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MRI Safety
Ch. 10 Study Guide

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Safety Zones
The American College of Radiology (ACR) has
issued important MR safety information, Guidance
Document for Safe MR Practices: 2007. The
guidelines break down the areas of the MR facility
into Zones I through IV according to safety relative
to the magnetic field.

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 Zone I
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• Zone I is outside the MR scanner environment; it

includes all areas that patients, health care
personnel, and other employees use to access
the MR department.

• Te c h n o l o g i s t s d o n o t c o n t r o l a c c e s s t o Z o n e I

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Zone II
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Zone II is the interface between the publicly accessible

Z o n e I a n d Z o n e I I I , w h i c h i s s t r i c t l y c o n t r o l l e d . Ty p i c a l l y,
Zone II is the area in which patients are greeted. Non-MR
personnel can only move about in Zone II under the
supervision of MR staff. Patients typically answer
questions regarding MR screening, medical histories,
medical insurance and other issues while in Zone II.

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Zone III
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All access to Zone III should be strictly limited and

controlled by MR technologists, with constant
consideration of the static and gradient magnetic
fields. The presence of unscreened individuals and
ferromagnetic objects or equipment in Zone III
could result in serious injury or death.

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Zone IV
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Zone IV encompasses the room in which the MR

magnet is located and always is within the
perimeter of Zone III. Designated MR personnel
should accompany or visually supervise all nonMR
personnel who enter Zone III or Zone IV

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Personnel

The ACR safety guidelines classify people who enter the MR facility based on the
amount of safety training they have received. The ACR defines each classification as
the following:
• Non-MR personnel include patients, visitors or staff who have not been trained.
Specifically, people who have not undergone formal training within the previous
12 months.
• Level 1 MR personnel are facility staff members who have participated in minimal
safety educational programs to ensure their own safety as they work in Zone III.
Examples include MR department office staff and patient aides
• Level 2 MR personnel are staff members who have been more extensively trained in
the broader aspects of MR safety issues, including the potential for thermal
burns and peripheral nerve stimulation. Examples include MR technologists,
radiologists and radiology department nursing staff.

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MR Safe: Poses no hazards in the MR environment

MR Conditional: Items demonstrated to pose no hazard in specified MR environments

under specific imaging conditions.

MR Unsafe: An item that will pose a hazard in all MR environments.

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Effects

• Psychological
• Spatially varying static magnetic field
• RF fields
• Time-varying gradient magnetic fields
• Cryogens

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Psychological effectstitle style

• The design of MRI equipment, particularly closed-bore scanners, may

increase levels of anxiety and emotional distress in patients. A nervous
patient may find it difficult to keep still or comply with instructions
related to breath-holding. This is likely to degrade image quality due to
phase mismapping artifacts.
• Examinations prolonged due to patient intolerance may place a burden
on staff, decreasing patient throughput. Failed examinations also waste
scanner time and other valuable resources, incurring financial
penalties. Finally, rescheduling may delay diagnosis, adversely affect
waiting list times, and increase the burden on administrative staff.
• For very young children, or patients who are very claustrophobic,
sedation or anesthesia may be required.

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static field

The static field of the MRI scanner presents four

main implications for patient safety:
• Transient biological effects
• Projectile hazards
• Torque on implanted devices
• Foreign bodies in the static field

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Transient Master title
biological style
effects

• The main magnetic field B0 is responsible for certain transient

biological effects experienced
• As the external magnetic strength field increases the biological effects
become more pronounced
• Transient symptoms including a metallic taste in the mouth and
vertigo.
• Transient biological effects are not of great concern from a safety
perspective. The International Committee on Non-Ionizing Radiation
states that there is no evidence of serious adverse health effects from
whole-body exposure up to 8 T.

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Projectile Master title style
hazards

• Ferromagnetic projectiles have the potential to be very dangerous.

• The static field is homogenous at the isocenter of the magnet bore.
However, the flux density changes dramatically over increasing
distance from the end of the magnet bore. This creates a spatially
varying gradient.
• Active shielding by the bucking coils considerably increases this
effect.
• On actively shielded systems, by the time it becomes apparent that
the item is being attracted to the magnet, there is nothing that can be
done to prevent it becoming a projectile.

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devices

• The static field may affect implanted medical devices.

These include stents, clips, neurostimulators, and cardiac
pacemakers.
• Devices may experience torque in addition to
ferromagnetic attraction
• Torque is a rotational force that causes the alignment of an
object to align with the lines of magnetic flux
• Nonferrous metals may also experience torque when
exposed to an external static magnetic field gradient. This
is due to the Lenz effect.
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static field

Ferromagnetic foreign bodies are likely to be

contraindicated due to translational and rotational forces.
The risk is particularly prevalent in areas where movement
of the item has the potential to cause hemorrhage or
damage to delicate anatomical structures.

