MR Safety Level 1

Continue Continue Continue Continue Continue Continue Continue Continue Continue Continue MR Safety Level 1 6 5 4 3 2 1 %CurrentTab% This online training will focus on level one MRI safety training. This will provide an awareness of potential risks related to the magnet and ways to avoid adverse events. Select each number to review the objectives. MRI Safety Level 1 online training Objectives Select each number to the right to review the course objectives. Layers At this end of this module, you should be able to: Describe the MR Environment Recite the MR Safety Zones Identify the difference between MR safe, unsafe, and conditional. Explain MR Safety Screening and Patient Preparation Describe Emergency Procedures & Emergency Switches Identify MR Personnel & MR Safety Officers Recall the cleaning procedures in Zone III and Zone IV in the MR Environment 1 2 3 4 5 6 At the end of this module, you should be able to: Recall the cleaning procedures in Zone III and Zone IV in the MR Environment. Objective six 1 2 3 4 5 6 At the end of this module, you should be able to: Identify MR Personnel & MR Safety Officers. Objective five 1 2 3 4 6 5 Line Motion Path Line Motion Path At the end of this module, you should be able to: Describe Emergency Procedures & Emergency Switches Objective four At the end of this module, you should be able to: Explain MR safety screening and patient preparation. Objective three 1 1 2 3 6 5 4 Line Motion Path Line Motion Path At the end of this module, you should be able to: Identify the difference between MR safe, unsafe, and conditional. Objective two 1 2 6 5 4 3 6 5 4 3 2 1 At the end of this module, you should be able to: Describe the MR environment and the MR safety zones. Objective one ? Siemens Healthineers disclaimers The information presented in this MR Safety – Level 1 presentation is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any healthcare practitioner reading this information is reminded that they must use their own learning, training, and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Healthineers to be used for any purpose in that regard. The MRI restrictions (if any) of the metal implant must be considered prior to the patient undergoing an MRI exam. MR imaging of patients with metallic implants brings specific risks. However, certain implants are approved by the governing regulatory bodies to be MR conditionally safe. For such implants, the previously mentioned warning may not be applicable. Please contact the implant manufacturer for specific conditional information. The conditions for MR safety are the responsibility of the implant manufacturer, not Siemens Healthineers. MR scanning has not been established as safe for imaging fetuses and infants less than two years of age. The responsible physician must evaluate the benefits of the MR examination compared to those of other imaging procedures. Disclaimers MR environment, safety zones, and safety labeling Untitled Slide The following section will discuss the M-R environment, safety zones, and safety labeling. ? MR environment Tab 1 Tab 1 Tab 1 Tab 1 Tab 2 Tab 2 Tab 2 Tab 2 Tab 3 Tab 3 Tab 3 Tab 3 Select each tab to review content. MR environment Select each of the tabs to review the MR enviornment. Tab 1 The Magnetic field is always on even when the M-R system is not being used to image patients, and, even when the M-R system electronics are turned off. The M-R-I Technologists determines who enters Zone three, the MR Controlled access room, and Zone four, the M-R scanner room. Anyone entering the M-R scanner room must be screened by the M-R-I Technologist to ensure it is safe for them to be in the M-R magnetic field to prevent any serious injury. Tab 2 The controlled access area is encompassed by the five-gauss line in the M-R magnet room and is typically marked on the floor. The five-gauss line in the M-R magnet room defines the controlled access area of the static magnetic field. Tab 3 The area leading to the M-R control and magnet room is clearly marked with signs and symbols. The M-R system owner is responsible for ensuring accessible areas in the vicinity, or adjacent areas of the M-R electromagnetic field are clearly identified with appropriate signs. These warning signs must be installed in a clearly visible area: On the door to the M-R Scan room at eye level On the floor in front of the M-R Scan room, or on Either side of the M-R scan room door. Depending on the M-R system, the field strength may also be displayed. Tab Slide Click on one of the tabs to display the corresponding content on this page. MRI Safety – Signs and Symbols The system owner is responsible for properly identifying the accessible areas (e.g., regarding the electromagnetic field), the vicinity of the MR system, as well as adjacent areas by using the appropriate signs. Warning signs installed must be in a clearly visible area. Door to the MR Scan room at eye level Floor in front of the MR Scan room door Either side of MR Scan room door Depending on the system, the field strength may also be shown (e.g., .55T, 1.5T, 3T, 7T). Reference:System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 MR 5-Gauss Line The controlled access area encompassed by the five-gauss line for the field strength is established around the MR magnet and is typically marked on the floor. The five-gauss line in the examination room defines the controlled access area of the static magnetic field. Reference: MR Safety – Introduction MR Safety – Siemens Video Magnet is always On The magnetic field is ALWAYS ON even when the MR system is NOT being used. The magnetic field is still ON, even if the MR system is turned OFF. The MRI Technologist has the final say in who is allowed to go into the MR scanner room (or) operating room where the MR scanner is located. The MR magnet field can cause serious injury or even death if proper procedures are not followed by all personnel entering the MR scanner [magnet] room. MR Safety Zones Z one I Zone II Zone III Zone IV + Zone I + Zone I + Zone I + Zone I + Zone I + Zone II + Zone II + Zone II + Zone II + Zone II + Zone III + Zone III + Zone III + Zone IV + Zone IV + Zone IV + Zone IV + Zone IV Reference: MR Safety | American College of Radiology (acr.org) MR Safety Zones the American College of Radiology has defined four safety zones within M-R-I facilities. Zones one through four correspond to the level of increasing magnetic field exposure and potential safety concerns. The area in Zone one, is freely accessible to the public. It is typically located outside of the M-R-I environment, in the M-R reception area or waiting room. Patients, health-care personnel, and other employees of the M-R-I facility have access to this area. Zone two, is the area that interfaces the publicly accessible uncontrolled Zone one and the strictly controlled areas of Zones three and four. Screening and ferromagnetic detection is often performed in Zone two, for example: the patient screening area, changing rooms, or where the office staff is located. Zone three, is the M-R controlled access area next to the M-R magnet room, for example: the M-R control room or computer room. This entrance has restricted access to the public and is controlled by installed key locks, access control cards, badges with Radiofrequency I-D, or similar technology to ensure access is limited to authorized personnel. These entrances are clearly marked so you can identify them with Caution, and restricted access signs. All individuals entering Zone three and four, including non-M-R personnel must be accompanied and under the supervision of M-R Level two personnel, except when in changing rooms and, or in the bathroom. Zone 4 Zone four is inside the M-R scan room, this is the physically walled confined area where the M-R scanner is located. This is generally located within a surrounded controlled access Zone three. The precise boundaries of Zone four and Zone three can be in flux depending on the clinical situation and configuration, for example: preoperative M-R. These areas should be clearly labeled as potentially hazardous due to the presence of a very strong magnetic field. The entry door should be closed to Zone four except when entering the room for patient examinations, or M-R system maintenance. It is also recommended to place a Caution barrier at the entrance to the M-R scanner room when the door is open. Inside MR scanner room (physical walled confines where a scanner is located). Generally located within a surrounding controlled access Zone III Precise boundaries of Zone IV and Zone III can be in flux depending on the clinical situation and configuration (e.g., preoperative MR) Should be clearly labeled as potentially hazardous due to the presence of a very strong magnetic field Entry door should be closed to Zone IV except for patient care or room/MR system maintenance It is recommended to place a Caution barrier at the entrance to the MR system room when the door is open Z one IV **Magnet is always ON** MR controlled access area, next to the MR Magnet room. Restricted access to the public by: using reliable key locks, access control cards/badges with radiofrequency ID (RFID), or similar technology to ensure access is limited to designated personnel Identify entrances with Signs: Caution, Restricted Access, etc. All individuals including non-MR personnel must be accompanied and/or under the supervision of MR Level 2 personnel while in Zones III and IV, except when in changing rooms, or in the bathroom This area is the interface between the publicly accessible, uncontrolled Zone I and strictly controlled areas of Zones III and IV. Screening and ferromagnetic detection is often performed in Zone II Patient screening area, patient changing rooms, office staff, etc. This area is freely accessible to the public: typically outside MR Environment where patients, health care personnel, and other employees of the MR facility access the MR environment MR reception area/waiting room MR Safety Zones Functional diagram Reference: ACR Manual on MR Safety Functional diagram This diagram is an example from the A-C-R Manual on M-R Safety. This is an idealized sample floor plan that illustrates site-access restriction considerations. Other potential M-R-related safety issues, such as M-R System site planning associated with magnetic-fringe–field considerations are not intended to be included herein. In any zone of the facility, there should be compliance with Health Insurance Portability and Accountability Act regulations regarding privacy of patient information. However, in Zone three, there should be a privacy barrier so that unauthorized persons cannot view the control panels. MR Conditional MR Unsafe MR Safe MR Safe, MR Conditional, MR Unsafe MR safety labeling Reference: ACR Manual on MR Safety MR safety labeling M-R Safety labelling consists of M-R Safe, M-R Conditional, and M-R Unsafe. MR Safe objects or devices pose no know hazards to a patient or individual in the M-R environment, without conditions. It is reserved for non-metallic and non-conducting objects that pose no known hazards in any M-R environment. MR Unsafe objects or device are known to present safety risks in the M-R environment. These objects or device are a contraindication for an M-R procedure and, or for an individual to enter the M-R environment. In the case of non-implanted devices, these are primarily ferromagnetic objects, for example, scissors, patient beds, gurneys, oxygen tanks, etc. Audio M-R Conditional objects or devices may or may not be safe for a patient undergoing an M-R procedure. These devices have shown that they pose no known hazards in a specified M-R environment with specific conditions of use. These decisions are based on published M-R Conditional, or safety claims that recognize that all such claims apply to the specifically tested static field and spatial gradient field strengths and only apply to the precise model, make, and identification of the tested device or object. Conditions defining the specified M-R environment include: Static Magnetic Field Strength. Spatial Gradients. Time rate of change of magnetic field. Radio Frequency Fields, and Specific Absorption Rate. Since M-R Conditional devices may present hazards, always refer to the manufacturer’s operator manual to avoid potential hazards and injuries. Conditions defining the specified MR environment include: Static Magnetic Field Strength Spatial Gradients dB/dt (time rate of change of magnetic field) Radio Frequency (RF) Fields Specific Absorption Rate (SAR) Electromagnetic fields Magnetic field In the examination room, there are different kinds of electromagnetic fields and the resulting risks that include: Static Magnetic Field Gradient Fields (or) Time-Varying Magnetic Field Gradient [dB/dt] Magnetic Field [B0] / Time-Varying RF Fields (or) Radiofrequency (RF) Fields [B1] Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 Electromagnetic fields In the M-R magnet room, there are different kinds of electromagnetic fields that pose certain risks, these include the: Static Magnetic Field. Gradient Fields (or) Time-Varying Magnetic Field Gradient, and the Magnetic Field [B-one]. Select each of the icons to discover more about the safety risks that must be considered with these fields. Static magnetic field The Static Magnetic Field [B0] is generated by a superconductive magnet and may extend beyond the examination room (i.e., walls, ceilings). The strong static magnetic field associated with the MR Magnet can interact with metallic objects, potentially turning them into dangerous projectiles. Spatial Field Gradient (SFG) Hazards: Rotational Force (Torque) causes the ferrous object to turn and align with the magnetic field direction. In terms of risk, rotational forces on objects are determined primarily by B0 field strength and are greatest at the center of the magnet. Translational Forces tend to be greatest near the edge of the magnet, where the Static Field Gradient is largest. As the ferromagnetic object approaches the face of the magnet bore, the translational forces can easily turn them into dangerous projectiles. To Minimize Hazards The controlled access area of the basic field is typically identified on the magnet room floor [0.5mT-Gauss line] Outside the controlled access area, the magnetic flux density is less than 0.5 mT Restrict access for personnel and objects into Zone IV, all personnel entering this environment must be thoroughly screened Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 Ferromagnetic Projectile Risks External [non-implanted] devices, objects, and equipment may be a projectile risk. All portable metallic or partially metallic objects entering Zone III or Zone IV must be labeled as MR Safe, MR Conditional, or MR Unsafe. Unsafe Transport Equipment [e.g., wheelchairs, Stretcher, Gurneys] should be tethered and fixed to an anchor point in Zone III. Portable Equipment in Zone IV objects should only enter Zone IV if required for immediate patient care [e.g., MR Conditional Ventilator, etc.]. The item should be labeled as MR conditional, and conditions clearly documented and communicated. Ferromagnetic Projectiles include: Oxygen tanks IV Pumps IV Poles Carts Stretchers, Gurneys Wheelchairs Monitoring equipment [e.g., Pulse Oximeter, ECG lead] Stethoscopes Needles Scissors Knife Cell phone Guns And more… Reference: ACR Manual on MR Safety Static magnetic field In the M-R magnet room, The Static Magnetic Field [B-zero] is generated by a superconductive magnet and may extend beyond the examination room, for example, the walls, and ceilings. The strong static magnetic field associated with the M-R Magnet can interact with metallic objects, potentially turning them into dangerous projectiles. Spatial Field Gradient (SFG) Hazards include: Rotational Force (Torque), that can cause the ferrous object to turn and align with the magnetic field direction. In terms of risk, rotational forces on objects are determined primarily by the b-zero field strength and are greatest at the center of the magnet. Translational Forces, tend to be greatest near the edge of the magnet, where the Static Field Gradient is largest. As the ferromagnetic object approaches the face of the magnet bore, the translational forces can easily turn them into dangerous projectiles. To Minimize Hazards, limit access in these areas to M-R Level two authorized personnel: The controlled access area of the basic field is identified on the magnet room floor. The point-five-milli-Tesla-Gauss line. Outside the controlled access area, the magnetic flux density is less than point-five-milli-Tesla. Restricted access for personnel and objects into Zone four, all personnel entering this environment must be thoroughly screened. In the M-R magnet room, there are different kinds of electromagnetic fields. The Static Magnetic Field [B-zero] is generated by a superconductive magnet and may extend beyond the examination room, for example, the walls, and ceilings. The strong static magnetic field associated with the M-R Magnet can interact with metallic objects, potentially turning them into dangerous projectiles. Spatial Field Gradient (SFG) Hazards include: Rotational Force (Torque), that can cause the ferrous object to turn and align with the magnetic field direction. In terms of risk, rotational forces on objects are determined primarily by the b-zero field strength and are greatest at the center of the magnet. Translational Forces, tend to be greatest near the edge of the magnet, where the Static Field Gradient is largest. As the ferromagnetic object approaches the face of the magnet bore, the translational forces can easily turn them into dangerous projectiles. To Minimize Hazards, limit access in these areas to M-R Level two authorized personnel: The controlled access area of the basic field is identified on the magnet room floor. The point-five-milli-Tesla-Gauss line. Outside the controlled access area, the magnetic flux density is less than point-five-milli-Tesla. Restricted access for personnel and objects into Zone four, all personnel entering this environment must be thoroughly screened. In the Static Magnetic Field there is a potential risk of Ferromagnetic projectiles. Ferromagnetic Projectiles are external [non-implanted] devices, objects, and equipment that can become a projectile