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Magnetic Resonance Imaging (MRI) Safety and Screening (2.3.5)

Magnetic Resonance Imaging (MRI) Safety and Screening (2.3.5) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Procedures

2.3.5


UW HEALTH CLINICAL POLICY 1
Policy Title: Magnetic Resonance Imaging (MRI) Safety and Screening
Policy Number: 2.3.5
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: June 8, 2016

I. PURPOSE

To ensure a safe Magnetic Resonance Imaging (MRI) environment for adult and pediatric patients,
personnel, visitors and students having potential access to the MRI environment. This w ill support the UW
Health mission of clinical, research and educational endeavors associated w ith Magnetic Resonance
Imaging, and to provide high quality patient care and diagnostic services.

II. DEFINITIONS

A. MRI Device Labeling

MRI Safe: The device has undergone testing to demonstrate that it is safe or it is made from material(s) that
are considered to be safe (e.g., nonmetallic materials such as plastic, silicone, glass, etc.) .

MRI Conditional: The device has been demonstrated to pose no know n hazards in a specif ied MRI
environment w hen scanned under specif ied conditions.

MRI Unsafe: The device is considered to pose a potential or realistic hazard to an individual in the MR
environment primarily as a result of movement or dislodgement of the device.

B. MRI Zoning

The MRI environment is divided into four zones:
i. Zone I: This region includes all areas that are freely accessible to the general public.
ii. Zone II: This area is the interface betw een the publicly accessible, uncontrolled Zone I and the
strictly controlled Zones III and IV.
iii. Zone III: Restricted area only accessed by qualif ied MRI Staff. Non-MRI individuals must be
accompanied by qualif ied MRI Staff.
iv. Zone IV: This area is synonymous w ith the MRI scanner room itself (Signs are posted at entrance
of MRI scanner room stating “Magnet is alw ays on”) .

C. Other

Ferromagnetic: Items that are attracted to magnetic f ields.

MRI Staff: Equivalent to “Level 2 MR personnel” as defined by the ACR Guidance Document on MR Safe
Practices: 2013. These individuals have been “extensively trained and educated in the broader aspects of
MR safety issues, including, for example, issues related to the potential for thermal loading or burns and
direct neuromuscular excitation from rapidly changing gradients.”

III. POLICY ELEMENTS

Medical Director, Safety Officer, and Medical Director of Patient Safety: The Chief Medical Director, Safety
Officer, and Medical Director of Patient Safety of each UW Health MRI site are appointed by the Chair of
Radiology.

The MRI Safety Committee: The MRI Safety Committee is an interdisciplinary committee that is composed
of members representing Administration, Medical Physics, Radiology, Registered Nursing, and UW Health
Aff iliations. This committee meets quarterly to review and establish MRI safety guidelines.

Screening of Patients: All patients scheduled for MRI scans must go through a comprehensive safety
screening before they enter Zone III. Family members w ho accompany a patient into Zone III and/or Zone IV
must also undergo comprehensive screening. Non-MRI personnel, including hospital personnel
accompanying a patient, must undergo comprehensive screening prior to entering Zone III and/or Zone IV.



UW HEALTH CLINICAL POLICY 2
Policy Title: Magnetic Resonance Imaging (MRI) Safety and Screening
Policy Number: 2.3.5


Screening of Employees: UW Health personnel requiring safety training must annually complete the basic
MRI safety training offered through the Safety and Infection Control Computer Based Training (CBT)

Advanced Employee Training: UW Health Advanced Trained MRI Staff w ith access to MRI Zone III and
Zone IV complete an Advanced MRI Safety CBT in addition to the Safety and Infection Control CBT.

Acoustic Noise: While the MRI scanner is in operation, all individuals in Zone IV are required to w ear hearing
protection. Adult and pediatric patients have a variety of hearing protection available including ear plugs and
headphones w ith music.

