Call for Enhanced MRI Safety Protocols in Interventional Radiology

As MRI-guided interventions gain prominence in the medical field, researchers are advocating for the implementation of specific safety protocols to mitigate adverse events and bolster the safety of both patients and staff. A narrative review published in Cureus highlights the need for expanded guidelines, noting that current MRI safety recommendations remain limited and predominantly principle-based.

Lead author Pan Pan Ng, MBChB, an associate consultant at the Department of Diagnostic and Interventional Radiology at Queen Elizabeth Hospital, emphasizes the fundamental role of thorough safety training and the application of standardized protocols for optimal MRI practice. Dr. Ng underscores the increasing role of MRI technology due to its superior tissue contrast and ability to guide interventions in real-time without the use of ionizing radiation, despite it being primarily reserved for scenarios where its advantages are clear.

The review, spearheaded by a team from Hong Kong, draws attention to the frequency of adverse events associated with MRI-guided procedures. UK-based studies estimate these events at approximately 0.05% of examinations, equaling about one incident per 1,987 scans. With the field's growth, concerns such as projectile incidents and radiofrequency (RF)-induced burns have been highlighted, alongside effects like nerve pain and hearing damage.

The research team conducted an extensive literature search spanning from January 1995 to August 2025, revealing a notable gap in MRI safety literature relative to the growing adoption of MRI-guided interventions. Dr. Ng mentions that the lack of detailed guidelines specific to interventional environments creates challenges, as the existing recommendations tend to be broad, calling for site-specific adaptations.

Reports to the U.S. Food and Drug Administration (FDA) indicate that RF-related burns constitute a significant portion of MRI adverse events, accounting for 32% of reported incidents after root-cause analysis. Safety protocols have been suggested to prevent a substantial majority—up to 97%—of such thermal injuries. Additionally, projectile incidents and nerve stimulation events account for a notable proportion of adverse outcomes during MRI-guided procedures.

To enhance safety measures, the American College of Radiology (ACR) advises dual-screening processes for personnel and patients and recommends zone-based access control in MRI facilities. Furthermore, the use of clear labeling for MR equipment, comprehensive training for multidisciplinary teams, and regular emergency drills are critical components of a robust safety framework. Monitoring procedures and aligning team efforts are imperative for preventing potential mishaps during MRI-guided interventions.

Technological advancements such as robotics and artificial intelligence (AI) hold promise for improving MRI safety by streamlining procedural efficiency and reducing exposure risks. Automated needle-alignment systems and AI models could aid in minimizing procedural times and preemptively addressing thermal risks, respectively.

The review by Dr. Ng and her team aims to serve as a foundational reference for radiological teams aiming to establish or expand MRI-guided services. Highlighting both procedural and institutional safety considerations, the authors advocate for the formation of dedicated MR safety committees, comprehensive training programs, and the establishment of ongoing monitoring and review processes. These steps are seen as crucial for advancing the development of detailed safety guidelines and fostering increased awareness of MRI safety within the medical community.