risk. All portable metallic or partially metallic objects entering Zone three or Zone four must be labeled as M-R Safe, M-R Conditional, or M-R Unsafe. Unsafe Transport Equipment, such as, wheelchairs, Stretchers, and Gurneys should be tethered and fixed to an anchor point in Zone three. Portable Equipment in Zone four objects should only enter Zone four if required for immediate patient care, for example, M-R Conditional Ventilator, oxygen tanks, etc. The item should be labeled as M-R conditional, and conditions clearly documented and communicated to all personal. Ferromagnetic Projectiles include, Oxygen tanks, I-V Pumps, I-V Poles, Carts, Stretchers, Gurneys, Wheelchairs, Monitoring equipment [e.g., Pulse Oximeter, E-C-G leads], Stethoscopes. Needles, Scissors, Knifes, Cellphones, Guns, etc. Acoustic noise safety Select the tab arrows to learn more about the safety risks and considerations that must be taken for acoustic noise. Acoustic noise safety Hearing protection Noise safety Select the arrows on the left, to learn more about the acoustic noise safety considerations with these types of electromagnetic fields.. acoustic noise safety layer Appropriate hearing protection must be worn by patients and volunteers that lowers the noise to at least ninety-nine decibels. The Siemens headphones provided with the M-R system are not classified as hearing protection. The Siemens standard headphones are only intended for communication with the patient and should be used in combination with earplugs. All personnel should be trained to correctly apply hearing protection, and any personnel accompanying a patient in the examination room must also wear hearing protection during the examination that lowers the noise to at least eighty-five-decibels. [for example: nurses, anesthesiologists, and any other personnel in the M-R scanner room]. It is mandatory to provide anesthetized or unconscious patients with hearing protection. Hearing protection for these patients should not be omitted even at moderate sound levels. Neonates and infants, require special attention and training of personnel is required to ensure that hearing protection is properly positioned. Researchers and veterinarians should also use hearing protection for animals during an M-R-I exam. If the patient refuses hearing protection, facilities should have a process and procedure in place to discuss the risks of proceeding without hearing protection and they may even consider canceling the exam. hearing protection layer To properly insert the ear-plugs perform the following steps: With clean hands, roll and compress the foam earplug. Hold the ear plug between thumb and forefinger. Roll and progressively compress the entire tapered end of the earplug to a small, crease-free, cylinder. Reach hand over head and gently pull ear upward. Insert the foam earplug. Hold for at least twenty-to-thirty seconds as the foam earplug expands. If the ear plug doesn’t seem to fit properly, remove it and try again. Acoustic Noise Safety – Hearing Protection Steps to inserting Earplugs Properly With clean hands, roll and compress the foam earplug. Hold the ear plug between thumb and forefinger. Roll and progressively compress the entire tapered end of the earplug to a small, crease-free, cylinder. Reach hand over head and gently pull ear upward. Insert the foam earplug. Hold for at least 20-30 seconds as the foam earplug expands. If the ear plug doesn’t seem to fit properly, remove it and try again. Acoustic noise safety Hearing protection must provide patients/volunteers with appropriate hearing protection that lowers the noise to at least 99 dB (A). Headphones are not classified as hearing protection Siemens Healthineers standard headphones are intended for communication with the patient and should be used in combination with earplugs All personnel should be trained to correctly apply hearing protection Any personnel accompanying a patient in the examination room must wear hearing protection during the examination that lowers noise to at least 85 dB(A). [e.g., nurse, anesthesiologists, personnel] It is mandatory to provide anesthetized or unconscious patients with hearing protection. Ear protection for these patients should not be omitted even at moderate sound levels Neonates and infants, special attention and training of personnel is required for proper positioning of hearing protection Researchers and veterinarians should use hearing protection for animals during MRI exams If the patient refuses hearing protection, facilities should have a process and procedure in place to discuss the risks of proceeding without hearing protection and may consider canceling the exam. Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 Reference: MR Safety | American College of Radiology (acr.org) MR Safety Screening & Patient Preparation Untitled Slide The following section will discuss M-R safety screening and patient preparation. MR Safety – Patient preparation It is highly recommended that any individuals undergoing an MR examination wear site-supplied MR Safe pocketless garments (patient gown, scrubs, etc.) in place of their own clothing and undergarments. Patients must remove: Readily removable metallic personal belongings and devices (e.g., insulin pumps, glucose monitors, etc.) Remove all metallic jewelry, watches, cell phones, body piercings, contraceptive diaphragms, pocketknives, etc. Clothing containing metallic fasteners, hooks, zippers, or loose metallic components/threads that may have been treated with antimicrobial electrically conductive materials Cosmetics containing metallic particles (e.g., eye makeup, magnetic eyelashes, glitter hair spray, bobby pins, etc.) Metallic drug patches Face masks should not include any metal in the nose pieces or fibers incorporated into the mask Reference: MR Safety | American College of Radiology (acr.org) Patient preparation During patient preparation, it is highly recommended that any individuals undergoing an M-R examination wear site-supplied M-R Safe pocketless garments (patient gown, scrubs, etc.) in place of their own clothing and undergarments. Patients must remove: Readily removable metallic personal belongings and devices (e.g., insulin pumps, glucose monitors, etc.). Remove all metallic jewelry, watches, cell phones, body piercings, contraceptive diaphragms, pocket-knives, etc. Clothing containing metallic fasteners, hooks, zippers, or loose metallic components/threads that may have been treated with antimicrobial electrically conductive materials. Cosmetics containing metallic particles (e.g., eye makeup, magnetic eyelashes, glitter hair spray, bobby pins, etc.). Metallic drug patches. Face masks should not include any metal in the nose pieces or fibers incorporated into the mask. Preliminary safety screening Preliminary safety screening Aids in the prevention of scheduling patients that may be inappropriate candidates for MR examinations. Alerts that the patient has an implant or device, so the implant or device can be verified if MR Safe, MR Conditional, or MR Unsafe [e.g., pacemaker, aneurysm clip, cochlear implant, etc.] Schedule patients on the correct magnet [e.g., cardiac exams, breast exams] Screens patients for claustrophobia, so medication can be requested from their ordering physician in preparation for the MR examination Special considerations are needed for pediatric patients, minors, and mentally impaired patients Pregnant patients Imbedded metal fragments from military activities Permanent make-up Reference: MR Safety | American College of Radiology (acr.org) Preliminary safety screening The preliminary safety screening, aids in the prevention of scheduling patients that may be inappropriate candidates for M-R examinations. It alerts the M-R Technologists, that the patient has an implant or device, so the implant or device can be verified if it is M-R Safe, M-R Conditional, or M-R Unsafe, for example if they have a M-R unsafe pacemaker, aneurysm clip, cochlear implant, etc. It allows the facility to schedule patients on the correct magnet, for example, for a cardiac exams, or breast exam. It screens patients for the claustrophobia, so medication can be requested from their ordering physician in preparation for the M-R examination. It brings awareness to the M-R Technologists in case there are any special considerations, for example, a pediatric patient, a minor, pregnant, or mentally impaired patient. Let’s the M-R technologist know if there is any imbedded metal fragments from military activities, or if the patient has permanent make-up. Comprehensive safety screening Reference: MR Safety | American College of Radiology (acr.org) Comprehensive Safety Screening Written or electronic MR screening form is essential to prevent unsafe exposure to Zone IV in the MR environment for any personnel. This includes patients, guardians, research participants, MR personnel, non-MR personnel, and ancillary staff. MR Level 2 personnel reviews the screening form with the patient, guardian, research participant, non-MR personnel, or ancillary staff. Printed or electronic form to document the screening procedure All questions must be answered [yes or