02.03.02. Burn prevention
MRTs take precautions to prevent burns to patients during MRI scanning
Burns in MRI
- The radiofrequency (RF) present in the MRI environment is a form of non-ionizing radiation.
- Burns are the most common patient injuries to occur in the MRI environment1.
- Many burns are caused by the significant RF-induced heating of wires and leads, as well as conductive loops formed by the patient’s own body
- Excessive MRI-related heating has been reported for leads, guidewires, certain types of catheters (e.g., catheters with thermistors or other conducting components), and certain external fixation or cervical fixation devices2
Preventing burns
- Screening plays an important role in identifying potential risk for overheating and burns.
- All patients should be changed out of street clothes and into hospital provided gowns and pants if available
- Contraindicated devices (e.g., wires that may cause internal heating), external fixation devices or tattoos are identified during routine screening
- The patient is checked for previously used electrodes and cables that may have been inadvertently left behind3
- Patients with tattoos and body piercing are informed of the risk for heating; all types of metal may heat and should be removed
- Patients are monitored, with continuous communication throughout the exam (also see related guideline Patient monitoring and physical assessment) so that early signs of heating, excessive sweating or burning (e.g., tingling, warming) can be identified4.
- MRTs take steps to ensure that the creation of unwanted conductive loops are avoided during MRI procedures4,5:
- Cables must run parallel to the main magnetic field, without touching the bore, and exit the bore of the magnet as close to the centre as possible
- Cables remain straight, the formation of loops is avoided
- Coil cables, such as ECG/VCG cables are separated and parallel to each other and the magnet bore
- Insulation/padding is placed between the patient and the coils
- To prevent the patient’s skin from coming into contact with the bore of the magnet – insulation (foam pads) is used as necessary and should be a minimum thickness of 1 cm2
- No conductive loops form with any parts of the patient’s body (i.e., skin-to-skin contact) – insulation (foam pads) must be used as necessary
- Physiological monitoring sensors (e.g., pulse/oximeter) are placed outside the scanning area whenever possible, as well as away from RF coils4.
- Equipment that is damaged or past its expiry date must never be used in the MRI environment3,4.
- All coils, cables and leads are routinely checked for damage
- MRTs are familiar with manufacturers’ instructions
- Electrical devices that are not functioning properly during the scan should be removed immediately
- Implanted cardiac pacemakers and implantable cardioverter defibrillators should be considered a relative contraindication for MRI2.
- Any exception should be considered on a case-by-case basis and based on facility policy and procedures
Checking for burns
- Patients who complain of burning or discomfort must be examined for signs of burns or reddening of the skin3.
- If a burn is discovered on a patient:
- The MRT ensures that appropriate medical staff are notified to ensure the patient receives the appropriate treatment3
- All relevant information is documented in the medical record and an incident report is filed
- Notify your facility’s biomedical engineering department and quarantine the electrodes involved plus any remaining in the packet3
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References
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Joint Commission. Sentinel Event Alert: Preventing accidents and injuries in the MRI suite. Issue 38, February 14, 2008. Available at: http://www.jointcommission.org/assets/1/18/SEA_38.PDF. [Accessed 20 March 2013]
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Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices. 2013 ed. Los Angeles, CA: Biomedical Research Publishing Group; 2013.
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Lange SE, Nguyen ON. Cables and electrodes can burn patients during MRI. Nursing 2006;36(11):18.
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Medicines and Healthcare products Regulatory Agency (MHRA). Device Bulletin: Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use. Available at: http://www.mhra.gov.uk/home/groups/dts-iac/documents/publication/con2033065.pdf. [Accessed 3 Nov 2014]
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WillisHRH. Magnetic Resonance Imaging Hazards and Safety Guidelines. Strategic Outcomes Practice Technical Advisory Bulletin. August 2009. Available from: http://www.koppdevelopment.com/articels/Willis%20MRI_Safety.pdf. [Accessed 25 July 2018]