Monitoring of Patient: Continuous patient monitoring is performed w hile the MRI scanner is in operation. The
MRI staff achieves visual monitoring by w ay of the examination room w indow and/or a closed circuit
monitoring device. MRI staff communicates w ith patients during examinations via a tw o w ay intercom. An
alarm squeeze ball is given to the patient should the patient need assistance during the examination.

MRI Fire Safety: UWHC policy #12.05, Fire Prevention Management Plan, is designed to assure
appropriate, effective response to f ire emergency situations that could affect the safety of patients, staff, and
visitors, or the environment of UWHC. The program is also designed to assure compliance w ith applicable
codes and regulations.

IV. PROCEDURE

A. MRI Safety Screening
i. All individuals must complete a Comprehensive MRI Screening Form (UWH# SR301436-DT) prior
to entering Zone IV in order to identify any potential medical condition(s) or circumstances that may
place them at risk for an injury w hen exposed to the MRI environment. Individuals need to be
screened prior to receiving any sedatives for an MRI exam. If the individual is unable to complete
the necessary screening form (e.g., a child) the individual’s guardian is responsible for providing
information.
ii. Screening forms for outpatients are completed w ith the patient via an interview conducted by a UW
Health Nurse, MRI Technologist or MRI Imaging Assistant.
iii. Inpatient Comprehensive MRI Screening Forms are valid for 24 hours.
iv. Outpatient MRI screening forms must be updated every 30 days.
v. Prior to the MRI exam, qualif ied staff w ill review and approve all MRI screening forms.
vi. A “time-in” requires any individual entering the MRI environment to remove all readily removable
metallic personal belongings and devices on or in them (e.g., w atches, jew elry, pagers, cell
phones, body piercings (if removable), contraceptive diaphragms, metallic drug delivery patches
and clothing items that may contain metallic fasteners, hooks, zippers, loose metallic components
or threads).
vii. Prior to performing MRI exams on sedated, incoherent, or non-ambulatory inpatients there w ill be
an active verif ication time-out to confirm the patient identity and to confirm the correct procedures
and MRI safety guidelines are follow ed. The verif ication w ill be led by MRI Staff.
viii. Individuals w ho require urgent or emergent medical care and w ho are unconscious or unresponsive
w ill require a review of recently obtained imaging studies to exclude metallic foreign objects prior to
a MRI exam. Foreign bodies/hardw are w here the origin cannot be ascertained (MRI objects of
unknow n origin) w ill be review ed by the attending Radiologist and w ill be approved on a case-by-
case basis.
ix. Individuals w ho have sought medical attention to have metal fragments removed from either eye
must be cleared by either a prior CT scan or a plain X-ray orbit exam. An MRI Pre-Screening Orbit
X-ray exam w ill be ordered by the referring physician or UW Health personnel for any patient
meeting these criteria. If previous imaging studies w ere obtained by a non-UW Health institution,
the outside medical documentation must specif ically state there w ere no metallic foreign bodies.
The inability to obtain such documentation w ill necessitate new orbital images.
x. If questions regarding the safe scanning of a patient remain follow ing the screening process, the
attending radiologist from the section interpreting the exam should be consulted. If not available, or
if there are questions, the Chair of the MRI Safety Committee or the Medical Director of MRI may
approve proceeding w ith the exam, but w ill communicate this to a member of the relevant section,



UW HEALTH CLINICAL POLICY 3
Policy Title: Magnetic Resonance Imaging (MRI) Safety and Screening
Policy Number: 2.3.5

