Radiography School Magnetic Resonance Safety Policy
A. The American Registry of Radiologic Technologists (ARRT) does not require educational clinical rotations through Magnetic Resonance (MR) imaging areas for a Radiography curriculum. However, The University of Akron’s (UA) Radiography School considers MR an important educational opportunity, due to MR’s ability to access soft tissue components of the body. The intent of this policy is to educate all UA Radiography students about the possible risks associated with the MR suite, including but not limited to static or time-varying magnetic fields and radiofrequency pulses,, so that Radiography students may learn how to interact safely with the MR suite. This policy was developed based on the The American College of Radiology (ACR) established guidelines when dealing with MR1.
II. MAGNETIC RESONANCE CLINICAL ROTATIONS
A. Because MR is one of the many advanced radiologic imaging modalities, UA Radiography students will not be assigned a clinical rotation to an MR suite until: (a) their ARRT Radiography clinical competencies have been met; (b) they have read and have acknowledged understanding of this policy; and, (c) they have watched the program-assigned MR Safety video.
III. MAGNETIC RESONANCE SAFETY ZONES
A. Zone I - This zone is freely accessible to the public, is typically outside the MR environment, and is the area through which patients, healthcare personnel, and other employees of the MR site access the MR environment.
B. Zone II - This area is the interface between the publicly accessible, uncontrolled Zone I and the strictly controlled Zones III and IV. Typically, patients are greeted in Zone II and are not free to move throughout Zone II at will, but are rather under the supervision of MR personnel. It is in Zone II that the answers to MR screening questions, patient histories, medical insurance questions, etc. are typically obtained.
1 Kanal & Barkovich, ACR GUIDANCE DOCUMENT ON MR SAFE PRACTICES: 2013, Journal of Magnetic Resonance Imaging, Volume 37, Issue 3, pages 501–530, January 23, 2013
C. Zone III - This area is the region in which free access by unscreened students, patients, or ferromagnetic objects or equipment is restricted as serious injury or death may occur as a result of interactions between the individuals or equipment and the MR scanner’s particular environment. These interactions include, but are not limited to, those involving the MR scanner’s static and time-varying magnetic fields. All access to Zone III is to be strictly restricted, with access to regions within it (including Zone IV see below) controlled by, and entirely under the supervision of, MR personnel. Specifically identified MR personnel are to be charged with ensuring that this MR safe practice guideline is strictly adhered to for the safety of the student, patients, other non-MR personnel, the health care personnel, and the equipment itself. Zone III areas should be demarcated and clearly marked as being potentially hazardous.
D. Zone IV - This area is synonymous with the MR scanner magnet room itself. Zone IV should also be demarcated and clearly marked as being potentially hazardous due to the presence of very strong magnetic fields. Zone IV should be clearly marked with a red light and lighted sign stating, ‘‘The Magnet is On’’.
E. Zone IV Emergencies - In case of cardiac or respiratory arrest or other medical emergency within Zone IV for which emergent medical intervention or resuscitation is required, appropriately trained and certified MR personnel should immediately initiate basic life support or CPR as required by the situation while the patient is being emergently removed from Zone IV to a predetermined, magnetically safe location. All priorities should be focused on stabilizing (e.g., basic life support with cardiac compressions and manual ventilation) and then evacuating the patient as rapidly and safely as possible from the magnetic environment that might restrict safe resuscitative efforts. Furthermore, for logistical safety reasons, the patient should always be moved from Zone IV to the prospectively identified location where full resuscitative efforts are to continue.
IV. RADIOGRAPHY STUDENT SCREENING
A. Student Screening - All Radiography students wishing to enter Zone III are required to complete a written MR safety screening questionnaire and pass an MR safety screening process. Only MR personnel are authorized to perform the MR safety screen before permitting the Radiography student into Zone III.
