Basic MRI Safety

Course Objectives
At the end of this course the learner will:

• Know the basic principles of how MRI works.

• Understand MRI safety precautions and
procedures.
• Comprehend the differences and the roles of
both Level I and Level II staff.
Chapter 1
MRI Basics
 THE
MAGNET IS
ALWAYS
ON!!!!
24 hours a day, 7 days a week, 365 days a year!!
The magnet NEVER shuts off!!

MRI Basics
 MRI Basics
• Clinical Magnetic Resonance
Imaging (MRI) uses the magnetic
properties of hydrogen and its
interaction with both a large
external magnetic field and
radiowaves to produce highly
detailed images of the human
body.
• NO radiation involved

From:
Basic Principles of MRI
Wm. Faulkner, B.S.,R.T.(R)(MR)(CT) MRI Basics
 MRI Terms
• Ferromagnetic
– Having a high susceptibility to
magnetization, the strength of which
depends on that of the applied
magnetizing field, and that may persist
after removal of the applied field.
– Examples: iron, nickel, cobalt, BB’s,
bullets
– Ferromagnetic items CANNOT be brought
into the MR environment

From:
Dictionary.com MRI Basics
 Chapter 2
MR Signs and Equipment
 Important signs:
• MRI safe

• Caution

• NOT Safe

MRI Signs and Equipment

 Important signs:
• MRI Safe
– These items can be
taken into the scanner
if marked properly with
an “MRI Safe” sticker
– Ex: IV poles, Step
stools, and
stethoscopes
– Keep these items in
MRI! They are very
expensive!

MRI Signs and Equipment

Important signs:
• MRI Conditional
– Some of these items
can be taken in the
scanner, some cannot
– Some items can only
be taken into 1.5
TESLA rooms
– Ask MRI Technologist
before taking into
scanner
– Ex: IV poles, Step
stools, and
stethoscopes

MRI Signs and Equipment

Important signs:

• MRI Unsafe
– These items
CANNOT be taken
into MRI
– Ex: Oxygen tanks,
Phones, Pagers,
Laryngoscopes

MRI Signs and Equipment

 Hand Magnet
• A hand magnet is used to test external items
for MR safety
• This is NOT a safe way to test implants in a
patient’s body
• If there is any doubt, DO NOT take items into
rooms!

MRI Signs and Equipment

 Specialty equipment for
the MRI…
• Wheelchairs
• Stretchers
• Monitors
• Oxygen tanks
• IV pumps
• These items are
kept in MRI

MRI Signs and Equipment

 Oxygen Tanks
• Color of oxygen tank DOES NOT determine
whether tanks are MR safe or not
• Oxygen tank MUST be labeled “non
magnetic”

MRI Signs and Equipment

 Chapter 3
Patient/Employee
Screening
 Patient/Employee Screening
• All patients, family members, and staff MUST
be screened by Level II personnel before
entering the MRI environment
– Note: Level II personnel are the only staff
able to metal screen
• Level II personnel must ask questions
regarding metal implants before patient is
brought into the MRI room
• Patient screening must be entered into
radiology assessment before bringing the
patient into the room

Patient/Employee Screening
 What to Ask?
• Example of
questions in
radiology
assessment
• Level II personnel
will ask all of the
questions to the
right
• If any answers are
yes, they will seek
more information.

Patient/Employee Screening
 Metal Implants
• If a patient, family member, or staff member
has a metal implant, the implant make and
model number will have to be reviewed in the
MRI safety handbook by level II personnel. If
there is no documentation, a radiologist will
have to decide on whether the patient can be
scanned or not.
• Documentation of implants and/or consents
MUST be entered into radiology assessment
before patient is brought into MRI
• If a parent has an implant without
documentation, they will NOT be allowed in
the scanner. There are NO exceptions

Patient/Employee Screening
 Working with Metal
• If a patient or staff member has worked with
metal and has had metal shavings in his/her
eyes, an orbital x-ray will need to be obtained
and a radiologist will need to clear the images
before the patient can have an MRI
• If a family member or staff member has metal
in their eyes they CANNOT enter the MR
environment without orbital x-rays. X-rays will
only be done if it is absolutely necessary that
the person be in the room
– (ex: MRI tech, MRI nurse)

