MRI Safety


It is the responsibility of the MRI Safety Committee to ensure that the MRI safety guidelines are established and maintained on a current basis, and is appropriate for the various MR systems operated by the University. It is the responsibility of the UCSF administration to ensure that the policies and procedures that are established by the MRI Safety Committee are implemented and adhered to at all time by all UCSF personnel.

MRI Safety Policy of UCSF

MRI Safety Committee

  • The University of California, San Francisco Medical Center (UCSF) will maintain MR Safety Polices and Procedures, which are to be established, maintained, and routinely reviewed by the University's MRI Safety Committee.
  • The policies and procedures shall be reviewed and updated regularly and in all cases at least annually. Introduction of any significant changes in MRI system hardware or software that will significantly change the safety parameters in the MR imaging environment (e.g. adding faster/stronger gradient capabilities, higher RF duty cycle sequences), will be reviewed by the MRSC prior to implementation. In this review process, national and international standards and recommendations should be taken into consideration prior to establishing our own local guidelines, policies, and procedures.
  • It is the responsibility of the MRI Safety Committee to ensure that the MRI safety guidelines are established and maintained on a current basis, and is appropriate for the various MR systems operated by the University. It is the responsibility of the UCSF administration to ensure that the policies and procedures that are established by the MRI Safety Committee are implemented and adhered to at all time by all UCSF personnel.
  • Procedures should be in place to ensure that all adverse MRI safety events, that occur in the MR site is reported to the Chair of the MRI Safety Committee in written form (incident report) within a 24 hour period.
    All incidents and adverse effects will be discussed at a quarterly meeting of the MRI Safety Committee. A serious adverse event will result in an immediate session of the MRI Safety Committee.
  • The MRI Safety Committee is responsible for the development of a MRI Safety training program for the hospital staff personnel.

Potential Hazards and Risks in a MRI Environment

  • Magnetic field risk: The static magnetic field of the MRI system is exceptionally strong, A 1.5 T magnet generates a magnetic that is approximately 21,000 greater than the earth's natural field. In such an environment ferromagnetic metal objects can become airborne as projectiles. Small objects such as paper clips and hairpins have a terminal velocity of 40mph when pulled into a 1.5 T magnet and therefore pose a serious risk to the patient and anyone else in the scan room. The force with which projectiles are pulled toward a magnetic field is proportional to the mass of the object and distance from the magnet. Even surgical tools such as hemostats, scissors and clamps, although made of a material known as surgical stainless steel, are strongly attracted to the main magnetic field. Oxygen tanks, gurneys, floor buffing machines, and construction tools are highly magnetic and should never be brought into the scan room. However there are non-ferrous oxygen tanks and gurneys available, which are MRI compatible. Sand bags must also be inspected since some are filled, not with sand, but with steel shot which is highly magnetic.
    Consumer products such as pagers, cell phones, cameras and analog watches may be damaged by the magnetic field. Pacemakers may be reprogrammed or turned off by the magnetic field. The magnet field erases credit cards with magnetic strips.
    Patients with ferrous intra-cranial vascular clips may be at risk due to the possible movement of the clip. See Contraindications for MRI below.
  • Radio-frequency (RF) field risk: The radio-frequency field may induce currents in wires that are adjacent or on the patient, causing skin burns. It may induce currents in intracardiac leads, resulting in inadvertent cardiac pacing. Prolonged imaging may cause the patient's core body temperature to rise. In practice, significant patient heating is only encountered in infants.
  • Cryogen risk: During a planned or accidental shutdown of the magnetic field, quench, the liquid Helium in the magnet turns into gas and may escape into the scan room displacing the oxygen in the room leading to asphyxia.
  • Biological effects due to the static magnetic field: For the static magnetic fields currently used in MRI up to 2 Tesla, there are no known biological effects. The majority of studies show no effects on cell growth and morphology. Data accumulated by the National Institute for Occupational Safety, the World Health Organization, and the US State Department show no increased risk for leukemia or other cancer.
    Some reversible biological effects have been observed on human subjects exposed to 2.0 T and above. These effects include fatigue, headaches, hypotension and irritability.

