Original Article

Reprinted from Radiologic Technology. Copyright 2019 by the American Society of Radiologic Technologists. Original Research
All rights reserved. Used with permission of the ASRT for educational purposes.

Safety Resources and Processes

in MR Imaging Departments
Asher Street Beam, DHA, R.T.(R)(MR), MRSO Ikia Celestine, MS, R.T.(R)(MR)
James M Ketchum, DHA, R.T.(R) Layna Phillips, MS, R.T.(R)(MR)
Audrey Wilson, MS, R.T.(R)(MR) Tyler Patrick, MS, R.T.(R)(MR)
Chris Scoles, MS, R.T.(R)(MR) Zack Gray, MS, R.T.(R)(MR)

Purpose To identify current standards of safety practices, common safety resources in use, and gaps in workflow practices in
magnetic resonance (MR) imaging departments.
Methods Qualitative observational research and visual assessments of safety resources available at clinical rotation sites were
conducted with subsequent open coding analysis.
Results The sample varied in terms of the strength of MR systems, types of facilities, patient populations, and safety resourc-
es available. Qualitative themes included carelessness of personnel, facility design flaws, and inconsistencies in safety prac-
tices and staffing.
Discussion Proper screening of patients and other individuals, appropriate use of barriers, and ferromagnetic detection sys-
tems can be effective tools for ensuring patient and personnel safety. Although various safety resources were available at
most MR imaging facilities, the resources proved to be only as effective as the safety practices of the MR technologists.
Conclusion Safety practices in MR imaging departments can be improved upon continually. This study provides a founda-
tion for future research on MR safety practices.

Keywords MRI safety, MRI zoning, magnetic resonance imaging, MRI projectile, MRI questionnaire
and accidents, fatal MRI accidents, MRI ferromagnetic detection systems, MRI screen-
ing, MRI facility design, MRI personnel training

M
agnetic resonance (MR) imaging is a widely
used imaging modality that acquires diag-
nostic images without using ionizing radia-
tion. MR obtains images of the body using a
magnetic field, radio waves, and hydrogen inside the
patient’s body. The strength of the primary or static mag-
netic field of an MR system is measured in Tesla.1
Technologists must understand how MR images are
obtained to ensure a safe environment for anyone enter-
ing the room where the scanner is located. Accidents such
as patient burns, ferromagnetic objects entering the MR
system room, or malfunction of implanted devices can
occur if personnel do not adhere to safety requirements.
Facility design and personnel training guidelines help to
ensure the safety of everyone in the MR department.2
Especially with recent focus on patient safety in out-
patient and inpatient facilities, it is essential to reduce
risks to patients and personnel in imaging departments.
For example, the risks associated with the powerful
static magnetic fields can be minimized by enforcing
safety policies and using safety resources fully. This
research seeks to answer the question: What are the
current standards of safety practices, common safety
resources in use, and gaps in daily workflow practices in
the MR imaging environment?
Literature Review
The literature was reviewed to identify key findings
regarding MR safety and associated practices. In addi-
tion, articles were reviewed for information regarding

