With safety events on the rise, new board will credential for MR safety

 - Siemens Sensation CT

An organization called the American Board of Magnetic Resonance Safety (ABMRS) has been formed with a mission to certify—through formally administered tests—individuals who have been delegated the responsibility of ensuring the safety of clinical and research magnetic resonance environments.

According to the ABMRS website, the new board is a not-for-profit, autonomous organization “that is independent of, and in no way affiliated with, any and all other credentialing bodies or boards, including but not limited to the American Board of Radiology or the American Board of Medical Specialties."

The purpose of the ABMRS, the website explains, is to “improve the safety of medical and research magnetic resonance (MR environments by certifying that our clinical, physicist, technical, and research diplomats have the necessary a) basic science knowledge of the underlying safety principles, and b) decision making capabilities to apply the, that are required of those who are assigned to ensure safety in MR environments.”

The ABMRS consists of a number of domestic and international experts in the field of MR safety, including Emanuel Kanal, M.D., director, magnetic resonance services, and professor of radiology and neuroradiology at the University of Pittsburgh Medical Center. Kanal, who is chair of the ABMRS, chaired the MR Safety Committee for the American College of Radiology from 2001 until 2012, and is the lead author for the ACR’s Guidance Document for Safe MR Practices in all four of its published versions and updates (2002, 2004, 2007, and the recently published 2013 update).

Why is a board of MR safety needed?

According to Kanal, despite the publication of numerous documents and papers over the years instructing people how to safely perform scans and to implement safety procedures in MR environments, “it hasn’t been working.”

Kanal and and Tobias Gilk, sr. vice president of RADIOLOGY-Planning and Founder of Gilk Radiology Consulting, presented a study at the annual meeting of the Radiological Society of North America in 2012 in which they determined that the number of MRI adverse events reported to the FDA between 2000 and 2009 increased by 523%. "If MRI accidents were a constant, we would expect to see the change in accidents track closely with the change in procedure volume, which the data clearly does not," said Gilk. In fact, over the same period of time procedure volume increased by just 90%, which means that there was about a 5-to-1 increase in the number of MRI accidents compared to the increase in patient volume.

Over the years, the rate at which MR safety incidents occur is increasing “markedly faster than the rate of new procedures being performed,” Kanal said. “In fact, I’m not familiar with any other modality in the field of medicine where the more we know about the potential dangers, the more we understand the science behind it and the more experience we have using it, the worse our track record gets.”

The ACR MR safe practice guidelines have clearly become “the standard of care in how we practice in the MR environment,” Kanal said, and calls for MR sites to name MR medical directors and safety officers. But, according to Kanal, those positions barely exist and are rarely filled, basically because people just don’t know how to perform the necessary tasks.

In 2014, Kanal put together an MR medical director/MR safety officer training course. Two sessions, held three months apart, were very well attended, suggesting to Kanal that there was a tremendous interest in learning about MR safety in order to become a safety officer or medical director.

And while the courses were very successful, attendees had nothing to show for it in the way of a credential.  As Kanal pointed out, in some states “it is entirely legal to scan a patient with zero required qualifications for the operator of the magnet.”

“You can confer upon someone the title of medical director or safety officer, but that doesn’t mean they are trained or educated,” he said. “So we went about setting objective criteria, similar to the way in which we credential physicians.”

The ABMRS is generally modeled after the American Board of Medical Specialties, which has 24 member boards, and the American Board of Radiology in particular. “We love that model,” Kanal said. “They administer an objectively created examination —and while it’s not mandatory and has zero legal jurisdiction—if you pass the test you can say you are board-certified. You have documented