Safety of MRI technology comes under the microscope

EXPERTS are calling for new measures to be introduced to improve the safety of MRI technology.

Earlier this week, delegates at an event organised by The Institute of Physics and Engineering in Medicine heard leading practitioners and researchers from around the world call for mandatory incident reporting, a national implant compliance database, improved education for referring doctors, and the introduction of ferrodetection systems.

Professor Frank Shellock, adjunct clinical professor of radiology and medicine at the Keck School of Medicine, part of the University of Southern California, said: “I strongly feel that ferrodetection systems should be carefully considered as a tool to facilitate proper pre-MRI screening. Their incorporation as a component of a carefully thought-out and controlled process can add to the safety of patients and staff.”

His comments come amid growing concern over the threat of injury to patients or damage to high-value equipment that can occur when metal taken into scanning rooms is pulled into the MRI magnet’s core at high speed. And speakers at the safety briefing were told that, due to the fact there is no mandatory reporting process, the exact extent of the problem was unknown.

Professor Barrie Condon, head of imaging physics at the Greater Glasgow and Clyde Health Board in Scotland, said that while in the UK the Medicines and Healthcare products Regulatory Agency (MHRA) had published guidance on MRI safety, which was fairly extensively followed, the reporting of adverse incidents was sketchy. And he called for it to be made a mandatory requirement that all problems were properly recorded and the causes investigated.

He said: “I don’t think there have been a huge number of safety incidents in the UK, but the problem is we don’t know how many. I think the rationale that people sometimes use is that if there is an incident, they decide not to report it because it is a well-known hazard, not a new hazard. Having this data would let us know when these incidents were happening and we could also find out which incidents were most prevalent. This would help us to provide a better safety ethos. It is only through having such data that we can quantify the importance of tools such as ferromagnetic detection.”

Another key safety issue surrounding MRI devices concerns scanning patients who have implants.

Professor Condon said: “The trouble is that it can be very difficult to find out the exact model of implant. And, even when you do have this information, it can be quite difficult to know whether it is contra-indicated or not. Implant companies cease trading, or are taken over, or the make and model changes over time. It then becomes very difficult to do the detective work to find out.”

He said that over the past 25 years he had been putting together a database of locally-used implants. But because of copyright and liability issues, he has not been able to make this generally available.

He added: “It would be good if we had a national database which indicated whether an implant was safe to scan or not. Professor Shellock provides this in the United States and we can access it, but it does deal with implants more commonly used in North America. A national database in the UK would be very useful.”

Improved training for staff is also needed, the conference heard. Dr Donald McRobbie, a fellow of the Institute of Physics and Engineering in Medicine, said: “The way to really guarantee a lack of adverse incidents is to have very well-trained staff who know what they are doing and take time to talk to patients.

“Staff education needs to be maintained and improved, particularly with referring clinicians. I think we could engage more with doctors in other areas of the hospital and with GPs. As the drive is to put more healthcare out into the community, there will need to be more engagement with referring doctors, so they understand any potential risks to their patients.”

On the role of ferrodetection in MRI suites, he added: “Anything we can do to improve safety is obviously a good thing. I have had experience of metal detection systems and there is now doubt that the technology works. How you use it in practice is also very important.”

Improvements are also being supported by industry, with Metrasens, manufacturer of ferromagnetic detection technologies, welcoming the emphasis on improving safety. Chief executive, Dr Simon Goodyear, said: “We are working to assist our customers in optimising the safety of the MRI environment. We recognise that technology alone is not the solution, so are pleased to be able to contribute through the provision of training, development and audit of safety processes, and working together to facilitate smooth patient flow in these increasingly busy facilities.”

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