An Investigation into MRI Safety Education in the Changing Face of MRI Safety

Abstract

Over recent years, the role of the Magnetic Resonance Imaging (MRI) technologist has evolved and there is now the need to undertake a higher level of clinical decision-making in daily clinical practice. The MRI technologist is at the frontline of MRI safety decision-making and has the primary responsibility to provide quality and efficient patient care in a safe MRI environment. This research aimed to determine how well current MRI safety education equips the technologist in today’s MRI environment to cope with the changes that have arisen as new MRI safety concerns emerge and evolve. This study involved qualitative and quantitative research methods, combining a Qualtrics hosted online questionnaire and semi-structured interviews with MRI technologists in both New Zealand (NZ) and Australia. A url link of the online questionnaire was disseminated via MRI social media forums, professional associations in both NZ and Australia, the University of Auckland (UoA) Medical Imaging database of MRI Clinical Supervisors, and via the Medical Imaging 2018 December quarterly newsletter. The online questionnaire drew in excess of 300 participants of which 246 were fully completed. A major part of the online questionnaire included a series of low, mid and advanced-level complexity questions to assess participants’ level of MRI safety knowledge. Fifty eight technologists from the online questionnaire volunteered to be interviewed. Using purposive sampling, 12 MRI technologists from both NZ and Australia were invited and participated in the interview. Responses from the online questionnaire and interview participants generally indicated that the current MRI safety education adequately prepared them to practise safely and competently. Overall, findings indicated that study participants in both countries are confident with regards to their MRI safety decision-making. However, discrepancy between participants’ confidence level and accuracy in the MRI safety knowledge questions in the online questionnaire demonstrated a variation in performance that needs to be addressed. With rapidly advancing technologies, it was established that MRI safety education must be ongoing and compulsory to ensure skills and knowledge remain up-to-date. However, there is ambiguity amongst both interviewees and participants of the online questionnaire as to the duration and the precise nature and content of this proposed mandatory MRI safety education. All MRI technologists are responsible for MRI safety, and as such need to be informed and competent with their clinical decision-making. Emphasis was placed on all MRI technologists maintaining adequate MRI safety education through continuing professional development (CPD) opportunities. Participants highlighted the need for MRI safety education resources to be readily available. Results also confirmed that while robust MRI safety education was provided by MRI safety experts, these resources must remain affordable, accessible and ongoing for all MRI technologists. Of great concern is the information offered by some MRI technologists that not all practitioners in the MRI workplace are actively participating in MRI safety education. In terms of formal education, NZ participants in this study strongly advocated for the continuation of compulsory MRI education in NZ, with registration in separate scope of practice for MRI to remain. Questionnaire and interview responses reiterated the importance for all MRI technologists to be responsible for ensuring an MRI safe workplace and have the appropriate MRI safety skills and knowledge to safeguard the patient. However, questions were raised as to who is ultimately responsible and accountable for MRI safety in the Department? While there was no consensus to the answer, it was agreed that teamwork is imperative in maintaining a safe MRI environment, with both MRI technologists and radiologists having responsibilities for the many and varied MRI safety duties. It is postulated that NZ and Australian radiology departments may have different workplace cultures which could be a contributory factor to the different MRI safety practices identified in this study. Although the MRI Safety Officer position was supported by most MRI technologists, the precise duties of the role appear to be uncertain. Findings from this research lean towards this role being involved in ensuring appropriate MRI safety education for all practitioners, rather than as the person in ultimate charge for MRI safety. The major recommendation arising from this study is that a MRI Safety Framework be established to determine a minimum MRI safety education level, with regulatory agencies within both NZ and Australia incorporating these standards into the appropriate registration and CPD requirements. A larger study replicating the online knowledge test should be conducted to better understand the variation of performance between Australian and NZ practitioners and the reasons for the differences. This framework should also clarify the role and responsibilities of each team member within the Radiology Department, including the newly created position of MRI Safety Officer (if required) with clear delineation of responsibilities and accountability. Such a framework will also minimise the impact of workplace culture from negatively influencing MRI safety in the workplace.