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?
Yes
No
Yes
No
c.
d.
Are the screening areas/public passageways
placed beyond the magnetic fringe field (5.0
Gauss)?
Is there a method for continuous visual,
verbal and/or physiological monitoring of the
patient during the examination?
Is hearing protection available and offered to
every patient?
Standards Reference - (4A)
Yes
No
Standards Reference - (4A)
Yes
No
3. Screening
a.
b.
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?
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?
Standards Reference- (4A)
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?
Was a minimum of one hour of MRI safety
instruction completed for the medical and
technical staff?
Standards Reference - (4A)
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
Yes
No
4. Training
a.
b.
Yes
No
Standards Reference - (1A)
Yes
No
5. Emergency Preparedness
a.
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 siteappointed medical physicist?
Yes
No
Standards Reference - (1B)
Yes
No
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 performing the tests?
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?
c.
Was the report signed and dated by the
person(s) performing the tests?
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?
Yes
No
Standards Reference - (1B)
Yes
No
Yes
No
Yes
No
Standards Reference - (1B)
Yes
No
Yes
No
7. Safety Policies
a.
b.
c.
d.
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?
Standards Reference - (4A)
Yes
No
Is there documentation of this incident?
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?
Is the administration of contrast agents,
medication and/or sedation performed by
licensed or qualified trained personnel, under
the direct supervision of a licensed physician or
in compliance with federal, state or local laws?
If cardiovascular procedures are performed,
are there MRI safety policies that include a
detailed description of the graded protocols
and/or infusion protocols described?
Yes
No
Standards Reference - (4A)
Yes
No
Standards Reference - (4A)/comments
Yes
No
Standards Reference- (4A)
Yes
No
Do the QI meeting minutes reflect the review
of clinical image quality, QC testing and
MRI safety?
Yes
No
Are there recommendations, actions needed,
or issues to be addressed?
Yes
No
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.
8. Finalization
9. Recommendations