preferably the relevant Section Chief. “Shopping” for an attending w illing to approve a procedure or
accepting the recommendation of non-Radiology staff if there are questions about the safety
screening is inappropriate. Any remaining concerns should be brought to the Chair of the MRI
Safety Committee or the Medical Director of MRI.
B. Pacemakers
Patients w ith pacemakers and/or implantable cardioverter-defibrillators needing an MRI exam are
individually evaluated by qualif ied MRI and device clinic personnel. See Resource; Contrast Corner, MRI
Guidelines for Patients w ith MRI Pacemakers and/or Implantable Cardioverter-Defibrillators.
C. Implanted Devices
Devices such as Codman ICP, neuro stimulators, IVES, or any other implanted device are conditional for
MRI based on manufacture safety guidelines or appropriate third-party testing.
D. Pregnancy and Breast Feeding See Resource; Contrast Corner, Memorandum from MRI Safety Committee.
i. If a patient thinks she may be pregnant, a pregnancy test is required prior to scheduling the MRI
exam. If pregnancy status is not certain w hen the patient has arrived for the MRI exam, the patient
w ill be required to take a pregnancy test prior to the MRI. The MRI w ill be rescheduled to another
time. If the patient’s test is negative, every effort w ill be made to rew ork the patient back into the
schedule at the MRI location w here the patient is located or another UW Health facility.
ii. If the patient’s pregnancy test is positive, the Radiologist w ill contact the referring physician to
discuss w hether the potential benefit w arrants the potential risk. The referring physician w ill make a
determination of w hether or not the exam is still desired. If so, MRI staff w ill discuss w ith the patient
the risks, benefits and alternatives to the procedure. MRI contrast agents are strictly
contraindicated in pregnant patients and are only given in highly unusual circumstances requiring
discussion betw een an attending referring physician and attending radiologist.
E. Department of Corrections
i. Offenders are only scanned at University Hospital (600 Highland Avenue). Department of
Corrections (DOC) off icer w ill complete and fax (608-263-6014) a completed copy of the screening
form for any offender receiving treatment on an outpatient basis. Offenders admitted to the hospital
w ill follow the same procedure as other inpatients regarding completion and submission of the
screening form (see section IV.A.iii.).
ii. Offenders w ill be held in a secure location until their scheduled time for the MRI scan. The DOC
off icer w ill call prior to transporting the patient to confirm that the MRI scanner schedule is on time
(608-262-6073).
iii. DOC off icer w ill remove all metal handcuffs and shackles from the patient prior to patient entry into
Zone IV. In Zone II or Zone III the offender w ill be placed in plastic cuffs for their MRI exam.
iv. There w ill alw ays be tw o (2) DOC off icers w ith the offender. One (1) DOC off icer w ill remove all
ferromagnetic objects and become MRI safe therefore the off icer can enter Zone IV if needed. The
DOC off icer w ill need to f ill out a MRI screening form (for him/herself) prior to the patient entering
Zone IV. Once the DOC off icer is cleared, he/she w ill receive a green sticker for the back of his/her
badge. The green sticker w ill need to be presented prior to them entering the MR room thereafter.
The MRI screening form w ill be given back to the DOC off icer for his/her reference.
v. DOC off icer w ill be provided a lock box for their equipment. DOC off icer w ill have to remove the
follow ing list of equipment in preparation of the MRI scan. The DOC off icer w ill be expected to
accompany the offender to the MRI area and monitor the Zone IV entrance during the procedure.
a. The follow ing is a list of DOC Tools/items that a Correctional Officer must remove prior to
the scan taking place: (All items tested below reacted to the magnet)
1. Taser
2. Gun
3. Keys, institutional and personal
4. Radio/communication devices
5. DOC badge
6. Metal cuffs/legs
7. Restraint cutters
8. Flash lights
9. Metal key holders
10. Loose change
11. Pens
12. Other ID badges, credit cards (Magnetic info w ill be stripped from any sw ipe
card)



UW HEALTH CLINICAL POLICY 4
Policy Title: Magnetic Resonance Imaging (MRI) Safety and Screening
Policy Number: 2.3.5