no], no empty responses are accepted, additional information requested must be provided Patient, guardian, research participant, etc., and the MR Level 2 personnel performing the screening must both physically or electronically sign the completed safety screening form after the interview Safety Screening Form should become part of the individual’s medical record Additional written or verbal information for inclusion on a screening form must be provided by a physician or an advanced practice provider or another reliable source and documented in writing [e.g., knowledge about specifics related to an implanted device] Comprehensive safety training Audio Comprehensive Safety Screening consists of a written or Electronic M-R Screening form. It is essential to prevent unsafe exposure to Zone four in the M-R environment for any personnel. This includes patients, guardians, research participants, M-R personnel, non-M-R personnel, and ancillary staff The M-R Level-two personnel then reviews the screening form with the patient, guardian, research participant, non-M-R personnel, or ancillary staff. This can be either a printed or electronic form documenting the screening procedure. All questions must be answered [yes or no], no empty responses are accepted, additional information requested must be provided. The patient, guardian, research participant, etc., and the MR Level-two personnel performing the screening must both physically or electronically sign the completed safety screening form after the interview. Then the M-R Safety Screening Form should become part of the individual’s medical record. Additional written or verbal information for inclusion on a screening form must be provided by a physician or an advanced practice provider or another reliable source and documented in writing. For example, knowledge about specifics related to an implanted device. Patient screening form https://www.acr.org/Clinical-858 Resources/Radiology-Safety/MR-Safety. Patient screening form Pediatric, minors, and teenagers, should be screened twice by Level 2 MR Personnel: Once, in the presence of parents or guardians Second time, separately, to maximize the possibility that all potential dangers are disclosed Screening Pediatric and Minor Patients These patients are required to complete a written or electronic MR Safety screening questionnaire prior to entering Zone III. At least one of these screenings must be performed by Level 2 MR Personnel verbally and/or interactively with the patient. Screening Conscious, Nonemergent Patients All MR Personnel must undergo initial on boarding MR screening. A yearly review of MR safety screening must be performed. Significant changes in screening status must be reported to the MRMD immediately before returning to the MR environment. Screening Staff/Personnel Screening Screening additional patients & personnel Untitled Slide Audio When screening staff or when preforming personnel screening, remember that all M-R Personnel must undergo initial onboarding and M-R Screening. A yearly review of M-R Safety screening must be performed. Any significant changes in screening status must be reported to the M-R-Medical-Director immediately before returning to the M-R environment. When screening conscious, or non-emergency patients, remember that these patients are required to complete a written or electronic M-R Safety screening questionnaire prior to entering Zone three. At least one of these screenings must be performed by Level-two M-R Personnel verbally and, or interactively with the patient. When screening pediatric and minor patients, remember that pediatric, minors, and teenagers, should be screened twice by Level-two M-R Personnel. They must also be screened, in the presence of parents or guardians and then screened again separately to maximize the possibility that all potential dangers are disclosed. All pediatric, minor, and teenage patients are recommended to change into M-R Safe pocketless garments to ensure that no metallic objects, toys, or other unsafe items enter Zone four. Emergency patients and their accompanying non-MR Personnel may be screened only once by Level 2 MR Personnel. In cases of extenuating circumstances, there must be an agreement between the ordering physician and the MR MD acknowledging the risks of a decision not to screen prior to proceeding. Screening Emergency Patients If deemed appropriate to accompany or remain with the patient, companions should be screened using the same criteria as anyone else entering Zone IV. Screening Companions in Zones III and IV Screening of Unconscious, Unresponsive, Altered-Consciousness, Mentally Impaired Patients Family members or guardians of these patients that have appropriate knowledge should complete a written or electronic MR safety screening questionnaire prior to the patient entering Zone III. Screening additional patients & personnel If no reliable patient history can be obtained, and if the requested MR examination cannot reasonably wait until a reliable history might be obtained it is recommended that these patients be physically examined and undergo plain-film radiography as necessary to exclude potentially harmful embedded or implanted metallic foreign bodies, implants, or devices. Screening of Unconscious, Unresponsive, Altered-Consciousness, Mentally Impaired Patients Untitled Slide When screening unconscious, unresponsive, altered-consciousness, or mentally impaired patients, the family members or guardians that have appropriate knowledge should complete a written or electronic M-R safety screening questionnaire prior to the patient entering Zone three. If no reliable patient history can be obtained, and if the requested M-R examination cannot reasonably wait until a reliable history might be obtained it is recommended that these patients be physically examined and undergo plain-film radiography as necessary to exclude potentially harmful embedded or implanted metallic foreign bodies, implants, or devices. When screening emergency patients, the emergency patient and their accompanying non-M-R Personnel only need to be screened once by Level-two M-R Personnel. In cases of extenuating circumstances, there must be an agreement between the ordering physician and the M-R Medical Director acknowledging the risks of a decision not to screen prior to proceeding. When screening companions in Zones three and four, it is deemed appropriate to accompany or remain with the patient. These companions should be screened using the same criteria as anyone else entering Zone four. Safety in alternative MR environments MR Systems are increasingly being operated in alternative environments outside of conventional diagnostic facilities. Each of these represents unique challenges regarding MR Safety, particularly regarding unique devices, procedures, personnel, site-access restrictions, screening, site contamination, infection control, and adverse event management. Alternative MR Environments include: PET/MR MR Interoperative & Interventional MR-guided Radiation Therapy Specialized personnel with MR safety training and specific training to the workflows and procedures in these alternative environments is recommended. Reference: MR Safety | American College of Radiology (acr.org) Safety in Alternative MR Environments M-R Systems are increasingly being operated in alternative environments outside of conventional diagnostic facilities. Each of these represents unique challenges regarding M-R Safety, particularly regarding unique devices, procedures, personnel, site-access restrictions, screening, site contamination, infection control, and adverse event management. Alternative M-R Environments include: PET/M-R M-R Interoperative and Interventional, and M-R-guided Radiation Therapy Specialized personnel with M-R safety training and specific training to the workflows and procedures in these alternative environments is recommended. The M-R Medical Director at these facilities should ensure there are specific Standard-Operating-Procedures in place defining roles and responsibilities for the M-R Personnel. Standard-Operating-Procedures should include: Identification of the responsible person to ensure the safety of the patient, M-R Personnel, and other personnel who may care for the patient while in these alternative environments. Personnel working in the M-R Environment should have a minimum of Level-one M-R Training or be supervised by Level-two M-R Personnel. Processes to educate all other personnel who need access to Zone four should be developed, for example, for nurses, anesthesiologists, respiratory technologists, surgeons, etc. Personnel working in an alternative M-R environment should have a minimum of Level-one M-R training or be screened and directly supervised by Level-two M-R Personnel. In a PET and M-R environment, M-R Safety and radiation regulatory requirements often have and require shared responsibilities between the two medical directors [M-R Medical Director and the nuclear medicine authorized user]. In the intraoperative and interventional M-R environment, policies and procedures must clearly indicate which specific Level-two M-R Personnel are responsible for overseeing M-R safety. For mobile M-R scanners, siting may be associated with additional challenges around M-R Zone restrictions. At seven-Tesla, the risk of accidents due to projectiles or complications related to implanted devices substantially increases. M-R Conditional status at seven-Tesla cannot be assumed from existing M-R Conditional status at three-Tesla or other field strengths. Point of Care MRI Systems have a lower risk of missile-effect projectile incidents. However, there is insufficient data to assess safety related to scanning in the presence of active implanted medical devices and other devices. All involved staff, including non-M-R Personnel, should follow appropriate safety procedures. Reference: ACR Manual on MR Safety Alternative MR Environments – personnel working in the MR environment should have a minimum of Level 1 MR training or be screened and directly supervised by Level 2 MR Personnel. PET/MR – MR Safety and radiation regulatory requirements often need shared responsibilities between two medical directors [MRMD and nuclear medicine authorized user]. Intraoperative/Interventional MR – policies and procedures must clearly indicate which specific Level 2 MR Personnel is responsible for overseeing MR safety. Mobile MR Scanners – siting may be associated with additional challenges around MR Zone restrictions. 