IAC MRI Safety Checklist/ Guidance Document

1. Review and Oversight
Are MRI safety policies and procedures well documented and reviewed annually by the QI Committee or Medical Director? / Standards Reference-(4A)
Yes No
2. Examination Room
a. / Is access to the examination room well defined, controlled and supervised by a technical staff member? / Yes No
b. / Is the entrance and door to the examination room clearly marked as hazardous, with appropriate warning signs displayed?
Are the screening areas/public passageways placed beyond the magnetic fringe field (5.0 Gauss)? / Yes No
Yes No
c. / Is there a method for continuous visual, verbal and/or physiological monitoring of the patient during the examination? / Standards Reference- (4A)
Yes No
d. / Is hearing protection available and offered to every patient? / Standards Reference- (4A)
Yes No
3. Screening
a. / Is there a mechanism in place to identify those patients/staff members/visitors at high risk for untoward effects or complications from entering the MRI environment? / Standards Reference- (4A)
Yes No
b. / Is there a mechanism in place that
assures that patients who could be pregnant are identified, along with an explanation of the proper steps to be taken if a patient may be or is pregnant? / Yes No
4. Training
a. / Is there a policy in place to educate, train and screen all MRI facility staff members and personnel that may be required to enter the MRI environment? / Standards Reference- (4A)
Yes No
b. / Was a minimum of one hourof MRI safety instruction completedfor the medical and technical staff? / Standards Reference - (1A)
Yes No
5. Emergency Preparedness
a. / Is there a written policy in place in the event of a MRI procedure-related emergency for patient management that includes rapid recognition, response and removal of the patient from the magnet room to administer emergency care? / Standards Reference- (4A)/comments
Yes No
6. Equipment Maintenance Assessment
a. / Was there an acceptance test performed after the MRI system installation or following a major upgrade by the manufacturers representative, service engineer or the site-appointed medical physicist?
Does the report include the QC tests performed, the results as compared to manufacturer’s or industry guidelines,
recommendations to the facility (if any) and was the report signed and dated by the person performingthe tests? / Standards Reference- (1B)
Yes No
Yes No
b. / Is a Preventative Maintenance (PM) service performed at least every 12 months?
Was the report of the PM, quality control tests and service records maintained at the MRI facility?
Was the report signed and dated by the person(s) performing the tests? / Standards Reference- (1B)
Yes No
Yes No
Yes No
c. / Are the routine quality control (QC) tests being performed by the technical staff operator in accordance with the IAC MRI Standards and the manufacturer’s recommendations?
Did the QI committee review the QC testing and a facility safety review at a minimum annually? / Standards Reference-(1B)
Yes No
Yes No
7. Safety Policies
a. / Is there a procedure in place for the identification of a patient or individual (i.e., visitor, staff member) who suffers an incident or complication from the MRI examination or exposure to the MRI environment?
Is there documentation of this incident? / Standards Reference-(4A)
Yes No
Yes No
b. / Is there a procedure in place to address possible contraindications that include Nephrogenic Systemic Fibrosis (NSF) and contrast material sensitivity, if used, and allergies to medications? / Standards Reference- (4A)
Yes No
c. / Is the administration of contrast agents, medication and/or sedation performedby licensed or qualified trained personnel, under the direct supervision of a licensedphysician or in compliance with federal, state or local laws? / Standards Reference- (4A)/comments
Yes No
d. / If cardiovascular procedures are performed, are there MRI safety policies that include a detailed description of the graded protocols and/or infusion protocols described?
These protocols must include the timing of assessing symptoms, heart rate, blood pressure and electrocardiographic tracings; exercise testing end points; pharmaceutical injection criteria and post stress monitoring. / Standards Reference- (4A)
Yes No
8. Finalization
Do the QI meeting minutes reflect the review of clinical image quality, QC testing and MRI safety? / Yes No
9. Recommendations
Are there recommendations, actions needed, or issues to be addressed? / Yes No