Building A Safer Radiology Future, with Tobias Gilk of Gilk Radiology Consultants
Episode Topic: In this enlightening episode of Skeleton Crew – The Rad Tech Show, we’re delving into the realm of MRI safety and its evolving landscape. Our distinguished guest, Tobias Gilk, Founder of Gilk Radiology Consultants, shares his wealth of knowledge and experience in ensuring the safety of MRI procedures.
Lessons You’ll Learn: Throughout this episode, you’ll uncover the essential lessons on MRI safety, including the significance of architectural insights, common challenges, and the future of this critical field. Mr. Gilk’s expertise offers a comprehensive guide for both professionals and aspiring individuals aiming to make a meaningful impact.
About Our Guests: Our guest, Mr. Tobias Gilk, brings a unique background in architecture to the world of MRI safety. As the Founder of Gilk Radiology Consultants, he has dedicated his career to improving MRI safety and MRI Remote Operation, through training, consulting, and legal expertise. His multi-faceted approach ensures that MRI procedures are as safe as they can be.
Topics Covered: In this captivating episode, we explore the intersection of architecture and MRI safety, shedding light on the pivotal role of architectural insights. Mr. Gilk discusses the challenges and misconceptions in MRI safety, his work as an expert witness, and the evolving landscape of this crucial field. Additionally, we delve into emerging technologies and practices that will shape the future of MRI safety, and how professionals can stay ahead of the curve.
Our Guest: Tobias Gilk: The MRI Safety Expert with a Unique Blend of Knowledge
Tobias Gilk, a prominent MRI safety personality, has a background that sets him apart in the field. With an initial career in architecture, he’s taken a remarkable journey to ensure the safety of MRI procedures. As the Founder of Gilk Radiology Consultants, he has dedicated over two decades to enhancing MRI safety through training, consulting, and expert witness services. His architectural insights bring a unique perspective to the world of MRI safety, creating safer procedures for both patients and healthcare providers.
Tobias’s approach to MRI safety is multifaceted, addressing the intricate interplay of technology, clinical practices, regulations, and economics. His contributions go beyond consulting; he actively shapes safety standards for MR professionals. He serves as a Board Member for the American Board of Magnetic Resonance Safety (ABMRS), certifying MR professionals in the knowledge and skills required to safeguard patients and caregivers in the MRI environment. Through his extensive work, Tobias Gilk plays a pivotal role in making MRI procedures safer and more efficient.
In addition to his consulting firm, Tobias actively participates in safety committees and academia, championing MRI safety. His efforts ensure that patients and healthcare providers can reap the benefits of cutting-edge medical imaging technology while maintaining a high level of safety. With a career spanning architecture to MRI safety, Tobias is a driving force in this critical field.
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Tobias Gilk: There are always better ways to do things changing from the way we did things yesterday to the way we’re doing things today does not necessarily mean you are doing them wrong yesterday. It just means that we recognize that over time, we’re going to uncover better ways to get things done. And if you have the death grip on the way we’ve always done things, you’re actually regressing in terms of your ability to stay current with the contemporary challenges.
Jennifer Callahan: Welcome to The Skeleton Crew. I’m your host, Jen Callahan, a technologist with ten-plus years experience. In each episode, we will explore the fast-paced, ever-changing, and sometimes completely crazy field of radiology. We will speak to technologists from all different modalities about their careers and education. The educators and leaders who are shaping the field today, and the business executives whose innovations are shaping the future of radiology. This episode is brought to you by xraytech.org. If you’re considering a career in X-ray, visit xraytech.org to explore schools and to get honest information on career paths, salaries, and degree options.
Hey, everybody, welcome back to the Skeleton Crew. We have a great episode set up for you. I have a distinguished guest with me joining. His name is Mr. Tobias Gilk, and he is the founder of Gilk Radiology Consultants. Tobias, thanks for being with us today.