7T [Tesla] – the risk of accidents due to projectiles or complications related to implanted devices substantially increases. MR Conditional status at 7T cannot be assumed from existing MR Conditional status at 3T or other field strengths. Point of Care MRI Systems – low risk of missile-effect projectile incidents. Insufficient data to assess safety related to scanning in the presence of active implanted medical devices and other devices All involved staff, including non-MR Personnel, should follow appropriate safety procedures The MRMD at these facilities should ensure there are specific SOPs in place defining roles and responsibilities for the MR Personnel. Standard Operating Procedure (SOP) should include Identification of responsible person to ensure the safety of the patient, MR Personnel, and other personnel who may care for the patient while in these alternative environments. Personnel working in the MR Environment should have a minimum of Level 1 MR Training or be supervised by Level 2 MR Personnel. Processes to educate all other personnel who need access to Zone IV should be developed. [e.g., nurses, anesthesiologists, respiratory technologists, surgeons, etc.] Reference: ACR Manual on MR Safety Emergency Procedures & Emergency Switches Emergency Procedures & Emergency Switches The following section will discuss M-R emergency procedures and switches. Emergency procedures & MR related adverse events Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 In Case of an Emergency Familiarize the location and functionality of installed emergency switches. Report all accidents resulting in personal injury or damage to the MR magnet to the appropriate personnel (e.g., Siemens CSE, Siemens CCC, MR Level 1, MR Technologists, MRSO, etc.). Observe established emergency plans: Emergency plan in case of coolant accidents Emergency plan for firefighting Medical Emergency if a medical emergency occurs during an MR measurement or when a patient is in the Magnet room. Terminate the measurement immediately Remove patient from the examination room for treatment unless equipment required is MR Safe for use inside the MR Magnet room Don’t store or operate oxygen CO2 canisters, defibrillators, or other auxiliary tools for resuscitation in the MR Magnet room MR Related Adverse Events and Near Misses in the MR Environment must be reported by the facility [MRMD, Level 2 MR Technologists] to the MR Vendor and the FDA MedWatch program. FDA Safety Information and Adverse Event Reporting Program. Emergency procedures & MR related adverse events In Case of an Emergency, you should Familiarize the location and functionality of installed emergency switches. Report all accidents resulting in personal injury or damage to the M-R magnet, to the appropriate personnel, for example, the Siemens M-R Customer Service Engineer, Siemens Customer Care Center, M-R Level-one personnel, M-R-M-D, and the M-R-S-O, etc.). Observe established emergency plans in case of coolant accidents and observe established emergency plans for fire-fighters. M-R Related Adverse Events and Near Misses in the M-R Environment must be reported by the facility [M-R Medical Director or the M-R Level Technologists] to the M-R Vendor and the F-D-A Med Watch program. If a medical emergency occurs during an M-R measurement or when the patient is in the Magnet room. You must terminate the measurement immediately and remove the patient from the examination room for treatment. Unless the equipment required is M-R Safe for use inside the M-R Magnet room. Do not store or operate oxygen C-O-two canisters, defibrillators, or other auxiliary tools for resuscitation in the M-R Magnet room. MR emergency procedures - Emergency switches Select each number to learn more about emergency switches on the MR system. 1 1 1 1 2 2 2 2 3 3 3 3 The MR system has different types of emergency switches. In case of emergency, the relevant switch should be pressed. Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 Emergency switches The M-R system has different types of emergency switches. In case of emergency, the relevant switch should be pressed.... Select the numbers to review each switch, its effect, and the emergency it should be used for.... The Magnet Stop, shuts down the static magnetic field. This is also referred to as a Quench. A Quench is only performed in emergencies related to accidents with attracted metal parts. For example, a patient gurney, cart, is attached to the magnet. Or in cases where physical harm may occur, for example, patient trapped between gurney and magnet, or in case of a fire. The Emergency Shut-down, switches off the electric power to the entire M-R system, however, it is important to note that the magnet remains at field. The Emergency Shut-down switch is used in emergencies related to fire. The Table Stop, halts the motorized table movement. This is used in emergencies, related to accidents, or related to injury due to table movement. Always, follow the instructions regarding which switches should be used in case of emergency. Table with 3 columns and 2 rows Switch Effect Emergency Table Stop Motorized table movement is stopped In case of accidents or injury due to table movement Table with 3 columns and 2 rows Switch Effect Emergency Emergency Shut-down Electric power of the entire MR System is switched off, but the magnet remains at field In case of fire Table with 3 columns and 2 rows Switch Effect Emergency Magnet Stop Shutting down static magnetic field (Quench) Accidents (e.g., patient is trapped between gurney and magnet) In case of fire Magnet Stop Switch [Quench] The Magnet Stop switch triggers a controlled Magnet Quench. During a quench, the super-conductivity of the magnet (magnetic field) is shut down. The MR system is not disconnected from the power Liquid helium (coolant) boils off rapidly, released outside via an exhaust vent line Escape of helium may be noisy (loud roaring noise) due to high gas flow Two locations for the Magnet Stop on the MR system Individual Switch – remove static magnetic field. EMERGENCY use only. Alarm box – removes static magnetic field. EMERGENCY use only. Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 1. Magnet stop switch 2. Magnet stop switch on alarm box Magnet stop switch (Quench) The Magnet Stop Switch triggers a controlled Magnet Quench. During a quench, the super-conductivity of the magnetic field is shut down. However, the M-R System is not disconnected from the power. The Liquid helium (coolant) boils off rapidly and is released outside via an exhaust vent line. The escape of helium may be noisy (loud roaring noise) due to high gas flow. There are two different locations for the Magnet Stop switch on the M-R System. The individual magnet stop switch removes the static magnetic field. The magnet stop switch on the alarm box, also removes the static magnetic field. Both locations for the magnet stop switches quench the magnet and should only be used in cases of an EMERGENCY. After the Magnet Stop [Quench], switch is pressed, a WARNING LED will light up and an alarm signal will sound. The formation of droplets due to condensation during a quenching is dangerous. The quench creates dangerously high pressure and displaces oxygen from the room. This can cause asphyxiation and hypothermia is induced within a very short time. Personal injury may include, for example frostbite. So, it is important that you don’t touch the exhaust line or quench pipe and that you do not stand under the exhaust line. Immediately evacuate all personnel from the Magnet Room and remove the patient or volunteer from magnet bore and the magnet room. Restrict all access to the examination room and notify the Siemens Healthineers Customer Service Engineer and the Siemens Customer Care Center following a quench. Only Siemens authorized personnel