**3.1 The radiology suite**

Most hospitals have a very large radiology suite. It can consist of MRI scanners, CT scanners and interventional radiology suites. Patients requiring both diagnostic and therapeutic procedures in these areas may need some form of sedation or analgesia to tide over the procedure. They may even need a general anesthetic. These areas need to be equipped from the start with all the airway kit that is required in an operating room setting. It is important to have MRI compatible airway equipment, as airway difficulties can arise when the patient is in the scanner tunnel. Laryngoscopes need to be non-ferromagnetic and MR compatible anesthetic machines, ventilators and vaporizers are available. Having long breathing circuits is the alternative to having MR compatible machines.

Another problem faced in scanner suites is the inability to prop-up the head-end of the patient. This can sometimes lead to partial airway obstruction in the deeply sedated patient who is spontaneously breathing. Partial obstruction to breathing causes movement artifacts on the head and neck scans. Nasal or oral airways can be carefully used in these deeply sedated patients (**Figure 2**).

The coils used in MR magnets need to be kept cold in order to maintain superconductivity. This is often achieved by immersing them in liquid helium. If the machine gets quenched (usually an emergency process involving the rapid boil-off


**Table 1.** *Sedation continuum.*

**Figure 2.** *The MRI room with the patient's airway in the tunnel and not easily accessible to the operator.*

of the cryogen that causes an immediate loss of superconductivity, to shut down the magnetic field) and if there is damage to the quench pipe, the build-up of helium within the scanning room could potentially lead to asphyxiation. The use of oxygen sensors is vital to the safe conduct of anesthesia.

## **3.2 The neuroradiology suite**

The neuroradiology suite would require a special mention, as they may be standalone from the rest of the radiology suite. These are very similar to the interventional radiology suites used by radiologists for other procedures, but the incidence of the patient needing intubation and a general anesthesia over just deep sedation is more here. Apart from the general risks of working in a dark environment with high radiation as is mentioned in the general risks below, these areas should be set up to mirror an OR as far as possible. It is comparable to the hybrid CT/MRI ORs that exists in many hospitals these days.
