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Target Audience

This program is intended for: Radiologists, Physicists, Radiology Administrators, MRI Technologists, Radiologic Technologists, related Imaging Professionals and those responsible for MRI Safety.

No special educational preparation is required for this CME/CE Activity.

Program Summary

Applied Radiology and William Faulkner & Associates are pleased to introduce “The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD)”. This comprehensive program, focusing on MR Safety, covers many aspects relating to the safety practices of the Magnetic Resonance Imaging (MRI) environment. It is designed for those individuals who are either currently serving as their facility’s MRSO and/or MRMD, or those who are preparing to assume these responsibilities. The content of this course will be helpful for those preparing for the American Board of Magnetic Resonance Safety MRSO and MRMD examinations.

Over the past 30+ years, Magnetic Resonance Imaging (MRI) has become a major tool in diagnostic imaging. Advancements in the technology have resulted in faster imaging sequences and clinical systems with field strengths ranging from low field at .2T, to high field at 7T. With the increase in MRI utilization, the number of reported safety incidents has increased significantly. Accrediting entities such as American College of Radiology and The Joint Commission have increased their focus on MR Safety, requiring that an MRI environment be safe and staffed with knowledgeable individuals who are regularly trained, with the goal of avoiding safety-related incidents and injuries. Often, for many MRI departments, MR Safety Training is not regularly provided, nor closely monitored or enforced as a part of the routine clinical practice. Therefore, MR Safety training is both necessary and important, for radiologists, technologists, and anyone working in, or entering the MRI environment. Having trained individuals in the role of MR Medical Director and MR Safety Officer is essential to creating and maintaining a culture of safety in MRI.

In 2002 the ACR published the first guidance document on MR Safety known as the ACR Guidance Document for MR Safe Practices. This document has been updated several times and has become the “de facto industry standard”.

The content of The Online Course for MR Safety Officers and MR Medical Directors is based upon current FDA and ACR guidelines, including the ACR Guidance Document for MR Safe Practices, as well as those promulgated by industry regulatory bodies such as the International Electrotechnical Commission.

Successful completion of the program results in 10 hours of Continuing Medical Education credits and 10 hours of Category A credits.

* The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD) is intended to be an online study course and is not considered to be a substitution for the MRSO/MRMD certification examination. Further, The Online Course is not affiliated with, nor endorsed by the American Board of Magnetic Resonance Safety. Participants must still schedule time to take the MRSO/MRMD certification exam when offered for full certification

Module 1: Basic MRI Physics Relevant to MRI Safety

Objectives:

• Identify the 3 types of magnetic fields used in MRI
• Describe the 3 major technologies used for MR system magnets (static field)
• Describe the difference between the spatial gradient field and the switched gradient fields
• Identify and describe the various types of configurations for RF coils

Module 2: Static Field: Bioeffects and Access Control

Objectives:

• Identify the forces exerted on metallic items in a static magnetic field
• Describe the main biologic effects resulting from exposure or movement through a magnetic field
• Distinguish between the various MR safety zones as defined by the American College of Radiology
• Explain the importance of the location of the 5 Gauss line
• Explain the difference between a conventional metal detector and a ferromagnetic detection device (FMD)
• Describe the major types of FMD devices currently available

Module 3: Gradient Magnetic Fields: Bioeffects and Safety

Objectives:

• Describe the configuration of the gradient coils used in MRI
• Define the term “Slew Rate”
• List common scan-related parameters affected by the systems slew-rate
• Name the concerns related to the time-varying gradient magnetic fields in relation to metallic and electrical implants and/or devices
• Name the major bioeffects resulting from exposure to time-varying gradient magnetic fields
• State the operating mode limits as it relates to the time-varying gradient magnetic fields
• Describe the source of the acoustic noise produced during an MRI exam
• State the limit above which hearing protection is required

Module 4: Radio Frequency Field: Bioeffects and Safety

Objectives:

• Name and describe the various types of radio frequency coils used in MRI
• Describe the use of RF coil distribution maps
• Define Specific Absorption Rate
• List factors affecting SAR
• State the SAR limits for whole body average and head SAR in both the normal and first level controlled operating modes
• Name the 3 major sources of RF-related burns
• List steps which should be taken to reduce the risk of RF-related burns