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Safety Resources and Processes in MR Imaging Departments
the use of different ferromagnetic detection systems
and the accidents that resulted from safety failures. Key
phrases in the search criteria included MRI safety, MRI
zoning, MR imaging, MRI projectile, MRI questionnaire
and accidents, fatal MRI accidents, MRI ferromagnetic
detection systems, MRI screening, MRI facility design, and
MRI personnel training. The common themes identified
during the literature review were zoning guidelines,
personnel and training practices, screening practices for
patients and personnel, accidents, and ferromagnetic
detection systems.
Zoning
The American College of Radiology (ACR)
guidelines, which have become the industry stan-
dard, recommend a 4-zone system for MR suites
(see Figure 1).3 Under these guidelines, each zone
should be indicated with proper signage and demarcat-
ed. Zone I is freely accessible to the public and includes
areas such as the registration desk. Initial interactions
between MR technologists and patients typically occur
in zones II or III, which include patient screening areas,
changing rooms, and family waiting areas. The MR
control desk is located in zone III. Zone III is poten-
tially hazardous because of the static magnetic field and
should be labeled clearly with warning signs. In general,
Zone I
Zone II
Zone III Zone IV
Figure 1. Example of a 4-zone model system for magnetic resonance
(MR) suites. © 2018 ASRT.
226
restricted access doors should be used to separate zones
III and IV. These doors can be secured by requiring a
badge swipe, code access, or other means to enter. Extra
barriers, such as chains or retractable caution ropes,
should be added between zones III and IV. Zone IV
is the room that contains the magnet. To ensure that
patients and unfamiliar personnel are aware of the dan-
gers associated with the static field, posted signage at
the entrance to zone IV should state that the magnet is
always on. 3,4 Zones III and IV should be accessible only
to trained personnel, and screened patients should be
accompanied by MR personnel.5,6
All equipment located in zones III and IV should
be labeled either MR safe, MR conditional, or MR
unsafe. These labels should be visible to anyone having
access to these zones. A green square label is affixed to
MR safe equipment, indicating that there is no known
hazard associated with any MR conditions. MR safe
equipment includes nonmagnetic, nonmetallic, and
nonconductive items. MR conditional objects pose no
harm under specific MR conditions, which must be
specified on the device or product labeling. These con-
ditions include7:
ƒƒ the static field strength
ƒƒ spatial gradient
ƒƒ time rate of change of the magnetic field
ƒƒ radiofrequency fields
ƒƒ specific absorption rate
A yellow, triangular label is affixed to MR conditional
objects. Objects considered MR unsafe pose hazards in
all MR conditions. These objects are known to cause
harm and pose a threat to the patient when introduced
into zone IV. A round red label with a diagonal line
across it—widely known as the international prohibi-
tion sign—should be affixed to items in this category.8,9
Black-and-white versions of the labels also are accept-
able for use (see Figure 2).
Personnel and Training
Personnel working in the MR setting are categorized
into 2 levels, as defined by the ACR. Level 1 personnel
include housekeepers, transporters, maintenance per-
sonnel, receptionists, engineers, and nurses. For level 1
MR personnel, minimal training includes issues related
to the static magnetic field, projectile hazards, zones,
asrt.org/publications