    MRI Environment. Static magnetic field issues: Access restriction

    • Magnetic field distribution (Fringe Field): The stray magnetic field outside the bore of the magnet is known as the fringe field and this is a 3 dimensional field measured in Gauss. MRI systems are shielded to confine the fringe field within the scan room. Magnetic fields, which are less than 5 Gauss, are inconsequential to MRI safety. In most systems the 5 Gauss field is confine within the scan room and therefore its fringe field does not affect any area external to the magnet room.
      The 30 Gauss field demarcates the point where projectile hazards become significant and only MRI compatible equipment can safely enter this region.
      Each MRI system has its own unique fringe field due to varying magnetic design, shielding characteristics, and field inhomogeniaty, and therefore each site must be supplied with a schematic, which clearly defines the fringe field of the magnet. The schematic must demarcate the 30 Gauss line and 5 Gauss line.
    • This section summarizes the different zones of a UCSF MR suite and points out specific safety issues, which are of greatest concern. At UCSF, each MRI site is divided into 4 safety zones based on the American College of Radiology guidelines:
      • Zone 1:  Zone I is the general public area outside the MR environment.  This area is the reception and waiting areas
      • Zone 2:  Zone II is the area between Zone I (Public Access) and the strictly controlled Zone III (Control Room) and Zone IV (Magnet). This is the area just outside of the restricted area Zone III.  This is the area of travel that patients are brought into their procedure. 
      • Zone 3:  Zone III is the Control Room. All access to Zone III is to be strictly restricted with access to regions within it controlled by and entirely under the supervision of MR personnel. This zone is restricted from general public access by a reliable restricting method that can differentiate between MR personnel and non MR personnel.  
      • Zone 4:  Zone IV is the Magnet Room. No individual is allowed in the scan room without being supervised by trained MRI personnel. The scan room door is always locked when unattended. Only MR compatible equipment approved by the MR Safety Committee may be brought into Zone IV.  The MR technologists must be able to directly observe and control via line of sight the entrances or access to Zone IV from their normal positions when stationed at their desks in the scan control Room.

    Screening: Patient/Non-MRI Personnel/MRI Personnel

    • Patient screening: Patients entering an MRI suite for a diagnostic exam are screened for contraindications such as pacemakers, metal foreign bodies in the eyes, cranial aneurysm clips, etc. A standard hospital approved MRI screening form is to be filled out prior to a patient entering the Restricted Zone. It will be the responsibility of the MRI technologist to review the MRI screening form prior to allowing a patient into the Restricted Zone. All contraindications are to be brought to the attention of the MRI radiologist in-charge of the case.
      All Non-MRI Personnel (e.g., patients, volunteers, varied site employees and professionals) with implanted cardiac pacemakers, auto-defibrillators, diaphragmatic pacemakers, and/or other electromechanically activated devices on whose function the Non-MR Personnel is dependent should be precluded from the Restricted Zone.
      Patients with history foreign bodies in the eyes will require a negative CT scan of the orbits prior to being admitted to the Restricted Zone.
      Patients with a cranial aneurysm clip will require a written report from the referring physician stating the name of the clip and the date of placement prior to being admitted to the Restricted Zone.
      Individuals undergoing an MRI procedure must remove all readily removable metallic personal belongings and devices on or in them (e.g., watches, jewelry, body piercing if removable, contraceptive diaphragms), metallic drug delivery patches, and clothing items which may contain, metallic fasteners, hooks, zippers, loose metallic components, metallic threads, etc. It is therefore advisable to require that the patient/research subject wear a site-supplied gown.
    • MRI Personnel screening: All MRI Personnel are to undergo an MRI screening process as part of their employment interview process to ensure their own safety in the MRI environment. A signed hospital approved screening form will be kept on file for every MRI Personnel. For their own protection and for the protection of the ancillary staff all MRI Personnel must immediately report to their supervisor any trauma, procedure, or surgery that they experience
      Which a ferromagnetic metallic object/device that may have been introduced within or on them. This will permit an appropriate screening to be performed upon the employee to determine the safety of permitting those MRI Personnel into the environment.
    • Ancillary Staff screening: Screening procedure is the same as Patient screening.