Patient/Employee Screening
 Example:
• Patient with metal
in or around eye
• No heavy eye
makeup or metal in
eyes
• Metal in eyes can
result in burning of
the optic nerve,
causing permanent
vision loss

Patient/Employee Screening
Burns
• MRI will generate heat at a
very fast rate
• Remove before the scan to
reduce the risk of burns:
– Medication patches
– EKG patches
– Pulse Ox sensors
– All metallic clothing
– Jewelry
• Burns can be caused by
any of the above items

Patient/Employee Screening
Examples of MRI Burns

Patient/Employee Screening
Items NOT permitted in
scanner:
• Purse, wallet, money clip,
credit cards, cards with
magnetic strips
• Electronic devices such
as beepers or cell phones
• Hearing aids
• Metal jewelry, watches
• Pens, paper clips, keys,
coins
• Hair barrettes, hairpins
• Any article of clothing that
has a metal zipper,
buttons, snaps, hooks,
underwire, or metal
threads
Patient/Employee Screening
 Chapter 4
MR Personnel
 MRI Personnel

• There are two types of MRI

Personnel:
– Level I Personnel
– Level II Personnel

Level I and II Personnel

 Level I Personnel
• Employees that need a basic knowledge of MRI,
but do not work in MRI on a full time basis
include:
– Facilities
– Public Safety
– Anesthesia Students
– Physician’s Assistants
– CRNP’s
– Floor Nurses
– ICU Nurses
• These employees DO NOT have access to MRI.
They need to be monitored by Level II personnel

Level I and II Personnel

 Level II Personnel
• Employees that work full time in MRI and have a
vast knowledge of MRI and the safety risks
involved
• These employees are in charge of making sure
the MRI area is a safe environment AT ALL
TIMES
• Examples:
– MRI Technologists
– MRI Nurses
– Radiologists
• Absolutely NO other staff can have access to
MRI

Level I and II Personnel

Chapter 5
MRI Zones
 MRI Zones
• All MRI suites have designated
“zones” to ensure safety
• Zones are labeled I-IV, I being the
furthest from the scanner and IV
being the scanner itself
• Note: Zones III and IV are restricted
to MRI staff ONLY

MRI Zones
 CHP MRI Zones

Zone I

Zone II Zone II

Zone III

Zone IV Zone IV Zone IV

Zone III
Staff Attire – Zones III and IV
• Anyone entering Zones III and IV of the
MRI department MUST be changed
into the approved MRI Pocketless
Scrubs! This includes:
– Technologists
– Floor Nurses
– Physicians
– Respiratory
– All other staff

Patient/Employee Screening
 Patient Attire
• A patient requires a FULL CHANGE of attire,
including undergarments. This also applies to
any accompanying parents/guardians.
• Not properly changing a patient can cause
burns and heating

Patient/Employee Screening
 Chapter 6
Condition A/C
 Condition A/C
• Codes are NEVER to be run in the
MRI room!
• If there is reason to call a code,
the patient will be removed from
the scanner and the code will be
run in the back hallway (Zone III)
• NEVER bring the crash cart into
the room!
Condition A/C Policy
• CHP Policy #460 “Response to
Cardiopulmonary Arrest/Medical
Emergencies”