A B C pivotal role in ensuring patient safety and recognizing
Figure 2. Labeling icons. A. Square label indicates that the object is
MR safe. B. Triangular label indicates that the object is MR condi-
tional. C. Round label with a diagonal slash indicates that an object
is MR unsafe. Reprinted with permission from ASTM F2503-13
Standard Practice for Marking Medical Devices and Other Items for
Safety in the Magnetic Resonance Environment.
implanted devices, site access restriction, and emer-
gency protocols.10,11 Someone designated as level 2 MR
personnel works in zones III and IV and has completed
extensive annual safety training that includes thorough
information on3,4,10,11:
ƒƒ the static magnetic field
ƒƒ projectile hazards
ƒƒ zones
ƒƒ implanted devices
ƒƒ site access restriction
ƒƒ emergency protocols
ƒƒ gradients
ƒƒ contrast agents
ƒƒ quench procedures
ƒƒ patient screening
ƒƒ pregnancy
ƒƒ labeling protocols
Appropriately trained and educated MR personnel
are vital to a safe and efficient MR environment.10,12
People who do not meet the level 1 or level 2 criteria of
are considered non-MR personnel (eg, patients, visi-
tors, volunteers, and employees who do not perform
MR-related duties); these individuals may not access
zones III and IV without level 2 MR personnel supervi-
sion.3,4,10,11
Specific MR department personnel are responsible
for ensuring that patients receive the highest quality
care possible. This group can consist of an MR medi-
cal director, an MR safety officer (MRSO), and an
MR safety expert.13 The MR medical director has a
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Beam, Ketchum, Wilson, et al
those who qualify to be level 1 and level 2 personnel.3,4
The medical director’s primary goal is to ensure that
the qualified MR technologists he or she is overseeing
are practicing all safety precautions. Practicing and
enforcing departmental protocol enables personnel
collaboration and minimizes the likelihood of mis-
takes. The medical director legally is responsible for
accidents that occur due to safety policies not being
practiced properly.13 The MRSO’s role is performed by
an MR technologist who has substantial experience.14
He or she must be accessible in the department during
operational hours, which helps to ensure that someone
with adequate experience and knowledge is consis-
tently available to provide safety advice when needed.
Another MRSO duty is to train and educate all MR
personnel, ensuring that everyone who comes in prox-
imity to the static field is knowledgeable about required
safety precautions. The MR safety expert typically
is a physicist whose primary duty is to provide scien-
tific information on the safe use of MR equipment.13
He or she provides MR technologists with insight on
sequence modifications and protocols to provide the
safest and most diagnostically useful studies. In addi-
tion, this expert provides information on safety and
quality assurance programs.13,15
Screening Practices
Proper patient screening is critical to achieving a
safe environment for all who enter the MR department.
The screening process should begin during patient
scheduling and requires that the scheduler be MR
trained and understand the risks associated with MR
imaging. The procedure should not be scheduled until
the patient answers questions regarding the presence of
a pacemaker, defibrillator, infusion or insulin pump, or
aneurysm clip in his or her body, or metal in his or her
eye. If the patient answers yes to any of the questions,
more information is needed before the procedure can
be scheduled. Patients who have devices should provide
a card with information stating the MR compatibility of
the device. If the patient does not have the card, the MR
technologist must obtain more information, either by
reviewing the patient’s chart or by contacting the refer-
ring physician. The patient’s occupational history also
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Safety Resources and Processes in MR Imaging Departments
is important, especially if the patient works with metal
or in welding. If the patient is unsure about the pres-
ence of metal in his or her eye, radiographs should be
taken to determine the presence of intraocular foreign
objects.8,16-18
Upon arrival on the day of the examination, the patient
must complete a written questionnaire, commonly
referred to as a screening form (see Figure 3). This form
contains questions about the patient’s medical history,
including all surgical procedures and previous imaging
Figure 3. Sample MR screening form for patients. Reprinted with permission from Frank
G Shellock, PhD, FACR, FISMRM, FACC, FACSM, adjunct clinical professor of radiol-
ogy and medicine, Keck School of Medicine, University of Southern California,
www.MRIsafety.com.
228
examinations. The list of surgical procedures potentially
provides important information about implants the
patient might have, and the radiologist can use previous
diagnostic studies for comparison purposes. Questions
regarding patient allergies also are included on the form so
the technologist can assess the risk of an allergic reaction
to any MR contrast administered during the procedure.
The form also contains an extensive list of implant-
able devices and foreign objects that could be inside
the patient. Devices and objects can include medically
necessary pacemakers, defibrillators, and
aneurysm clips, as well as foreign objects
such as bullets, body piercings, and hair
pins (see Figure 4).8,16-18
If the patient cannot complete the
form, it must be completed by the next
most qualified individual, which could
be the patient’s spouse, parent, sibling,
adult son or daughter, another family
member, caretaker, or physician. The
form should be completed every time the
patient arrives for a scan. If any informa-
tion seems inadequate, the technologist
should check the patient for surgical
scars or obtain radiographs to search for
implants before scanning the patient.19
The ACR suggests nonemergent patients
be screened at least twice.3,4,20
After completion of the written form,
the patient must undergo an oral inter-
view with the technologist. This allows
the technologist to clarify any questions
he or she has for the patient and any ques-
tions the patient has for the technologist.
Once the patient has completed the
screening process and is deemed safe to
enter zone IV, the scan can begin. The
technologist should remain in commu-
nication with the patient throughout the
scan. Patients who have confirmed the
presence of conditional foreign objects
should be monitored carefully to ensure
their comfort during the scan. Implanted
devices can dislodge or heat up inside
the patient and cause harm. If the patient
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 Original Article
Beam, Ketchum, Wilson, et al

