Adapting Radiology Magnetic Resonance Safety Workflows to Magnetic Resonance Imaging Simulation in Radiation Oncology

With the use of MRI simulation and MRI-linacs, magnetic resonance imaging (MRI) is becoming increasingly integrated into radiation oncology (RO) departments, requiring new safety considerations. While American College of Radiology guidelines describe MRI safety broadly, there is limited published experience in adapting these workflows to RO-specific settings and equipment, such as MRI simulators. This quality improvement study evaluated the impact of MRI safety interventions in RO at a single institution.

In an effort to improve safety surrounding the use of a 3-T MRI simulator in RO, three plan-do-study-act (PDSA) cycles were implemented at a single institution. Cycle 1 implemented a two-screen functional workflow used in radiology, adapted for the RO setting; cycle 2 implemented department-wide education; and cycle 3 introduced a visual aid to assist with screening. The MRI schedule was retrospectively reviewed for safety endpoints during each cycle. Endpoints evaluated included the number of same-day cancellations, the number of patients identified at the initial screen as having an implant, and safety events (SEs).

The percentages of MRI simulations that were same-day cancellations during PDSA cycles 1-3 were 6.6%, 10.4%, and 7.4%, respectively (p = 0.51). The number of patients identified at the initial screen as potentially having an implant that needs review by the MRI safety team, representing early identification of high-risk patients, was zero, zero, and three across the three PDSA cycles, respectively. There were no SEs during the study.

An MRI safety workflow developed in radiology was successfully implemented in RO. The number of patients successfully screened as high-risk at the initial screen increased after repeat education. Although overall cancellation rates did not significantly change, these findings suggest that repeated targeted education and visual reference tools may improve early detection of potentially unsafe implants. There were no SEs during the study period. Further improvements in early identification of high-risk patients could decrease same-day cancellations and increase the efficiency of MRI simulation, a limited departmental resource.