ACR Manual on MRI Safety
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Questions and Answers

What should be used to identify ferrous objects in Zone III?

  • An x-ray machine
  • A handheld magnet
  • A ferromagnetic detection device (correct)
  • A metal detector

    • What area is Zone III?

  • The region in which free access by unscreened Non-MR Personnel or ferromagnetic objects and equipment can result in serious injury or death.
  • The area where patients are greeted and allowed to move freely before entering Zone III.
  • The general area in which the MR scanner is located (correct)
  • The MR scanner room itself.

    • What should be done before initiating a quench in a nonemergent situation?

  • Verify the function of emergency exhaust systems (correct)
  • Verify or provide means of pressure relief
  • Verify the function of the MRI magnet system
  • Verify the function of the RF shield enclosure

    • What should design standards for passive pressure-relief mechanisms follow?

    <p>Design criteria similar to cryogen vent pathways and active exhaust</p> Signup and view all the answers

    What should be done for patients with a history of orbital trauma by a potential ferromagnetic foreign body?

    <p>Obtain plain x-ray orbit films</p> Signup and view all the answers

    Who is responsible for ensuring the safe execution of all MR examinations?

    <p>The MRMD</p> Signup and view all the answers

    What is the minimum number of MR Personnel required when two machines are in use during scheduled hours?

    <p>Two Level 2s</p> Signup and view all the answers

    What should be done to reduce the risk of lead or tissue heating during MR scanning?

    <p>Position the leads or wires as far away from the inner walls of the MR scanner as possible</p> Signup and view all the answers

    What is the safety of MRI at field strengths higher than 1.5 T during pregnancy?

    <p>It has not been thoroughly assessed, but no harmful effects have been found</p> Signup and view all the answers

    What is the unit of SAR?

    <p>Watts per kilogram</p> Signup and view all the answers

    What is Faraday's Law?

    <p>A law stating that a changing magnetic field will induce a voltage and subsequent current in a perpendicularly oriented electrical conductor</p> Signup and view all the answers

    What is the most important step before performing an MRI scan?

    <p>Evaluate the patient by a Level 2 physician</p> Signup and view all the answers

    What should all MR Personnel do as part of their employment agreement?

    <p>Undergo an MR screening process</p> Signup and view all the answers

    What is the responsibility of the MRMD?

    <p>To ensure appropriate evaluation and screening of patients and health care personnel</p> Signup and view all the answers

    What should MR facilities arrange to do in order to ensure safety?

    <p>Educate local fire marshals</p> Signup and view all the answers

    What is the main challenge of implementing MR safety policies and standard operating procedures in new MR facilities?

    <p>Personnel</p> Signup and view all the answers

    What should be done for patients with an unclear history of an implanted intracranial aneurysm clip?

    <p>Obtain CT or MR images</p> Signup and view all the answers

    What is the minimum number of MR Personnel required when one machine is in use during lunch or an evening shift?

    <p>One Level 1 and one Level 2</p> Signup and view all the answers

    Who is responsible for the development, implementation, and maintenance of MR safety policies and procedures?

    <p>The MRSO</p> Signup and view all the answers

    What should be the primary focus when dealing with a medical emergency in Zone IV?

    <p>Stabilizing the patient</p> Signup and view all the answers

    Who may establish and attend to peripheral IV access lines?

    <p>IV injection-qualified MR personnel</p> Signup and view all the answers

    What should be done to reduce the risk of RF exposure causing thermal injury?

    <p>Warn patients of the possibility of heat injury</p> Signup and view all the answers

    What is the consensus regarding the use of gadolinium-based contrast agents (GBCAs) in pregnancy?

    <p>They should be avoided</p> Signup and view all the answers

    What is the primary rationale for implementing SED limits?

    <p>To protect the patient from experiencing core temperature elevations</p> Signup and view all the answers

    What type of label should be attached to a portable metallic or partially metallic object before it can be brought into Zone IV?