ƒƒ parents, siblings, or spouses who

accompany the patient into the
room
ƒƒ health care workers who need to enter
with a patient
ƒƒ maintenance workers
ƒƒ custodial workers
ƒƒ firefighters
ƒƒ security officers

Ferromagnetic Detection Systems

Figure 4. Second page of sample MR screening form for patients, listing devices and objects entering zones III or IV. The stationary
that might be in the body. Reprinted with permission from Frank G Shellock, PhD, FACR,
FISMRM, FACC, FACSM, adjunct clinical professor of radiology and medicine, Keck
School of Medicine, University of Southern California, www.MRIsafety.com.
feels uncomfortable at any point during the scan, he or
she should notify the technologist, who then must ter-
minate the scan immediately. 16,18
Not only must the patient complete the screening
process before entering zones III or IV, any person
who needs to enter these zones for any reason at
any time also must complete a screening form and
undergo an oral interview before entering the room
(see Figure 5).16,18,19 These people might include:
Ferromagnetic detection systems are
a crucial physical resource used to detect
any ferromagnetic object being car-
ried by or implanted inside the patient;
however, proper screening should be
performed before using a ferromag-
netic detection system. These systems
are designed to detect ferromagnetic
objects while disregarding nonferro-
magnetic items.21 This differentiates
ferromagnetic detection systems from
basic metal detectors. All patients and
non-MR personnel should be monitored
using a ferromagnetic detection system,
if the facility has the capability. 4 Most
detectors are handheld or stationary
units placed at the threshold of zone IV.
The mobile capability of the handheld
detector allows the operator to inspect a
patient for ferromagnetic objects before
detector provides consistent, whole-body
coverage of the patient and is not opera-
tor dependent, which is a disadvantage of
the handheld detector because of incon-
sistencies in operator usage. 6,22,23
In a study conducted in the United Kingdom,
patients were screened with a Ferroguard Screener
(Metrasens Ltd) stationary detection system. A total
of 1032 screenings were performed on 977 patients.
Of those screenings, 21 (2%) gave false-positive read-
ings after patients being scanned twice, with no false
negatives. The detection system, used in conjunction
with other screening methods, was located at the

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Safety Resources and Processes in MR Imaging Departments

Accidents
When improper screening occurs,
an unsafe MR environment can result.
In 2005, an independent analysis of the
U.S. Food and Drug Administration’s
Manufacturer and User Facility Device
Experience, or MAUDE, database
revealed 389 MR-related events includ-
ing 9 deaths. Three of the deaths were
related to pacemaker failure, 2 to insulin
pump failure, and the other 4 to implant
disturbance. More than 70% of the 389
reports were burns, 10% were projectile
related, 10% were implant disturbance
related, 4% were fire related, and 2% were
internal heating related.24
High-static-field MR systems generate
radiofrequency pulses capable of causing
burns to patients exposed to incompatible
monitoring devices. For example, a 5-week-
old sedated inpatient underwent imaging
in a 3-T magnet. Her nurse was not asked
any screening questions about the patient,
and on completion of the scan, it was dis-
covered that the patient suffered a fourth
degree burn of the forearm due to a non–
MR compatible pulse oximeter that was
not removed before the study. As a result,
the extremity required amputation.25
Another MR issue is the threat of
projectile accidents. When ferromag-
Figure 5. Sample MR screening form for anyone who must enter zones III or IV. Reprinted netic objects and materials are brought
with permission from Frank G Shellock, PhD, FACR, FISMRM, FACC, FACSM, adjunct into the MR suite, the likelihood of a
clinical professor of radiology and medicine, Keck School of Medicine, University of projectile-related accident increases.
Southern California, www.MRIsafety.com. Many projectile incidents have occurred
as a result of improper screening or fail-
entrance to the patient changing rooms and added ure of proper zone monitoring. One incident occurred
minimal time to the screening process. This was the at an outpatient facility where a patient who worked
final screening process before taking the patient into in law enforcement was allowed to bring a firearm to
zone IV, and it was performed by trained MR person- the department dressing room. While the technologist
nel, using proper technique, with compliant patients. was reviewing the patient’s information away from the
However, because mobility can be an issue with this dressing room, the patient walked into the scan room
screening process, 23 patients were not screened with the gun. The gun was drawn into the magnet bore
because of their inability to stand and rotate within and discharged.26 No one was injured in this incident,
the limited confines of the detector. 23
but it shows why personnel must be mindful of what

