Patient movement, wrong parameters trigger repeated MRI exams

Patient movement and the use of incorrect technical parameters by diagnostic radiologic technologists are the two most common causes for the need to perform repeat MRI exams, according to a new study by Portuguese researchers.

In addition, more experienced technologists have a similar frequency of repeated MRI exam compared with their less experienced colleagues, according to the team led by study author Tiago Filipe, a radiology graduate from the University of the Algarve School of Health in Lisbon.

"Error is a process that is always inherent in all professions and can happen to any professional in the exercise of its functions," Filipe said. "Because health deals with people's lives, it is necessary to adopt measures and strategies to minimize the occurrence of errors in order to prevent the repetition of exams."

As MRI exams are "extremely expensive and consume time, it is necessary to reduce the maximum repetition of exams," he added during his presentation at the 2013 European Congress of Radiology (ECR) in Vienna.

To help determine the causes for repeated MRI exams, Filipe and colleagues distributed a questionnaire to radiologic technologists who conduct exams on a daily basis. Of the 57 diagnostic radiologic technologists who participated in the survey, 29 were women and 26 were men, with a median age of 28 (range 21 to 46).

Radiologic technologist survey

The questionnaire included five parts. The first section dealt with sociodemographic information of the radiologic technologists, while the second element characterized their workplace. The third part asked how they organized their work, and the fourth section queried work accidents and errors. The fifth part polled patient safety.

To gauge the radiologic technologists' responses, the study used a five-point scale, ranging from 1 (poor conditions) to 5 (excellent conditions).

In regard to working conditions, the results suggested that the technologists considered their workplace to have good working conditions, including adequate illumination, sufficient protection equipment, and a comfortable temperature.

The major finding came when researchers asked about accidents and errors. The technologists responded by noting that a patient's movement during an MRI exam was the main cause of a repeated exam, with a mean score of 3.88 on the questionnaire's five-point scale.

Part of the reason for the patients' movement was if they suffered from claustrophobia and could not remain still. In addition, the size of the patients, if they were obese, also was a factor in having to repeat an MRI exam, the researchers noted.

Wrong parameters

Repeat exams are also caused by radiologic technologists, according to the researchers. In the survey, 26 technologists (45%) cited wrong imaging parameters as the cause for a repeated MRI exam.

"The results show that the introduction of wrong imaging parameters by the [radiologic technologist] is a major cause," he said. "MRI exams to the abdomen, thorax, and pelvis are most repeated."

Under the category of work organization, Filipe and colleagues hypothesized that fatigue would influence the frequency of repeated exams. However, when asked about fatigue, technologists said tiredness did not play a factor in having to repeat an MRI exam.

In addition, relative to patient safety, researchers hypothesized that patient safety would be influenced by the frequency of repeated exams. However, based on the questionnaire results, patient safety was not a factor in repeated MRI exams.

"Based on the results, we can conclude that the repetition of MRI exams is not very frequent," Filipe said. "The most common causes that lead to the repetition of MRI exams are the patients' movement and the use of incorrect technical parameters by the diagnostic [radiologic technologists]."

The abdomen is the most repeated MRI exam due to patient movement, because "this is an exam that requires the maximum cooperation of the patient," he noted. "The patient's movement may disrupt the exam or degrade the images with artifacts."

The level of a radiologic technologist's experience also did not influence the frequency of repeated MRI exams, and the performance of senior technologist did not improve over time as should be expected.

Filipe and colleagues also recommended that training courses be implemented on a regular basis to improve and evaluate the performance of radiologic technologists.

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