Near-miss MRI incident prompts oversight questions

What has been called a "freak accident" at a California healthcare facility in April highlights a lack of standard reporting mechanisms and oversight in MRI safety incidents, according to a 6 September report from Fox KTVU.

In this case, a trainee reportedly brought a non-MRI-safe wheelchair into a Sutter Health Mountain View facility's MRI environment causing a dangerous reaction with the magnets -- "the wheelchair was sucked across the room, attaching itself sideways to the MRI scanner door, narrowly missing the patient."

The California Department of Public Health's radiological health branch was informed through a public inquiry but said MRI is outside their jurisdiction, KTVU noted in its coverage. In addition, the California Medical Board referred KTVU back to the California Department of Public Health for information about the matter, according to KTVU.

MRI safety advocate Tobias Gilk told AuntMinnieEurope.com via email that there appears to be a gap in California's statutory language regulating radiology, language that is specific to MRI. Gilk is the founder of Gilk Radiology Consultants in Overland Park, Kansas, and senior vice president of Radiology-Planning in Mission, Kansas.

"Their statutes identify ionizing radiation devices (such as x-ray, CT, and nuclear medicine), but only recognize ultrasound and thermography the non-ionizing imaging modalities in the statute," Gilk explained. "Their enabling statutes don't even acknowledge that MRI exists. I suppose it's not terribly surprising that these agencies are all playing 'pass the buck.' "

For KTVU , Gilk highlighted the need for an agency to standardize reporting and enforce consequences.

Sutter Health told KTVU that it adheres to strict standards and reports to the appropriate oversight and accreditation bodies as required, KTVU noted. Sutter added that no one was seriously injured and corrective action was promptly taken.