ESR Essentials: advanced MR safety in vulnerable patients—practice recommendations by the European Society for Magnetic Resonance in Medicine and Biology
For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise,...
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| Published in | European radiology Vol. 35; no. 4; pp. 1785 - 1793 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.04.2025
Springer Nature B.V |
| Subjects | |
| Online Access | Get full text |
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| Abstract | For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise, and device interaction by the gradient fields; and bulk and focal heating by the radiofrequency field. MR safety guidelines and procedures are typically designed around the “average” patient: adult, responsive, and of typical habitus. For this type of patient, we can safely expect that a detailed history can identify metallic objects inside and outside the body, verbal contact during the scan can detect signs of discomfort from heating or acoustic noise, and safety calculations performed by the scanner can prevent hyperthermia. However, for some less common patient categories, these assumptions do not hold. For instance, patients with larger habitus, febrile patients, or pregnant people are more subject to bulk heating and require more conservative MR protocols, while at the same time presenting challenges during positioning and preparation. Other vulnerable categories are infants, children, and patients unable to communicate, who might require screening for ferromagnetic objects with other imaging modalities or dedicated equipment. This paper will provide guidance to implement appropriate safety margins in the workflow and scanning protocols in various vulnerable patient categories that are sometimes overlooked in basic MR safety guidance documents.
Clinical relevance statement
Special care in the implementation of MR safety procedures is of paramount importance in the handling of patients. While most institutions have streamlined operations in place, some vulnerable patient categories require specific considerations to obtain images of optimal quality while minimizing the risks derived by exposure to the MR environment.
Key Points
Patients unable to effectively communicate need to be carefully screened for foreign objects
.
Core temperature management is important in specific patient categories
.
There are no hard quantitative criteria that make a patient fall into a specific vulnerable category. Protocols and procedures need to be adaptable
. |
|---|---|
| AbstractList | For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise, and device interaction by the gradient fields; and bulk and focal heating by the radiofrequency field. MR safety guidelines and procedures are typically designed around the “average” patient: adult, responsive, and of typical habitus. For this type of patient, we can safely expect that a detailed history can identify metallic objects inside and outside the body, verbal contact during the scan can detect signs of discomfort from heating or acoustic noise, and safety calculations performed by the scanner can prevent hyperthermia. However, for some less common patient categories, these assumptions do not hold. For instance, patients with larger habitus, febrile patients, or pregnant people are more subject to bulk heating and require more conservative MR protocols, while at the same time presenting challenges during positioning and preparation. Other vulnerable categories are infants, children, and patients unable to communicate, who might require screening for ferromagnetic objects with other imaging modalities or dedicated equipment. This paper will provide guidance to implement appropriate safety margins in the workflow and scanning protocols in various vulnerable patient categories that are sometimes overlooked in basic MR safety guidance documents.Clinical relevance statementSpecial care in the implementation of MR safety procedures is of paramount importance in the handling of patients. While most institutions have streamlined operations in place, some vulnerable patient categories require specific considerations to obtain images of optimal quality while minimizing the risks derived by exposure to the MR environment.Key PointsPatients unable to effectively communicate need to be carefully screened for foreign objects.Core temperature management is important in specific patient categories.There are no hard quantitative criteria that make a patient fall into a specific vulnerable category. Protocols and procedures need to be adaptable. For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise, and device interaction by the gradient fields; and bulk and focal heating by the radiofrequency field. MR safety guidelines and procedures are typically designed around the "average" patient: adult, responsive, and of typical habitus. For this type of patient, we can safely expect that a detailed history can identify metallic objects inside and outside the body, verbal contact during the scan can detect