Clinical Safety & Patient Care
Infection control · medication drawing · safe patient handling · everyday MR safety.
Local policy wins. This guide summarises international best practice with sources. Your department’s infection-control, medicines and manual-handling policies are the legal standard. Where they differ, follow local policy and escalate.
Key points
- Clean hands before and after touching each patient, and between patients wipe the table, pads and patient-contact coils per the IFU, observing the disinfectant’s wet contact time.
- Confirm you are authorised to draw up or give contrast or Buscopan, use a two-person check, and label every syringe as it is filled; unlabelled syringes are discarded.
- Plan every move with TILE and move patients with equipment, not your spine; only MR Safe or MR Conditional transfer equipment goes past the Zone IV door.
- In a cardiac arrest, evacuate the patient from Zone IV first, with compressions on the move; if a ferromagnetic object pins or traps someone who cannot be freed quickly and safely, quench.
- For every patient, every sequence, fit earplugs plus headphones or ear muffs whenever possible, and use pads to prevent skin-to-skin loops and cable contact that can cause RF burns.
Explain it simply
- Staff clean their hands before and after touching each patient. Between patients they wipe the table, cushions and any coils that touched the patient with the cleaner the maker approves, and leave it wet long enough to work.
- Only staff allowed to do so prepare or give the contrast dye or the bowel-relaxing injection. Two people check the drug, each syringe is labelled as it is filled, and unlabelled syringes are thrown away.
- Staff plan each patient move first and use equipment, not their own backs, to do it. Only transfer equipment labelled for use near the magnet goes through the scanner-room door.
- If a patient’s heart stops, staff move them out of the scanner room with chest compressions on the way, and shut the magnet down if metal traps someone who cannot be freed quickly and safely.
- Everyone being scanned wears earplugs, plus headphones or ear muffs whenever possible, for the whole scan. Staff also use pads so skin does not touch skin or cables, because that can cause burns.
A guide only: follow your departmental protocols and regional requirements.
Infection Control
Hand hygiene
WHO 5 Moments
- 1. Before touching a patient
- 2. Before a clean/aseptic procedure (cannulation, drawing up)
- 3. After body-fluid exposure risk
- 4. After touching a patient
- 5. After touching patient surroundings (table, coil, trolley)
TechniqueAlcohol rub 20–30 s routine; soap and water 40–60 s if hands are visibly soiled or after C. difficile / norovirus contact (alcohol does not kill spores).
MRI-specific catches
- Dispensers are often outside Zone IV; clean hands before entering, or use an MR Conditional pump inside.
- Gloves don’t replace hand hygiene: clean hands before donning and after doffing.
- Bare below the elbows where local policy requires; rings and watches fail ferromagnetic screening anyway.
Precautions
| Level | Applies to | In the MR suite |
|---|---|---|
| Standard | Every patient, always | Hand hygiene, gloves for body-fluid contact, sharps safety, clean equipment between patients, disposable sheet/pillowcase per patient |
| Contact | MRSA, CPE/CRE, C. diff, scabies | Gown + gloves; last on list where possible; strip and disinfect table, coils, pads, bore rim after; alcohol-free sporicidal for C. diff |
| Droplet | Influenza, RSV, meningococcus | Surgical mask for staff within 1–2 m; mask on patient if tolerated; clean high-touch surfaces after |
| Airborne | TB, measles, varicella, COVID-19 (AGPs) | N95/FFP3 respirator (fit-tested; metal nose-strips must pass local MR screening, or use a metal-free alternative); defer non-urgent scans; allow air-change downtime per local policy before the next patient |
Cleaning
Between every patient
Routine- Table top + pads (wipe, observe contact time)
- Coils that touched the patient (per IFU; most tolerate low-level disinfectant wipes, never immerse)
- Headphones/earbud sleeves, squeeze-ball, mirror
- Change linen, pillowcase, pad covers
PitfallPad covers with cracked seams cannot be disinfected; condemn and replace.
Disinfectant choice
Per IFU- Follow the coil/scanner IFU; wrong agents craze plastics and destroy coil housings.
- Typical: quaternary ammonium or 70–75% alcohol wipes for surfaces; chlorine-based agents where corrosion-safe.
- Observe the stated wet contact time; a dry-in-2-seconds swipe disinfects nothing.
Scheduled / deep cleaning
Daily+- Daily: bore liner, ventilation grille, door handles, console keyboard/mouse, injector head.
- Weekly/monthly per policy: under table, cable runs, storage, waiting-area high-touch points.
- Log it; cleaning schedules are a standing audit item (see the self-audit checklist).
Isolation patient workflow (contact/airborne)
- Confirm precautions level with ward before transfer; book end-of-list where clinically acceptable
- Prepare room: remove loose non-essential equipment, stage wipes and linen
- Don PPE per level; minimum staff inside Zone IV
- Screen PPE for ferromagnetic components (some respirators have steel nose strips)
- Scan; doff PPE at the threshold per local sequence; hand hygiene
- Terminal clean of all contact surfaces + floor path; air-change downtime for airborne cases
- Document cleaning before next patient
For patients: we clean the table, headphones and coils between every person, use fresh linen for each scan, and clean our hands before and after touching you. Tell us if you have an infection or are in isolation; we adapt, and you still get your scan.