can put the magnet back into operation. After the Magnet Stop [Quench] switch is pressed, a WARNING LED will light up and an alarm signal will sound. The formation of droplets due to condensation during quenching is dangerous. Creates dangerously high pressures and displaces oxygen from the room Cause asphyxiation and hypothermia are induced within a very short time Personal injury may include (e.g., frostbite) Don’t touch the exhaust line/quench pipe Don’t stand under the exhaust line Immediately evacuate all personnel from the Magnet Room Remove patient/volunteer from magnet bore Restrict access to the examination room Notify Siemens Healthineers CSE and CCC Emergency Shut-down switch Emergency Shut-down switch Switching off the electric power may be required: Voltage accidents Fire Emergency Shut-down switch Used to switch off the electric power from the entire MR System. The magnetic field remains ramped up. Fire and Electrical Accidents [e.g., smoke inhalation, electrical shock, and burns] Press Emergency Shut-down switch immediately. Make an emergency call (e.g., fire department]. Equipment that may be used in the MR Magnet room during a fire: Non-ferrous CO2 Fire Extinguishers Self-contained, anti-magnetic compressed-air breathing apparatus (or hose connection) Airtight chemical protective suit Establish emergency procedures and discuss precautions with the local fire department. Two (2) Emergency Shut-down switches are installed: Near the alarm box Near the examination room Select the hotspots to see the locations of the emergency shut-down switches in MR and to learn more. Reference: MAGNETOM Family Operator Manual – MR System and Coils, p.53 Emergency Shut-down switch The Emergency Shut-down Switch is used to switch off the electric power from the entire M-R System. Remember that the static magnetic field remains ramped up. It is important to establish emergency procedures and discuss precautions with the local fire department. Be aware that there are two Emergency Shut-down switches installed one near the alarm box and the other one near the examination room. Switching Off the electric power may be required if there is a voltage accident or in case of fire. In case of Fire and Electrical Accidents, for example, smoke inhalation, electrical shock, and burns. Press the Emergency Shutdown switch immediately, then make an emergency call to the local fire department. Equipment that may be used in the M-R Magnet room during a fire, includes a Non-ferrous C-O-two Fire Extinguisher, and a self-contained, anti-magnetic compressed-air breathing apparatus (or hose connection) and, an airtight chemical protective suit. Must always be reset on the component where it was activated [e.g., intercom, table, etc.]. Table Stop Button Reset Table movement and the current measurement are stopped immediately Message is displayed on the Select&GO display and the monitor LEDs on Intercom flash Table Stop Button Activated: The Table Stop button is located on the intercom and on the patient table [red button, indicated with a stop symbol]. Table Stop button Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.0 Table Stop button The Table Stop button is located on the intercom and on the patient table, it is a red button, indicated with a stop symbol. If the Table Stop button is activated, the table movement and the current measurement are stopped immediately. Then a message is displayed on the Select and GO display and on the Monitor the L-E-Ds on Intercom flash. To reset the table, Stop, the button used must always be reset on the component where it was activated, for example, on the intercom, or the table. Fire All facilities should provide MR Safety training to educate the local fire marshals, firefighters, police, and security personnel about potential hazards of responding to emergencies in the MR Magnet room [Zone IV]. It should be assumed in the event of a fire or other emergency in Zone IV, that the magnetic field is present, fully operational, and potentially dangerous. Free access to Zone III and IV by firefighters or other Non-MR Personnel with air tanks, axes, crowbars, or other firefighting equipment might prove catastrophic or lethal to responders. Reference: MR Safety | American College of Radiology (acr.org) MR Staff Response to Fire Rescue any personnel in danger only if safe to do so Activate the nearest Alarm, call to provide specific information about the event Contain fire by closing ALL doors or the room/are, including fire doors MR Conditional fire extinguisher may be used to control the fire, only if it is safe and that personnel have been properly trained Evacuate if instructed to do so by the fire department If a fire is in the magnet room [Zone IV] and cannot be contained by an in-room sprinkler or by safe use of an MR Conditional fire extinguisher, the fire department will require access to the room. In this instance, the magnet should be QUENCHED to avoid potentially serious injury to any personnel or damage to the MR equipment or scanner MR Emergency procedures - Fire MR personnel, safety officers, and cleaning Untitled Slide The following section will discuss M-R personnel & safety officers, along with cleaning precautions and recommendations. MR Level 1 & 2 personnel American College of Radiology (ACR) definitions Non-MR personnel Patients, visitors, or facility staff who don’t meet the criteria of Level 1 or Level 2 MR personnel. Level 1 MR personnel Individuals that have passed the facility’s MR Safety educational requirements (defined by Facilities MRMD) to ensure they do not constitute a danger to themselves or others in the MR environment. Level 2 MR personnel Those who have been extensively trained and educated in broader aspects of MR Safety and issues that may arise. Including but not limited to: Potential for RF-related thermal loading or burns Direct neuromuscular excitation from rapidly changing gradients Reference: MR Safety | American College of Radiology (acr.org) MR level 1 & 2 personnel The American College of Radiology has definitions for various personnel, they are defined as follows: Non-M-R Personnel, are patients, visitors, or facility staff who don’t meet the criteria of Level-one or Level-two, or M-R Personnel. Level-one, M-R Personnel, are individuals that have passed the facility’s M-R Safety educational requirements (defined by Facilities M-R-M-D) to ensure they do not constitute a danger to themselves or others in the M-R environment. Level–two, M-R Personnel have been extensively trained and educated in broader aspects of M-R Safety and issues that may arise. Including but not limited to the Potential for R-F-related thermal loading, burns, and direct neuromuscular excitation from rapidly changing gradients. Appropriate staffing in routine operating hours is essential to maintain patient safety in the MR environment. Staffing in emergency situations must ensure the safety of the MR Personnel, staff, and patients. If different staffing is considered and implemented outside of routine operating hours, essential safety measures must be implemented. MR staffing MR staffing ACR definitions Reference: MR Safety | American College of Radiology (acr.org) MR staffing & remote scanning Appropriate M-R staffing in routine operating hours is essential to maintain patient safety in the M-R environment. Staffing in emergency situations must ensure the safety of the M-R Personnel, staff, and patients. If different staffing is considered and implemented outside of routine operating hours, essential safety measures must be implemented. If performing remote scanning, M-R safety should not be diminished. When using a remote M-R operator, adequate staffing is essential to provide safe patient care. MRMD layer The M-R-Medical Director is a licensed physician or radiologists with appropriate training in M-R Safety. They are responsible for overseeing the M-R facility operational safety. The M-R-Medical Director responsibilities include: Safe execution of all M-R examinations. Appointing the M-R-Safety-Officer and the advisory M-R-Safety-Expert. Developing, implementing, and the maintenance of specific policies and procedures pertaining to the safe operation of M-R services. Implementing and maintaining appropriate M-R safe and quality assurance programs. Developing an appropriate system for record keeping and analysis in case of adverse events. Developing an appropriate ongoing assessment of risk for the facility. Developing appropriate investigation and recording all reported M-R safety adverse events. MRSO layer The M-R-Safety-Officer is responsible for working with the M-R-Medical Director and the M-R-Safety-Expert to implement the day-to-day practice of a comprehensive M-R Safety program. The M-R-Safety-Officer responsibilities include: To always ensure accessibility to operators of active M-R facilities. Making sure proper policies and procedures of the M-R-M-D are implemented and enforced. Development, document, and execute, in conjunction and under the authority of the M-R-M-D, safe working procedures for the M-R environment. Confirm that adequate written safety, emergency procedures, and operating instruction