02.03.07. MRI screening
A thorough screening process is used to assess all individuals entering the MRI environment
Screening procedure
- Screening is a critical component of an MRI safety program and one of the most important responsibilities assumed by MRI technologists.1
- Performed correctly, screening is an effective method to identify potential hazards and reduce the likelihood of patient harm.
- Most MRI safety incidents have been related to deficiencies in screening methods or in access restriction to the MRI environment.1
- For example, although screening occurred, research has shown that patients are commonly found with items on their person, such as coins, keys and mobile phones.2
- To date, there have been at least two cases of very serious injury caused by oxygen cylinder projectile incidents and two known fatalities.3
- MRI personnel are to undergo an MRI screening process as part of their employment agreement to ensure their safety in the MRI environment.4
- All MRI personnel must immediately report to the MRI Medical Director any trauma, procedure, or surgery they experience where a ferromagnetic object/device may have been introduced within. This will determine the safety of permitting the employee into Zones III and/or IV.4
- All patients and Non-MR Personnel must be screened and pass an MRI screening process before entering the MRI environment.1,3
- The screening form should be signed by the Level 2 MR Personnel, and patient/ guardian or substitute decision maker prior to entry into the MRI environment. This form should then become part of the individual’s medical record.4
- Only Level 2 MR Personnel can authorize entry to the MRI environment.4
- Level 2 MR Personnel are defined by the American College of Radiology as those who have been more extensively trained and educated in the broader aspects of MR safety issues, including but not limited to issues related to the potential for RF-related thermal loading or burns and direct neuromuscular excitation from rapidly changing gradients.4
- A screening form must be completed each time a patient undergoes an MRI scan, or enters the MRI environment.1
- Each screening question must be completed and a response left incomplete is not acceptable.
- Each question must be answered with a yes/no response and specific information provided to the MRI personnel as requested.4
- The importance of screening is carefully explained to the patient, who may forget to mention something, or neglect to mention an issue for fear of losing their appointment.5
- Screening procedures on nonemergent patients are carried out at least twice prior to being granted access to the MRI environment.4
- For patients, the first screening is performed at the time the exam is ordered and is completed by the ordering physician in discussion with the patient or guardian.
- At least one of these screenings should be performed by a Level 2 MR Personnel verbally and/or interactively. The patient (or their proxy) may complete a screening form and subsequently have the responses and contents of that form reviewed, together with a Level 2 MR Personnel.4
- If information gathered through screening is incomplete or in question, the MRT may1:
- consult with the radiologist to obtain or clarify information,
- contact the referring physician to obtain or clarify information,
- refer to previous diagnostic imaging to identify potential concerns,
- look for surgical scars or other indications of the presence of implants, and/or
- obtain radiographic images of the areas in question.
- If something is discovered through the screening process that contraindicates the MRI exam, the MRT should:
- discuss the findings with a radiologist to determine the appropriate course of action to ensure continuity of care;
- explain the situation to the patient, answering any questions the patient has to the best of their ability (and within their scope of practice);
- communicate the finding to the referring healthcare professional for consideration as per facility procedure.
- It is recommended that the MRT perform a “full stop and final check” to confirm the satisfactory completion of the MRI safety screening for the patient, support equipment and personnel prior to crossing from Zone III to Zone IV of the MRI environment.
- This final check is to confirm the patient’s identification, ensure that all screening has been appropriately performed, and to ensure no change in patient/equipment status while in Zone4
Screening questions
- Screening questions focus on issues that could pose a potential danger to the patient in the MRI environment.
- The screening process includes questioning about the presence of any metallic objects.1
- The patient is asked to list all prior surgical procedures.
- Any previous injuries to the body involving metallic foreign bodies are to be noted.1
- All patients who report having suffered a penetrating eye injury should be considered for plain radiography if no recent imaging is available for review.3
- Confirm all implanted devices are identified by manufacturer and model via device card issued by medical facility at time of implantation or surgical report.
- If, at the time of the MRI exam, it is not possible to positively identify the implant or the conditions for MRI safety then the exam should be postponed until the required information and documentation is obtained.