230 asrt.org/publications

is allowed into the department and the importance of
monitoring zone IV.
Other objects that often are involved in MR acci-
dents are oxygen cylinders. Personnel who enter zone
IV with an oxygen tank put patients at risk for serious
injury or death, as the tank becomes a projectile. A case
was reported of a 47-year-old woman who was sedated
for her scan in a 1.5-T magnet. As the technologist and
an assistant were transferring the patient from the table,
the patient’s physician, who had been warned twice of
the magnetic field before the scan, walked into the room
with an 80.6-kg oxygen tank. The tank was propelled at
the assistant, causing minor injuries.20 The patient was
not injured, but a controlled magnet quench had to be
performed so that the patient could be removed from
the bore safely and the cylinder stabilized.
Many of these incidents require the hospital to pay
substantial damages. As a result of the case involving
the oxygen tank, the gradient coils were displaced and
had to be replaced, at a cost of $8000. Other expenses
were $10 000 to replace 600 L of helium, emergency
after-hours services of 60 person-hours at a cost of
$93 000, and loss of the use of the scanner for 34 hours.
The facility implemented new policies and regulations
such as nonferromagnetic cylinders, tethering tanks to
the ground, and requiring all visiting personnel to com-
plete and sign a screening form detailing the potential
risks of entering the field.20
Methods
Information from the literature search was used to
establish an observational plan to record acceptable
practices and resources for MR safety as well as devia-
tions. The observations were made in a 2-step process.
The first step involved visual assessment of physical
resources and staffing levels and qualifications in the
selected sites. These observations were recorded in
a password-protected shared spreadsheet document
accessible only to the researchers. These observations
were verified by a second assessor for each site at a later
time. Only sites accessible to the researchers through
clinical affiliations were included in the assessment
sample. All of the observational sites are either ACR–
MR-accredited facilities or in the process of obtaining
ACR MR accreditation.
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Beam, Ketchum, Wilson, et al
The second step involved observations of person-
nel safety practices over a 3-week period. To observe
various personnel and shifts, 6 individuals completed
qualitative observations covering 6 8-hour work days.
Observations were completed at 7 facilities encompass-
ing a total of 15 magnets. Based on predetermined
criteria, the researchers compiled handwritten field
notes of their findings, which were transferred to an
electronic, password-protected shared document at
the end of each observation day (see Box). Data were
compiled and analyzed using an open coding process to
establish key concepts regarding MR safety. During the
process, the researchers evaluated the observation notes
multiple times, identified key concepts, and made nota-
tions that were compiled into a list on completion of the
initial analysis process. From this list, they identified
and grouped related items to determine overarching
themes. Three individuals independently completed
manual coding and then compared it to reach consen-
sus. The use of multiple coders enhanced inter-rater
reliability. Findings were used to establish common
safety issues in MR departments.
An institutional self-certification form was com-
pleted for this research. Because of the observational
nature of the study, and because the definition of
human research was not met, institutional review was
not required.
Results
The study sample consisted of 7 sites in a metro-
politan area encompassing a total of 15 magnets; 13
were 1.5 T, and 2 were 3 T. Of the sites included, 2 were
Box
Observation Items
 Number of times patients are screened
 Watching entrance to zone IV
 Zone III screening of non-MR personnel
 Screening patients who are unconscious, confused, or who
have difficulty with the screening form
 Personnel breaks
 Unattended magnets
 Additional relevant safety information or practices
Abbreviation: MR, magnetic resonance.
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Safety Resources and Processes in MR Imaging Departments