are issued, in consultation with the M-R-M-D and the M-R-S-E as needed. Implement and monitor appropriate measures for minimizing risk to staff and patients, in cooperation with the M-R-M-D. Manage hazards posed by the M-R equipment and monitoring the measures taken to protect against such hazards. In cooperation with the M-R-M-D, that medical, technical, nursing, emergency, and all other relevant staff groups (including ancillary workers) who may be exposed to the M-R environment are educated appropriately and updated as necessary as to M-R safety requirements. Provide M-R safety education and training in cooperation with and as per the policies of the M-R-M-D in addition to maintaining records of M-R personnel education. Consult with the M-R-M-D and, or M-R-S-E when further advice is required regarding M-R safety. Report to the M-R-M-D in a timely fashion any, and all M-R safety-related issues. Confirm that there is a clear policy for purchasing, testing, and clearly marking of all equipment that will be taken into Zones three and four. Provide safety advice on the modification of M-R protocols (in cooperation with the M-R-M-D and, or the M-R-S-E) as needed. Maintain regular contact with other relevant groups or committees responsible for the safety and welfare of personnel on site. Provide expertise in root cause analyses, solutions meetings that are related to M-R-I adverse events. MRSE layer The M-R-Safety-Expert is a resource for the M-R-M-D and the M-R-S-O for non-medically related M-R safety issues, for example, issues other than contrast agents, anxiolytics, and other pharmaceuticals. The M-R-Safety-Expert responsibilities include: Providing advice on the engineering, scientific, and administrative aspects of the safe use of M-R equipment, which includes quantification assistance for energy, force, and risk exposures. Advice on the development and continuing evaluation of a safety framework for the M-R environment. Advice for the development of local rules and procedures to ensure the safe use of M-R equipment. Safety advice regarding non-routine M-R procedures, which includes advice regarding safety related to implanted devices and other similar issues. Advise regarding the choice of M-R Safety programs and M-R Quality Assurance programs, evaluations, and audits. Safety advice regarding M-R equipment acceptance testing. Establishing and maintaining links with appropriate regional and professional bodies and reporting back to the M-R-M-D and M-R-S-O on safety-related issues. Expertise in root cause analyses, solutions meetings, related to MRI adverse events. The MRSE serves as a resource for the MRMD and MRSO for non medically related MR Safety issues (i.e., issues other than contrast agents, anxiolytics, and other pharmaceuticals). It is assumed the MRMD and MRSO are part of the organization performing the scan. The MRSE may be external to the organization. The MRSE is often an MR Physicist, but others with suitable expertise could also fill this role. The MRSE serves in an advisory role for one (1) or several MR facilities and thereby does not need to be physically present at the MR facility, although a prospectively and clearly defined means to contract the individual is expected. MR Safety Expert (MRSE) Note: Always refer to the ACR Manual on MR Safety for the MRSE responsibilities. MR Safety officer (MRSO) The responsibility will be assumed by a suitably trained individual, often an MR Technologist. Multiple MRSOs can be appointed by a facility, but a single MRSO should be identified and should always oversee safety practices within a defined component of the MRI Practice. It might be appropriate to name an MRSO for each facility location for each shift Note: Always refer to the ACR Manual on MR Safety for the MRSO responsibilities. MR Medical Director (MRMD) The responsibility will be assumed by a licensed physician/radiologists with appropriate training in MR Safety. The MRMD assumes overall and ultimate responsibility for the MR facility operational safety. They also ensure, always, either in person or via delegation to another qualified individual, the satisfactory performance of the responsibilities as defined in the ACR Manual on MR Safety. Note: Always refer to the ACR Manual on MR Safety for the MRMD Responsibilities. Remote scanning Safety should not be diminished with the use of remote MR Operator and adequate staffing is essential to provide safe patient care. ? Cleaning All facilities should provide MR Safety training to educate the cleaning personnel and accompanying personnel about the potential hazards of entering the MR Magnet room [Zone III]. Select the tab arrows to learn more about cleaning the room in MR zones III & IV. MR system Care and cleaning Floors System components Patient Table, Control Unit, Straps, Plugs, & Connectors RF coils & positioning aids Cleaning All facilities should provide M-R Safety training to educate the cleaning personnel and accompanying personnel about the potential hazards of entering the M-R Magnet room and Zone-three. Cleaning in Zone four is performed by the M-R Technologists or Level-two-M-R personnel. Improper cleaning of the M-R system including coils and accessories may pose of risk of electric shock or damage to the equipment. When cleaning only: Use commercially available cleaning and disinfection solutions. Follow the manufacturer's instructions and refer to the lists of approved detergents in the Siemens operator manual. Do not use hard or sharp objects, for example, knives or tweezers to remove residue. Do not pour cleaning fluid on surface areas and do not spray fluids, always use a damp cloth for cleaning. Do not submerge in cleaning or disinfection liquid. Do not rinse with water. The following cleaning or care products should not be used: Sprays. Silicone-based cleaning or care products. Cleaning or care products with substances that release ammonia. Cleaning or care products that destroy the anti-static properties of the floor covering. Use commercially available cleaning or care products for the floor and always follow the manufacturer's instructions. The following table lists classes of active agents that have been tested and approved. The detergents listed under Not Approved must not be used. Clean the system and components with a damp cloth. The following table lists classes of active agents that have been tested and are approved. The detergents listed under Not Approved must not be used. Carefully wipe the plugs and connectors with the cloth, don’t touch the contacts. To clean the Select and GO display, switch on Cleaning Mode. The following table lists classes of active agents that have been tested and are approved. The detergents listed under Not Approved must not be used. RF coils & positioning aids The following table lists classes of active agents that have been tested and are approved. The detergents listed under Not Approved must not be used. Patient Table, Control Unit, Straps, Plugs, & Connectors The following table lists classes of active agents that have been tested and are approved. The detergents listed under Not Approved must not be used. Carefully wipe the plugs and connectors with the cloth, don’t touch the contacts. To clean the Select&GO display, switch on Cleaning Mode. Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 System components Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 The following table lists classes of active agents that have been tested and approved. The detergents listed under Not Approved must not be used. Clean the system and components with a damp cloth. Care and cleaning floors Do not use the following cleaning or care products: Sprays Silicone-based cleaning or care products Cleaning or care products with substances that release ammonia Cleaning or care products that destroy the anti-static properties of the floor covering Use commercially available cleaning or care products for the floor. Follow manufacturer's instructions. Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 MR system cleaning Cleaning in Zone IV is performed by the MR Technologists or a Level 2 MR Technologist. Improper cleaning of the MR system including coils and accessories may pose of risk of electric shock or damage to the equipment. Cleaning Use commercially available cleaning and disinfection solutions. Follow the manufacturer's instructions. Refer to the lists of approved detergents. Do not use hard or sharp objects (e.g., knives or tweezers) to remove residue. Do not pour cleaning fluid on surface areas and do not spray fluids. Always use a damp cloth for cleaning. Do not submerge in cleaning or disinfection liquid. Do not rinse with water. Reference: System_Owner_Manual_MAGNETOM_Sola_SAPEDM_CUT_N10VA51A_SOM_Sola_M11-01002G.629.08.01.02 Disclaimer Please note that the learning material is for training purposes only. For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Please note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Unrestricted | Published by Siemens Healthineers AG | © Siemens Healthineers AG, 2024 Siemens Healthineers HQ | Siemens Healthineers AG Siemensstr. 