Pediatric MRI safety events require vigilance, study finds

Pediatric MRI safety events are uncommon but persistent enough to require continued vigilance, according to research published in the Journal of the American College of Radiology.

The multicenter analysis reviewed Zone IV safety events at 5 pediatric hospitals between 2017 and 2022. Researchers identified 146 safety incidents across nearly 541,000 pediatric MRI exams.

Zone IV refers to the MRI scanner room, the area with the highest safety risk because of the static magnetic field. The American College of Radiology’s MRI safety model uses controlled zones to limit access and reduce hazards around the magnet.

Across the participating sites, the average rate was about 5 Zone IV safety events per site per year, or roughly 3 events per 10,000 exams, Radiology Business reported. Most events did not cause serious harm, but the authors emphasized that MRI incidents can have serious consequences for children, caregivers, and staff.

“Although uncommon, MRI safety incidents do occur in Zone IV of pediatric imaging departments,” Jonathan R. Dillman, MD, MSc, of Cincinnati Children’s Hospital, and colleagues wrote.

Projectiles were the most common category, accounting for 44 of 146 events, or 30%. Burn and thermal injuries accounted for 19 events, or 13%, while implant-related events accounted for 14, or 10%. Ten events, or 7%, were classified as serious safety occurrences.

Protocol adherence was a major issue. MRI safety protocols were not correctly followed in 88 of the 146 events, or 60%, and 78 events, or 53%, directly involved patients, the article noted.

Medical equipment, supplies, and personal items such as phones, pens, badges, and jewelry were among the common contributors. The authors said those findings support stronger screening of patients, staff, and accompanying adults before Zone IV entry.

Implants add another challenge in pediatric MRI. The authors estimated that 20% to 30% of children undergoing MRI may have implants such as glucose monitors, surgical K-wires, aneurysm clips, or hearing implants. Some implant-related events occurred even when manufacturer guidelines were followed, underscoring the need for more coordinated safety review.

The authors said implant safety requires coordination among radiologists, technologists, scanner manufacturers, device manufacturers, and the U.S. Food and Drug Administration. They also called for consistent use of device checklists during screening and the imaging encounter

A related review in Pediatric Radiology has also emphasized that MRI safety depends on culture, not only written protocols. Key elements include patient and staff screening, physical barriers, zoning rules, emergency response protocols, adverse event management, and clear safety roles such as MRI medical director, MRI safety officer, and MRI safety expert.

The JACR authors concluded that continued reporting, protocol reinforcement, and safety improvement efforts are needed to reduce risk in pediatric MRI departments.