    <p>A triangular yellow MR Conditional label</p> Signup and view all the answers

    What screening is required for conscious, nonemergency patients before they are allowed into Zone III?

    <p>Questioning by Level 2 Personnel</p> Signup and view all the answers

    What should be provided for visual observation by Level 2 MR Personnel to access pathways into Zone IV?

    <p>A closed entry door</p> Signup and view all the answers

    What should be included in an emergency preparedness plan?

    <p>Contact information for the MRI system vendor</p> Signup and view all the answers

    What is the current construction of many RF-shielded observation windows?

    <p>Difficult to break</p> Signup and view all the answers

    What is the location of the magnet poles and therefore maximal SFG?

    <p>The outer edges of the openings or entrance(s) to the magnet bore</p> Signup and view all the answers

    What is the minimum number of MR Personnel required when patients or research subjects are present in Zones II through IV?

    <p>Three Level 1s</p> Signup and view all the answers

    Who is responsible for the development of an appropriate investigation and recording of MR safety adverse events?

    <p>The MRSE</p> Signup and view all the answers

    What should be documented before an MR examination of a patient with an intracranial aneurysm clip?

    <p>The manufacturer, model, and type of aneurysm clip</p> Signup and view all the answers

    What should be done if an unanticipated ferromagnetic implant or foreign body is discovered during an MRI scan?

    <p>Immediately notify the MRMD and/or Level 2 MR Physician responsible for the patient</p> Signup and view all the answers

    What is Lenz's Law?

    <p>A law asserting that the induced current will generate a secondary magnetic field that opposes the original magnetic field</p> Signup and view all the answers

    What should be done with the entry door to Zone IV?

    <p>It should be closed except when it must remain open for patient care or room/MR system maintenance</p> Signup and view all the answers

    What should MRI facilities inspect annually?

    <p>Cryogen vent systems</p> Signup and view all the answers

    What should be done with skin staples or SMSs near the area to be irradiated?

    <p>Cover them with a cold compress or ice pack</p> Signup and view all the answers

    What must be done with all devices before they are brought into Zone IV?

    <p>Labeled</p> Signup and view all the answers

    What type of monitoring is often necessary during MR examinations?

    <p>Thermal injury monitoring</p> Signup and view all the answers

    What should be done in the event of a system quench?

    <p>Evacuate Zone IV</p> Signup and view all the answers

    What should be done for research and volunteer subjects before they are allowed into Zone III?

    <p>Questioning by Level 2 Personnel</p> Signup and view all the answers

    What is the risk-benefit analysis that should accompany the decision to administer an MR GBCA to pregnant patients?

    <p>A well-documented and thoughtful risk-benefit analysis.</p> Signup and view all the answers

    What is the most likely consequence of a seismic event?

    <p>Damage to the RF shield enclosure</p> Signup and view all the answers

    What is the difference between SAR and SED?

    <p>SAR is the rate of energy absorption, while SED is the total dose of energy</p> Signup and view all the answers

    What should be done for patients in whom there are long electrically conductive leads before permitting access to the MR scanner?

    <p>Review and clear them by an attending Level 2 MR Physician</p> Signup and view all the answers

    What is the minimum number of MR Personnel required when Non-MR Personnel are in Zones III or IV?

    <p>One Level 1 and one Level 2</p> Signup and view all the answers

    What should be done if a patient cannot provide a reliable history?

    <p>Plain-film radiography</p> Signup and view all the answers

    What is the recommended procedure for patients with non-MR Conditional cardiac devices?

    <p>Perform an MR examination</p> Signup and view all the answers

    What has been demonstrated regarding some of the MR GBCAs and the placental barrier?

    <p>They can pass through the placental barrier and enter the fetal circulation.</p> Signup and view all the answers

    What type of monitoring can be accomplished using pulse oximetry?

    <p>Heart rate and rhythm</p> Signup and view all the answers

    What is the minimum strength of the handheld magnet that should be used for testing portable metallic or partially metallic objects?