    Staff Training Program

    • MR-Personnel training: It is key that all personnel working in the
      MR environment be fully briefed on MR safety. The program will include the following:
      • A comprehensive information packet on MR safety.
      • A video on MR safety.
      • A written competency test on MR safety, which is to be done annually as part of the Radiology Department Safety review.
    • All new medical center employees are to attend the New Employee Orientation program provided by the medical center, which includes MR safety as part of the program. Ancillary Staff training: Most accidents that occur in a MR static magnetic field environment are due to a lack of knowledge of MR safety by the ancillary staff of the hospital (e.g. physicians, nurses, housekeeping, anesthesia technologist, etc.). It is vital that all hospital employees that may come in contact with the magnetic field be informed about MR safety in the following manner:
    • Introduction to MR safety during the New Employee orientation course sponsored by the hospital. This is to include written information and watching a 15-minute video on MR safety.
    • Participate in the annual hospital safety review course sponsored by the hospital and completion of the written safety review exam.

    Cardiac, Respiratory Arrest or Other Medical Emergency

    As in any medical facility, the MR suite should be equipped with emergency medical supplies on a crash cart. These emergency supplies should be located in the Unrestricted Zone. Many of these supplies can be dangerous in the Restricted Zone. For this reason, in any medical emergency, all patients should be removed from the scan room to a predetermined magnetically safe location in the Unrestricted Zone before resuscitation begins. Restricted Zone access must be maintained during resuscitations and other emergent situations. See MRI Code Blue Protocol.

    Magnet Quench

    Quenching is the process whereby there is a sudden loss of absolute zero of temperature in the magnet coils, so that they cease to be super conducting and become resistive, thus eliminating the magnetic field. This results in helium escaping from the cryogen bath extremely rapidly. It may happen accidentally or can be manually instigated in the case of an emergency. Quenching may cause severe and irreparable damage to the super conducting coils, and so a manual quench should only be performed in extreme cases when the physician and service engineer are involved in the decision to quench. A fire in the scan room may also be a cause to quench the magnet, so the fire fighting personnel can safely enter the room (see MRI Code Red Protocol). All systems should have helium-venting equipment, which removes the helium to the outside environment in the event of a quench. However if this fails, helium will vent into the room and replace the oxygen. For this reason all scan rooms should contain an oxygen monitor that sounds an alarm if the oxygen falls below a certain level. Under these circumstances immediate evacuation of the patient and personnel is necessary. It is noted that if the scan room door is closed when a quench occurs and helium escapes into the scan room, the depletion of oxygen causes a critical increase in pressure in the room compared with the control area. This produces high pressure in the scan room, which may prevent opening of the door. If this should happen, the glass partition between the scan and control rooms should be broken to release the pressure. The scan room door can then be opened as usual and the patient evacuated. In such a case the patient should be immediately evacuated and evaluated for asphyxia, hypothermia and ruptured eardrums.

    Acoustic Noise

    As current is passed through the gradient coils during image acquisition, a significant amount of acoustic noise is created. Although these levels are anticipated to be well below the OSHA standards whereby a hearing loss prevention program must be started (80 dB over 8 hours or half the exposure time for each additional 5 dB exposure), it can cause some reversible and irreversible effects, These effects include communication interference, patient annoyance, transient hearing loss and in patients who are susceptible to hearing impairment, permanent hearing loss. It is recommended that all patients are provided with earplugs or head phones.

    Radio frequency and gradient fields related issues (thermal)

    In contrast to the main magnetic field, RF and gradients are only present during scanning. RF energy (64 MHz-between AM and FM radio) is exchanged with the patient in order to create MR images. A relatively powerful amplifier (25kW) generates this energy and software controls limit the specific absorption rate in the patient. The effects of RF absorption are the heating of the tissue and the patient's ability to dissipate excess heat. This can be expressed in terms of SAR, which is the FDA limit for RF exposure and is primarily set to avoid warming of the patient. The recommended SAR level for imaging in the US is 0.4W/kg (whole body), 3.2W/Kg (head) and 8 W/kg (small volume). The RF field is focused within the bore of the magnet and is negligible external to it.

