3 Tips to Improve MR Safety with Implants and Devices

MRI scans routinely provide critical information, but there is a great deal of preparation that goes into making sure a scan is safe for a patient. Does he or she have a metal implant or a medical device? Does that mean there will be extra steps with your scanner to provide an injury-free, diagnostic-quality scan? Or are you facing a delay or cancellation?

The presence of an implant of device does not automatically mean you will have a scheduling disaster. It is possible to successfully image these patients, said Tobias Gilk, Ph.D. senior vice president at RADIOLOGY-Planning, but it requires some forethought and planning on your part.

In a presentation during this year’s AHRA: Association of Medical Imaging Management virtual meeting, he shared insights about the cost associated with not providing timely care, as well as best practices to ensure you do so.

The Price of MRI Delays

It is no secret that MRI scans can be time-consuming under the best of circumstances. However, if you add in the minutes needed for technologist to complete effective device screening, the process gets longer. The parameters and requirements for each scanner are different, but, on average, Gilk said, technologists devote between 6-to-8 hours per scanner per week to figuring out whether it is safe to scan patients who have devices or implants.

If you do the math, he explained, for two scanners, that can equate to 12-to-16 hours weekly that not eligible for reimbursement. In hard dollars, he said, that can potentially add up to a loss of $2,275 each week -- $118,300 in delays each year. Ultimately, he explained, it is possible that time lost to screening patients can cost your practice up to $1.2 million over the 10-year life of an MRI scanner.

Given this hefty impact, he advised, figuring out how to better scan your patient and train your technologists to feel confident in their assessments of whether they can safely clear a patient for a scan can be critical.

Related Content: Q&A: Tackling the Complexity of MR Safety

Best Practice Tips

To ensure your practice is providing MRI experience for your patients based on best practices, there are three tips you should follow, Gilk explained.

• Eliminate delays: As he pointed out, these days can be expensive, potentially costing you $1 million over the life of your scanner. To avoid this substantive loss, take the time to identify where these slow-downs or cancellations are occurring so you can pinpoint the spots where you might unknowingly be leaking revenue.
• Standardize training: Invest in making sure all of your technologists and radiologists have the same understanding of the risks associated with implants and devices, as well as how your practice chooses to address them.

“Don’t depend on the training your techs or radiologists might have had before they came to you,” he said. “If your staff and radiologists are nervous about screening patients or are unable to answer questions about specific harm to the patient or they can’t identify potential harm to the patient, they’re not acting in the interest of safety.”

This training includes providing details about the specifics on the types of magnetic fields used in MR imaging, as well as their impacts on the body, Gilk said.

• Build a support tree: Design a protocol that can guide your staff and radiologists through the decision-making process – akin to an “if this, then that” map – for how to safely navigate the risks of any implants or devices in patients who need MRI imaging. Not only will this strategy protect your patients, but it will also help you process patients more expediently.

How to Get There

To be sure you can implement those best practices, he said, you will largely need to re-engineer your screening process. You’ll not only need to identify what is behind your screening hiccups, but you will also need the right tools to address the problem.

Identifying delays: Overall, you can organize the root cause of your delays into four categories. Knowing what problems you are facing can help you devise a strategy to address them. Evaluate your situation to determine if any of these are your setback:

• Poor quantification: Either your technologists or your radiologists are not able to effectively identify and mitigate a potential risk with a patient. Confusion slows down the process.
• Radiologist discomfort: Providers generally fall into two camps, Gilk said. “Ghost” radiologists are timid and frequently elect to avoid even the slightest possibility that something could go wrong with a scan, opting instead to postpone or cancel. If a “cowboy” has not heard of a real-life problem with a particular device or implant and a scanner, he or she will forge ahead even in the face of a warning. Neither is in the best interest of safety.
• Ambiguous policies: If you do not have a clear policy for how to address and provide care for a patient with a tricky device or implant, it will be difficult for your radiologists – particularly those new to the practice – to know how to proceed.
• Technologist discomfort: Without clarity in your practice’s policy, your technologists will be at a loss for what to do if the scanner guidance is at odds with what your radiologist tells them. This could potentially put the technologist in the position of feeling as though he or she must make a clinical judgement call that should fall to the radiologist instead.

Helpful tools: Fortunately, Gilk said, implementing a decision support tool can help you navigate these murky waters.

• MagnetVision™: Developed by Emanuel Kanal, M.D., director of MRI services at the University of Pittsburgh Medical Center, this smartphone app offers robust guidance to help you decide whether to screen a patient. This tool provides information about the various types of magnetic fields and how they interact with implants and devices, as well as the major consequences of scanning. It can help you make an assessment in almost any situation, he said. But, because of this tool’s complexity, Kanal prefers to personally train anyone who wishes to use it.
• AHRA Reference Article: Alongside the MagnetVision™ app, the AHRA published an article in 2016 based on Kanal’s expertise with MR safety. The team-based method outlined in the article is designed to ensure that technologists, physicists, and physicians have the knowledge base and competency needed to provide the safest patient care.

By following these tips and using these tools – including others that can tell you when to avoid screening, when to seek additional guidance, or when to proceed – you can better streamline your MR imaging processes, Gilk said.

“If you do these things, you will improve safety because you will have people accurately identifying risks and appropriately mitigating them,” he said. “You will spend less time in screening, and you will be able to get the patient into the magnet more effectively and efficiently.”