    <p>1000 G</p> Signup and view all the answers

    What type of hazard may be posed to patients in Zone III?

    <p>Magnetic hazard</p> Signup and view all the answers

    What is not advised for cardiac or respiratory arrest?

    <p>Quenching the superconductive magnet</p> Signup and view all the answers

    What must be established and implemented in order to ensure infection control?

    <p>Standard operating procedures</p> Signup and view all the answers

    What is the magnitude of the voltages and current generated when an electrical conductor is moved through the SFG?

    <p>Directly proportional to the rate of motion as well as the regional SFG value</p> Signup and view all the answers

    What should be done to help safeguard against thermal injuries or burns?

    <p>Place pads between the patient’s skin and any transmit RF coil</p> Signup and view all the answers

    Who is responsible for the safety of personnel within the MRI environment?

    <p>The MRMD</p> Signup and view all the answers

    What should the cryogen safety exclusion zone be devoid of?

    <p>All of the above</p> Signup and view all the answers

    What should be done to protect gantries and sensitive electronics in an emergency?

    <p>Provide backup power for the vacuum pump/cold head</p> Signup and view all the answers

    What should facilities assess to ensure it meets minimum design requirements?

    <p>The current cryogen vent system</p> Signup and view all the answers

    What are the guidelines for sedation protocols in MRI?

    <p>The American Academy of Pediatrics, the American Society of Anesthesiologists, and The Joint Commission (TJC).</p> Signup and view all the answers

    What should be primarily considered when selecting physiological monitoring during MR examinations?

    <p>Risk of thermal injury</p> Signup and view all the answers

    What is the most important thing to have in place with MRI equipment and facilities?

    <p>Emergency preparedness plans</p> Signup and view all the answers

    What is the most important factor to consider when attempting to “retrofit” safe practices into an intraoperative/interventional MR environment?

    <p>Planning</p> Signup and view all the answers

    What should be done to reduce the potential for lead or tissue heating during MR scanning?

    <p>Apply cold compresses or ice packs to contact areas</p> Signup and view all the answers

    What is the requirement for Level 2 MR Personnel when Non-MR Personnel are in Zones III or IV?

    <p>They must be accompanied by, or under the immediate supervision of, a Level 2 MR Personnel</p> Signup and view all the answers

    What is an acceptable form of documentation for a patient with an implanted intracranial aneurysm clip?

    <p>Electronic copies of operative reports</p> Signup and view all the answers

    What is the maximum sound pressure that MRI can produce with hearing protection in place?

    <p>99 dB(A</p> Signup and view all the answers

    What should not have free access to Zone III or IV?

    <p>Firefighters</p> Signup and view all the answers

    Who is expected to provide advice on the engineering, scientific, and administrative aspects of the safe use of MR equipment?

    <p>The MRSE</p> Signup and view all the answers

    What should patients do during MRI scans?

    <p>Remain motionless</p> Signup and view all the answers

    What should be done with the entry door to Zone IV during times that it must remain open?

    <p>A “caution” barrier should be implemented</p> Signup and view all the answers

    What should be done for children before they are allowed into Zone IV?

    <p>Questioning by Level 2 Personnel</p> Signup and view all the answers

    What is the potential for thermal injury to adjacent or contiguous patient tissue increased by?

    <p>Large currents or voltages induced in the patient</p> Signup and view all the answers

    What should be done in the event of a medical emergency in Zone IV?

    <p>Initiate basic life support</p> Signup and view all the answers

    What is the potential risk of performing an MR examination on a patient with an intracranial aneurysm clip?

    <p>Death</p> Signup and view all the answers

    What should be analyzed in both horizontal and vertical orientations to identify areas that may pose a hazard to patients?

    <p>Magnetic-field-strength spatial plots</p> Signup and view all the answers

    What should be done with electrically conductive implants near the skin?

