**1. Introduction**

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The various equipment and chemicals used in the radiology departments can be a source of hazards and hence result in an adverse effect to affected individuals (Johnston and Killion, 2005). Interdisciplinary approach to monitor the activities at radiology departments to en‐ sure compliance in safety standards may help avoid or reduce hazards in the working envi‐ ronment (Byrns*et al.,* 2000). Magnetic Resonance Imaging (MRI) unit in a radiology department is one particular place where safety precautions should be directed due to the ferromagnetic nature of the equipment and the strong magnetic field used in its operations (Joseph, 2006).

MRI is a painless, non-invasive and one of the most advanced imaging modalities current‐ ly available in radiology departments (Kusumasuganda, 2010). Research and awareness of safety issues concerning MRI has received much attention (Ordridge*et al.,* 2000). Accord‐ ing to Westbrook *et al* (2009), recent occurrences in the operation of MRI have led to ques‐ tions being raised on the safety of the modality. Phin (2001) has suggested that adequate policies and procedures should be developed and adhered to in order to ensure safe, effi‐ cient and operating conditions of MRI. Several potential problems and hazards are associ‐ ated with the performance of patient monitoring and support in the MRI environment (Kanal and Shellock, 1992). According to Henner and Servomaa (2010), the main factors that affect safety practice in the MRI unit is management style and attitude of staff. Vari‐ ous reports found in the literature have indicated that MRI accidents are mostly caused by human errors rather than scanner malfunction. These have led to several calls for regu‐

© 2013 Opoku et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 Opoku et al.; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

lations and policies to guide the operations of MRI (New York Times, 2010; Healthcare Purchasing News, 2010). This has become necessary because the risk in the MRI environ‐ ment does not only affect the patient, but also affects the health professionals and those who find themselves in the magnetic field (Kanal *et al.,* 2007). There is therefore the need for maximum safety to be ensured in the MRI unit. Moreover Chaljub (2003) and Joseph (2006) have both emphasized the need to keep training health personnel on safety issues relating to MRI. In particular, Joseph reiterated that the MRI's magnet which is over 100,000 times the earth's natural magnetic pull is always on mode; hence those who ap‐ proach it should have training due to the special safety risk it poses. In addition to the risks to people, it is also important to put in precautionary measures to protect the equip‐ ment from damage and breakdowns. The need to assess the staff of the radiology depart‐ ment and hospital's management on their attitude and adherence towards maintaining safety at the MRI can therefore not be overemphased.

**3. Literature review**

**3.1. The concept of safety screening**

ed and adhered to (Kanal, 2004).

In order to have a broad perspective of MRI safety issues, an extensive literature review were done which centred on the concept of safety screening; principle and framework of

Assessment of Safety Standards of Magnetic Resonance Imaging at the Korle Bu Teaching Hospital…

http://dx.doi.org/10.5772/52699

57

It has been suggested that in dealing with safety issues the emphasis should be placed on prevention of accidents (Harding, 2010). This means measures need to be implemented to prevent accidents from occurring. Harding argued that even though total prevention of acci‐ dents is not achievable, every effort should be made to reduce their occurrences to the barest minimum. The concept of safety has a wider significance as safety is seen as a systemic ap‐ proach with thresholds that define the standard of safety (Elagin, 1996). In order to ensure an accident free, Elagin has suggested that an ordered procedure, which shows the level of safety in a particular environment should be followed. In recent times, concerns have been raised about the safety of the MRI facility due to the increasing number of MRI incidents by an alarming 185% over the last few years (Gould, 2008). Gould further suggested that there is need for a comprehensive safety programme for any health institution with a zero toler‐ ance for MRI errors. Several studies have shown that compromising patient safety have re‐ sulted in fatal consequences (Launders, 2005; Emergency Care Research Institute (ECRI), 2004). In 2005, Launders conducted an independent analysis of the Food and Drug Adminis‐ tration (FDA)'s Manufacturer and User Facility Device Experience Database (MAUDE) and gave a report on a database over a 10-year time span. This revealed 389 reports of MRI-relat‐ ed events, including nine deaths with three events related to pacemaker failure, two due to insulin pump failure and the remaining four related to implant disturbance, a projectile, and asphyxiation from a cryogenic mishap during installation of an MR imaging system. Vari‐ ous claims have been made in several publications which indicate that MRI accidents are largely due to failure to follow safety guidelines, use of inappropriate or outdated informa‐ tion related to the safety aspects of biomedical implants and devices and human errors (Shellock and Crues, 2004; New York Times, 2010; Healthcare Purchasing News, 2010). A panel under the auspices of the American College of Radiology (ACR) was constituted to address these critical issues. Kanal et al (2004) who were part of this panel pointed out that there was a continuous change in the use of the MRI as a technology with a drastic increase in the number of examinations done. They maintained that though there were safety guide‐ lines, the increased number of MR practitioners and the increased use of the technology for critically ill patients, contributed to the increasing incidence of mishaps occurring in MRI surroundings. According to McRobbie et al (2007), the overall objective of a safety procedure is to provide an appropriate standard of protection of patients and staff in the MRI unit, without unduly limiting the beneficial practices and also prevent the occurrences of tragic events in the MRI suite. MRI suites in clinical and hospital surrounding should establish safety protocols with an MRI safety officer designated to ensure that policies are implement‐

safety in MRI; operational principles, safety policies and guidelines of MRI.

In recent times, Magnetic Resonance Imaging (MRI) unit of the Korle - Bu Teaching Hospital (KBTH) in Accra, Ghana has witnessed various degrees of accidents. In particular, there was a fire outbreak in 2007 which brought the operation of the MRI facility down for a whole year. Again in 2010, a wheelchair was pulled into the gantry of the MRI scanner by the mis‐ sile effect when a patient was lifted off the wheelchair onto the MRI table as shown in ap‐ pendix I on page 28. This incident resulted in three weeks down time of the facility. A second incident in the same year occurred where a Radiographer Intern at the MRI unit wrongly switched off the safety button, resulting in three weeks shut-down of the entire unit. These incidences have been documented in the Incidence Reporting Book at the MRI Unit and are reproduced here with the permission from the Radiology Department of the hospital. These incidences at MRI Unit at the Korle Bu Teaching Hospital are very worrying, suggesting that the safety aspects might have been compromised. Thus it is imperative that the existence of policy guidelines and manuals regarding the operational safety of the MRI in the hospital and their compliance and adherence by staff needed to be evaluated. Similar incidences occurring in other hospitals around the world are documented in the literature and some of which are reproduced in Appendix II on page 29.
