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One of the popular misconceptions is that accreditation

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is somehow a promise,

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a guarantee that you are practicing that a site is

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practicing following existing best practices.

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So if we look at this webpage capture from the Joint

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Commission, whatever you may be able to do on your own,

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you will do better.

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You will surpass your safety targets with joint commission

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accreditation.

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And it isn't just the Joint commission that makes promises of

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accreditation delivering on safety. The ACR does this as well.

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This is an excerpt from a press release that the ACR

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provides its accredited facilities once they earn MRI accreditation.

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What I want you to pay attention to is the opening line of the second paragraph.

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The ACR Gold Seal of accreditation represents the highest level of image

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quality and patient safety, highest level of patient safety.

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Now,

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is it a situation where everybody understands that we are just sort of making

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general statements and that's really not specifically what

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is expected or understood.

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I was curious the degree to which that specific statement,

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highest level of image quality and patient safety was

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reproduced.

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How many people actually use this press release and share it with their

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communities?

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So I did a little investigation

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with Google.

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I looked up exactly that term with mri and I

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limited the search results to within the past year.

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And it turns out that many, many,

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many ACR accredited organizations

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echo that promise to their patients and their referring community.

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So it's widely accepted,

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widely understood that that promise of safety

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is not simply something that the ACR makes to their accredited

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organizations or accredited sites.

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But it is also something that the accredited sites

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extend that promise to their communities, to their referring physicians,

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to their patients.

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We need to take a good look at what actually is the

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highest level of patient safety and if the

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promises from the Joint commission, the acr,

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and all of the other accrediting organizations that offer some different form

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Of, of a promise of patient safety with respect to mri.

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If the accreditation is really fulfilling that,

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and if we are depending on that promise as somehow

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protecting us individually and our role in patient care,

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we may wanna rethink that. One of the things,

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if we're talking about safety and the prevention of injury,

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one of the things we should spend a few moments on is how do people

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get injured in mri? In 2012,

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I presented a paper that I wrote with Dr.

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Emmanuel Kal at the RS N A annual meeting,

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specifically on the breakdown of MRI accidents, adverse events,

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and their preventions. Now, a few years ago,

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I repeated that research with a support from Metro

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Ends, and it's what we're seeing on the screen now. Interestingly,

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95% of the injury accidents were

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burns projectiles and hearing damage.

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Let's start with the most photogenic of these,

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and that is projectile related accidents.

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When measuring the causal effects of these

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projectile related injury accidents, we identified Dr.

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Kana and I three existing best practice preventions that

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likely would've interrupted,

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prevented the vast majority of these accidents,

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utilizing the ACR four zone principle for facility layout and

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design,

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utilizing feral magnetic detection for pre-screening of in individuals

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and equipment before going into the magnet room and

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conspicuously labeling objects with information about their safety in the

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MRI environment.

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We did the same thing with burn injuries, thermal injuries,

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again, taking existing best practices,

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providing a centimeter of either air gap or padding or

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whatever quantity is identified by the MR manufacturer for that system.

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But providing that air gap or padding between the active transmitting

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RF element and the patient removing any unneeded electrically

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conductive materials in the bore with the patient using only MR Conditional

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if it needs to remain and provide insulation between the electrically conductive

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material and the patients. And number three,

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preventing large caliber body loops, skin tokin contact,

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often medial thighs or thumb to thigh types of connections.

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At the time that Dr. Canal and I did the original 2012 presentation,

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there was only one best practice guidance on hearing

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protection, and that was to provide hearing protection to your MRI patients.

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Now,

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89% of the hearing injuries occurred in patients who

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were minimally offered hearing protection.

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So offering hearing protection,

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requiring hearing protection probably would've only had a modest

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positive effect.

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So to the one best practice that was

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existent in the 2007 ACR guidance document for SAFE

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MR practices providing hearing protection,

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we actually invented two additional ones, verify,

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fit and function,

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and provide an alternative means of hearing protection if a patient

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struggled with in the ear compressible foam earplugs. Now,

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we didn't measure the performance of these other two simply because they weren't

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best practices in the 2007 ACR guidance document at the time.

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So we only measured the first one and we found that it likely would have

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mitigated 11% of the hearing damage injury cases.

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So if we look at the three preventions for projectiles,

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the three preventions for burns,

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and the one prevention for hearing damage that we actually quantified,

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those taken together likely would've prevented approximately

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three quarters of the injury accidents.

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In the two year study that we looked at now,

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a number of the projectile accidents that weren't prevented with those

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three best practices were accidents in which service personnel

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were injured. If you take those out of the mix,

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then we're actually looking at a prevention rate of approximately 80%,

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80% injury accident prevention with existing best

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practices.