Thread by @MrYearof

Welcome to MRI Safety Week!

All this week we're highlighting various 'why' elements of MRI Safety Week and the Year of MRI Safety.

Today's 🧵: What has changed in MRI safety?

#MRI #MRIsafety #MRIsafetyweek

Immediately following the Colombini accident (see yesterday's thread), the @RadiologyACR convened what they called a 'blue ribbon panel' on MRI safety. That group published the first MRI safety best practice manual in 2002.

That specific document was expanded and re-released in 2004, 2007, 2013, and most recently in 2020.

The UK's @MHRAgovuk released MRI safety guidelines in 2007. Also in 2007, the @RANZCRcollege released their MRI safety guidelines (borrowing heavily from the ACR's publicaitons).

The @TJCommission released their Sentinel Event Alert on MRI accidents in 2008 (later deferring to the ACR's publications), and Diagnostic Imaging Standards in 2015.

Plus there have been many articles, journal articles, and training resources made available.

In the past 20 years there has been explosive growth in MRI safety best practice published knowledge. We have remarkably greater access to MRI safety information than at any previous time in MRI's history.

But it's not just the body of accessible knowledge that has changed in the last 2 decades, so too have MRI's risks.

Magnets are stronger. Fields are more compact (higher SFGs). Pulse sequences use more RF energy. Thinner slices and faster acquisitions means more dB/dt energy.

And that's just the hardware!

MRI patients are bigger (more RF), imaged at higher acuities, subject to intervention during MRI, with a vast range of implants and devices that were outright prohibited 20 years ago.

And in this time frame, reimbursements for MRI procedures have dropped, dramatically. With large fixed expenses for equipment and building, the single biggest cost-cutting option available to operators is staffing, so MRI's are often operated by fewer techs then 20 years ago.

The economic reality of clinical MRI, today, is often "do more with less." Scan more patients, in less time, with fewer people (and/or people who can be paid less).

So apart from the fact that there's still an MRI scanner at the heart of MRI imaging, and that these are typically in hospitals or imaging centers, nearly everything else about the safety of MRI imaging has changed -dramatically- in the last 20 years.

So *both* MRI safety knowledge and MRI risks have grown, significantly, in the last 2 decades, but they're *not* in a close race. Growth in reported MRI adverse events suggests that the risks have been growing faster than our ability to put our knowledge into effective practice.

Tomorrow we're going to touch on what *hasn't* changed, in terms of standards and structures to keep patients (and caregivers) safe, and we hope you'll return for that very important 'flip side' of MRI safety.

As always, we invite you to 'like' and 'RT' our threads generously to help your Twitter friends and colleagues see this information.

We also invite you to follow us for daily doses of #MRIsafety best practices. Thank you very much.