    <p>Cover them with a cold compress or ice pack</p> Signup and view all the answers

    Who should make screening criteria exceptions for accompanying companions?

    <p>Qualified, responsible Level 2 MR Physician</p> Signup and view all the answers

    What should be done before administering MRI contrast agents?

    <p>Only be administered by a duly licensed physician</p> Signup and view all the answers

    What is the main concern for metallic implants, devices, and foreign bodies in the 7 T environment?

    <p>Resonant circuit-induced heating</p> Signup and view all the answers

    What should facilities ensure the cryogen discharge point has?

    <p>A weather-head</p> Signup and view all the answers

    What is the most sensitive to water of the following?

    <p>MRI equipment</p> Signup and view all the answers

    What should be in place before initiating any MR sequences?

    <p>Hearing protection</p> Signup and view all the answers

    What type of label should be attached to a portable object that is known to be nonmetallic and not electrically conductive?

    <p>A square green MR Safe label</p> Signup and view all the answers

    Who may be external to the organization performing the scan?

    <p>The MRSE</p> Signup and view all the answers

    What is the recommended method for monitoring body temperature in the neonatal and young pediatric population in the MR suite?

    <p>Temperature monitoring equipment and neonatal isolation transport units and other warming devices.</p> Signup and view all the answers

    What is the total energy absorbed by the patient referred to as?

    <p>SED</p> Signup and view all the answers

    What is the potential for lead or tissue heating during MR scanning?

    <p>High</p> Signup and view all the answers

    What should be included in an emergency preparedness plan for restoring clinical services?

    <p>Contact information for affiliated hospital and professional organizations</p> Signup and view all the answers

    What is the gradient of the static magnetic field around an MR scanner?

    <p>Decreasing with increasing distance from the physical poles of the magnet hardware</p> Signup and view all the answers

    What type of label should be attached to a portable object that is known to be ferromagnetic and MR Unsafe?

    <p>A round red MR Unsafe label</p> Signup and view all the answers

    What is the MR Safety Coordinator expected to provide advice on?

    <p>MR Safety Programs</p> Signup and view all the answers

    What area is Zone II?

    <p>The area where patients are greeted and allowed to move freely before entering Zone III.</p> Signup and view all the answers

    What is the largest group that requires sedation for MRI?

    <p>Children</p> Signup and view all the answers

    What is the FDA's position on 7 T MR scanners?

    <p>Cleared for clinical use</p> Signup and view all the answers

    What is the purpose of an emergency exhaust pathway for MRI systems that use superconducting magnets?

    <p>To provide a means of timely pressure relief in the event of a quench</p> Signup and view all the answers

    What is the primary difference between thermal load and focal RF-related thermal injury?

    <p>Thermal load is dissipated over time, while thermal injury is not</p> Signup and view all the answers

    What should be done before performing an MRI scan?

    <p>Evaluate the patient by a Level 2 physician</p> Signup and view all the answers

    What should be provided to the Non-MR Personnel individual before undergoing radiographic screening?

    <p>Written informed consent</p> Signup and view all the answers

    What should be the focus when dealing with a medical emergency in Zone IV?

    <p>Stabilizing the patient</p> Signup and view all the answers

    What type of data is helpful for patients with postoperatively retained cardiac pacing wires?

    <p>Survey data</p> Signup and view all the answers

    What should be done for higher-field systems and faster-spin-echo sequences?

    <p>Review and clear them by an attending Level 2 MR Physician</p> Signup and view all the answers

    What should be provided for free access to Zone III?

    <p>Access keys or passkeys</p> Signup and view all the answers

    What is the purpose of patient risk assessment before an MRI scan?

    <p>To assess potential risks associated with MRI</p> Signup and view all the answers

    What should be done if someone is experiencing cardiac or respiratory arrest?

    <p>Move the patient as quickly and safely as possible</p> Signup and view all the answers

    What should be done when determining whether a certain patient diagnostic question should undergo MRI?