    While software limits RF exposure to safe levels, looped conductors (e.g. wires) within the bore of the magnet can focus these RF fields, producing elevated energy deposition. These concerns are greatest on high field scanners and have been known to cause substantial burns. Accordingly, looped conductors within the bore must be avoided at all cost.

    Care should be taken to ensure that the patient's tissue do not directly come into contact with the inner bore of the magnet during the MR imaging process. Pads and other such insulating devices are provided for this purpose. It is also important that the patient's own tissues do not form large conductive loops. Therefore, care should be taken to ensure that the patient's arms and legs not be positioned in such a way as to form a large caliber loop within the bore. For this reason it is preferable to instruct patients not to cross their arms or legs in the MR scanner.

    Pregnant Patients

    As yet, there are no known biological effects of MRI on fetuses. However, there are a number of mechanisms that could potentially cause adverse effects as a result of the interaction of electromagnetic fields with developing fetuses. Cells undergoing division, which occurs during the first trimester of pregnancy are more susceptible to these effects.

    The FDA states "If the information to be gained by MR would have required more invasive testing, MRI is acceptable. In light of the high risk potential for pregnant patients in general, delay of the MR exam until after the first trimester is preferable. The American College of Gynecology and Obstetrics recommends that pregnant patients should be reviewed on a case-to-case basis, and the risk-benefit ratio needs to be made by the physicians involved.

    It should be noted that numerous fetuses have undergone MRI without any abnormalities at birth, or after 4 years of childhood development. Gadolinium enhancement is at present best avoided when examining a pregnant patient. For more info, see Pregnant Patients and MRI.

    ​Pregnant Employees

    MR is too new to make an informed decision on magnetic safety for pregnant employee. Each person must make their own decision to stay in MR or if possible rotate back to the radiology department.

    Contraindications for MRI

    All persons coming in contact with the magnetic field should be appropriately screened for contraindications. A useful reference for determining MR compatibility is Shellock's Pocket Guide to MR Procedures and Metallic Objects. An online reference is

    The following devices are absolutely contraindicated for MR imaging because they are magnetically, electrically, mechanically activated or affected:

    • Neurostimulators
    • Cochlear implants
    • Bone Growth simulators
    • Implant able pediatric sternum device
    • Metallic foreign body in the eye
    • Gastric Reflux device

    Neurostimulators:  They are two types of neurostimulators:

    1. Passive receivers: neurostimulators that receive RF energy that is magnetically coupled from an external device by means of a coil placed over the implanted device.
    2. Hermetically encased pulsed generators: neurostimulators that contain a battery and are programmed by an external device to produce the various stimulus parameters.
    3. Because of the specific design and intended function of neurostimulators, the electromagnetic fields used for MR procedures may produce problems with the operation of these devices. Malfunction of a neurostimulator that results from exposure to the electromagnetic fields of an MR system may cause discomfort or pain to the patient.

    Cochlear implants: Some types of cochlear implants employ a relatively strong cobalt samarium magnet used in conjunction with an external magnet to align and retain a radio frequency transmitter coil. Other types of cochlear implants are electronically activated. Consequently, MR procedures are strictly contraindicated in patients with these types of implants because of the possibility of injuring the patient and/or damaging or altering the function of the cochlear implants.

    Bone growth stimulators: These devices usually have an external electronic component that attaches to electrodes implanted in areas of fractured bones and are used to enhance and facilitate the rate of bone healing. Similar to neurostimulators, patients with bone growth stimulators should not undergo MR procedures until data are available to support that there are no hazards associated with the presence of these devices in patients during the operation of MR systems. Currently there is no neurostimulator or bone growth stimulator that has received from the FDA the designation of being "MR-compatible".