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Electromagnetic title style
(radiofrequency) field

An MRI scanner employs RF at a frequency to match the

Larmor frequency of the magnetic moments of hydrogen
nuclei inside the imaging volume.
• Determined by the field strength of the magnet
There are three principal safety hazards associated with RF:
• Patient heating/burns,
• Antenna effect
• Adverse effects on implant function due to induced
currents
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Heating

• Resonance involves the transfer of energy from an RF pulse to the

hydrogen nuclei inside the imaging volume
• The RF pulse is absorbed by the patient’s body tissues and causes an
increase in thermodynamic temperature.
• Burns may occur where naturally occurring loops are formed by the
patient’s anatomical position. If the hands are in contact with the sides of
the legs, or if the heels are resting against each other, there may be a
small surface area of skin in contact. This creates a “biological circuit”
through which induced current may flow.
• Specific absorption rate (SAR) -a measure of radiofrequency (RF) energy
absorbed by the body and expressed in watts per kilogram (W/kg)

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IEC and the British Standards Institution (BSI) have published a set of
standards for SAR limits

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• Any conductor acts as an antenna if it happens to be of a certain critical

length.
• Occurs when waves are reflected back and forth inside a medium resulting
in a stationary wave that oscillates over time.
• If the conductor length is at the resonant frequency of the wave, the
antinodes are found at the ends of the wire, and heating may occur.

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Time-varying title
gradient style fields
magnetic

• The gradients are applied in all three orthogonal directions

and the polarity of the gradient field may be rapidly alternated
many times per second. This creates potential for the
induction of a current in the body tissues.
• Nerve stimulation could pose a risk if the cardiac muscle or
the diaphragm were affected.
• If the induced current exceeds a certain threshold, over a
certain time interval nerve stimulation occurs and could cause
tapping, tingling, and throbbing sensations in the extremities.

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gradients

• May have an adverse effect on implanted electronic

medical devices due to interference with the circuitry.
• Can induce a current in metallic objects such as cervical fixation
devices. The induced current may, in turn, induce a magnetic
moment in the metalwork of the device causing an interaction
with the static field. In turn causing high frequency vibrations.

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noise

• Lorentz forces are responsible for this noise, whereby

the current flowing through the gradient coil interacts
with the static magnetic field.
• The Occupational Safety and Health Administration (OSHA)
recommends that exposure to noise should be maintained
below a level equivalent to 85 dB over an 8 h period to minimize
the risk of hearing loss. At 100 dB, this drops to just 15 min/day.

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Cryogens

There are four primary safety concerns associated with its use:
• Thermal sensitivity
• Asphyxia
• Quench
• Explosion

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sensitivity

• Liquid helium has a boiling point of just 4 K above absolute zero
• A helium dewar is a highly pressurized double container having
an inner chamber separated from the outer container by an
evacuated annulus
• This extremely low temperature poses a hazard when handling
liquid helium as splashes may cause damage to sensitive
biological tissues, especially the cornea of the eye.

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Asphyxia

• Liquid helium displaces oxygen and can cause asphyxiation.

• Danger to personnel if helium gas reduces the oxygen
concentration to a level below 19.5%
• Oxygen concentrations below 19.5% cause impaired perception
and judgment, which prevent individuals from self-rescue.
• If the oxygen concentration falls below 8%, an individual in the
magnet room is likely to lose consciousness.
• At concentrations less than 6%, loss of consciousness occurs in
as little as 10 s and heart failure and death within 2–4 min.

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Quench

• A quench pipe is designed to evacuate any gaseous

helium from the building in the event of a quench.
• Under such circumstances, the building must be
completely and quickly evacuated.
• The expansion ratio of helium is 1 : 754
• Quench pipe failure can cause a sudden increase in
atmospheric pressure in the magnet room

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Explosion

• The cryostat is a pressurized container

• During a quench, a valve (known as a burst disk) opens

to allow the helium gas to be vented

• MRI cryostats have exploded due to a build-up of

pressure inside the cryogen chamber that failed to
activate the bursting disk

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• Never assume that any member of staff has prior knowledge about the dangers of entering a
magnet room. Screen them with the same rigor as used for the patients, even if they have been
before.
• Avoid using a digital code lock for Zone III. Codes can easily be shared with staff from other
departments who have no knowledge of MRI safety
• Never assume that a patient who has been scanned elsewhere yesterday is safe to scan at your
facility today. Your field strength may be greater; your gradients may be stronger and faster; the
patient may have discovered that they are pregnant this morning.
• Ensure that patients are asked about contraindications before their appointment. This prevents
wasted time and aggravation when patients wait a long time for their appointment, only to find that
they cannot be scanned.
• Provide plenty of information to the patient in advance of the procedure. This may help to alleviate
any fears caused by scare-stories and misinformation from other sources.
• If a patient appears to be a “poor historian” giving tangential answers to screening questions, take
extra care, check history with relatives, and get them fully changed into a gown.

