RSNA: Rads need to focus on MR safety, risk reduction

CHICAGO—Outlining how to avoid patient harm and subsequent litigation in MR procedures, presenters of a Nov. 27 session during the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) stressed taking patient safety into one’s own hands. Emanuel Kanal, MD, Pittsburgh, and Craig E. Frischman, Esq., Pittsburgh, described a number of “slam dunk” cases for prosecutors, where patients were harmed during imaging procedures and radiologists were found responsible. The incidents ranged from oversights and outright negligence to horrific accidents.

Take, for example, a case where a police officer underwent an MRI examination with a loaded gun on his waist, which was pulled with magnetic force from its holster, striking the MRI, turning off the safety and discharging a round. Luckily, the gunshot didn’t cause injury. Or, the example of 21-month-old Noah Crowe, who was given a “space blanket” to keep warm during an MRI procedure, and suffered from severe burns as a result. Another example required the amputation of an infant limb, when radiologists performed an MRI on a child that still had a pulse oximeter lead wrapped around the arm.

Increasingly, dangers associated with MR procedures can include foreign conductive objects that make their way past radiology staff and subsequently harm the patient, which in turn, leaves the department liable. Some of the most common issues in MR include thermal injuries or radiofrequency burns, projectile effects and contrast adverse events. Virtually 100 percent of RF burns are entirely avoidable, noted Kanal. They can occur when a patient is too large or wearing conductive clothing. Even some tattoos can cause burns, he said. Evaluation all of the potential risks is pertinent to avoiding harm.

The interactive session began with an informal survey of the audience. Asked whether they had been named as a defendant in a medical malpractice case, nearly 25 percent of the audience indicated they had. Another 7.7 percent had been named as a defendant in an MR adverse event suit and 18.8 percent had inadvertently scanned a patient with a cardiac pacing system—which included taking the patient into the room for screening. Another 61 percent of the crowd indicated that their site had experienced a serious MR related adverse event or near-miss.

"You cannot contract away your liability,” said Kanal. “Liability is triggered by patient expectation. The idea that ‘this is not my patient’ is so unbelievably prevalent, I guarantee you that will not work in court.”

Despite the requests of the referring physician—contract, type of procedure—the liability and responsibility still falls on the radiologist performing the examination. “Too many radiologists think they’re doctor’s doctors. The safe execution of the examination is my responsibility,” Kanal said.