The European MR safety landscape
Authors:   European Society of Radiology (ESR), Santini Francesco , Pichiecchio Anna , McFadden Megan , Bargalló Núria , Neri Emanuele , Blankholm Anne Dorte , Busoni Simone , Trattnig Siegfried ,   The ESR MR Quality and Safety Working Group
Published: October 2024

Abstract
Objectives
Despite the absence of ionizing radiation, magnetic resonance (MR) has inherent risks in clinical practice that can have serious health consequences if overlooked. At an international level, there are MR safety guidelines that help define the organization of a radiology department to minimize the risks for patients and personnel. However, competing guidelines exist and not every country and institution adheres to the same standards. In this work, we aim to understand the current situation regarding MR safety practices across Europe, and to identify the points where harmonization, coordination, or further education is needed.

Methods
An anonymous survey questionnaire was distributed between April and June 2023 through ESR member societies to healthcare professionals, aimed to assess personnel training, local policies, scanning practices, and accidents.

Results
Seven hundred and ninety-three responses were obtained from 44 different countries. The majority of respondents from five countries reported that MR safety is mandated by law, but we could only confirm two (Italy and Austria). While 77% of the responses said that their institution had a clear MR safety guideline, 52% said that nobody in their institution had received specific MR safety training. MR-conditional cardiac devices are mostly scanned in university hospitals (reported by 75% of respondents from this type of institution) but in only 42% of outpatient facilities. MR-unsafe cardiac devices are only scanned off-label in 27% of university hospitals, and in an even smaller share of other institutions. Approximately 12% of the respondents reported MR-related accidents resulting in patient or personnel injury. Overall, there is the sentiment that MR safety education and regulation are needed.

Conclusions
The European landscape in terms of MR safety is very heterogeneous, with different regulations across countries, and different procedures for MR safety training and their application in clinical routine. The European Society of Radiology is optimally positioned to play an active role in the harmonization of MR safety education and practices across Europe, and we are proposing a four-tiered framework for the development of a teaching curriculum for MR safety training.

Critical relevance statement
There is room for raising awareness of MR safety issues to ensure patient safety, reduce accidents, and benefit more patients. We advocate for radiologist-led standardization and improvement of MR safety training as a way to address this problem.

Key Points

Our survey of MR safety practices across Europe revealed significant heterogeneity in regulations, training, and scanning practices.

There is a widespread lack of awareness and implementation of MR safety guidelines and diffuse uncertainty, under-scanning of eligible patients, and preventable accidents.

The ESR proposes a harmonized, four-tiered MR safety training curriculum to standardize, and improve safety practices across Europe.