Medication Drawing
Scope of practice. Who may draw up, check and administer contrast, hyoscine butylbromide (Buscopan) or glucagon differs by country and employer. Confirm your authorisation and standing orders/PGDs, and always know who prescribes.
Drawing up (ANTT)
The rights, every time
- Right patient: two identifiers + wristband
- Right drug: read the ampoule label aloud at the second check
- Right dose: weight-based for contrast (mmol/kg or mL/kg)
- Right route: IV vs IM changes contraindications (Buscopan!)
- Right time + documentation (drug, dose, batch, expiry, site, time)
Aseptic non-touch technique
- Hand hygiene → clean tray → key parts (needle hub, syringe tip, vial septum) never touched or laid down unprotected.
- Scrub vial septa/ampoule necks with 70% alcohol, let dry.
- Use a filter needle for glass ampoules where policy requires.
- Single-dose vials are single-patient; never re-enter for a second patient.
- Label every syringe as it’s filled. An unlabelled syringe is discarded, not guessed.
Power injector prep
- Prime and purge air with the head tilted; verify no bubbles in syringe or tubing.
- Check contrast agent + concentration against the protocol before loading.
- Multi-patient injector systems only with manufacturer-validated multi-use sets, changed per IFU.
- Confirm cannula patency with a saline flush at injection pressure before contrast.
Gadolinium-based contrast (GBCA)
Pre-checks
Screen- Prior reaction to GBCA? Severity? (premedication/agent change per radiologist)
- Renal function: targeted eGFR screening in at-risk patients; group II agents carry low-to-nonexistent NSF risk (ACR Manual on Contrast Media).
- Pregnancy: GBCA only if benefit clearly outweighs risk (radiologist decision).
- Standard adult dose 0.1 mmol/kg for most agents; verify agent-specific concentration.
Extravasation
Manage- Less injurious than iodinated contrast (small volumes, lower toxicity) but still: stop injection, elevate limb, apply cold compresses or ice packs (the ACR and ESUR prefer cold to warm), mark and record the area, inform radiologist, and give written advice on when to seek help.
- Obtain urgent surgical consultation whenever there is concern for a severe extravasation injury, and for any of the six ACR criteria: progressive swelling or pain; altered tissue perfusion; change in sensation; skin ulceration or blistering; severe pain; worsening passive or active range of motion (ACR Manual on Contrast Media, current edition).
Reaction readiness
Emergency- Know your acute contrast reaction pathway and trolley location before you inject.
- Patient stays where staff can observe post-injection; cannula stays in until the scan is complete.
- Document any event on the site’s acute contrast reaction form.
Hyoscine butylbromide (Buscopan)
| Item | Detail |
|---|---|
| Use in MRI | Reduces bowel peristalsis for pelvic/abdominal MRI (rectal, cervical, prostate, small bowel). Typical adult dose 20 mg IV or IM per SmPC/local protocol; short duration: time it against the motion-sensitive sequences. |
| Contraindications | Untreated narrow-angle glaucoma · tachycardia · myasthenia gravis · prostatic hypertrophy with urinary retention · GI stenosis or paralytic/obstructive ileus. IM route additionally contraindicated on anticoagulants (haematoma risk); use IV. Angina, cardiac failure and other cardiac disease are SmPC cautions, not contraindications: monitor, with resuscitation equipment and trained staff readily available. A stricter departmental rule is local policy. |
| Warnings | Can cause tachycardia, hypotension, anaphylaxis; caution in any cardiac disease. Warn every patient about blurred vision (no driving until resolved) and to seek urgent help for a painful red eye after injection (undiagnosed angle-closure glaucoma). |
| Alternative | Glucagon 1 mg IV/IM where antimuscarinics are contraindicated. Avoid in phaeochromocytoma and insulinoma; transient nausea and hyperglycaemia (diabetics). |
Two-person check (contrast or Buscopan)
- Checker reads ampoule: drug name, strength, concentration, expiry, batch
- Drawer confirms against prescription/protocol and patient weight
- Draw up with ANTT; label syringe immediately (drug, dose, date/time, initials)
- Both sign the record; retain the ampoule until administration is complete
For patients: the “bowel-relaxing” injection commonly blurs vision for up to a few hours and can cause a dry mouth or brief fast heartbeat. Don’t drive until your vision is normal. If you get a painful red eye with loss of vision in the day after your scan, go to an emergency department and mention the injection.
Safe Patient Handling
Plan the move: TILE
T: Task
- What needs to move: bed-to-table, sit-to-stand, positioning shift?
- Can the patient do part of it? Ask first. Transfers go wrong when we handle an independent patient, or trust a dependent one.
I: Individual
- Your capability, training and staff available. Never lift alone what is assessed as a two-person task.
L: Load
- Patient weight, weight-bearing status, attachments (lines, catheters, O2), pain, cognition, tone/spasticity.
- Check table weight limit and bore diameter before transferring a bariatric patient; know your scanner’s rating.
