A final safety check immediately before entering the MRI scanner room provides an important opportunity to identify hazards that may have been missed, changed or introduced since the initial MRI safety screening.
Why perform a final safety check?
A patient may have completed an MRI safety questionnaire earlier in their pathway, but circumstances can change before they reach the scanner room.
Personal belongings may have been returned, additional equipment may have been attached, information about an implant may have become available, or an item may simply have been overlooked during the initial screening process.
A deliberate final check creates a last opportunity to identify a potential hazard before the patient, accompanying person or equipment enters the MR environment.
STOP — CHECK — ESCALATE
1. Confirm the patient and examination
Before entering the scanner room:
- Confirm the patient’s identity using local identification procedures.
- Confirm the examination being performed.
- Confirm that the appropriate MRI safety screening process has been completed.
- Check whether anything has changed since the screening was performed.
- Confirm that relevant implant, device or foreign-body information has been reviewed where applicable.
- Ensure any additional people entering the controlled MR environment have undergone the appropriate local screening process.
2. Implants, devices and foreign bodies
Where an implant, device or potential foreign body has been identified, establish exactly what it is and determine its MR status using appropriate evidence and your local MRI safety procedure.
Information may need to include:
- Manufacturer
- Exact make and model
- Implant or device type
- Implantation date where relevant
- Anatomical location
- MR safety classification
- Applicable MR Conditional requirements
- Current device status or configuration where relevant
- Any additional requirements specified by the manufacturer or local policy
Do not assume that two devices of a similar type have identical MR conditions.
If the identity or MR status cannot be satisfactorily established, follow the local escalation and risk-assessment pathway before proceeding.
MR Safe, MR Conditional and MR Unsafe
These terms are not interchangeable.
MR Safe
An item classified as MR Safe poses no known hazards resulting from exposure to any MR environment.
The designation should not simply be applied because an object appears non-magnetic or has previously been used within an MRI department.
MR Conditional
MR Conditional does not mean universally “MRI safe”.
An MR Conditional item has demonstrated safety only under specified conditions.
MR Unsafe
An MR Unsafe item poses unacceptable risks to the patient, staff or other persons within the MR environment.
Such items must be managed in accordance with their classification and the department’s controlled-access procedures.
Understanding MR Conditional requirements
Depending on the device, conditions may relate to factors such as:
- Static magnetic field strength
- Spatial field gradient
- RF exposure and heating limits
- Operating mode
- Gradient magnetic fields
- Coil configuration
- Patient or device positioning
- Scan duration
- Required waiting periods
- Device programming or configuration
- Other manufacturer-specific restrictions
An item acceptable under one set of MR conditions should not automatically be assumed acceptable under different conditions or on another MR system.
MR status unknown or unlabelled
Unknown does not mean safe.
Where the MR status of an item cannot be established, do not infer safety from its appearance, material, previous use or anecdotal information.
Follow the local MRI safety policy and escalation procedure.
A previous MRI is not proof of current MR safety
A patient saying:
“I’ve had an MRI with it before.”
should not, by itself, be considered evidence that an implant or device is appropriate for the proposed examination.
The previous examination may have involved:
- A different field strength
- A different scanner
- Different RF or gradient conditions
- Another anatomical region
- A different coil
- Different device settings
- A different implant or device configuration
- Conditions that cannot now be verified
The relevant device and applicable MR conditions should still be established for the examination being proposed.
3. Clothing, pockets and personal belongings
Immediately before entering the scanner room, check for external items that could introduce projectile, heating, device malfunction or other risks.
Depending on local procedures, examples may include:
- Mobile phones
- Keys and coins
- Watches
- Jewellery
- Hair accessories
- Wallets and purses
- Bank or magnetic-stripe cards
- Hearing aids
- Removable medical devices
- Electronic devices
- Tools and pens
- Lighters
- Clothing or accessories containing metallic components
- Objects inadvertently left in pockets
Do not rely solely on the patient remembering everything they are carrying.
Follow your organisation’s local clothing and changing policy.
4. Equipment entering the MR environment
The check does not stop with the patient.
Any equipment accompanying the patient must also be appropriate for the MR environment and used within its applicable conditions.
Patient trolleys
Oxygen equipment
Monitoring equipment
Infusion equipment
Transfer aids
Positioning equipment
Anaesthetic equipment
Emergency equipment
Equipment brought by another clinical team
Confirm its MR status and follow local procedures.
Particular care is required when staff who do not routinely work within MRI bring equipment into the controlled area.
5. RF burn and positioning check
Before scanning, consider potential radiofrequency heating and contact risks.
- The patient is positioned according to local and manufacturer guidance.
- Avoidable skin-to-skin contact that could form conductive loops has been addressed.
- Cables and leads are appropriately routed and positioned.
- Cables are not unnecessarily looped.
- Equipment and accessories are being used according to their MR conditions.
- The patient is appropriately insulated from relevant surfaces where required.
- Clothing, monitoring devices, patches or other items have been considered for potential heating risk.
- The patient understands how to alert staff if they experience unexpected heating, pain or discomfort.
The exact precautions required will depend on the scanner, examination, patient, equipment and local procedures.
6. Stop when something does not match
A strong MRI safety culture should support staff who stop an examination when something is uncertain.
Do not allow pressure to maintain the appointment list or avoid a delay to override an unresolved safety concern.
Investigate and escalate through the appropriate local pathway.
BAMRR Final Safety Check
Immediately before entering the scanner room, consider:
Correct patient and correct examination?
MRI safety screening complete and still accurate?
Exact device identified and MR status established?
If MR Conditional, can every relevant condition for the proposed examination be met?
Any unresolved metallic foreign-body concern?
External metallic, electronic or potentially hazardous items removed or appropriately managed?
Everything accompanying the patient suitable for the MR environment and being used within its conditions?
Patient, cables, leads and accessories appropriately positioned to minimise avoidable heating/contact risks?
Has anything changed or is anything uncertain?
Follow your local MRI safety policy
This BAMRR resource is intended as an educational and professional-practice aid. It is not a replacement for local MRI safety policies, procedures, manufacturer instructions, formal risk assessments or specialist advice.
MRI departments should work within their organisation’s established governance arrangements.
Where there is uncertainty regarding an implant, device, equipment or proposed scanning conditions, follow the department’s local escalation pathway and obtain appropriate expert advice, including involvement of the local MR Safety Expert or other designated MR safety personnel where required.
Manufacturer-specific conditions and current device information should be checked using appropriate authoritative sources.
