FMIS 105 Test#4

What is the primary responsibility of the MRI tech in regards to monitoring patients in MRI?

Identifying which patients need monitoring and what type of monitoring is required

What are some of the challenges with implants and current MRI systems

1) Stronger magnetic fields

2) Higher and faster RF systems with higher RF deposition

3) Stronger/Faster Gradients (induction)

(T/F) Implants are rarely seen in MRI

FALSE

Name a couple of companies that make MRI compatible monitoring equipment:

1) Invivo (philips)

2)Tesla

3)IRadimed

What type patients need monitoring in MRI?

1)High risk

2)Critically ill (ICU)

3) Sedated/Anesthetized

4)Neonates and Pediatrics

(T/F) Monitoring patients in MRI is critical to prevent Minor problems from becoming "Life-Threatening" situations

TRUE

(T/F) All Oxygen tanks in the hospital are MRI safe

FALSE- Some hospitals use regular tanks for flor patients, plus outpatients will bring their own.

What color is the MRI safe sticker?

Green

(T/F) A patient should be monitored if there's a greater potential for a change in physiological status

TRUE

(T/F) Patients that get MRI contrast require device monitoring.

FALSE- No actual device is attached. The tech visually and verbally checks to see if patient is having a reaction.

What does GBCA stand for?

Gadolinium Based Contrast Agent

What is the percentage of Severe reaction/death after MRI contrast injection.

<0.0000025%

(T/F) Low Blood Pressure and Tachycardia are signs of Vasovagal Reactions from GBCA.

FALSE- Signs of Anaphylactic reactions

What are signs of Vasovagal Reactions with GBCA?

1) Low Blood Pressure

2) Bradycardia

Who gets specially consideration before MRI contrast injection?

1) Pregnant patients

2) Children/pediatrics

3) Renal insufficiency

4)Patients with previous reactions to MRI contrast

Visual and verbal communication is required for what type of patients?

All Patients

Sedated, Anesthetized and patients that are unable to communicate require what type of monitoring?

Physiological Monitoring

What types of physiologic monitoring are available in MRI?

1) Pulse Oximeter

2)Cardiac- EKG

3) Blood Pressure

4) End tidal CO2

(T/F) Only a single parametric device is required for sedation/anesthesia.

FALSE- A Multi-parametric device is required.

The Commission on Accreditation of Healthcare Organizations (JCAHO) indicates 4 stages of monitoring for sedated/anesthetized patients.

1) Before- Baseline

2) During administration of sedative

3) During the scan

4) During recovery

(T/F) If a patient receives sedation their Respiratory rate, signs of Apnea, and/or Oxygen saturation should be monitored.

TRUE

(T/F) The emergency plan in MRI will give instructions on what to do during an emergency in MRI

TRUE

(T/F) A patient and Nurse can be left unsupervised outside zone 4.

FALSE- If the tech needs to leave the area, another MRI trained personnel should be in the area.

(T/F) The Emergency Power Off button (EPO) releases the Liquid Helium and stops the magnetic field

FALSE- The Quench button does

(T/F) Temperature is a common vital sign measured in Anesthetized patients in MRI

FALSE; Blood pressure is

(T/F) Tattoos are not a concern in MRI

FALSE

(T/F) Sedated and anesthetized patients are monitored the same way in MRI

False- anesthetized patients require multi-parametric devices

Where should emergencies with patients be handled in MRI?

Outside zone 4

(T/F) Crash-Carts are MRI safe

FALSE-

Liquid Helium (He) is a very safe chemical

False

What are some of the dangers from a Quench

1) Asphyxiation

2) Hypothermia

3) Ruptured eardrums

What is the job of the "Cold Head" in MRI

To re-condense the Helium gas to liquid to prevent it from boiling off

(T/F) EPO (Emergency Power Off) is another name for the Quench button

FALSE

What is one place you can find information on implants and MRI compatibility

MRIsafety.com website

Who published guidelines and recommendations concerning the monitoring of patients during MRI procedures ?

SMRI - Safety Committee of the Society for Magnetic Resonance Imaging

Personnel involved in patient monitoring must be experienced with equipment operation and be able to :

• recognize equipment malfunctions

• device problems

• recording artifacts

Monitoring of physiologic parameters and management of the patient may be the responsibility of one or more individuals depending on:

• level of training

• patient condition

• medical history

• type of procedure being performed

What are some complications of sedation ?

• hypoventilation

• airway obstruction

What is the best means of maintaining written documentation for sedation of patients in MRI environment ?

the use of time-based anesthesia-type record such as Reinking Rothschild (2000)

Prior to patient leaving MRI room they should be

• alert

• orientated

• stable vital signs

The medical care of the patient must continue after seadtion

TRUE

Why is post-sedation recovery especially important for pediatrics ?

b/c of medications having relatively longer half-lives

Written Instructions that include an emergency phone number should be provided to the patient AFTER SEDATION

FALSE; before sedation

CPR team (code blue team) must be trained to conduct their activities in the MRI environment.

TRUE

What volume is the region in which an item might pose a hazard for exposure to electromagnetic fields produce

3D vol. of space surrounding the MR magnet that contains both Faraday shield volume and 0.50mT field contour (5 G line)

Ferromagnetic projectile zone (area)

• locally defined vol. containing full extent of 3mT magnetic field contour

  • field strength of 3mT historically chosen to avoid the projectile hazard , also relevant static field action given in physical agents (EMF) directive

Controlled Access Zone (AREA)

locally defined area of such a size to contain MR environment

Emergency policy start up list

• patient codes

• evacuation

• power to cold head is out for an extended period

• signage/markings at quench vent discharge

• if you know your magnets active shielding failure modes

What is referred to as the cold head?

inside the cooling system

The measure of the Cold head’s performance is called

recondensing margin

what should be done if the recondensing margin approaches zero?

cold head should be replaced as soon as possible

WHat happens if you do not replace the cold head on time?

it could lead to a magnet quench

Cold head lifespan:

• NEW

• REFURBISHED

• 4-5 years

• 3-4 years

Cold Head Maintanence

• monitoring recondensing margin

• contamination test

• fresh absorber every year