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Alkhulaifat D, Vidal L, Larsen E, Serai SD, Sinti-Ycochea M, Mecca P, Orfe L, Sotardi S. MRI safety-developing the right culture. Pediatr Radiol 2025; 55:895-901. [PMID: 39953297 PMCID: PMC12065676 DOI: 10.1007/s00247-025-06179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 01/16/2025] [Accepted: 01/18/2025] [Indexed: 02/17/2025]
Abstract
In recent years, magnetic resonance imaging (MRI) among pediatric populations has risen, requiring strict adherence to MRI safety protocols for patient care. Children often face more complex safety risks compared to adult populations due to several challenges, such as increased need for sedation, and the limited data and testing on implant safety in pediatric patients. Our aim is to examine the key features of MRI safety and how safety culture impacts important aspects of MRI processes, including patient and staff screening, physical barriers, zoning regulations, emergency response protocols, and adverse event management. This article also explores the cornerstone of MRI safety, the Just Culture approach, which emphasizes transparency, accountability, and improvement of processes over punishment. Key efforts towards building and maintaining safety culture focus on raising awareness, outlining escalation procedures, and instilling a safety-first mindset. Given MRI safety's critical importance in pediatric patient care and staff well-being, the development of a culture that supports these goals is an imperative for every imaging center.
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Affiliation(s)
- Dana Alkhulaifat
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lorenna Vidal
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Ethan Larsen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Mario Sinti-Ycochea
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Patricia Mecca
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lauren Orfe
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Susan Sotardi
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania, Philadelphia, PA, USA.
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Uramatsu M, Takahashi H, Barach P, Fujisawa Y, Takahashi M, Mishima S, Yamanaka G. Improving pediatric magnetic resonance imaging safety by enhanced non-technical skills and team collaboration. Brain Dev 2025; 47:104311. [PMID: 39729739 DOI: 10.1016/j.braindev.2024.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Revised: 12/02/2024] [Accepted: 12/04/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND Safe pediatric magnetic resonance imaging (MRI) ideally relies on non-sedative techniques, as avoiding risky sedation is inherently safer. However, in practice, sedation often becomes unavoidable, particularly for younger children or those with anxiety, to ensure motion-free, high-quality imaging. This narrative review explores the current practices and proposes strategies to enhance safety in pediatric MRI examinations. METHODS We identified and analyzed 247 studies addressing various aspects of pediatric MRI safety, including sedation protocols, patient monitoring, and team-based management approaches. RESULTS Safe sedation requires careful drug selection tailored to individual needs, continuous monitoring, and robust emergency preparedness. While efforts are underway to minimize sedation, safer drug protocols and improved monitoring technologies remain essential. Assembling dedicated MRI teams trained in both technical and non-technical skills-such as situational awareness, communication, and teamwork-supports these strategies. Structured team briefings covering monitoring procedures, emergency scenarios, response protocols, and specific resuscitation roles are also critical. Developing a strong organizational culture that promotes patient safety and continuous learning from incident reports helps ensure ongoing improvements. CONCLUSIONS Achieving safe pediatric MRI examinations requires balancing the need for sedation with the goal of minimizing its use. Strengthening collaboration, refining sedation protocols, and implementing advanced safety monitoring systems are essential steps. Further advancements in imaging technologies are also necessary to reliably obtain high-quality scans without sedation, reducing risks and improving patient outcomes.