Table 1 location (facility D). This MRSO was responsible for 4

Magnet Demographics magnets and was available during day shift hours. This
Magnet Type of Patient same facility was the only site with technologist assis-
Facility Strength Facility Population tants available to help screen and prepare patients for
their scans. Three of the 7 sites had 2 MR technologists
A
assigned to each magnet; however, only 1 of the sites
MR system 1 3T Hospital Inpatient and strictly enforced a 2-technologists-per-magnet rule.
outpatient
Four of the 15 magnets were isolated from other
MR system 2 1.5 T Hospital Inpatient and hospital personnel, meaning they were away from other
outpatient departments. Eight of the 15 MR suites required badge
B access. All of the facilities had signage in the depart-
MR system 1 1.5 T Clinic Outpatient ment noting each zone. Eleven of the 15 magnets had a
MR system 2 1.5 T Clinic Outpatient stationary portal ferromagnetic detection system at the
threshold of zone IV, and 6 magnets had a portable fer-
C
romagnetic detection system readily available. Six of the
MR system 1 1.5 T Clinic Outpatient 15 magnets had a chain or retractable caution rope at
D the entrance to zone IV (see Table 2).
MR system 1 3T Hospital Inpatient and Carelessness was established as a theme from the quali-
outpatient tative observations. On several occasions throughout the
MR system 2 1.5 T Hospital Inpatient and observation days, multiple sites left the door to zone IV
outpatient open and unattended. Compounding this issue, chains or
MR system 3 1.5 T Hospital Outpatient retractable caution ropes often were detached for person-
nel entering or leaving the room and were not reattached,
MR system 4 1.5 T Hospital Outpatient
making them an ineffective safety barrier. Of the magnets
E equipped with a stationary ferromagnetic detection sys-
MR system 1 1.5 T Clinic Outpatient tem, most alarms were consistently disregarded by MR
MR system 2 1.5 T Hospital Inpatient and technologists and ancillary personnel such as physicians
outpatient and nurses. In addition, 2 of the stationary ferromagnetic
F detection systems frequently were inactivated by MR
MR system 1 1.5 T Hospital Inpatient and personnel. Zone IV was left unattended recurrently for a
outpatient variety of reasons, 1 being the need to enhance workflow
by prescreening the next patient. Occasionally prescreen-
MR system 2 1.5 T Hospital Inpatient and
ing was done while a patient was being scanned.
outpatient
Inadequate facility design was a main finding dur-
G
ing the observation. Design flaws restricted visibility of
MR system 1 1.5 T Clinic Outpatient the entrance to zone IV at multiple MR sites. Visibility
MR system 2 1.5 T Clinic Outpatient was limited at some sites by walls and at others by the
Abbreviation: MR, magnetic resonance. control panel. At 1 facility, another design flaw was the
magnet’s orientation in the scanning room: When the
affiliated with each other. Nine magnets were hospital patient table was fully extended, the door to zone IV
based and 6 were at clinics. The patient population could not be closed.
included outpatients only at 6 magnets and both outpa- In addition to facility design flaws and carelessness,
tients and inpatients at 9 magnets (see Table 1). inconsistencies throughout each department were
Of these 7 sites, 1 had an American Board of noted. For instance, patients at 1 site were not screened
Magnetic Resonance Safety–credentialed MRSO on orally, but were screened using forms obtained during

232 asrt.org/publications
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Beam, Ketchum, Wilson, et al