E: Environment
- Ordinary hoists, metal pat slides and standard wheelchairs stay outside Zone IV. Only MR Safe or MR Conditional transfer equipment past the door.
- Brakes on, table height matched, clear cable runs on the floor.
Transfers
| Patient | Method | Notes |
|---|---|---|
| Independent | Stand-and-step with supervision | Hand on standby, non-slip footwear/socks; watch the step over coil cables |
| Partially dependent | Slide sheet ± standing aid, 2 staff | MR Safe slide sheets; move on coordinated count; no lifting through the axillae, ever (shoulder injury risk) |
| Dependent / trolley | MR Conditional trolley + lateral transfer board + slide sheet, 3–4 staff | Heaviest section (thorax/pelvis) gets the most staff; lead at the head coordinates airway and count |
| Bariatric | MR Conditional hover/air-assisted device where available | Verify table limit and bore fit first; plan the exit; extra staff booked in advance |
Golden ruleMove the patient with equipment and body weight, not your spine: feet apart, knees bent, load close, no twisting. If it feels like a lift, stop and re-plan; policy is minimal-lift, not “lift properly”.
Falls & pressure care
Falls prevention
- Falls-risk flag travels with the patient; never leave them standing or seated unattended in the cubicle or on the table edge.
- Table at lowest height for on/off; step provided; gowns that don’t trail.
- Sedated or post-sedation patients transfer as dependent, however awake they look.
Pressure & comfort
- Pad bony prominences (heels, sacrum, elbows): pressure care and burn prevention (skin-to-skin and skin-to-bore contact points).
- Check lines/catheters run free and are not trapped under the patient before landmarking.
- Neuropathic or unconscious patients can’t report discomfort; inspect positioning twice.
For patients: tell us how much help you need getting on the table. There’s no prize for struggling. If anything hurts or goes numb, squeeze the call ball; we can fix positioning between sequences.
Other Safety
The magnet is always on
Projectiles
Zone IV- Screen every person and object before Zone IV: staff, cleaners and the “just this once” oxygen cylinder included.
- Classic missile events: ferromagnetic cylinders, drip poles, sandbags with metal shot, standard trolleys, floor polishers.
- If something sticks to the magnet: keep everyone clear, don’t wrestle it, call the MRSO. If someone is pinned or trapped by it and cannot be freed quickly and safely, quench.
Burns prevention
RF- No skin-to-skin loops (hands clasped, thighs touching); use pads.
- No looped cables and none crossing the patient; insulation pads between patient, cables and bore wall.
- Remove metallic-backed drug patches and all removable metal; check for tattoo/permanent-makeup discomfort.
- Monitor high-SAR sequences in vulnerable patients (see the SAR guide).
Hearing protection
Always- Earplugs correctly inserted, plus headphones or ear muffs whenever possible, for every patient, every sequence. Sequences can exceed 110 dB.
- Verify protection on unconscious/sedated patients and neonates (mini-muffs); protect accompanying persons too.
Quench & cryogens
Emergency- Quench = rapid helium boil-off; the quench pipe vents outside, but a failed vent can flood the room. Evacuate, don’t lock the door shut (pressure), oxygen monitor alarm response per local drill.
- Know your quench button’s location and criteria: person pinned by ferromagnetic object, or fire brigade requiring field-off entry.
Cardiac arrest in Zone IV
Drill it- Rule one: evacuate the patient from Zone IV first; the crash team and defibrillator do not come to the magnet.
- Compressions on the move; designated route to the resus point outside Zone IV.
- A rehearsed drill, not an improvisation; schedule it.
Pregnancy
Staff + patients- Patients: MRI can be done in any trimester when there is expected benefit and no other practical way to get the information, at 3 T or below in Normal Operating Mode (ACR Manual on MR Safety, 2026 edition). In Australia and New Zealand, RANZCR (v3.0) also requires that the result is needed before the pregnancy ends, that no other non-ionising test can give it and that waiting is not clinically prudent, and advises written consent. GBCA only when benefit clearly outweighs risk.
- Staff: pregnant staff can keep working in the MR unit throughout pregnancy, including in Zones III and IV, but should not stay in the scanner room while scanning is under way (ACR Manual on MR Safety, 2026 edition; MHRA 2026; RANZCR v3.0). Local occupational health policy may add to this.
Deep dives: screening & zoning workflow, implant decisions (MRI Implant Checker), SAR physics, the ACR/MHRA/IEC/ISMRM guideline comparison, and the self-audit checklist.
Sources
- WHO Hand Hygiene / 5 Moments
- CDC Core Infection Prevention & Control Practices
- ISID Guide: IPC in the Radiology Department
- ACR Manual on Contrast Media (current edition)
- ESUR Contrast Media Safety Committee Guidelines 2025
- Hyoscine butylbromide 20 mg/mL SmPC (emc)
- ACR Manual on MR Safety, 2026 edition (zoning)
- HSE Manual Handling (TILE)
- MHRA Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use, 5th edition (2026)
- RANZCR MRI Safety Guidelines, version 3.0 (2021)
Always defer to local policy and the current edition of each source.
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