Investigating MRI safety practices in Greece. A national survey

Abstract

Purpose: Although the safety of clinical magnetic resonance imaging (MRI) has been discussed and analysed in great depth, safety-related incidents do still occur. In Greece, there are no previous studies exploring the employed MRI safety practices and policies. This study aims to explore the current status of MRI safety in Greece and to compare it to the well-established guidelines issued by the American College of Radiology. Specific changes in safety policies are recommended based on the results of the study.

Material and Methods: A quantitative methodological approach was followed for this study. Census sampling strategy was employed and specifically designed questionnaires were distributed to the entire population of MRI units currently operating in Greece. Statistical analysis was performed using descriptive statistics to analyse the findings. Pearson’s chi-square test was used to evaluate relationships between variables.

Results: Out of 307 MR scanners currently operating within Greece, 104 valid responses were received (response rate 33.9%). 77 (74.0%) have implemented a zoning system, while 27 (26.0%) have not. Optimal signage of zone IV with a “the magnet is always on’’ sign exists only in 45 (43.3%) of MRI facilities. 94 (90.4%) have clearly marked zone III with appropriate sings, while 10 (9.6%) have not. However, access to zone III is strictly restricted by 48 (46.2%) participants. 90 (86.5%) units have clearly marked the area in which the magnetic field exceeds 5 Gauss (5 G). A statistically significant difference exists between hospital-based MRI units that have not clearly marked zone IV (28, 70%) compared to private sector units (31, 48.4%), p-value=0.031. 97 units (93.3%) provide patients with a pre-MRI written screening form, while 28 (26.9%) have implemented preliminary screening as a way of screening patients before scheduling MRI examinations. 7 centers (6.7%) use hand-held magnets for screening, while 97 (93.3%) do not use metal detection systems at all. 89 MRI centers (85.6%) are not equipped with MR-safe or MR-conditional fire extinguishers at all, 68 (65.4%) units are equipped with MR-safe stretchers and 42 (40.4%) with MR-safe wheelchairs. 85 (81.7%) are not equipped with MR-safe emergency resuscitation equipment, or MR-safe/conditional equipment such as ventilators (40, 26.1%), monitoring devices (47, 30.7%) and anaesthesia machines (20, 13.1%). A statistically significant difference was found in the frequency of MR-safe emergency resuscitation equipment of MRI centers in large cities (15, 29.4%) compared to small cities and islands (4, 7.5%), p-value=0.003, as well as between hospital-based units (14, 35%) and private sector outpatient centers (5, 7.8%), p-value=0.001. Regarding infection control measures, 87 units (83.7%) have seamless floorings and 99 use hand sanitisers (95.2%) but only 47 (45.2%) have hand-washing stations within the MRI departments. 85 (81.7%) units are equipped with an emergency exit as well as a specific plan for emergency situations (71, 68.3%). 59 (56.7%) are also equipped with alternative power outage, but only 13 (12.5%) perform drills on emergency response. There is a statistically significant difference in the frequency of performing emergency drills between hospital-based MRI units (9, 22.5%) and private sector outpatient units (4, 6.3%), p-value=0.014.

Conclusions: Most of the responders have generally employed optimal policies regarding pre-MRI screening methods and appropriate use of zoning system. However, there is a relative lack of MR-safe equipment and metal detection systems. In addition, some specific safety steps must be taken to enhance safety in terms of emergency preparedness and infection control. The recommendations of this study include the adoption of rigorous safety policies, education of healthcare professionals and greater provision of MR-safe safe equipment.