Table 2
Safety Resources
Location of Zone Restricted Tester Handheld Chains or
Facility MR System Signage Access Magnet FMDS Stationary FMDS Retractable Ropes
A
MR system 1 Not isolated Yes Yes Yes Yes Yes No
MR system 2 Not isolated Yes Yes Yes Yes Yes No
B
MR system 1 Not isolated Yes No No Yes Yes No
MR system 2 Not isolated Yes No No No Yes No
C
MR system 1 Isolated Yes Yes No Yes Yes No
D
MR system 1 Not isolated Yes Yes No No Yes Yes
MR system 2 Not isolated Yes Yes No No Yes Yes
MR system 3 Isolated Yes Yes No No Yes Yes
MR system 4 Not isolated Yes Yes No No Yes Yes
E
MR system 1 Isolated Yes No No No No Yes
MR system 2 Isolated Yes No No No No No
F
MR system 1 Not isolated Yes Yes No Yes Yes, frequently Yes
inactivated
MR system 2 Isolated Yes Yes No Yes Yes, frequently No
inactivated
G
MR system 1 Not isolated Yes No No No No No
MR system 2 Not isolated Yes No No No No No
Abbreviation: FMDS, ferromagnetic detection system.

prior MR examinations. At the remaining sites, some
patients were screened only once, not twice as recom-
mended, and with little to no consistency. One site
had simplified screening forms that easily could be
completed by the patient and the remaining 6 sites had
traditional screening forms. Ancillary personnel also
were observed entering zones III and IV without per-
mission or supervision of an MR technologist. These
personnel entered these zones to retrieve needed sup-
plies from the scan room, make necessary repairs, clean,
or search for other personnel. Another inconsistency
was staffing. Often, facilities were limited to 1 technolo-
gist per scanner, not allowing time for a sufficient lunch
break, which frequently resulted in technologists eating
at the control desk after leaving the scanner unattended
while preparing their lunch (see Table 3).
Discussion
As indicated in the qualitative themes section, tech-
nologists commonly left open doors to zone IV, which

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Safety Resources and Processes in MR Imaging Departments
posed a threat to the safety of patients and personnel and
allowed any hospital personnel to enter zone IV without
supervision by MR personnel. Chains or retractable cau-
tion ropes are an effective deterrent when used properly
to prevent untrained personnel from entering zone IV and
serve as a reminder to trained personnel of the potential
dangers of the static field. These issues demonstrate the
importance of an MRSO being onsite to oversee that MR
technologists abide by safe practices and protocols. An
American Board of Magnetic Resonance Safety–certified
MRSO who demonstrates a deep understanding of MR
safety can enhance service and care for MR patients and
research subjects and can be a valuable tool in the MR
department.27
Another factor contributing to individuals enter-
ing zone IV without permission is poor facility
design. Visability of the entrance to zone IV often was
obstructed because of the layout of the MR suite. Before
construction of an MR suite, special consideration
should be given to magnet placement in relation to the
control panel and floor plan to ensure optimal viewing
ability for the technologist. Limitations in existing facil-
ity floor plans should be taken into consideration when
installing an MR unit and zoning system.
Proper patient screening is vital to ensuring safety.
Screening forms vary by clinical site, causing incon-
sistencies in screening practices. ACR–MR-accredited
facilities could be mandated to use specific approved
screening forms to reduce these inconsistencies. The
ACR recommends that all patients be screened at
Table 3
Qualitative Themes
Carelessness  Doors left open and unattended to zone IV
 Disregarded FMDS alarm
 Forgotten retractable ropes or chains
 Unattended MR systems
Inadequate  Restricted visibility to zone IV entrance
 MR system orientation in scan room
Inconsistencies  Nonstandardized screening practices
 Non-MR personnel entering room without
permission
 Number of staff per magnet
 Staffing personnel breaks
234
least twice before entering zone IV. This practice is
important to maintaining a safe environment because
it prevents patients with contraindications from being
scanned.
Ferromagnetic detection systems are popular
because of their increasing availability and reliability.
These systems can be useful in the patient screening
process and require minimal time. They also can help
prevent human errors, as well as alert personnel to fer-
romagnetic items that might have been missed or not
properly identified during the routine screening pro-
cess.4,6,22,23 However, MR personnel can develop alarm
fatigue and begin to ignore alarms unintentionally.
Implementing a “lights-off advancement” links the MR
room lights to the ferromagnetic detection system, dim-
ming the lights on detection of a ferrous object. 6 This
technique ensures MR personnel do not ignore the typ-
ical visual and audio warning signs whenever a detector
is activated. This method could be useful in alerting
personnel to overlooked ferrous objects.
This study found that ferromagnetic detection
systems and other barriers frequently are used in MR
suites, in clinic and hospital settings; however, the
safety resources available at each facility were only as
effective as the safety practices implemented by the
technologists.
Conclusion
Although MR generally is considered a safe imaging
modality, to ensure patient safety, MR personnel must
heed important precautions, such as proper screening
practices, zoning, and facility design. The initial patient
screening process can be tedious and time consuming,
but it is a vital aspect of MR imaging safety. Everyone
who enters the MR scan room must be screened before
entry to ensure a safe environment for all patients and
personnel. In addition to initial screening, supplemen-
tary measures to prevent possible injury include the
use of zones, barriers, ferromagnetic detector systems,
and signage. The safety strategies outlined in the MR
Safe Practice Guidelines document include accurate
design and signage for zoning purposes, labeling MR
equipment as safe or unsafe, and implementing policies
that restrict personnel access. Precautionary measures
are vital to patient safety and should be used to the
asrt.org/publications