Module 5: Implants and Devices

Objectives:

• Define the ASTM standards for labeling
• Describe the current standard for confirmation and documentation of a specific implant or device
• Name the person ultimately responsible for the decision to perform an MR exam on a given patient
• List various MR-system related parameters and specifications which may be listed in condition of use for an implant or device
• Summarize the assessment of non-labeled items with regard to MR safety

Module 6: Gadolinium-Based MR Contrast Agents

Objectives:

• Define the basic classifications of currently approved Gadolinium-Based Contrast Agents (GBCAs)
• State the route of excretion for the various agent types
• Calculate volume to be administered based on patient weight and molar concentration of the agent
• Name the common physiologic and anaphylactoid adverse events which can occur following the IV administration of a GBCA
• List the treatment options following various adverse events
• Describe the type of physician supervision during a contrast enhanced MR exam as required by CMS
• Describe the various types of GBCA chelate molecular structures
• Define NSF
• Name the agents currently contraindicated in patients with an eGFR below 30
• Name the agents in each of the ACR groups
• Summarize the FDA and ACR’s current statements regarding GBCA deposition and retention

Module 7: MR Safety Screening

Objectives:

• Describe the screening process for both patients and non-patients
• Summarize the benefit of the use of FMD in patient screening
• Describe the process for the safety screening of the unresponsive patient
• Name the major reasons for changing all patients out of street clothes prior to an MRI exam
• State the standard for screening for intra-ocular metallic objects
• Name the type of tattoo pigment of most concern for heating
• State the FDA and ISMRM stance on the use of MRI in pregnant patients
• State the ACRs recommendation for documenting the use of MRI in pregnant patients
• State the ACRs recommendations for the use of a GBCA in pregnant patients

Module 8: Managing Emergent Situations and Patient Considerations: Quench and Patient Anxiety & Patient Monitoring

Objectives:

• Describe what occurs during a quench
• List the dangers should the primary vent system fail during a quench
• State the dangers of quenching a magnet with an active fire in Zone IV
• Describe what should occur in the event a patient experiences a cardiac arrest during an MRI exam
• Name techniques for managing patient anxiety

Faculty

Conflict of Interest Disclosure Policy

IAME requires everyone who is in a position to control the content of a CE/CME activity to disclose all relevant financial relationships with any commercial interest. This information is utilized to 1) determine if a conflict exists, 2) resolve the conflict by initiating a content validation process, and 3) advise learners of this information. Any individual who refuses to (or chooses not to) disclose relevant financial relationships will be disqualified from participating as an instructor, planner or manager and cannot have control of or responsibility for the development, management, presentation or evaluation of a CE/CME activity certified by IAME.

Disclosures

William Faulkner, has no personal conflicts of interest to be reported.

Kristan Harrington, has no personal conflicts of interest to be reported.

No individual at IAME who had control over the content of this program has relationships with any commercial supporter.

Accreditation

Physician
The Institute for Advanced Medical Education (IAME) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Institute for Advanced Medical Education (IAME) designates this enduring material for a maximum of Ten (10) AMA/PRA Category 1 CME Credits.™ Physicians should only claim credit commensurate with the extent of their participation in the activity.

Radiologic Technologist:
This course meets all criteria and has been approved by the AHRA, The Association for Medical Imaging Management for Ten (10) ARRT Category A CE Credit.

Radiology Administrator:
This course meets all CRA renewal credit criteria and has been approved for Ten (10) continuing education credit in the following CRA domain: Operations Management (OM).

For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board or other credentialing organization.

Method of Participation/Criteria for Success

CME Credits
To receive CME credits for participating in this CME activity you must successfully complete the online post examination with a passing score of 70% or higher.

CE Credits
To receive CE credits for participating in this CE activity you must successfully complete the online post examination with a passing score of 80% or higher.

Online examinations return an immediate grade report. Upon receiving a passing score click Continue and complete the evaluation form. To view and print your Statement of Credit click the Print/View Certificate button displayed from within your MyAR Archives page.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.