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When small is big: MR safety for pediatric patients

March 16, 2021
MRI Pediatrics
From the March 2021 issue of HealthCare Business News magazine

By Tobias Gilk

MR safety is important for all patients, but it carries additional weight for our most vulnerable.
As compared to MR safety for all patients, MR safety in pediatric environments is all the more emphasized, in part, because the most prominent MR accident in the United States — an accident that occurred 20 years ago this year — resulted in the death of a six-year-old boy. The weight of such a tragedy is simply that much more when the victim is a child.

Not only are public-perception consequences greater, but pediatric patients all bring unique and additional risk factors to MR imaging. Often children are less able to participate in their own pre-MR screening for risks or contraindications. Pediatric patients often require sedation or anesthesia in order to tolerate exams, and anesthesia both carries its own risks and can sometimes obscure native MR risks, too. And children with congenital and/or serious illnesses may need recurring MR scans throughout their developmental years, meaning that the risks are repeated, over and over. As a patient population, in several regards, children can add risk in MR.

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Tobias Gilk
To be clear, MR is a profoundly safe study type, and injuries almost never occur because of malfunctions with the hardware. The accidents that do happen, however, are almost always because of poor decision-making at the point of care, and a failure to properly respect the real risks and hazards that do exist in MR imaging. Said another way, MR injuries are almost 100% preventable, so structured best practices and vigilance are the best tools for MR patient safety.

Unlike conventional X-ray-based modalities that have reams of state regulations, standards, and professional responsibility programs like “Image Gently” to guide pediatric radiation safety, MR providers are largely left to forge their own path for MR safety. There have been no formal “MR Safely” pledges as there are with the “Image Wisely” and “Image Gently” campaigns, and little in the way of fixed sets of best practices required for MR provider licensure or accreditation (despite accreditation entities’ near-universal marketing of “quality and safety” as the expected outcome of accreditation). In this regard, Katherine Bushur, the Advanced Modality supervisor for Children’s Hospital Colorado, acknowledges that “MR is behind the curve,” and MR patient safety — in general — doesn’t benefit from the regulatory, accreditation, or industry standards that ionizing radiation safety does.
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Steven Ford

MRI safety

March 25, 2021 02:35

Tobias,

A lot of people would be interested to know the circumstances of the tragic death you refer to, so we can take appropriate countermeasures.

The existing requirements for 'Zone 1', 'Zone 2' labeling in the MRI suite are less than ideal in my opinion because the meaning of those terms is not immediately and intuitively obvious. A Zone 1 sign in the waiting room does not change anyone's behavior.
Better to have signage that is more obvious, more in-your-face, even if that is at the expense of 10% accuracy. Better to require floor markings as well as impossible-to-ignore physical barriers. Better to restrict access inside the MRI room even to hospital staff who have not undergone specific MRI training, including doctors. In my experience, doctors are the chief violators of magnet safety protocols.

Another common real-world safety weakness is that some MRI suites are not locked in off-hours.

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