    <p>Risk-versus-benefit assessment</p> Signup and view all the answers

    What is the purpose of ultrafast MR examinations?

    <p>To diagnose conditions without the need for sedation.</p> Signup and view all the answers

    What is the purpose of the SFG map or chart supplied by the MR system manufacturer?

    <p>To demonstrate the strength of the SFG at specific locations</p> Signup and view all the answers

    What should be taken into consideration when electrically conductive material is required to be within the volume undergoing direct RF irradiation?

    <p>Large-caliber electrically conducting loops</p> Signup and view all the answers

    What should be done for patients with an implanted intracranial aneurysm clip that is not MR Conditional?

    <p>Perform a risk-benefit assessment</p> Signup and view all the answers

    What should be done only in nonemergent situations?

    <p>Initiate a quench</p> Signup and view all the answers

    What should the MR Safety Coordinator keep in close contact with?

    <p>Regional and Professional Bodies</p> Signup and view all the answers

    What should the individual be aware of before undergoing radiographic screening?

    <p>The risks and benefits of the procedure</p> Signup and view all the answers

    What should facilities inspect after any significant seismic event or damage to the building?

    <p>Cryogen vent systems</p> Signup and view all the answers

    What should be done if an implanted device is inadvertently exposed to any level of the MR system's energies?

    <p>Immediately notify the MRMD and/or Level 2 MR Physician responsible for the patient</p> Signup and view all the answers

    What is the main purpose of Zone IV?

    <p>To prevent the introduction of potentially dangerous objects or equipment</p> Signup and view all the answers

    What is the unit of SED commonly reported in?

    <p>Kilojoules per kilogram</p> Signup and view all the answers

    What should the cryogen discharge point be positioned so that it cannot enter or occlude the pipe?

    <p>All of the above</p> Signup and view all the answers

    What right should the individual be aware of before undergoing radiographic screening?

    <p>The right to refuse the screening</p> Signup and view all the answers

    What is the secondary magnetic field induced by the current generated when an electrical conductor is moved through the SFG?

    <p>Oriented in the opposite direction as the motion of the conductor</p> Signup and view all the answers

    What should be done after the patient is stabilized?

    <p>Evacuate the patient from Zone IV</p> Signup and view all the answers

    What should be labeled as potentially hazardous in Zone IV?

    <p>Magnetic field</p> Signup and view all the answers

    What should be done to ensure that non-MR personnel and materials are not brought into Zone IV?

    <p>Restrict access to Zone IV until the patient is removed from the scanner</p> Signup and view all the answers

    What has been the majority of published material regarding the acoustic safety of fetal scanning?

    <p>It has found no deleterious effects on newborn hearing if exposed to MRI in utero.</p> Signup and view all the answers

    What should be done for patients with a history of injury or implantation associated with a ferromagnetic foreign body or implant?

    <p>Undergo further investigation</p> Signup and view all the answers

    What can RF exposure from MR scans cause?

    <p>Heat injury</p> Signup and view all the answers

    What is the most likely consequence of power outages?

    <p>Loss of cryogen levels</p> Signup and view all the answers

    What should be done with MR scans of prisoners/detainees?

    <p>Obtain permission from the corrections department</p> Signup and view all the answers

    Who is responsible for providing safety advice regarding nonroutine MR procedures?

    <p>The MRSE</p> Signup and view all the answers

    What is the effect of certain medications on the patient’s thermoregulatory responses to a heat load?

    <p>Synergistic</p> Signup and view all the answers

    What should be included in an emergency preparedness plan?

    <p>Instructions on how to protect gantries and sensitive electronics</p> Signup and view all the answers

    Who should have hearing protection in place when undergoing research sequences?

    <p>Both patients and volunteers</p> Signup and view all the answers

    What should the MR Safety Coordinator report back to the MRMD and MRSO on?