B. Ferromagnetic materials - Any Radiography student entering the MR suite must remove all readily removable metallic personal belongings and devices on or in them (e.g. watches, jewelry, pagers, cell phones, body piercings (if removable), contraceptive diaphragms, metallic drug delivery patches, cosmetics containing metallic particles (such as eye
make-up), and clothing items which may contain metallic fasteners, hooks, zippers, loose metallic components or metallic threads).
C. Foreign bodies & Implants - All Radiography students with a history of potential ferromagnetic foreign object penetration must undergo further investigation before being permitted entrance to Zone III. Examples of acceptable methods of screening include patient history, plain X-ray films, prior CT or MR studies of the questioned anatomic area, or access to written documentation as to the type of implant or foreign object that might be present. Once positive identification has been made as to the type of implant or foreign object that is within a patient, best effort assessments should be made to identify the MR compatibility or MR safety of the implant or object. All students who have a history of orbit trauma by a potential ferromagnetic foreign body are to have their orbits cleared by either plain X-ray orbit films (2 views) or by a Radiologist’s review and assessment of contiguous cut prior CT or MR images (obtained since the suspected traumatic event) if available.
D. Restricted devices - Any Radiography student with implanted cardiac pacemakers, implantable cardioverter defibrillators (ICDs), diaphragmatic pacemakers, electromechanically activated devices, or other electrically conductive devices upon which the non-MR personnel is dependent should be precluded from entering Zone IV specifically cleared in writing by a level 2 designated attending Radiologist or the medical director of the MR site.
E. Device and Object Screening - Ferrous objects are restricted from entering Zone III. To assess if a material is ferromagnetic, all metallic or partially metallic equipment must be tested with a strong handheld magnet (1000-Gauss) and/or a handheld ferromagnetic detection device. All portable metallic or partially metallic devices that are on or external to the patient (e.g., oxygen cylinders) are to be positively identified in writing as MR Unsafe or, alternatively, MR Safe or MR Conditional in the MR environment before permitting the patient into Zone III. Examples of devices that need to be positively identified include fire extinguishers, oxygen tanks and aneurysm clips.
V. STUDENT RESPONSIBILITIES IN MR
A. Pregnant Radiography Students - Pregnant health care practitioners are permitted to educationally rotate in and around the MR environment throughout all stages of their pregnancy. Pregnant students are not allowed to remain in Zone IV during actual data acquisition or scanning.
B. Acceptable activities while in MR - Student Radiographers may assist in positioning patients, scanning (under the direct supervision of an authorized MR Technologist), archiving, and entering the MR scan room in response to an emergency.
C. Screening of patients - Radiography students are forbidden to screen patients prior to their examinations.
VI. MR SAFETY ISSUES
A. The Constant MR Field - Students should never assume that the MR is ever turned off. It is constantly running regardless whether or not a patient is in the MR scan room (Zone IV).
B. Cryogen-Related Issues - For superconducting systems, in the event of a system quench, it is imperative that all personnel and patients be evacuated from the MR scan room (Zone IV) as quickly as safely feasible and be immediately restricted to all individuals until the arrival of MR equipment service personnel. A quench is indicated by the observation of cryogenic gases venting partially or completely into the MR scan room, as evidenced in part by the sudden appearance of white ‘‘clouds’’ or ‘‘fog’’ around or above the MR scanner.
C. Projectiles - Ferromagnetic materials introduced into the MR scan room (Zone IV) will become projectiles that will be attracted at a high rate of speed into the bore of the MR gantry. This could produce severe injury and/or death to a patient who is occupying that space during their examination.
D. Static Magnetic Field - The static MR field is fully capable of erasing magnetic strips (e.g. credit cards, ID cards, etc.) and permanently freezing analog watches.
E. Time-varying Magnetic Field - The time-varying magnetic field is capable of producing auditory, induced voltage, and thermal effects on internal ferromagnetic implants that could produce severe internal injuries. Patients will be issued earplugs or headphones during the scan and be pre-screened about the type and make of the implants to reduce these risks.
Last revision date: September/2017
Last review date: July/2017