signs of discomfort from heating or acoustic noise, and safety calculations performed by the scanner can prevent hyperthermia. However, for some less common patient categories, these assumptions do not hold. For instance, patients with larger habitus, febrile patients, or pregnant people are more subject to bulk heating and require more conservative MR protocols, while at the same time presenting challenges during positioning and preparation. Other vulnerable categories are infants, children, and patients unable to communicate, who might require screening for ferromagnetic objects with other imaging modalities or dedicated equipment. This paper will provide guidance to implement appropriate safety margins in the workflow and scanning protocols in various vulnerable patient categories that are sometimes overlooked in basic MR safety guidance documents. CLINICAL RELEVANCE STATEMENT: Special care in the implementation of MR safety procedures is of paramount importance in the handling of patients. While most institutions have streamlined operations in place, some vulnerable patient categories require specific considerations to obtain images of optimal quality while minimizing the risks derived by exposure to the MR environment. KEY POINTS: Patients unable to effectively communicate need to be carefully screened for foreign objects. Core temperature management is important in specific patient categories. There are no hard quantitative criteria that make a patient fall into a specific vulnerable category. Protocols and procedures need to be adaptable. For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise, and device interaction by the gradient fields; and bulk and focal heating by the radiofrequency field. MR safety guidelines and procedures are typically designed around the “average” patient: adult, responsive, and of typical habitus. For this type of patient, we can safely expect that a detailed history can identify metallic objects inside and outside the body, verbal contact during the scan can detect signs of discomfort from heating or acoustic noise, and safety calculations performed by the scanner can prevent hyperthermia. However, for some less common patient categories, these assumptions do not hold. For instance, patients with larger habitus, febrile patients, or pregnant people are more subject to bulk heating and require more conservative MR protocols, while at the same time presenting challenges during positioning and preparation. Other vulnerable categories are infants, children, and patients unable to communicate, who might require screening for ferromagnetic objects with other imaging modalities or dedicated equipment. This paper will provide guidance to implement appropriate safety margins in the workflow and scanning protocols in various vulnerable patient categories that are sometimes overlooked in basic MR safety guidance documents. Clinical relevance statement Special care in the implementation of MR safety procedures is of paramount importance in the handling of patients. While most institutions have streamlined operations in place, some vulnerable patient categories require specific considerations to obtain images of optimal quality while minimizing the risks derived by exposure to the MR environment. Key Points Patients unable to effectively communicate need to be carefully screened for foreign objects . Core temperature management is important in specific patient categories . There are no hard quantitative criteria that make a patient fall into a specific vulnerable category. Protocols and procedures need to be adaptable . For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise, and device interaction by the gradient fields; and bulk and focal heating by the radiofrequency field. MR safety guidelines and procedures are typically designed around the "average" patient: adult, responsive, and of typical habitus. For this type of patient, we can safely expect that a detailed history can identify metallic objects inside and outside the body, verbal contact during the scan can detect signs of discomfort from heating or acoustic noise, and safety calculations performed by the scanner can prevent hyperthermia. However, for some less common patient categories, these assumptions do not hold. For instance, patients with larger habitus, febrile patients, or pregnant people are more subject to bulk heating and require more conservative MR protocols, while at the same time presenting challenges during positioning and preparation. Other vulnerable categories are infants, children, and patients unable to communicate, who might require screening for ferromagnetic objects with other imaging modalities or dedicated equipment. This paper will provide guidance to implement appropriate safety margins in the workflow and scanning protocols in various vulnerable patient categories that are sometimes overlooked in basic MR safety guidance documents. CLINICAL RELEVANCE STATEMENT: Special care in the implementation of MR safety procedures is of paramount importance in the handling of patients. While most institutions