"Ignore it and it will go away."
"What you don't know can't hurt you."
"Out of sight, out of mind."
Choose your axiom. That's what some magnetic resonance imaging departments are doing in the face of last year's white paper on MRI safety released by the American College of Radiologists. That report described both operational and physical safety protocols for MR facilities.
Once again facilities are faced with a crucial decision about embracing a new standard. You can either try to bring your facility into compliance, which may require significant work. Or you can simply ignore the issue, hoping you don't find yourself in a lawsuit, testifying to what you didn't know and when you didn't know it.
Thus far, the ACR has not adopted the new physical standards for sequential safety zoning as a part of their MR certification program. However, the growing knowledge of the document and its recommendations will leave those who ignore it further and further in the legal and ethical wilderness.
Surprisingly, a small number of facilities are actually refusing reviews and safety audits as a result of concerns about litigation. A MR department head recently told me that, at his facility, any information furthering the institutional knowledge of safety hazards is seen as a greater liability than ignorance. It seems that concerns over potential litigation are weightier than those about real and persistent hazards from high-strength magnetic fields and cryogens, a coolant used to reduce the temperature of the coils that make the MR an electromagnet.
More worrisome is the notion that administrators, even heads of radiology departments, may have a severely distorted perception of their facility's safety.
The very best MR facilities, operated long enough, will have near misses, if not real accidents. These can be as minimal (yet common) as a wheelchair being pulled toward a magnet's bore that is caught by the tech or transport personnel and removed from the suite. Some accidents, however, can be fatal. For example, a 6-year-old boy was killed not long ago during a post-operative scan in New York. A metallic oxygen cylinder was impelled into the bore, striking the child in the head.
The reality is that only a patient and one or two staff members are usually aware of a magnet-related safety episode, unless the incident is catastrophic. The ability to keep these events quiet is uncomfortably easy. The general public views magnets as something to hang their children's artwork on the refrigerator and has no concept of the personal risk of a near miss. Because at times they fear for their jobs, staffers are reluctant to share these incidents with supervisors, safety officers and administration. Episodes are often explained away to patients as if the magnet were a curiosity of physics, no more threatening than a child's science project.
As a result of this incomplete information about these events, facility administrators may be basing life-safety decisions on an unwarranted sense of security. Given the accessibility of the ACR white paper and the speed and ease of obtaining a safety audit, the primary obstacle to appropriate action is the belief that accidents only happen at other institution's facilities.
The challenge to hospitals and imaging facilities is two-fold.
First, a safety audit should be performed. The audit results may require something as inexpensive as keypad entry on the doors and improved hazard signs, to more expensive requirements such as overall suite modifications. Most safety audits and corrective designs are among the least expensive risk-management tools at a facility's disposal. That's especially true when compared with the real costs and lost revenue of a single emergency reduction in the magnetic field, to say nothing of an accident.
The audit itself may be performed by an internal quality assurance committee formed from existing staff for just this purpose, or by an outside consultant. It does not need to be a long and drawn-out process. In fact, with the right background information, the significant findings of an audit can often be available in a week or two after the facility survey. Each facility will have a unique set of issues depending on variables such as the equipment, layout and adjacencies. For those reasons, the facility must be prepared to tailor the audit to its unique needs.
Second, facilities must establish an incident-reporting procedure that allows all staff (including transport, housekeeping and security) to identify the "harmless incidents" and develop operational standards to reduce the likelihood of future incidents. This procedure must protect the individual reporting an incident, support an analysis of how it happened and encourage input about the ways in which a recurrence of the incident can be prevented. The procedure should also be flexible enough to be proactive as well as reactive, with the ultimate goal being the prevention of accidents.
Of course, the only guaranteed way to prevent accidents is to pull the plug on all of our magnets. Realizing that is not practical, we could introduce restrictive pre-screening for everyone passing into the hazard zones, including a gated, guarded entry vestibule, metal detectors, complete medical history reviews and physical exams. This, however, is only slightly less palatable than shutting the machines down altogether.
Although there are some unavoidable risks in the operation of MR, we do have the ability to reduce the risk of and exposure to accidents. The ACR white paper is an excellent tool, but it is up to each facility to take the first step. Hospitals and imaging facilities must individually decide if they will take it. Will they embrace this new safety standard and explore their compliance level or view their MR as too valuable a resource to interfere with-until someone gets hurt?
|Tobias Gilk is an associate architect with Junk Architects, Kansas City, Mo.|
|Robert Junk is a founding principal of the firm, which specializes in healthcare projects.|