- If an identified implant/device is not listed in the reference manual for MRI safety or any other MRI safety database, the manufacturer is contacted directly to obtain the necessary safety information in accordance with local policies and procedures.5
- The screening process also identifies any past and present medical conditions that may affect the MRI procedure or the use of a contrast media, including1:
- current or recently taken medications;
- known drug allergies;
- potential or confirmed pregnancy5;
- pre-existing psychiatric disorders, anxiety or claustrophobia; and
- history of renal impairment or hepatic insufficiency (nephrogenic systemic fibrosis [NSF] is associated with gadolinium use in such patients).4,5
- The ACR MR Safety Screening Form is a standard and maintained form that can be used by MRTs.6
Special cases
- There are scenarios where completing the screening process directly with a patient may be impractical or impossible, such as:
- pediatric/minor patients;
- unconscious, unresponsive or altered level of consciousness patients; and/or
- patients with a language barrier.
- In these scenarios, it is important that the MRT completes the screening process as described:
- A family member or guardian should complete a written/digital MR safety questionnaire prior to the patient entering Zone4
- For pediatric/minor patients, who may not be reliable historians, and especially for older children and teenagers, it is recommended they be screened twice by Level 2 MR Personnel; once in the presence of parents/guardians, and once separately to maximize the possibility that all potential dangers are disclosed.4
- For unconscious/unresponsive, or altered level of consciousness patients, family members or guardians of such patients should complete a written MR safety screening questionnaire prior to the patient’s entrance into Zone4
- If no reliable history can be otherwise obtained and if the requested MRI procedure cannot reasonably wait until a reliable history can be obtained, patients are physically examined by Level 2 MR Personnel.4
- Patients are examined for visible scarring or deformities that might be indicative of an implant.
- It is recommended that such patients undergo plain film/digital radiography (if recently obtained CT or MR studies of the following areas are not already available) to exclude potentially harmful embedded/implanted metallic foreign bodies, objects, or devices. Plain film/digital radiography should include the head/neck, chest, abdomen, pelvis, and upper arms and thighs. If there are obvious post-traumatic changes to the distal extremities, those areas should also undergo plain film radiography prior to MR exposure.4
- For patients with a language barrier, measures are taken to secure the services of an interpreter in advance of the patient examination.7,8
- A family member or guardian should complete a written/digital MR safety questionnaire prior to the patient entering Zone4
References
- Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants, and Devices. Biomedical Research Publishing Group; 2020. Accessed August 7, 2020. http://www.mrisafetybook.com/
- Hudson D, Jones AP. A 3-year review of MRI safety incidents within a UK independent sector provider of diagnostic services. BJR|Open. 2018;1(1):bjro.20180006. doi:10.1259/bjro.20180006
- Westbrook C, Talbot J. MRI in Practice. 5th ed. Wiley-Blackwell; 2018. Accessed August 26, 2020. https://www.wiley.com/en-us/MRI+in+Practice%2C+5th+Edition-p-9781119392002
- ACR Committee on MR Safety. ACR manual on MR safety. Published online 2020. Accessed August 7, 2020. https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/Manual-on-MR-Safety.pdf
- Canadian Association of Radiologists. CAR standard for magnetic resonance imaging. Published online April 2011. Accessed August 7, 2020. https://car.ca/wp-content/uploads/Magnetic-Resonance-Imaging-2011.pdf
- American College of Radiology. Safety screening form for magnetic resonance (MR) procedures. Published online May 2020. Accessed August 7, 2020. https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/MR-Safety-Screening-Form.pdf
- Moissac D de, Bowen S. Impact of language barriers on quality of care and patient safety for official language minority francophones in Canada. J Patient Exp. Published online April 18, 2018. doi:10.1177/2374373518769008
- Taffel MT, Huang C, Karajgikar JA, Melamud K, Zhang HC, Rosenkrantz AB. Retrospective analysis of the effect of limited English proficiency on abdominal MRI image quality. Abdom Radiol. 2020;45(9):2895-2901. doi:10.1007/s00261-020-02433-6
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