The Joint Commission (Oakbrook Terrace, Illinois) last week issued a Sentinel Event Alert urging hospitals and ambulatory care centers to pay special attention to methods for preventing accidents and injuries that can occur during MRI procedures.

More than 10 million MRI scans are performed each year in the U.S., and while most cause no harm, the inherent dangers of the process are not well known, according to the commission. It says that the most common types of injuries are burns. Additionally, common objects can become “missiles” when brought into the MRI scanner’s powerful static magnetic field and can cause some of the more devastating accidents and injuries to patients and healthcare workers.

MRI uses powerful magnetic and radio waves to produce detailed images of a patient’s organs and other structures, without the use of X-rays or other ionizing radiation. But the use of an alternative type of power creates another category of risks.

“MRI technology represents an important advance in diagnostic medicine, but special care must be taken to protect patients,” said Mark Chassin, MD, president of the Joint Commission. “The increasing use of MRI scans as a diagnostic tool, coupled with stronger MRI technology, suggests that the risk of accident and injury may increase. This alert offers healthcare organizations specific steps that can be taken to keep patients safe.”

But one expert in the area thinks the alert is less than adequate.

“I think it’s interesting, but I don’t know that it goes far enough,” Frank Shellock, PhD, an expert on MRI safety, told Diagnostics & Imaging Week, in commenting on the alert.

Shellock has written extensively about the risks in the MRI environment and says that the commission’s alert is “very limited,” given the amount of available information in the literature about MRI safety.

The information provided in the alert is “not anything new, not anything earth-shattering,” Shellock said, adding that some of the information is similar to what has already been published by other organizations, such as the Institute for Magnetic Resonance Safety, Education, and Research (Los Angeles) — and organization which he founded — the International Society for Magnetic Resonance in Medicine (Berkeley), the American Heart Association (Dallas) and the American College of Radiology (ACR; Reston, Virginia).

The ACR last March expanded and updated its guidance document, first published in 2002, addressing a number of MRI safety topics.

According to the Joint Commission’s alert, the FDA has received nearly 400 reports of MRI-related accidents over the past decade.

More than 70% of accidents were burns, while 10% of injuries occurred when metal objects —such as ink pens, cleaning equipment and oxygen canisters – were turned into “missiles” when pulled into the scanner’s magnetic field.

The alert also includes a warning about injuries related to dislodged ferromagnetic implants such as aneurysm clips, pins in joints, and drug infusion devices.

To reduce the risk for MRI injuries to patients, The Joint Commission’s Sentinel Event Alert newsletter recommends that healthcare organizations take the following steps:

• Restrict access to all MRI sites by creating safe zones recommended by the ACR.

• Use trained screeners to perform double checks of patients for items such as metal objects, implanted or other devices, drug delivery patches and tattoos. The alert suggests the use of ferromagnetic detectors to assist in this screening process. (Shellock said, “I think it’s Interesting that they made comments on the use of ferromagnetic detectors, because there is no evidence that these things are useful,” and that, in his opinion, the devices are “expensive” and don’t represent 100% safety.)

• Ensure that the MRI technologist has the patient’s complete and accurate medical history to ensure that the patient can be safely scanned.

• Have a specially trained staff person accompany any patients, visitors and staff into the MRI suite at all times.

• Annually educate all medical and ancillary staff that may accompany patients into the MRI suite about the risk of accidents.

• Take precautions to prevent patient burns during scanning.

• Only use fire extinguishers, oxygen tanks and other equipment that have been tested and approved for use during MRI scans (equipment that will not be attracted to the magnet).

• Manage critically ill patients who require monitoring and life-sustaining drugs to assure that their care needs are continuously met while in the MRI suite.

• Provide all MRI patients with earplugs to diminish the loud “knocking” noise emanating from the equipment.

• Never run a cardio-pulmonary arrest code or resuscitate a patient in the MRI room.

While Shellock said he does not expect the recommendations to have a significant impact on MRI use, he added: “We like to see the Joint Commission do substantial things.”

“Anything we can do in addition to what we’re already doing coming from other entities is going to be beneficial in the long run,” Shellock said. “It will keep it in people’s minds.”

Shellock, an adjunct clinical professor of radiology and medicine at the Keck School of Medicine, University of Southern California (Los Angeles, California), maintains a web site that provides information about MRI safety, www.mrisafety.com. He has more than 20 years of experience conducting laboratory and clinical investigations in this field.

The warning about risks associated with MRIs is part of a series of alerts issued by the Joint Commission. It says that much of the information and guidance provided in these alerts is drawn from the organization’s Sentinel Event Database, which includes information about adverse events and their underlying causes. Previous alerts have addressed wrong-site surgery, medication mix-ups, health care-associated infections, and patient suicides, among others.

Founded in 1951, the Joint Commission evaluates and accredits more than 15,000 healthcare organizations and programs in the U.S., including more than 8,000 hospitals and home care organizations, and more than 6,300 other healthcare organizations that provide long-term care, assisted living, behavioral healthcare, laboratory and ambulatory care services.

The organization also accredits health plans, integrated delivery networks, and other managed care entities.