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Affiliation(s)
- Masashi Uramatsu
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Hidekuni Takahashi
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Paul Barach
- Jefferson College of Population Health, 4201 Henry Avenue, Philadelphia, PA 19144, USA; Interdisciplinary Research Institute for Health Law and Science, Sigmund Freud University, Freudplatz 1, 1020 Vienna, Austria; Department of Surgery, Imperial College, Hammersmith Hospital,Du Cane Road, London, W12 0NN, United Kingdom; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd., Chapel Hill, NC 27599-7590, USA
| | - Yoshikazu Fujisawa
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; School of Project Design, Miyagi University, 1 Gakuen, Taiwa-cho, Kurokawa-gun, Miyagi 981-3298, Japan
| | - Megumi Takahashi
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Shiro Mishima
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Gaku Yamanaka
- Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
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Calixto C, Gee MS. Practical strategies to improve MRI operations and workflow in pediatric radiology. Pediatr Radiol 2025; 55:12-23. [PMID: 39704827 DOI: 10.1007/s00247-024-06114-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 11/05/2024] [Accepted: 11/16/2024] [Indexed: 12/21/2024]
Abstract
Magnetic resonance imaging (MRI) is an essential tool in pediatric imaging. It offers detailed, high-contrast images without ionizing radiation, making it particularly suitable for children. Creating an efficient MRI service is challenging given the balancing priorities of image quality and scan time and the overlying logistical challenges, including MRI safety protocols, the need for sedation in certain patient populations, and flexibility to accommodate patients at different phases of care. This paper reviews practical strategies to improve MRI operations and workflows in pediatric radiology, emphasizing protocol standardization and customization, scheduling optimization, and identification of key performance indicators (KPIs). Operational data through dashboards and reports enable continuous quality assessment and improvement, while specialized staff training ensures high imaging and patient safety standards. The strategies outlined in this paper highlight the importance of a comprehensive, patient-centered approach to MRI operations. By prioritizing efficiency, quality, and patient care, radiology departments can improve diagnostic outcomes and patient experience.
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Affiliation(s)
- Camilo Calixto
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- NYC Health + Hospitals/Elmhurst, 79-01 Broadway, Elmhurst, NY, 11373, USA
| | - Michael S Gee
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
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Ayasrah M. MRI Safety Practice Observations in MRI Facilities Within the Kingdom of Jordan, Compared to the 2020 Manual on MR Safety of the American College of Radiology. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:131-142. [PMID: 35592097 PMCID: PMC9113556 DOI: 10.2147/mder.s360335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The absence of ionizing radiation in MRI applications does not guarantee absolute safety. Implementing of safety guidelines can ensure high-quality practice in the clinical MRI with the minimum risk. For this purpose, this cross-section quantitative study conducted in Jordan Kingdom aimed to assess current MRI safety guidelines in comparison with those of 2020 Manual on MR Safety of the American College of Radiology (ACR). Patients and Methods A site observation study of 38 MRI units was undertaken in June 2021. A well-structured MRI safety questionnaire was the primary data collection method. Data were subjected to a descriptive statistics content analysis by the SPSS version 20. The results were analyzed to yield comprehensive discussions. Results A total of 38 MRI facilities in participated in this study with the responding rate of 44.7%. Patient screening areas and changing rooms were available in about 29% (11/38) of the MRI facilities. Most facilities (55%, 21/38) conducted verbal screening only whereas 21% implemented both written and verbal screening for their patients and companions in zone II, which was present in a percentage of 29% in the approached facilities. Meanwhile, only 13 (43.2%) of 38 facilities used handheld magnets for physical screening, 25 (65.8%) of MRI units did not use any kind of ferromagnetic metal detection systems. Three (7.9%) participating centers had MR-safe wheelchairs, ventilators, anesthesia machines, and stretchers. Most MRI facilities participating in this study (71%) had emergency preparedness plans for alternative power outages. Despite a relatively low number of participating centers having an emergency exit or code (26.3% and 10.5%, respectively), none of them performed practice drills for such scenarios. Conclusion Investing in new MR-safe equipment requires introducing ferromagnetic detecting systems. More research is needed to establish the degree of MRI professional’s safety-related education.
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Affiliation(s)
- Mohammad Ayasrah
- Department of Allied Medical Sciences-Radiologic Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Amman, Jordan
- Correspondence: Mohammad Ayasrah, Department of Allied Medical Sciences-Radiologic Technology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan, Tel +962 27201000-26939, Fax +962 27201087, Email
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