Magnetic resonance (MR) imaging is widely used and generally considered safe. However, MR safety is a key issue and a concern among MR professionals worldwide.

The number of MR examinations is increasing, and so is the number of patients with both active and passive implants. Furthermore, there is a demand for improved productivity and patient flow in the healthcare system to meet financial goals. The number of reported incidents related to MR safety is relatively low; however, incidents can be serious or even deadly for both patients and staff. Whether the low number of incidents reported in Denmark is related to lack of central reporting to the national database is unclear. The need for up-to-date education on MR safety for radiographers, radiologists and physicists is obvious, but there is also a need for a special focus on other staff that occasionally attend MR facilities. Furthermore, focus is on who is responsible and for what needs to be addressed. Thus, proposals for certified education in MR safety for responsible MR radiographers, radiologists and physicists have been published and acknowledged by several organisations.

Databases for reporting incidents at hospital level or national level exist in some countries, such as the U.S. Food & Drug Administration (FDA), Manufacturer and User facility Device Experience (MAUDE) database (USA), Medicines & Healthcare products Regulatory Agency (MHRA) (UK) and Danish Patient Safety Authority where all unintended events related to patient safety must be reported (Denmark).

The most feared incident in relation to MR is the so-called projectile effect, where magnetic material is attracted to the strong magnetic field. This can be extremely dangerous and even deadly for patients and staff. Other types of incidents are cases in which the patient has a magnetic or metallic foreign body.

Furthermore, there are cases in which a safety check form has not been filled in correctly.

Some of the most difficult cases occur, when it is unknown whether the type of implant the patient has is MR safe, MR conditional or MR unsafe. The need for databases containing information on type of implants is obvious and could save both time and costs. Moreover, when an accident happens this can be associated with significant costs. In daily practice, the radiographer decides whether it is possible to perform the examination, but in cases of doubt, the radiologist is asked and has the responsibility to determine whether to perform the MRI examination; in some but not all departments, a physicist may be available for advice and counselling, but that is not always the case. This situation has directed the focus on education and whether the MR safety education of different groups of professionals are sufficient.

Through a research agreement with the Danish Patient Safety Authority the National Database was searched for MR-related incidents from 2015-2017 and a link to a national questionnaire was mailed to MR-personnel in Denmark.

Analyses showed that far from all incidents were reported to the national database and that there is a need for better education in MR-safety, especially among groups of staff that only occasionally work in the MR facility.

• Publication submitted. Poster presented. Blankholm, Anne Dorte. MR safety incident reporting and a questionnaire. Poster no. 10, SMRT annual meeting, Montreal, Canada.
• Several invited speaks at a conference at the Danish Parliament, European Congress of Radiology, Nordic Congress of Radiology, Danish Society for Medical Magnetic Resonance (DSMMR) and European Congress of Radiology (ECR) regarding this project and challenges in MR-safety in general in 2019.
• Maureen N. Hood, PhD, RN, Anne Dorte Blankholm, PhD, MSc, Alan Stolpen, MD, PhD, FACR. The Rise of Off-Label Iron-Based Agents in Magnetic Resonance Imaging.  Journal of Radiology Nursing 38 (2019) 38-41.
• Anne Dorte Blankholm and Boel Hansson RN. Incident reporting and level of MR safety education: A Danish national study Radiography (2020) May;26(2):147-153. doi: 10.1016/j.radi.2019.10.007. Epub 2019 Nov 6.

Anne Dorte Blankholm, PhD, MSc., Radiographer, Department of Radiology, Aarhus University Hospital, Aarhus, Denmark and Department of Clinical Medicine, Aarhus University. The research programme “The acute patient”, Aarhus University Hospital, Aarhus, Denmark. e-mail: anneblan@rm.dk