AHRA 2018: Tobias Gilk on why imaging providers should take MRI safety more seriously
Tobias Gilk, MArch, MRSO, MRSE, has made it his personal mission to improve MRI safety in the United States. And Gilk—the founder of Gilk Radiology Consultants, a senior vice president of RAD Planning, a safety consultant for Metrasens and chairman of the American Board of Magnetic Resonance Safety (ABMRS)—brought that mission to the AHRA 2018 Annual Meeting in Orlando, co-hosting two sessions related to the subject.
Gilk sat down to speak with Radiology Business at AHRA as he was preparing for those two sessions, “Do You Suffer From PFD (Poor Facility Design)? Ask Your Architect How FGI Can Help” and “Magnets, Cryogens and RF, Oh My! An MRI Safety 2018 Update.”
Read the full conversation below.
Radiology Business: A growing number of imaging specialists celebrate MRI Safety Week every July. What’s the history behind this special week?
Tobias Gilk, MArch, MRSO, MRSE: We first started celebrating MRI Safety Week about 15 years ago. We saw that we had Radiation Safety Week and National Radiologic Technology Week, but there was nothing about MRI safety. In my opinion, that has been an industry problem for years—we just don’t pay enough attention to MRI safety.
So we started celebrating MRI Safety Week each year on the anniversary of the infamous Michael Colombini accident. He was the young boy who died when an oxygen cylinder was brought into the magnet room. This week is both a way to pay tribute to Michael and an opportunity to pause and spend a week’s worth of time reflecting on what is being done in MRI safety. Are we correctly identifying risks? Are we correctly responding to risks? Beyond that, there’s no set structure to the week—it’s just about raising awareness about risk assessment and risk response.
You currently serve as the chairman of the ABMRS. What can you tell me about this relatively new imaging society?
The ABMRS was the brainchild of Emanuel Kanal, MD, who was the chair of the American College of Radiology (ACR) MRI Safety Committee for more than a decade. Dr. Kanal and I were having conversations about MRI accidents and injuries, and it became clear to us that the common thread through almost all of them was actually mistakes in decision-making. They chose A when they should have chosen B—things like that.
Th ACR will accredit a device and the Joint Commission will accredit an enterprise—but when it came to accrediting the individuals at the point of care who make these key decisions, there was really no way to be accredited. The ABMRS was formed to address this. We wanted to identify a minimum knowledge base for people charged with the responsibility of patient safety in the MRI environment. And the ABMRS does one thing: we accredit Magnetic Resonance Safety Officers (MRSOs), Magnetic Resonance Medical Directors (MRMDs) and Magnetic Resonance Safety Experts (MRSEs).
What are some common mistakes you see when it comes to MRI safety?
One common mistake is that practices have internalized our own industry marketing and view MR as the “safe modality.” That causes some huge challenges, because providers aren’t thinking enough about keeping these exams as safe as possible. We have Image Gently and Image Wisely, but that is really it when it comes to policies about keeping MR imaging safe. I think we need a companion to those programs that focuses more on MR.
As an industry, I just think we have been drinking our own Kool-Aid. Providers are walking around with a deeply flawed understanding of what risks are associated with this modality. We don’t teach MRI safety in a meaningful way in a lot of RT training programs or radiology residency programs. Physicians are not being exposed to the information they need to identify and address the risks that do exist.
What should facilities focus on if they want to take MRI safety more seriously?
For the folks who want to be proactive, it comes down to two things: training and risk assessment. Professional radiology safety training in this country is almost all focused on ionizing radiation, not MR. So stakeholders need to make sure anyone who needs this additional training can get that training. And, of course, it’s more than just about training. Just because you have had the training, it doesn’t mean you are all set. You also have to be able to assess the risks that exist.
If a provider has only had 1.0-Tesla equipment and then they move to a 3.0-Tesla magnet, for example, that’s more than simply buying new hardware. That affects the risk profile associated with the imaging exams. The FDA also just approved 7.0-Tesla equipment, so that’s another instance where risks are going to need to be reassessed. MRI risks are not all ubiquitous, whether it’s the hardware or the clinical setting.
Unfortunately, there will always be individuals who will not work toward MRI safety best practices unless they absolutely must. Until there is some sort of ultimatum that says they will be not be reimbursed, they will move forward as normal and change nothing.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.