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Irogers{at}ajroffice.org
The need for safe practices and procedures is readily acknowledged, thus the coining and promotion of safety slogans. But safe practices and procedures are more than glib sloganeering.
Safety is a full-time job. Safe practice requires discipline. Safe practice requires an awareness of the risks involved and a personal and organizational commitment to avoid and prevent accidents. No one is exempt. Safety in the workplace requires that everyone be informed and involved. Take MR imaging, for instance.
MR imaging has been shown to be a relatively safe procedure; thousands of MR imaging examinations are done each day without incident. But occasionally things can go wrong, very wrong, and accidents do happen [1,2].
As radiologists, we are all aware of the inherent dangers of ferromagnetic objects that may reside within or on the patient, beginning with intracerebral aneurysm clips, metallic objects in the orbit, hairpins, cardiac pacemakers, and ECG leads as well as pulse oximeters and other monitoring devices. Also, iron pigments in extensive or dark tattoos may lead to skin burns. Patients are routinely queried and examined by technical and clerical personnel to identify such things and avoid problems.
That said, the major source of significant accidents is the inadvertent introduction of heavy metal objects into the MR suite. Large ferromagnetic objects that have been drawn into MR equipment include a defibrillator, a wheelchair, an IV pole, a tool box, a vacuum cleaner, a floor buffer, mop buckets [1], and a policeman's gun that discharged as it flew from his hand across the room [2].
The most common culprit, however, is an oxygen or nitrous oxide cylinder brought into the MR examination room by unknowing, well-intentioned, nonradiology personnel [1]. Once the cylinder enters the magnetic field, the cylinder is precipitously drawn into the magnet. The result, at best, is no more than damage to the MR machine; but, at worst, such a missile may maim or even kill a patient in the magnet [2]. Needless to say, such incidents are to be avoided.
We need not dwell on the ramifications for those involved: shock, sadness, and remorse. Such accidents can lead to a bitter cascade of travail. Those involved may become the targets of endless investigations, recriminations, and possibly a concerted effort to identify a scapegoat. Inevitably, this tale of woe is capped by litigation. The anguishing chain of events precipitated by such accidents gives meaning to the old maxim, "Better safe than sorry."
But how do you ensure safety? What steps can be taken to prevent such accidents? How do you establish and maintain a safe environment in and about the MR examination suite?
Reflection makes it quickly evident that safety in the MR suite is not just the responsibility of the department of radiology. This responsibility must be shared by the broad array of ancillary departments that service the MR suite: housekeeping, patient transportation, nursing, anesthesia, security, engineering, facility services, and maintenance—indeed, all departments that may have reason, either regularly or even occasionally, to enter the MR environment. Safety in the MR suite must be a collaborative effort. Every institution that has MR imaging equipment must recognize the potential dangers and take steps to ensure that proper procedures and guidelines are in place and that all personnel who may enter this environment are properly trained.
The tragic accident on July 27, 2001, involving a ferromagnetic oxygen cylinder that killed a 6-year-old boy in an MR facility in Westchester County, NY [2], sounded an alarm for the need to improve MR safety at all MR installations. The American College of Radiology (ACR) responded. A task force was named to write a white paper fully addressing the issue of MR safety. You have before you in this issue of the Journal the ACR White Paper [3] that includes the recommendations of the task force on MR safety; this paper is everything you and your administrative colleagues need to know to ensure a safe environment for MR imaging. Read, mark, and broadcast this document. The recommendations of the ACR White Paper are augmented by an informative commentary by Shellock and Crues [4].
Safety depends on knowledge of the risks involved, education and training of all personnel, appropriate screening procedures, restriction of access, and eternal vigilance. Everyone must be vigilant. Accidents do happen. But accidents can be prevented.
Compare the recommendations of the ACR White Paper [3] and the commentary of Shellock and Crues [4] with the MR safety procedures now in place at your facility. Update your safety procedures as required. Share a copy of this ACR White Paper with your administrators. If need be, tell them about the accident that occurred in Westchester County. Have a meeting with all the hospital services that may enter your MR facility. Tell them about the accident, too. Explain the need for proper training of all personnel who may enter your MR environment. Work with all these services to create a safe environment for MR imaging at your institution.
I know this sounds like a lot of effort, but it is no more than "an ounce of prevention" as compared with "a pound of cure." Put yourself in the situation of those at Westchester County.
Better safe than sorry!
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