13. Metal hair accessories
14. Some jew elry including w rist, neck, f ingers, ears other piercings
15. Sun glasses
16. Metallic belt keepers
vi. If DOC off icer is carrying an OC Foam canister, this canister should be checked to ensure it is not
ferromagnetic. If it is deemed safe, it should remain w ith DOC off icer at all times.
F. Sedation
Minimal sedation or anxiolysis, moderate conscious sedation (IV), deep conscious sedation and general
anesthesia (GA) can be offered for individuals w ho may experience claustrophobia, anxiety, or emotional
distress.
i. Oral – See Resource; Contrast Corner – Anxiolytics- Claustrophobia Anxiety Prophylaxis for MRI
ii. IV and GA- See Resource; Contrast Corner – Moderate Conscious Sedation for MRI
iii. Pediatric sedation w ill be performed by a pediatric sedation team or anesthesia staff, according to
age and individual patient characteristics. See Resource; Pediatric Sedation
http://w w w.uwhealthkids.org/anesthesia-medicine/pediatric-sedation/33808
G. Equipment, Emergency Life Support
i. A pulse oximeter w ill be used if patient has taken pain medicine, medicine for claustrophobia or has
sleep apnea or trouble breathing w hen sleeping.
ii. Patients w ith pumps w ill be sw itched to MRI compatible equipment prior to entry to Zone IV; MRI
Safe or Conditional resuscitation equipment is available.
iii. Patients requiring oxygen w ill be sw itched to the w all source provided in MRI facility prior to entry to
Zone IV. No ferrous gas cylinders are allow ed in Zone IV.
iv. All compressed gas cylinders and regulators, w hich might be used inside Zone IV as part of the
anesthesia machine or otherw ise, must be made of non-ferromagnetic material.
v. Patients requiring sedation, general anesthesia or life support during an MRI procedure are only to
be scanned at locations equipped w ith MRI safe or conditional physiologic monitoring equipment.
All patients receiving IV sedation must be monitored as specif ied in UWHC clinical policy #8.38,
UWHC Adult Sedation or UWHC clinical policy #8.56, Pediatric Sedation.
vi. MRI safe or conditional physiologic monitoring equipment for anesthesia must provide at least
pulse oximetry, electrocardiogram, non-invasive blood pressure and capnography data. Monitoring
must also include view ing of the patient and physiologic data from the console room using at least
a video system and line of sight view ing.
vii. MRI safe or conditional intravenous equipment, including syringe pumps, must be available in the
MRI area for patients requiring sedation, general anesthesia or life support.
viii. An MRI safe or conditional anesthesia machine must be located in the MRI scan room w here
anesthesia is to be conducted. The machine w ill be managed and serviced under the direction of
the Department of Anesthesiology. The Department of Anesthesiology is responsible for developing
and maintaining clinical guidelines for the safe conduct of anesthesia in the MRI environment, and
Anesthesiology personnel providing anesthesia services in MRI must comply w ith these guidelines.
ix. Patients coming to MRI requiring ventilator support must be sw itched to an MRI safe or conditional
ventilator support device, as determined by and under the direction of the Respiratory Therapy
Department.
x. If external devices/objects are demonstrated to be ferromagnetic and non-MRI safe/MRI
conditional, they may still, under specif ic circumstances, be brought into Zone IV if, for example,
they are deemed by MRI Staff to be necessary and appropriate for the care of the patient. They can
only be brought into this area if they are under the direct supervision of MRI Staff w ho are
thoroughly familiar w ith the device, its function, and the reason supporting its introduction into the
MRI suite. The device must be appropriately physically secured or restricted at all times to ensure
that it does not come too close to the MRI scanner.
xi. Adverse events including patient burns, projectile or other ferromagnetic events are reported via
the Patient Safety Net (PSN).
H. Emergency Patient Removal
i. The magnetic f ield in an MRI scan room is alw ays on. In the case of a cardiac or respiratory arrest ,
contrast reaction or other patient care emergency the MRI Technologist w ill initiate basic life
support or CPR as required by the situation w hile they evacuate the patient from the scanner by
disengaging the scan table from the scanner and moving it out of Zone IV into Zone III or Zone II.
The response team w ill not enter Zone IV to administer advanced life support.
ii. A MRI Staff member is responsible for initiating emergency shut dow n procedures in case of