    Sternal magnet, brace device (“Magnimplant and Magnatract”): There is a new implanted device system utilized for pediatric patients that is contraindicated for MRI. Dr. Michael Harrison, pediatric surgery UCSF, has informed the MRI Safety Committee that they are currently running a phase 2 research procedure, The Magnetic Mini-Mover procedure. This research procedure utilizes the following products, “Magnimplant” and “Magnatract”in a combined system to correct for pectus excavatum or sunken chest deformity, in pediatric patients. As part of the system “Magnimplant” is an internal magnet that is surgically placed behind the sternum, and “Magnatract” is an external brace with a magnet implanted. The devices combine to exert a defined magnetic force to the chest wall.
    Per Dr. Harrison: “The device is made for us by Texcel and stays in 18-30 months.” “It is implanted on the sternum through a small subxiphoid incision which will always be visible, so this would be the best marker in an unconscious patient.” “The patients are teen and preteen and they and their parents have verbal and written warnings about MRI. In addition the patients wear (or at least are given) a medi alert bracelet saying no MRI.”
    This device system is totally contraindicated for MRI at any field strength.
    We should specifically ask the parents of pediatric patients if this magnet device has been implanted in the sternum of their child. It seems that currently they are doing it on older kids, but they plan to do it in patients as young as 1 year old in the future. It also seems that these devices may remain implanted for years, although studies are still ongoing to determine the best clinical usage. For more information concerning the research procedure, utilize the following links:, or, or contact the principle investigator, Dr. Michael Harrison, Professor of Surgery, Pediatrics.

    Intra-ocular ferrous foreign bodies: Intra-ocular metal foreign bodies are a cause of major concern in MR safety. It is not uncommon for patients who have worked with sheet metal to have metal fragments or slivers located in and around the eye. Since the magnetic field exerts a force on ferromagnetic objects, a metal fragment in the eye could move or be displaced and cause injury to eye or surrounding tissue.

    Gastric Reflux Device: The LINX Reflux Management System is a series of titanium beads with a magnetic core implanted around the lower end of the esophagus to control gastro esophageal reflux disease (GERD).  This implant is totally contraindicated for MRI in both the 1.5T and 3T.  The FDA website has more information.

    The following are relative contraindications for MR imaging:

    • Intra-cranial vascular clips
    • Penile implants
    • Shrapnel
    • Halo
    • Stents
    • Pregnancy
    • Pacemaker / Implant able Cardioverter-Defibrillators (ICD)
    • Implant able Drug Infusion Pumps

    Intra-cranial vascular clips: Some intra-cranial aneurysm clips are absolute contraindications in MR imaging. The surgical management of intra-cranial aneurysms and arteriovenous malformations by the application of aneurysm clips is a well-established procedure. The presence of an aneurysm clip in a patient referred for a MR procedure represents a situation that requires the utmost consideration because of the associated risks.

    Certain types of intra-cranial aneurysm clips (e.g., those made from martensitic stainless steels such as 17-7PH or 405 stainless steel) are prone to torque in a MR produced magnetic field. The displacement of these clips may damage the vessel, resulting in hemorrhage, and or death. Intra-cranial clips made of a material known as titanium are now commonly used, and have proved safe for MR.

    To minimize the possibility of inadvertently imaging a patient with a magnetically active metallic implant, implanting physicians must provide patients with information about the type and identity of their particular implants, and suggest, where appropriate, that the patients carry an alert card or wear a medical alert bracelet, or necklace identifying them as having such an implant. In addition, physicians who order MR procedures must carefully screen patients and inform the MR imaging facility of any metallic implants the patient may have and provide written documentation stating the name and model number of the clips.

    Penile implants: Some penile implants evaluated for ferromagnetic qualities had substantial deflection forces measured when exposed to a 1.5 Tesla magnetic field. Although it is unlikely that a penile implant would severely injure a patient undergoing an MR procedure because of the manner in which it is used, it would undoubtedly be uncomfortable. For this reason, subjecting a patient with one of these implants to an MR procedure is inadvisable.

    Shrapnel: Most pellets and bullets tested for MR compatibility are composed of no ferromagnetic materials. Ammunition that proved to be ferromagnetic tended to be manufactured in foreign countries and or used for military applications. Because pellets, bullets, and shrapnel may be contaminated with ferromagnetic materials, the risk versus benefit of performing an MR procedure in a patient should be carefully considered as well as whether or not the metallic object is located near a vital anatomic structure.

    Halo: Halo vests pose several risk factors which include deflection and subsequent dislodging of the halo, heating due to RF absorption, electrical current induction within the halo rings, electrical arcing and severe art factual consequences which could render the imaging acquisition useless. Non-ferrous and non-conductive halo vests, which are MR compatible, are commercially available.