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• If there is recent imaging available, such as chest and skull X-rays, these might help rule
out the presence of pacemakers or aneurysm clips.
• Place MRI unsafe stickers on any large ferromagnetic objects kept in the MRI
department. Always use a nonferrous alternative if available. For example, if you keep a
set of steps to allow patients to climb onto trolleys in the waiting room, make sure that
you choose nonferrous steps. Even if they are not intended to go into the magnet room,
they may accidentally be taken in. Choose nonferrous fire extinguishers for the same
reason.
• Always verbally check for contraindications in addition to the written screening form.
Patients occasionally identify potential hazards when asked verbally that they did not
indicate on the form.
• Never allow yourself to be bullied or persuaded into scanning a patient that you have
concerns about. If in doubt, postpone the ex ccasionally identify potential hazards when
asked verbally that they did not indicate on the form.

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permitted enter the various safety zones in
an MRI department?

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permitted enter the various safety zones in
an MRI department?
• Zone I is a publicly accessible zone. Anyone is permitted to enter.

• Zone II is used to greet and screen the patients, it is also accessible to

anyone, but is supervised to prevent unauthorized access to Zone III.

• Zone III is only accessible to safety-screened patients and safety-screened

and safety-trained personnel. It should be guarded by a locked door.

• Zone IV is the magnet room. Access is only possible via Zone III and is
restricted to the patient and essential personnel who have had extensive
safety training, such as the radiologists and MRI technologists.

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patient cannot answer the
screening questions convincingly?

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patient cannot answer the
screening questions convincingly?
Some patients may be unconscious, confused, or just plain
awkward. If you are unable to achieve a satisfactory answer to
a safety question, then you will need to postpone the study
until further evidence can be acquired. This may come from
the patient notes, other recent medical imaging, the patient’s
family, and the referring physician. There must be a
risk/benefit consideration before the examination is allowed to
proceed.

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categories style to describe device safety in
MRI?

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categories style to describe device safety in
MRI?
Devices can be MR safe, MR conditional, or MR
unsafe. MR safe devices pose no known hazards in all
MRI environments. MR conditional devices pose no
known hazards when specified conditions are met. MR
unsafe devices are known to pose hazards in all MRI
environments.

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four main style concerns relating to the
static field?

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four main style concerns relating to the
static field?
The actively-shielded static magnetic field has a very
steep spatially varying gradient. This can cause
transient vertigo and metallic taste sensations,
ferromagnetic projectile hazards, torque (twisting
force) on implants, and may cause movement of
ferromagnetic foreign bodies.

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should be the title style of action in the event that a
first course
patient is trapped by a large ferromagnetic projectile such
as a gurney or an oxygen tank?

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should be the title style of action in the event that a
first course
patient is trapped by a large ferromagnetic projectile such
as a gurney or an oxygen tank?
When there is threat to life or limb, the magnet should
be quenched. This is activated by a quench-button,
the location of which should be made clear to all Zone
III/IV personnel. If there is no danger to the patient
and a ferromagnetic item is not causing entrapment,
the patient may be escorted from the room and an
engineer called to ramp down the system in order to
remove the projectile safely.

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three main safety concerns relating to the use
of radiofrequencies (RF)?

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three main safety concerns relating to the use
of radiofrequencies (RF)?
RF can cause patient heating, heating in implanted
wires and devices (antenna effect), and induced
currents in the circuitry of implanted devices (such as
pacemakers) causing malfunction.

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patient heating during an MRI scan?

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patient heating during an MRI scan?

Remove saturation pulses, increase the TR, decrease

slice number, use an appropriate receive coil, avoid
trains of 180° RF pulses, and reduce the flip angle of
rephasing pulses.

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primary styleconcerns relating to time-
safety
varying gradients?

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primary styleconcerns relating to time-
safety
varying gradients?
Time-varying gradients may induce currents in the
body tissues, leading to nerve stimulation. They may
also induce currents in devices such as external
fixators causing unpleasant vibrations when there is
interaction with B0. There is also a slight risk to hearing
as the gradient coil creates a loud sound during
scanning.

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cryogens title style

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cryogens title style

Liquid helium creates one of the coldest environments

in the universe (−269 °C). It can damage tissues if
splashed, it can evaporate quickly to displace oxygen
in a room causing asphyxia, and it can, under certain
abnormal circumstances, cause explosive destruction
of the MRI scanner and surrounding area.

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should be donetitle style
in the event of an unexpected magnet
quench?
The actions to be taken depend on the nature of the
quench. In the event of a quench-pipe failure, rapid
response is required. There may be a local protocol for
the actions to be taken, but the most pressing concern
is where liquid or gaseous helium is being vented into
the magnet room. If the patient is in the room, they
may asphyxiate very quickly unless evacuated. Always
remember your own safety first and be especially
careful if working alone.

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References

ASRT. “MR Basics: Module 7 Safety Essentials.” 2012.

“MRI Safety.” Mri in Practice, by Catherine Westbrook and

John Talbot, 5th ed., Wiley Blackwell, 2019, pp. 346–
369.

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