[Music] welcome to the mri safety video for level one personnel recently updated in january 2021 my name is jeremy corwin and i am a medical physicist with core one health physics we are a provider of medical physics services throughout the northwest and also provide mri safety consultation to many of our clients this educational event will primarily be using the most recent version of the acr manual on mri safety from 2020 additionally we will include information from the acr guidance document on mr safe practices from 2019 a common emphasis in both of these documents is that all mri facilities should maintain and critically review mri safety policies your facility has several mri safety policies and applicable ones should be presented to you based upon the work you complete in the mri suite an important note was included in the 2019 update the guiding principles of mri safety remain mri personnel must be appropriately educated be vigilant in their awareness of a dynamic environment and apply that knowledge to screening before and fulfilling patient and staff member safety during their time in the mri suite before we get too far into this i should point out that there are two different levels of mri personnel level 1 personnel are those that basically know the hazards associated with mri and can ensure their own safety within zone 3 but they do not have access to zone 4. level 2 personnel are those that are more extensively trained on mri safety they can access zone four and they can escort others within zone four they are able to screen and scan patients level two personnel are typically mri technologists and mri radiologists this educational presentation is primarily for level one personnel remember all level one personnel must be screened before entering zone four the mri system is a very large and powerful magnet most mri systems operate at 1.5 tesla to 3 tesla which is about 30 000 gauss for comparison the earth's magnetic field is only about 0.5 gauss so we are dealing with a very strong magnet one of the most important things to know about mri systems is that they are always on they are not like other imaging equipment such as x-ray or ct systems those systems only irradiate when the exposed buttons are pushed the mri system is different in that it it is always on the magnetic field from the mri system is unique from other imaging equipment hazards for instance we typically understand that a computed tomography system or ct system which operates with ionizing radiation will only provide radiation within the room itself with very little going outside the room with mri however the magnetic field will often exceed the boundaries of the room in the diagram here we see that the magnetic field from this 3t magnet exceeds the boundaries of the room magnetic fringe field lines which indicate the location and intensity of the magnetic field are shown with concentric lines outside the mri room the magnetic field is continuously present since we have a strong magnetic field continuously present we restrict access to areas in mri facilities by creating zones the four zones are listed here and we will go into detail with each of these zones as noted on the previous slide zone 1 is the area for the general public zone 2 is typically the area in which the general public is interviewed and screened before entering zone 3. zone 2 is also populated by staff that may not be trained in mri safety zones 3 and 4 are for individuals that have been trained or are escorted by someone that has been provided adequate training zone 3 is an area that is typically located directly outside the scanner room we usually indicate that serious problems can occur in this area if the wrong equipment or an unscreened patient is present this area should be restricted and employees entering zone 3 need to have mri safety training many mri sites are old and they were configured before many of these safety regulations were created so compliance with zone 3 is very difficult we would typically like to have zone 3 separated and access controlled by badge or code but this is sometimes not possible for these sites that struggle with engineering controls for zone 3 we recommend that you make your best effort to evaluate and comply with zone three requirements ensure that all individuals are trained within zone three maintain vigilant security of the scanner room also consider some modified engineering controls such as ferromagnetic monitors or plastic fences to prevent individuals accessing zone four zone four is the most hazardous area in mri it is the scanner room itself if zone four is directly accessible from zone 3 the mri technologist must keep the mri door monitored at all times to ensure no one enters the technologist should keep the door closed at all times only screened individuals access this area including staff and a level 2 trained individual must be present to allow level 1 personnel in do not enter the mri room without permission as a reminder since this is an educational video for mri trained level 1 personnel you must remember that you cannot enter the mri room unless you are escorted by a level 2 trained individual this individual will screen you prior to entering the mri room to ensure that all foreign objects are removed and that you can safely enter the mri room now regarding the magnetic field current research indicates that there are no permanent biological effects from the field itself so the field does not cause any harm to the person but we are primarily concerned with the magnetic field attracting metallic objects or interfering with equipment some people have indicated some effect from the magnetic field such as flashing of light feelings of vertigo or metallic tastes in their mouth as you are aware the main concern with the magnetic field is the pulling of objects into the magnet one of the main reasons we provide level one training is to let you know that you can't enter the mri room and that you need to ensure that nothing ferromagnetic enters the room here is an example of the wrong bed being brought into the mri suite please be aware of many common ferromagnetic items in the hospital all of these items and more need to be prevented from entering the mri suite there are serious consequences if ferromagnetic items enter the mri room the forces are so great the items are pulled fast into the bore if someone is in between the metallic item and the mri system they could be seriously injured by these items these objects can cause injuries to patients or staff and they damage the mri system significantly so because of this extreme magnetic field we have a policy that no unsafe items enter into the mri room there are three separate classifications of items for entry into the mri room an item that has a mri safe symbol on it will indicate that the item is considered safe when brought into the mri suite under any conditions an item that is unsafe is one in which we know it pose hazards in all mri environments and must not be brought into the mri suite an mr conditional label device is one that has been demonstrated to pose no known hazards under specific conditions the documentation with these devices must be reviewed and evaluated to ensure the mr conditional device can be brought into the mri room for instance some items may be labeled conditional and specified that they have been evaluated and found safe in a 1.5 t magnet room this would mean that the item has not been found safe to be within an mri room that is a 3t system so every facility has a policy that no unsafe items are taken into the scanner room if you don't know if an item is safe do not guess make sure someone evaluates the item another policy for every mri facility is to ensure that all staff and patients entering the mri room must be screened an mri screening questionnaire must be completed for the patient before each exam for staff such as ancillary nurses or doctors that are not always present in an mri environment we recommend you complete the mri screening questionnaire annually and then ensure a physical screening for objects prior to entering the room evaluating the patient or staff for ferromagnetic objects is just one part of the screening there are several other elements of the screening which include looking for devices or implants that may be disrupted assessing from metallic tattoos and evaluating the patient for the risk of nsf or nephrogenic systemic fibrosis if there is someone pinned against the magnet due to a ferromagnetic object being allowed into the mri room there is a way to turn off the magnet the emergency button to turn off the magnet is called a quench button most level 1 trained individuals do not need to know where this is or how to use it as it should only be used if there is someone pinned against the magnet or there is an uncontrollable fire in the mri room each room has an emergency quench button but we should note that turning the magnet back on after a quench is a very expensive and time-consuming process the mri system should not be turned off or quenched unless it is really necessary there have been many questions regarding pregnant mri workers there have been no documented adverse health effects for pregnant workers in the mri environment so an mri technologist or physician may continue work as they typically do there is a recommendation that workers not be within the scan room during the acquisition primarily due to potential effects from the noise all sites should have a documented mri safety program there typically is an mri medical director and mrso or mri safety officer that will be responsible for mri safety you should be aware of these safety individuals and know how to contact them if you have questions you may send them to me at this address thanks for taking time to watch this presentation