    Coronary stents within 6 weeks of implantation: Various types of intra-vascular stents have been evaluated for safety with MR systems. Several of these stents have demonstrated magnetic field interactions associated with exposures to MR systems. Fortunately, these particular devices typically become incorporated securely into the vessel wall within 6 weeks after their introduction.

    Pregnancy: See Pregnant Patients and Pregnant employees in above section.

    Pacemaker / Implant able Cardioverter-defibrillator (ICDs):  See MRI Imaging of Patients with Pacemakers and ICDs below.

    Implant able drug infusion pumps:  A drug infusion pump is used for automatic delivery of antineoplastic agents, morphine, or narcotics. The infusion pump has a motor that may have ferromagnetic properties, a magnetic switch, and is programmed by telemetry.  Potential issues pertaining to MRI imaging of patients with a drug infusion pump include the following:

    1. Temporary or permanent stall of the motor.
    2. Local tissue heating adjacent to implant during imaging
    3. Increase potential for Peripheral nerve stimulation (PNS)

    Although many drug infusion pumps are contraindicated for MRI, there are currently some pumps that can be exposed to the MRI environment during imaging under strict conditional requirements.  Always review the manufacturer guidelines for the specific pump before introducing the patient into the magnet room and proceeding with the exam.  Strictly adhere to the manufacturer’s conditional requirements for managing the pump prior to, during, and post imaging.  See the MRI Implant Table (pdf) for more detailed pump information.

    MRI Imaging of Patients with Pacemakers and ICDs

    In the past, cardiac pacemakers and implantable cardioverter-defibrillator (ICDs) were considered absolute contraindications for a MRI exam due to the following potential issues:

    1. Movement and/or vibration of the pulse generator or lead(s)
    2. Temporary or permanent modification of the function (i.e., damage) of the device
    3. Inappropriate sensing, triggering, or activation of the device
    4. Excessive heating of the leads
    5. Induced currents in the leads
    6. Electromagnetic interference

    Normally these problems were related to pacemaker models produced prior to 1996.  Several pilot studies have shown that limited MRI imaging of patients with nondependent pacemakers, in a controlled and monitored environment, following strict conditional guidelines, can be performed safely.  With the results of these studies, along with the creation and approval of several MRI conditional pacing systems, pacemakers are now considered a relative contraindication.  Please note the current guidelines from the American Heart Association and the Food and Drug Administration (FDA) do not support MRI in pacemaker patients, who do not use one of the new MRI conditional approved pacing systems. 

    Risks associated with MR examination in patients with ICD are expected to be higher than in patients with pacemakers. Therefore, MR examination of patients with ICDs should not be performed unless there are highly compelling circumstances and when the benefits clearly outweigh the risks. ICD patients must be non-pacemaker dependent.

    The following guidelines have been set here at UCSF to scan a patient with a pacemaker or ICD:

    • A risk- benefit ratio must be established and benefit from the MRI examination should clearly outweigh the risks of the procedure.
    • MR imaging in the thoracic region is subject to additional risk and this should be considered when evaluating the benefit to risk for a specific patient.  Multiple MR exams in a single patient should also be avoided, as there is potential for increased risk and this should needs to be considered when determining if the benefits clearly outweigh the risks.
    • The study should not be performed if similar clinical information could be obtained by a different image modality.
    • The MRI scan must be approved by an attending radiologist and an electro-physiologist.
    • For Pacemaker patients: The patient must be non-pacemaker dependent.
    • For ICD patients: Risks associated with MR examination in patients with ICD are expected to be higher than in patients with pacemakers. Therefore, MR examination of patients with ICDs should not be performed unless there are highly compelling circumstances and when the benefits clearly outweigh the risks. ICD patients must be non-pacemaker dependent.
    • The patient must have the pacemaker/ ICD in place for more than 6 weeks. The patient must be not at or near Elective Replacement Indicator (ERI). Abandoned temporary epicardial (cut at skin) leads are not a contraindication for MRI (please see images a. and b. below). Abandoned/capped trans-venous leads are a contraindication to MRI (please see image c. below).
    • MRI Safety contraindication
    • Prior to the scan date, a cardiology consult must be scheduled, where it will be determined if the pacemaker/ICD patient is safe to have an MRI.  At this time, a written informed consent will be established. If a patient is referred from and outside physician, a visit to the UCSF device clinic should be scheduled before the MRI is acquired.
    • An electro-physiologist, or cardiologist or device nurse (with pacemaker/ICD monitoring experience) must be present before, during, and after the MRI exam to validate the performance integrity of the pacemaker/ICD prior to the MRI exam, monitor the patient during the exam, and check the pacemaker/ICD performance after the exam. An electro-physiologists should be carrying a pager and be within quick reach of the MRI scanner during the entire examination. For patients with ICDs, a physician with electrophysiological expertise should perform post scan device reprogramming and defibrillation threshold testing. Arrangements should be made for the patient to follow-up with electro physiologist at 3 months after the MRI.
    • The patient should be monitored continuously during the MR procedure (e.g., blood pressure, pulse rate, oxygen saturation, and ECG).
    • Appropriate personnel, a crash cart, and defibrillator must be available throughout the procedure to address an adverse event.
    • Maintain visual and voice contact throughout the procedure with the patient.
    • The patients must be able to communicate in case any complications arise.
    • Instruct the patient to alert the MR system operator of any unusual sensations or problems so that, if necessary, the MR system operator can immediately terminate the procedure.
    • The patients will only be scanned during normal workday hours (8A-5P) on 1.5T scanners, only in hospital setting with appropriate trained personnel. For urgent, on-call cases, scans may need to be done after 5P or on weekends, although it is preferable to wait until normal workday hours if possible.
    • The MRI will only be scheduled during the day and appointments will be coordinated to ensure that an MRI physicist and an attending radiologist are involved to tailor the study for minimum SAR while obtaining the essential clinical information.
    • Patients with MR conditional Medtronic pacemaker (Revo MRI SureScan pacing system) can undergo an MRI study only if the MR isocenter is superior to the C1 vertebra or inferior to the T12 vertebra. In that case, Medtronic specific guidelines should be followed. In case MR isocenter is contained between C1 and T12, specific MR safety protocols described above should be followed.
    • The current protocol is effective now for cardiac imaging and neuroimaging studies of the head area.  Additional clinical indications will be considered in the future.

    MRI Safety in Patients Unable to Complete Screening

    Revised November 27, 2014

    Mow, Fong, Hess

    Patients are normally screened for contraindications to MRI using a hospital-approved screening form prior to entering the scanner suite. This form is completed by the patient or by his or her healthcare provider, and reviewed by the scanning technologist prior to the patient’s MRI examination. Occasionally, urgent or emergent MRI studies are indicated in patients who are unable to complete the screening form due to neurologic issues. This policy is written to outline the procedure for obtaining MRI in patients who are unable to undergo the normal screening process.

    A knowledgeable family member or caretaker for a patient can complete the screening form on behalf of the patient. In the case of family members, this should be a member familiar with the patient’s exposures and medical history, such as a spouse, partner, or child.  Healthcare providers familiar with the patient’s medical history may also complete the screening form in consultation with the medical record. However, in the absence of sufficient history the following steps should be performed to document the safety of MRI:

    1. Attending radiologist approval for the MRI, along with medical necessity for MRI documented in the medical record by the attending physician requesting the study.
    2. Separate chest and abdominal (KUB) radiographs should be obtained and reviewed prior to scanning to ensure the absence of contraindicated devices (pacemakers, spinal stimulators, et al) or other metallic material (shrapnel in close proximity to a major vessel or organ) that may be a contraindication to MRI. It is the responsibility of the requesting provider to order these radiographs.
    3. Screening orbits CT should be obtained and reviewed for metallic foreign bodies. The scout image for this CT can be used to screen for aneurysm clips. When the request is for a brain MRI, a full head CT should be obtained instead of orbits CT. The requesting provider is responsible for ordering these screening CT examinations.

    Note that this policy does not apply to patients who cannot complete screening due to language difficulties; in this case a translator should be retained to complete screening together with the patient in their native language.