best of every institution’s ability. Enforcement of the
ACR-established MR zones promotes safety in the
MR setting. Furthermore, MR personnel must work
as a team. Each individual has numerous duties with
the same goal: providing the safest environment for
employees and patients. Synergism is important in the
MR department. By working as a team with a com-
mon goal and by consistently applying safety policies
and protocols, MR personnel can help ensure excellent
patient safety.
A limitation of this study was its observational
design. Because of the researchers’ inability to interact
with the MR technologists, it could not be determined
why certain practices were not followed properly.
Another limitation was the practices followed by dif-
ferent technologists. Some technologists would follow
certain protocols, while a different technologist would
abide by an alternative set of rules. The relatively small
number of observational sites might be considered a
limitation as well.
In light of these research findings, future research
should evaluate the magnitude of technologists’ alarm
fatigue from ferromagnetic detection systems in the
MR suite. It might be beneficial to determine the
number of alerts occurring each day and evaluate the
validity of those alerts. In addition, a qualitative analy-
sis of carelessness in MR departments might help focus
efforts on the root causes of negligent practices. Finally,
an evaluation of safety perceptions from the perspec-
tives of technologists, administrators, and radiologists
might prove valuable in bridging the safety gap.
Asher Street Beam, DHA, R.T.(R)(MR), MRSO, is
director of the master of science in magnetic resonance
imaging program and assistant professor in the department
of radiologic sciences for the University of Mississippi Medical
Center, School of Health Related Professions, in Jackson,
Mississippi.
James M Ketchum, DHA, R.T.(R), is associate professor
in the department of radiologic sciences for the University
of Mississippi Medical Center, School of Health Related
Professions, in Jackson, Mississippi.
Audrey Wilson, MS, R.T.(R)(MR), works for Madison
Medical Imaging in Madison, Mississippi.
RADIOLOGIC TECHNOLOGY, January/February 2019, Volume 90, Number 3
Original Article
Beam, Ketchum, Wilson, et al
Chris Scoles, MS, R.T.(R)(MR); Layna Phillips, MS,
R.T.(R)(MR); and Zack Gray, MS, R.T.(R)(MR), work for
St Dominic Hospital in Jackson, Mississippi.
Ikia Celestine, MS, R.T.(R)(MR), works for Dell Seton
Medical Center at the University of Texas in Austin, Texas.
Tyler Patrick, MS, R.T.(R)(MR), works for the University
of Mississippi Medical Center in Jackson, Mississippi.
Received November 28, 2017; accepted after revision
March 6, 2018.
Reprint requests may be mailed to the American Society
of Radiologic Technologists, Publications Department,
15000 Central Ave SE, Albuquerque, NM 87123-3909, or
emailed to publications@asrt.org.
© 2019 American Society of Radiologic Technologists.
Reprinted from Radiologic Technology. Copyright
2019 by the American Society of Radiologic Technologists.
All rights reserved. Used with permission of the ASRT for
educational purposes.
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