UW HEALTH CLINICAL POLICY 5
Policy Title: Magnetic Resonance Imaging (MRI) Safety and Screening
Policy Number: 2.3.5

extreme emergency w arranting the rundow n of the magnetic f ield. Firefighter, police, and other f irst
responders to non-medical emergency situations must either be specif ically trained in MR safety or
must be monitored by MRI Staff. As the magnet must be considered to be at full f ield strength at all
times, only MR-safe f ire extinguishing equipment can be used in Zone IV unless the magnetic f ield
rundow n procedure is initiated by the MRI Staff and the magnetic f ield is confirmed to be dow n.
iii. The UWHC magnets are superconducting systems. In the event of a loss of cryogens (referred to
as a system "quench"), it is imperative that all personnel/patients be evacuated from Zone IV as
quickly as safely feasible and the site access be immediately restricted from all individuals until the
arrival of the MRI manufacturer's service personnel. In this situation, so if cryogenic gases are
observed to have vented partially or completely into the scan room itself.
I. Patient Burns
Radiofrequency (RF) burns are avoided by utilizing proper patient and RF coil positioning and thoroughly
inspecting coils and any required MRI safe physiological monitoring equipment and their cables.
The patient must be positioned appropriately to ensure the extremities are not crossed. Proper padding must
be placed betw een the patient and the coil as w ell as betw een the patient and the scanner to avoid RF
burns.
The fan in the bore should be kept on and the Specif ic Absorption Rate (SAR) closely monitored w hile the
examination is being performed to keep patient heating to a minimum.
In the event a patient has alerted the MRI staff to report he/she has an area that feels “hot,” the follow ing
steps should be taken:
i. Remove patient from scanner.
ii. Assess the area that feels “hot”; do not place ice over area of concern
iii. Contact a Radiologist to assess the area if skin is red.
iv. If the Radiologist is concerned about the site, the patient can be evaluated by the Burn Center.
v. The MRI Technologist w ill contact a MRI Physicist, contact the MRI manufacturer’s service
personnel regarding the event, contact the MR Manager and complete a Patient Safety Net (PSN).
vi. In consultation w ith the MRI manufacturer’s service personnel the MRI physicist w ill determine if
the MRI system can be used for patient care thereafter.

V. FORMS

Radiology Informed Consent for MRI Examination during Pregnancy Form UWH# 301506-DT
MRI Screening Form UWH# SR301436-DT

VI. COORDINATION

Author: MRI Manager and MRI CPC
Senior Management Sponsor: VP, Professional and Support Services
Approval committees: UWHC Safety Committee; UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: May 16, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VII. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VIII. REFERENCES

UWHC policy #12.05, Fire Prevention Management Plan



UW HEALTH CLINICAL POLICY 6
Policy Title: Magnetic Resonance Imaging (MRI) Safety and Screening
Policy Number: 2.3.5

UWHC clinical policy #8.38, UWHC Adult Sedation
UWHC clinical policy #8.56, Pediatric Sedation

University of Wisconsin School of Medicine and Public Health, Department of Radiology; Contrast Corner
w ebsite; https://w w w.radiology.w isc.edu/contrastCorner/

Kanal E, Barkovich AJ, et al. ACR Guidance Document on MR Safe Practices: 2013. J Magn Reson Imaging
37:501-530, 2013. Available at: http://w ww.acr.org/quality-safety/radiology-safety/mr-safety

Memorandum from MRI Safety Chair regarding Pregnant Patients
Resource: Pediatric Sedation; http://w ww.uwhealthkids.org/anesthesia-medicine/pediatric-sedation/33808

IX. REVIEW DETAILS
Version: Revision
Next Revision Due: June 2019
Formerly Know n as: Hospital Administrative policy #12.11