org/mission/. Accessed December 1, 2015.
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Signals is a publication produced four times per calendar year by the
International Society for Magnetic Resonance in Medicine for the benefit of the SMRT membership and those individuals and organizations that support the educational programs and professional advancement of the SMRT and its members. The newsletter is the compilation of editor, Julie Strandt-Peay, BSM, RT (R)(MR) FSMRT, the leadership of the SMRT and the staff in the ISMRM Central Office with contributions from members and invited participants.
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