3 91301 Forchheim Germany Phone: +49 9191 18-0 siemens-healthineers.com Disclaimer Course Review Congratulations. You have completed the MR Safety – Level 1 course. Select the numbered buttons below to review the material before proceeding to the final assessment. Objective Three Objective Two Objective One 1 1 1 3 3 3 2 2 2 4 4 4 6 6 6 5 5 5 Objective Four Objective Six Objective Five Course Review Objective 6 Recall the cleaning procedures in Zone III and Zone IV in the MR Environment. Cleaning Use commercially available cleaning and disinfection solutions. Follow the manufacturer's instructions. Refer to the lists of approved detergents. Do not use hard or sharp objects (e.g., knives or tweezers) to remove residue. Do not pour cleaning fluid on surface areas and do not spray fluids. Always use a damp cloth for cleaning. Do not submerge in cleaning or disinfection liquid. Do not rinse with water. Objective 5 Identify MR Personnel & MR Safety Officers. Level 1 MR Personnel Individuals that have passed the facility’s MR Safety educational requirements (defined by Facilities MRMD) to ensure they do not constitute a danger to themselves or others in the MR environment. Level 2 MR Personnel Those who have been extensively trained and educated in broader aspects of MR Safety and issues that may arise. Including but not limited to: Potential for RF-related thermal loading or burns Direct neuromuscular excitation from rapidly changing gradients MRMD The MRMD assumes overall and ultimate responsibility for the MR facility operational safety. MRSO Multiple MRSOs can be appointed by a facility, but a single MRSO should be identified and should always oversee safety practices within a defined component of the MRI Practice. The MRSO is typically an MR technologist. MRSE The MRSE serves as a resource for the MRMD and MRSO for nonmedically related MR Safety issues (i.e., issues other than contrast agents, anxiolytics, and other pharmaceuticals). Objective 4 Describe Emergency Procedures & Emergency Switches. Table with 3 columns and 2 rows Switch Effect Emergency Magnet Stop Shutting down static magnetic field (Quench) Accidents (e.g., patient is trapped between gurney and magnet) In case of fire Table with 3 columns and 2 rows Switch Effect Emergency Emergency Shut-down Electric power of the entire MR System is switched off, but the magnet remains at field In case of fire Table with 3 columns and 2 rows Switch Effect Emergency Table Stop Motorized table movement is stopped In case of accidents or injury due to table movement Objective 3 Explain MR safety screening and patient preparation. Preliminary Safety Screening Aids in the prevention of scheduling patients that may be inappropriate candidates for MR examinations. Alerts that the patient has an implant or device, so the implant or device can be verified if MR Safe, MR Conditional, or MR Unsafe [e.g., pacemaker, aneurysm clip, cochlear implant, etc.] Schedule patients on the correct magnet [e.g., cardiac exams, breast exams] Screens patients for the claustrophobic, so medication can be requested from their ordering physician in preparation for the MR examination Special considerations are needed for pediatric patients, minors, and mentally impaired patients Pregnant patients Imbedded metal fragments from military activities Permanent make-up Comprehensive Safety Screening Written or Electronic MR Screening form is essential to prevent unsafe exposure to Zone IV in the MR environment for any personnel. This includes patients, guardians, research participants, MR personnel, non-MR personnel, and ancillary staff. Objective 2 Identify the electromagnetic fields and the difference between MR safe, unsafe, and conditional. In the examination room, there are different kinds of electromagnetic fields and the resulting risks that include: Static Magnetic Field Gradient Fields (or) Time-Varying Magnetic Field Gradient [dB/dt] Magnetic Field [B0] (or) Time-Varying RF Fields (or) Radiofrequency (RF) Fields [B1] MR Safe objects or devices that pose no know hazards to a patient or individual in the MR environment, without conditions. MR Unsafe object or device is known to present safety risks in the MR environment. The object or device is a contraindication for an MR procedure and/or the individual to enter the MR environment. MR Conditional objects or devices that may or may not be safe for a patient undergoing an MR procedure. It demonstrated to pose no known hazards in a specified MR environment with specified conditions of use. Objective 1 Describe the MR environment and the MR safety zones. The Magnetic Field is ALWAYS ON even when the MR System is NOT being used. Zone I The areas freely accessible to the public: typically, outside MR Environment where patients, health care personnel, and other employees of the MR facility access the MR environment MR reception area/waiting room Zone II This area is the interface between the publicly accessible, uncontrolled Zone I and strictly controlled areas of Zones III and IV. Screening and ferromagnetic detection is often performed in Zone II Patient screening area, patient changing rooms, office staff, etc. Zone III MR controlled access area, next to the MR Magnet room, such as the MR Control Room/Computer Room. Entrance has restricted access to the public by using reliable key locks, access control cards/badges with radiofrequency ID (RFID), similar technology, or a method to ensure access is limited to designated personnel Identify entrances with Signs: Caution, Restricted Access, etc. All individuals including non-MR personnel must be accompanied and/or under the supervision of MR Level 2 personnel while in Zones III and IV, except when in changing rooms and/or in the bathroom Zone IV Inside MR scanner room (physical walled confines where a scanner is located). Generally located within a surrounding controlled access Zone III Precise boundaries of Zone IV and Zone III can be in flux depending on the clinical situation and configuration (e.g., preoperative MR) Assessment Assessment Welcome to the assessment. For each question, select the button to the left of your answer, and then select Submit. You will have 3 attempts to take this assessment and to successfully pass this course, you must receive a score of 80% or higher. You will receive your score when you have completed the assessment. Note: If you close the learning activity at any time before you have finished the quiz, your answers will not be saved. Select Start to begin. Start Assessment Select the best answer. ? Zone I Zone IV Question 1 of 6 _____________ areas are freely accessible to the general public. Zone II Zone III Zone III Zone III Multiple Choice Select the best answer. ? Zone I Zone IV Question 2 of 6 _____________ is the controlled access area and the entrance has restricted access to the general public with key locks, access control cards/badges or similar technology. Zone II Zone III Multiple Choice Select the best answer. ? Localized Translational Peripheral Question 3 of 6 _______ forces tend to be greatest near the edge of the magnet, where the Static Field Gradient is largest? Rotational Multiple Choice Select the best answer. ? True Question 4 of 6 The Magnetic Field is ALWAYS ON even when the MR System is NOT being used. False Multiple Choice Select the best answer. ? Magnet Stop Table Stop Transfer Question 5 of 6 The _____________ switch triggers a controlled Magnet Quench. Emergency Shutdown Multiple Choice Select the best answer. ? MR Safety Zone Expert (MRZE) MR Medical Director (MRMD) Question 6 of 6 The __________________ assumes overall and ultimate responsibility for the MR facility operational safety. MR Safety Expert (MRSE) MR Safety Officer (MRSO) Multiple Choice Retry Assessment Results %Quiz1.ScorePercent%% %Quiz1.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Results Slide You have exceeded your number of assessment attempts. Exit You did not pass the course. Select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Certificates tab from the learning activity overview page. You can also access the certificate from your PEPconnect transcript. You have completed the MR Safety – Level 1 assessment. Completion Question Bank 1 MRI Safety Level 1 1 MR Safety Level 1 1.1 Objectives 1.2 Disclaimers 1.3 MR environment, safety zones, and safety labeling 1.4 MR environment 1.5 MR Safety Zones 1.6 Functional diagram 1.7 MR safety labeling 1.8 Electromagnetic fields 1.9 Static magnetic field 1.10 Noise safety 1.11 MR Safety Screening & Patient Preparation 1.12 Patient preparation 1.13 Preliminary safety screening 1.14 Comprehensive safety training 1.15 Screening additional patients & personnel 1.16 Screening additional patients & personnel 1.17 Safety in Alternative MR Environments 1.18 Emergency Procedures & Emergency Switches 1.19 Emergency procedures & MR related adverse events 1.20 Emergency switches 1.21 Magnet stop switch (Quench) 1.22 Emergency Shut-down switch 1.23 Table Stop button 1.24 MR Emergency procedures - Fire 1.25 MR personnel, safety officers, and cleaning 1.26 MR level 1 & 2 personnel 1.27 MR staffing & remote scanning 1.28 Cleaning 1.29 Disclaimer 1.30 Course Review 2 Assessment 2.9 Completion