Dan Anderson

The Joint Commission offers some frightening statistics in risk alert

Immediately after joining Imaging Economics and Medical Imaging last April, I scheduled a tour of the radiology department at the University of California, Los Angeles, Medical Center. Knock on wood: I've never spent much time in a hospital. A few years ago, I had a CT scan, the result of an attempted sports maneuver I'd sooner forget. But other than that, I, and those closest to me, have been blessed with good health. So I wanted to see firsthand some of the imaging equipment I'd be discussing in the new job.

The staff led me, along with a contingent of Chinese imaging professionals, through the basement corridors, finally ending up in an MRI suite. My tour guides made sure my watch, keys, and anything else that could interact with the MRI's magnet were left in an anteroom, and explained why.

For me, it was a first lesson. The Joint Commission thinks the industry needs a reminder of the importance of safety, and it has some pretty scary evidence why.

The organization notes that more than 10 million MRI procedures take place in the United States every year. It has been universally recognized as a groundbreaking, lifesaving, and relatively safe modality. Of course, there are exceptions to every rule. And the exceptions to safe MRI, while rare, are severe.

In issuing Sentinel Event Alert #38, The Joint Commission cited a 2005 study by a medical physicist at the ECRI Institute. Over a decade, 389 reports of MRI-related incidents were reported to the Manufacturer and User Facility Device Experience Database of the Food and Drug Administration. Nine of the incidents were fatal.

In some cases, metal detectors are used to scan patients and workers before they enter the MRI suite, but it's not always effective. However, the American College of Radiology's Magnetic Resonance Safety Committee has done studies that show ferromagnetic detectors have 99% sensitivity. Such scanning would clearly be helpful, but in the meantime, The Joint Commission has some recommendations:

• Restrict access
• Screen nonemergent patients twice for metal objects or implants
• Ensure complete medical histories of patients
• Have trained personnel accompany patients, visitors, and others not familiar with the MRI environment
• Peform annual safety training for any staff who might enter the MRI suite
• Take precautions to prevent burns
• Use only appropriately tested equipment (including fire extinguishers, oxygen tanks, and monitors)
• Plan for managing critically ill patients who require physiologic monitoring and continuous infusion while in the MRI suite
• Provide hearing protection for patients
• Never attempt a cardiopulmonary arrest code or resuscitation within the magnet room

As the old campaign says, safety begins with you.

A quick update on an issue I wrote about in my February column. The Centers for Medicare and Medicaid Services has decided to leave unrestricted coverage of cardiac computed tomographic angiography (CCTA). The government had planned to limit reimbursement to clinical research participants even though CCTA had been sanctioned under local coverage for more than 2 years with very favorable results.

Every once in a while, the DC folks get it right. Thanks for having a heart on this one.

Dan Anderson
Editorial Director