– “Condition A or C in Magnetic Resonance

Imaging (MRI) In the event of a crisis in MRI, it is
the responsibility of the MRI technologists and
nurses to remove the patient from the scanner and
take the patient into the hallway behind the MRI
scanners. The Condition A/C team will respond to
the MRI suite and their entrance will occur via the
MRI technologist opening the door to this hallway.
The code team will care for the patient in this area.
The Condition A/C team is not to enter into the
scanner because of safety and therefore will take
responsibility for the patient once the patient is in
this designated hallway.”
 Chapter 7
MRI Accidents
 MRI Accidents
• If a ferromagnetic item is brought into the
room (wrench, oxygen tank) this item will
become a projectile and attract towards
the magnet with tremendous force
• This item will fly toward the center of the
magnet and take anything in its path with
it
• Ex: If a patient comes in with an unsafe
wheelchair, the wheelchair will fly to the
center of the magnet with the patient in
the chair
MR Accidents
 MRI Accidents (cont.)
• There have been many MRI accidents
since MRI was introduced in the 1980’s
• Examples include, but are not limited to:
– Patient having an MRI Unsafe aneurysm clip
in the brain, resulting in the death of the
patient
– Six year old boy struck with an oxygen tank,
resulting in his death
– Patient having nail clippers in his pocket.
When being sent into the scanner, the
clippers flew out of the pocket and struck the
patient in the eye. As a result, this patient lost
his eye

MR Accidents
 MRI Accidents (cont.)
• Patient bed that was brought into the MR
environment

MR Accidents
MRI Accidents (cont.)

IV Pole

Floor Buffer

MR Accidents
 Chapter 8
Magnet Quench
 Magnet Quench
The only way to deplete the magnetic field is to
perform a quench. A quench involves the rapid
boil-off of cryogenic fluid.
• Only to be done in a life threatening emergency
– Ex: if a person is trapped between a table and the
magnet OR if there is a fire in the room and
emergency staff are coming into the area

Quenching the magnet is extremely expensive and

takes the magnet out of commission for weeks.
There is a possibility that quenching the magnet
could be irreversible.

Magnet Quench
What Happens During a
Quench?
• Extremely loud noise
• Gas being ventilated from the magnet to
outside
– Some gas will be ventilated into the room,
raising the risk for an oxygen shortage and
liquid oxygen on the floors
• Possible dangers of quenching:
– Frostbite
– Asphyxiation
– Hearing damage

Magnet Quench
 Magnet Quench Button

• DO NOT touch this button unless directly

advised to by MRI staff!
Magnet Quench
In Conclusion…
 What If?
• A patient has an unknown implant?
– See the MRI technologist. An MR
technologist and radiologist must
clear the patient in writing before
starting the exam
• A patient codes in the scanner?
– Take the patient in the back hallway
to conduct the code. NEVER run
the code in the room
• A patient complains of burns?
– Take the patient out of the room
and investigate further
 What If?
• A person is pregnant?
– See MRI technologist. As far as science can tell,
MRI is safe, but policy at CHP is that no person be
in the room during radiofrequency while pregnant.
This means a pregnant person should not be in
the room while there is noise in the room.
• Policy MOD-102.0: Pregnant Staff (MR)
– The pregnant staff member may continue to
perform the duties/responsibilities as defined by
her job description unless otherwise directed by a
personal physician. The pregnant RT may
archive, film, inject contrast, and enter the scanner
room before and/or after an acquisition to attend to
patient care needs. The pregnant RN may
administer adjunct medication, monitor vital signs
and enter the scanner room before, during, and/or
after an acquisition to attend to patient care needs
as appropriate.
 Important Reminders:
• NEVER bring metal into the room
• DO NOT bring anyone into the MR
environment without completing the
metal screening process by level II
personnel
• Codes are NEVER to be run in the
MRI room
• Ferromagnetic items being brought
into the MR environment can easily
cause injury or death
 Policies
• For additional information on any of
these topics, see these policies on
Radiology Sharepoint:
– MOD 100.0: General Magnetic Resonance
Safety
– MOD 101.0: Metal Screening for Patient,
Parent, Legal Guardian, Staff
– MOD 102.0: Pregnant Staff (MR)
• See these items in CHP Policies on
Intranet:
– CHP Policy #460: Response to
Cardiopulmonary Arrest/Medical
Emergencies
 Questions/Comments
• If there are any questions
regarding MR Safety, please
contact a lead MRI technologist:
– Kristen Harman
– Colleen Cooper
– Denny Willaman
• 692-3038
 Remember…

THE
MAGNET IS
ALWAYS
ON!!!!