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MRI ELSC Neuroimaging Unit

Guidelines & Safety

Safety Training

Safety training is scheduled every four months. Those who are planning to attend the next safety training are requested to register here; at least five registrants are required.

All safety training sessions are held at the ENU.

Scanning people with tattoos or permanent makeup

Scanning people with tattoos (including permanent makeup) can be dangerous, as the tissue around the tattoo may overheat and cause burns. This danger is rare, and more likely to happen with older tattoos (from several decades ago), or with very large tattoos, or tattoos that contain certain geometrical elements. Although incidents of tattoo burn in the MRI are rare (see below), the damage can be quite considerable.

At the ENU, tattooed participants may be scanned with the following limitations:

People with permanent makeup, with tattoos on the head, neck, or face, or with large tattoos (over 10% of the skin) can not be scanned.
For participants whose tattoos are not exclusionary, extra care should be taken when scanning:

The participant must declare the existence of a tattoo, including its size, location on the body, and the shop where the tattoo was done. All this should be recorded in writing as part of the mental questionnaire form.
In addition to written information, the participant must make a verbal declaration to the RT about any tattoos or permanent makeup.
The participant will be given all information about the potential risks associated with scanning tattoos. This information will be given both orally and as part of the informed consent form that was approved by the Helsinki committee.
The participant will be instructed to immediately report any heat, pain, or abnormal sensation in the area of the tattoo. The participant should explicitly be told that they should press the stress button (and thus stop the scan) at any time during the scan if they feel heat in the area of the tattoo.
Subjects with tattoos will be monitored closely while maintaining auditory and/or visual contact throughout the exam.

Even when all the above limitations are followed, the RT may still decide not to scan a participant with a tattoo.

Note that the inclusion of participants with tattoos in the research must be confirmed for each research protocol (Helsinki) separately, and must be explicitly included in the informed consent form of that research!

For full details on when and how to scan people with tattoos, as well as other safety issues, please refer to the ENU working guidelines and safety regulations (available in Hebrew and English).

Adverse MRI events in the last decade, worldwide

The MRI environment is safe when all appropriate precautions are taken, but it can easily become dangerous if such precautions are neglected. Recently, Delfino et al. (2019) published a report that summarizes the adverse events in MRI research over the previous decade. Here are the main findings:

Between 2008 and 2017, the United States’ Food and Drug Administration (FDA) recorded 1,548 MRI-related adverse events worldwide, including 3 deaths directly associated with MRI:

Malfunction of an implantable pain pump after exposure to the static field of the MR system.
A field service engineer was crushed by a blower panel that became a projectile.
A field service engineer who went into cardiac arrest while under anesthesia for follow-up treatment of a cryogen burn.

Other adverse events included:

Thermal events (906 events, 59%). Thermal events range from local irritations to second- and third-degree burns. Some events were due to direct contact with the coil cables (16%) and scanner bore (10%). Other major risks were skin-to-skin contact that caused radiofrequency loops (16%) and the introduction of other conductive elements inside the bore (jewelry and clothing, electrocardiograms, or other electrodes or other medical devices, totaling about 12%). Other events had either insufficient data to pinpoint the exact cause of the burn (40%) or were unrelated to scanning (6% – e.g., fires or cryogenic events during maintenance). Only 6 cases of tattoo-related burns were recorded.
Projectile events (133 events, 9%). Projectile events occur when magnetic items are introduced into the scanner room and get attracted to the strong magnet inside the scanner. These magnetic items, as projectiles, can cause cuts and bruises and, in extreme cases, severe injuries and even death. Most projectiles were service carts, wheelchairs, monitors, surgical tools, and other patient-care equipment. Service tools and equipment (e.g., floor polishers, firefighting equipment) also became projectiles occasionally. In most cases, human error or untrained personnel was the cause of the projectile event. In one example, a family member carrying a gun rushed to help the patient inside the magnet room. The gun discharged, and the bullet went into the family member’s leg.
Acoustic events (86 events, 6%). Most of the acoustic events were reports of ringing (tinnitus) or hearing loss due to prolonged exposure to scanner noise without adequate ear protection. In some cases, however, acoustic effects were reported even when protection was provided. The most likely explanation is that the protection was not applied properly or fitted poorly.
Mechanical malfunctions (170 events, 11%). Mechanical malfunctions were mainly falls from the scanner bed and finger pinching from moving the patient bed (which sometimes required the amputation of fingers).
Peripheral Nerve Stimulation (0 events, 0%). No adverse events were listed for Peripheral Nerve Stimulation, and it is considered an issue of patient comfort rather than safety.

What can we at the ENU do to avoid these adverse events?

Double-check upon entering the MRI room. Never allow anyone who is untrained or who is not required for the experiment to get near the door to the MRI room.
Explain to the participant the importance of filling in the metal screening form correctly (Ideally, present the form to the participant beforehand, to avoid wasting their time and yours).
Place the participant carefully into the scanner. To avoid pinching, make sure the participant’s hands and fingers are on the bed. Instruct the participant to keep their hands and legs apart to avoid forming radiofrequency loops, and make sure there is no direct contact between the coil cables and the participant’s hands and feet.
Take your time when putting on the participant’s earplugs and headphones. Make sure that everything is in place, and verify with the participant that they are comfortable.
Encourage the patient to inform you immediately if they begin to experience any problems, burning, or other irregular sensations.
Never bring any object to the MRI room if it was not approved by ENU personnel beforehand.
In emergencies, keep calm and follow the procedures. Do not let untrained personnel near the MRI room.
If you are not sure about something, avoid doing it, and contact ENU personnel if necessary.