0:01

So let's take a look at how the accreditation

0:05

organizations fair when we look at those existing best practices

0:10

that are demonstrably effective at preventing M R I injury

0:15

accidents. So on the left hand column,

0:18

we have probably the top two enterprise

0:23

or hospital level parent H accrediting organizations,

0:27

the Joint Commission and D N V Healthcare.

0:31

And below that we have the two largest modality level or

0:36

outpatient accrediting organizations,

0:39

the ACR and the I A C.

0:43

So I want you to think about your facility and you likely

0:48

have one of these accreditations,

0:50

or you may actually have more than one of these accreditations.

0:53

But I want you to ask yourself the question,

0:57

does my accreditation require these

1:02

projectile related safety protections? Does it require the ACR four zone?

1:07

Does it require ferromagnetic detection?

1:09

Does it require conspicuous device labeling of the safety

1:14

attributes of that product or device? Think about your answer.

1:20

So in fact,

1:23

the Joint Commission requires what it largely

1:28

describes as zones three and four. It doesn't call it that,

1:32

but the text suggests that.

1:36

But other than the joint commission requiring part of the

1:40

ACR four zone or the the four zone model,

1:44

none of the accrediting organizations actually require any

1:49

of the best practices that we know would prevent these types of

1:54

injury accidents.

1:56

The ACR requires policies related to

2:00

access restriction. They just don't require any staff training,

2:04

and they don't actually require their own guidance be practiced.

2:10

So everybody fares kind of poorly with projectile related

2:14

protections in accreditation.

2:17

What about radio frequency burns? Again,

2:21

the three preventions that we're looking at here requiring the use of padding

2:26

between the patient and the transmitting RF element,

2:29

removing unneeded electrically conductive materials and preventing large caliber

2:34

body loops or skin tokin contact. Again,

2:38

I want you to ask yourself what minimally is required

2:43

under your accreditation regime. And again,

2:48

you may be shocked at how little of

2:53

the actual best practices are required.

2:57

Joint commission by and large, requires training on the risks.

3:02

They don't, however,

3:04

require that there is an institutional policy

3:09

addressing those risks and they don't actually require the prescriptive

3:13

practices.

3:15

ACR requires the existence of a policy,

3:20

but they don't require either staff training on the risks nor the explicit

3:25

practices either.

3:27

So we did poorly for both projectiles and burns.

3:32

How about hearing protection?

3:35

And if you're thinking that we're leading up to a theme,

3:40

a trend, you're probably not gonna be disappointed.

3:44

Requiring hearing protection, verifying fit and function,

3:47

providing an alternative means for those patients for whom the compressible

3:52

foam earplugs simply do not work. Again,

3:57

joint commission requires training on the

4:02

potential for hearing damage.

4:04

ACR requires the existence of a policy on

4:09

potential hearing damage,

4:11

but nobody actually requires the practices.

4:17

If we take a look at a scorecard across the top two

4:23

hospital or enterprise level accreditation organizations,

4:27

and the top two modality or outpatient level accrediting

4:31

organizations, a scorecard of our nine preventions,

4:36

three for burns, three for projectiles, three for hearing damage.

4:41

Joint commission gets partial credit on one of the nine

4:45

preventions, and that's it.

4:49

One of nine partial credit.

4:51

One of nine is our highest scoring accreditation

4:56

criteria.

4:58

While MRI safety practices are not site minimums

5:03

under the ACRs MRI accreditation,

5:06

they are requirements for the modality supervising

5:11

physician.

5:12

If you go on the ACRs website and you look under the accreditation requirements

5:17

and you look specifically within the personnel requirements,

5:21

there is a page,

5:22

a section on the modality supervising physician

5:27

requirements. Essentially,

5:29

the modality supervising physician is the MD who signs off

5:34

on the accreditation paperwork and makes promises or

5:38

attestations about the site's compliance.

5:42

So there are site requirements and then there are personnel requirements.

5:47

Interestingly,

5:49

the compliance with the ACR manual on MR. Safety,

5:54

the ACRs best practices

5:57

Guidance on MRI safety,

5:59

that is not a requirement under this site requirements.

6:04

They are a requirement under the modality supervising

6:09

physician. Now this can be problematic because in many hospitals,

6:14

the radiologist work contracted to

6:19

a group.

6:21

The radiologist and even the contracted group don't have direct

6:26

control over what MRI equipment is purchased,

6:30

how the facilities are designed and constructed,

6:33

how many individual Mr.

6:35

Technologists are going to be on staff at any given moment,

6:39

what the minimum training is for the MR technologists.

6:44

While radiologists often have influence over those issues,

6:48

they typically don't have direct control.

6:51

So it's a bit confusing that the ACR

6:56

requires the modality supervising physician to be the

7:01

one and only place where compliance with the ACRs

7:06

guidance on MR. Safety is prescribed.

7:09

There are two other interesting things about this prescription for

7:14

supervision, for MRI safety best practices.

7:18

One of them is that the ACR says in the example

7:23

of staffing that the,

7:25

they're not going to check that staffing is not directly

7:30

evaluated during the ACR MR. Accreditation review.

7:34

Presumably that's just an example of the MRI safety best practices

7:39

in general, that they aren't going to be directly evaluated.

7:44

And second interesting point is that the ACR

7:49

identifies that if God forbid something does go badly and that

7:54

thing that goes badly is attributable to a failure to

7:58

adhere to a safety best practice,

8:01

the ACR reserves the right to request a response from the facility.

8:07

So even if they're not checking for it,

8:11

if something goes badly,

8:13

the a c R reserves the right to investigate

8:18

or presumably take some sort of corrective action for that facility

8:23

and the individuals involved. So this,

8:27

even though it falls under the modality,

8:30

supervising physician's responsibility does have broader implications and

8:35

ramifications to the site and everybody involved.