have streamlined operations in place, some vulnerable patient categories require specific considerations to obtain images of optimal quality while minimizing the risks derived by exposure to the MR environment. KEY POINTS: Patients unable to effectively communicate need to be carefully screened for foreign objects. Core temperature management is important in specific patient categories. There are no hard quantitative criteria that make a patient fall into a specific vulnerable category. Protocols and procedures need to be adaptable.For every patient, the MR safety evaluation should include the assessment of risks in three key areas, each corresponding to a specific hazard posed by the electromagnetic fields generated by the MR scanner: ferromagnetic attraction and displacement by the static field; stimulation, acoustic noise, and device interaction by the gradient fields; and bulk and focal heating by the radiofrequency field. MR safety guidelines and procedures are typically designed around the "average" patient: adult, responsive, and of typical habitus. For this type of patient, we can safely expect that a detailed history can identify metallic objects inside and outside the body, verbal contact during the scan can detect signs of discomfort from heating or acoustic noise, and safety calculations performed by the scanner can prevent hyperthermia. However, for some less common patient categories, these assumptions do not hold. For instance, patients with larger habitus, febrile patients, or pregnant people are more subject to bulk heating and require more conservative MR protocols, while at the same time presenting challenges during positioning and preparation. Other vulnerable categories are infants, children, and patients unable to communicate, who might require screening for ferromagnetic objects with other imaging modalities or dedicated equipment. This paper will provide guidance to implement appropriate safety margins in the workflow and scanning protocols in various vulnerable patient categories that are sometimes overlooked in basic MR safety guidance documents. CLINICAL RELEVANCE STATEMENT: Special care in the implementation of MR safety procedures is of paramount importance in the handling of patients. While most institutions have streamlined operations in place, some vulnerable patient categories require specific considerations to obtain images of optimal quality while minimizing the risks derived by exposure to the MR environment. KEY POINTS: Patients unable to effectively communicate need to be carefully screened for foreign objects. Core temperature management is important in specific patient categories. There are no hard quantitative criteria that make a patient fall into a specific vulnerable category. Protocols and procedures need to be adaptable. |
| Author | Pansini, Michele Santini, Francesco Caligiuri, Maria Eugenia Deligianni, Xeni Oei, Edwin H. G. |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39240349$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1148/radiology.169.2.3175004 10.1186/1750-1172-2-21 10.1007/174_2010_122 10.1002/nbm.3256 10.1016/j.dcn.2021.101055 10.1016/j.radi.2021.09.008 10.1177/13623613211065542 10.1016/j.burns.2007.11.008 10.1117/1.JBO.20.1.010901 10.1016/j.adnc.2004.07.006 10.1016/j.radcr.2020.09.046 10.1093/ofid/ofab161 10.1177/0009922816677806 10.3390/jpm12010009 10.1002/jmri.25761 10.1016/B978-0-444-63912-7.00026-6 10.1227/01.NEU.0000180810.16964.3E 10.3949/ccjm.84a.15164 10.1016/j.radi.2014.12.004 10.1017/CBO9780511545405 10.1007/BF02596115 10.1259/0007-1285-68-814-1090 10.1272/jnms.71.360 10.1002/jmri.26880 10.1002/jmri.29002 10.1016/j.radcr.2019.02.023 10.3174/ajnr.A2827 10.1088/0031-9155/55/4/001 |
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| Keywords | Pregnancy Patient safety Obesity Magnetic resonance imaging Child |
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| SubjectTerms | Acoustic noise Adult Body temperature Categories Child Diagnostic Radiology Electric fields Electromagnetic fields Electromagnetic Fields - adverse effects Electromagnetism Europe Female Ferromagnetism Fever Heat Heating Humans Hyperthermia Image quality Imaging Internal Medicine Interventional Radiology Magnetic fields Magnetic resonance Magnetic Resonance Imaging - adverse effects Magnetic Resonance Imaging - standards Medicine Medicine & Public Health Neuroradiology Patient Safety - standards Patients Pregnancy Radio frequency Radiology Review Risk assessment Risk reduction Safety Safety margins Scanners Skin Societies, Medical Transplants & implants Ultrasound Vulnerable Populations Workflow |
| Title | ESR Essentials: advanced MR safety in vulnerable patients—practice recommendations by the European Society for Magnetic Resonance in Medicine and Biology |
| URI | https://link.springer.com/article/10.1007/s00330-024-11055-1 https://www.ncbi.nlm.nih.gov/pubmed/39240349 https://www.proquest.com/docview/3178016144 https://www.proquest.com/docview/3101240422 https://pubmed.ncbi.nlm.nih.gov/PMC11913975 |
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