New database measures safety of implantable devices in MR imaging

A streamlined database detailing protocol for scanning patients with a variety of implanted devices could be changing radiologists’ efficiency and confidence for the better, according to research out of Montefiore Medical Center in the Bronx, New York.

“Radiologists must make safety decisions when performing MRIs for patients with medical and cosmetic devices or embedded foreign bodies,” corresponding author Michael L. Lipton, MD, PhD, and colleagues wrote in the Journal of the American College of Radiology this month. “Although many sources  of safety information are available online, MRI may be delayed or canceled, especially after hours when staffing is limited and the on-duty radiologist is unsure of a device’s MRI safety status.”

Hospital resources and accessible sites such as MRIsafety.com provide information pertinent to the safety of thousands of medical devices in MRI scanners, but that content is hardly rudimentary, Lipton and co-authors said. Radiologists looking for a quick fix are confronted with extensive lists and warnings, and a lack of straightforward material means clinicians often leave those sites without straightforward answers.

In some cases, like those in which radiologists need to seek out manufacturer documentation or institutional policy documents for devices, doctors are also often forced to postpone imaging because of a lack of accessibility.

Lipton and his team in New York developed their own database—an online library they call MR. Implant—to ease the problem, they said. MR. Implant was built around the ACR White Paper on MR Safety, manufacturer-specific recommendations, literature review, institutional policy and procedure documents and local experts’ knowledge.

The library categorizes implants and embedded devices into eight classes and 53 unique categories. For each device, the researchers created a summary page designed to succinctly convey the device’s MR safety status and, if necessary, outline steps for determining MR compatibility. 

“We designed MR. Implant as an extension of our institutional MR safety policy to empower radiologists at the point of care with specific actionable knowledge,” Lipton et al. wrote. “Institutional policies form the basis for the content or MR. Implant, which simply makes clear and definitive policy readily accessible at the point of care."

The team tested MR. Implant’s utility in a group of 15 radiology residents, who completed an MR safety test both before and after the database’s release. In both cases, tests contained 20 MR safety screening scenarios that residents might face on a call, and tests were spaced a year apart. Students were permitted to use any and all resources they chose for the duration of the exam.

Lipton and colleagues found that after MR. Implant became available online, half of the residents found and turned to the library for help in completing the test. Accuracy increased from an average 54.7 percent to 71.7 percent, the authors reported, while confidence increased from a mean 2.8 to a 3.7.

“The impact of MR. Implant is dependent on the awareness of and acceptance by radiologists and staff,” the authors said. “Interinstitutional dissemination could be feasible with review, oversight and endorsement by a national body, such as the ACR.”