Peter Rothschild, MD, is no stranger to the field of magnetic resonance imaging research centers. For more than 25 years he has been involved in both clinical interpretation and research in MRI as well as being labeled as instrumental in researching the lack of infection control in MRI and alerting that community. He also authored the groundbreaking paper, Infection Control in MRI, published in AuntMinnie.com, a web portal for radiology.
So it should come as no surprise then, that Rothschild wouldn't pull any punches either, when describing the quality of infection control procedures for MRIs throughout the country.
"I don't want to paint all our patient imaging centers under one brush, because there are some that are extremely conscientious – but overall, if I had to give a grade for reducing infections from an MRI . . . I'm going to have to give it a "D", Rothschild told Diagnostics & Imaging Week.
Hospitals, on the other hand, get a slightly higher grade for their infection control in MRIs – a C+.
Most recently Rothschild compiled yet another study, titled: Survey of Infection Control in the MRI Environment: Lack of Infection Control Procedures in MRI May Place Patients and Staff at Risk.
The paper documents the lack of infection control at MRI centers leading to concern over methicillin-resistant Staphylococcus aureus (MRSA) spread during MRI scanning.
The results were reviewed to get an approximate idea of the infection control at 100 randomly chosen freestanding and hospital MRI facilities.
In all, 53 hospital-based MRI centers and 47 freestanding MRI centers were contacted by telephone.
The study found that there was a substantial difference between the responses from the outpatient MRI facilities and the hospital-based MRI facilities. The personnel at hospital-based facilities were clearly more educated on infection control and had a much higher number of infection control policies, many of which were in writing. However, these were more general policies and covered the entire radiology department, or in some cases the entire hospital. It became clear that many of these personnel had been trained in infection control procedures and it was very reassuring that policies were in place and being followed.
The study was prompted by the recent report of MRSA being cultured from within MRI facilities and the death of Nile Moss, a healthy 15-year-old boy, from MRSA a few days after an MRI. The goals of the study were to determine the state of infection control in the MRI environment and what, if any, obstacles would be faced by patients or referring physicians when they attempt to determine the state of infection control at an individual MRI facility.
The problem leading to most infections in MRI suites comes from the simple fact that most MRI centers don't have written infection-control procedures.
"Many facilities had infection-control policies, but none had infection control policies for MRIs," he said.
He added that these key questions need to be asked whenever patients go through an MRI scan are "What are the cleaning procedures?," "How old are the pads?," Do the imaging technologists wash their hands between patients?" and "How do technologists disinfect the MRI table and pads?"
Rothschild said if these questions can't be answered, then the patient perhaps should look to another facility for treatment.
"The best way I have found for patients to protect themselves is to visit the center before their scan and ask to see the center's written infection control policies. If there are no written policies, I can assure you that infection control has a low priority at that MRI center, and I would look for another MRI center where infection control is taken seriously."
He added, "Unfortunately, this study shows that few centers have any written policies concerning infection control in MRI. Most disconcerting is that there was a tendency to tell the surveyor the politically correct answer and not the real answer to the questions."
Another problem stems from the fact that MRI operators don't have the proper training.
In the study, Rothschild gives an explanation as to why MRI operators' training in the U.S. has been brought into question. He said that stems from a legal loophole in the requirements established to become an MRI "operator."
"While individuals must be certified as a radiologic technologist following an accredited education program of at least two years, in order to legally operate any X-ray equipment (i.e., ionizing-based equipment), this is not the case for MRI examinations," Rothschild said. Since the MRI procedure does not involve the use of ionizing radiation, there are no federal requirements either to be certified or even properly trained before becoming an MRI operator.
"Until recently, there were no state requirements for any sort of training or certification to operate an MRI and currently only one state, West Virginia, requires an MRI operator to be licensed."
He said that these MRI operators are often incorrectly referred to as "technologists" by the imaging center staff, but this is misleading because they are not registered radiologic technologists. Consequently, any individual, trained or untrained, can legally operate an MRI system. A person without even a high school diploma could be operating the MRI system that scans you or your family member, and you wouldn't be aware since he or she is still called a "tech."
Rothschild said it is his hope that the study will bring to light these issues and thus change will follow.
"While I don't have all the answers, I hope that once patients see and understand this, we'll see a push for change," he said.