    <p>Safety-related Root Cause Analyses</p> Signup and view all the answers

    Who may administer MRI contrast agents?

    <p>A duly licensed physician</p> Signup and view all the answers

    What is the increased exposure level of first-trimester pregnancies to gadolinium?

    <p>Increased screening and vigilance may be warranted</p> Signup and view all the answers

    What type of environment presents substantial challenges for intraoperative/interventional MR?

    <p>Dynamic MR environment</p> Signup and view all the answers

    What area is Zone IV?

    <p>The MR scanner room itself.</p> Signup and view all the answers

    What should the magnet room for superconducting magnets also be provided with?

    <p>An additional form of passive pressure relief</p> Signup and view all the answers

    What could potentially happen when quenching a superconductive magnet?

    <p>It could take more than a minute</p> Signup and view all the answers

    What type of label should be attached to a portable object that has an MR Conditional status?

    <p>A triangular yellow MR Conditional label</p> Signup and view all the answers

    What should be done with leads or wires during MR scanning?

    <p>Position the leads or wires as close to the inner walls of the MR scanner as possible</p> Signup and view all the answers

    What is the risk of MRI scanning of an intracranial aneurysm clip (or other implant)?

    <p>Adverse event</p> Signup and view all the answers

    What should be obtained in advance for Non-MR Personnel individuals before undergoing radiographic screening?

    <p>Written informed consent</p> Signup and view all the answers

    Study Notes

    • All individuals responsible for safety in Zones III or IV of the MR environment should be documented as having been successfully educated regarding MR safety issues (in a manner defined by the facility’s MRMD).
    • MR Personnel are individuals who have passed the facility’s MR safety educational requirements (as defined by the facility’s MRMD) to ensure that they would not constitute a danger to themselves or others in the MR environment.
    • There are 2 levels of MR Personnel, Level 1 MR Personnel and Level 2 MR Personnel. Level 1 MR Personnel are individuals who have passed the facility’s MR safety educational requirements (as defined by the facility’s MRMD) to ensure that they would not constitute a danger to themselves or others in the MR environment. Level 2 MR Personnel are 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.
    • There will be a minimum of two MR technologists or one MR technologist and one other individual with the designation MR Personnel in the immediate Zone II through Zone IV MR environment whenever patients are in the MR environment. During this time, the two MR Personnel must be able to directly communicate within earshot of each other at all times. In all other ways, the ACR MR Safety Committee supports the Veterans Health Administration responsibilities directive 1105.05 for the Medical Facility Director of 2018: ensuring that when routinely scheduled patients or research subjects are present in Zones II through IV, there will be a minimum number of MR personnel in Zones III through IV to assure safe operation and adequate access control.
    • There will be a minimum of one Level 2 MR Personnel for each machine and a minimum of one additional MR personnel, i.e. two machines during scheduled hours will require two Level 2 MR personnel and an additional Level 1 or 2 MR personnel.
    • When only one machine is in use, e.g. during lunch or an evening shift, there will be a minimum of two MR personnel in Zones III through IV, and at least one of these personnel will be designated as Level 2 MR Personnel.
    • Non-MR Personnel must be accompanied by, or under the immediate supervision of and in visual contact with, an individual from Level 2 MR Personnel throughout their stay in Zones III or IV, except in the changing room and/or bathroom, where verbal communication is sufficient.
    • Level 1 MR Personnel are permitted unaccompanied access throughout Zones III and IV. Level 1 MR Personnel are not permitted to directly admit, or to be responsible for, Non-MR Personnel in Zones III or IV.
    • No Level 2 MR Personnel shall relinquish their responsibility to supervise Non-MR Personnel in Zones III and/or IV until such supervision has been formally transferred to other Level 2 MR Personnel.

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    Test your knowledge of MRI personnel safety regulations with this quiz. Learn about the requirements for level 1 and level 2 MRI personnel, supervision of non-MRI personnel, and safety protocols in different zones of the MRI environment.

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