Tobias Gilk: Thank you very much.
Jennifer Callahan: Interesting enough, that today, instead of going into the world that’s really dealing with X-ray itself and ionizing radiation, we’re on the latter end of radiology and we’re going to be speaking about MRI. Not exactly MRI production or image production, but we’re going to be talking about MRI safety, which is super important in the world of radiology, and anyone who’s in the field knows that because MRI safety is one of those continuing education, at probably your health system or anywhere that you’re working that has an MRI that you have to do every year. Tobias, I’m interested and looking forward to our conversation today. So to get started, interesting point that we were just talking about. Toby was saying that his background is in the norm of being within the world of radiology. He’s not a doctor. He didn’t go to grad tech school or anything. He’s actually an architect by trade and kind of have circumnavigated into this field. So can you give me a little bit of like the predecessor of where you were there and then how you ended up here?
Tobias Gilk: There are really two parts to how I wound up here. One of them is by my own initiative and one is with the help of other people. So I started out freshly graduated from master’s program, getting my master’s degree in architecture, and I’m working in a small firm that had really never done any health care before, and coincidentally, just about the time that I joined them, they got some work from the local community hospital, and all of the other architects were essentially assigned to other projects. And me being the loose end, they essentially gave me to the hospital. And I began working in health care essentially, from day one of my architectural practice, I very quickly fell in with the radiology department within the hospital, and I did a gamma camera and a CT simulator and an MRI project, and I became alarmed, if that’s the right word. At the absence of safety regulations from a planning, design, and construction standpoint for MRI as compared to when I was doing projects on the ionizing side, whether it was CT project or the gamma camera, and I felt like I had missed something, I was really afraid that I had screwed a project up, because I had done an MRI project where I didn’t follow any of the state rules for safety, only to come and find out that there aren’t any rules or weren’t at the time governing the physical environment and safety for MRI. And so this is the first chapter of my becoming involved in MRI safety. I became an advocate for safety standards in design and construction of MRI facilities. That work and some assistance that I got in doing that work really led me to the second part of this, which was befriending Doctor Emanuel Kanal, who is the godfather of MRI safety.
He helped me understand zones and design criteria with respect to safety, and then he wound up inviting me to serve on the ACR’s MRI Safety Committee. And I’m one of the contributing authors to their 2007 document. And that work really opened my eyes to a much broader world of MRI safety beyond just the physical environment piece. And quite frankly, I went into working with the ACR MRI safety committee, convinced I was going to teach these radiologists a thing or two about physical environment safety. And I guess, in all fairness, I did. But the piece of MRI safety, that is physical environment as opposed to the operational piece or clinical decision making, the physical environment is very important, but it really only hits once every ten years or so. When you’re replacing equipment or buying a new MRI machine. The other nine years and 364 days out of the year that aren’t consumed with planning for a new piece of equipment or a new addition, you have to deal with all of the day-to-day clinical decision-making and operational issues. And it was in that ACR Safety Committee meeting that I realized I really didn’t have a good understanding of what that was, and I was embarrassed, chagrined. And so I essentially committed myself from that point on that I was going to learn everything I could about MRI safety, not just the physical environment, but I wanted to understand the physics, wanted to understand the operational issues. I wanted to understand the clinical decision-making issues. And so that decision that happened somewhere around 2006 has really been the main springboard for everything I’ve done after.
Jennifer Callahan: So to touch on that, where you said that you expanded your information for yourself into MRI safety, I want to touch on your accreditations that you have. You have MRSO MRSE, and we all have in the world of radiology, those connotations at the end of our name. So can you just give a brief oversight of what those two stand for and what information has given to you?
Tobias Gilk: I think it was in 2014, there was an international collaboration led by the ISMRM that published a paper outlining the three principle roles with respect to MRI safety, the MR medical director supervising physician or radiologist typically, the MR safety officer who is analogous to a radiation safety officer somebody whose job it is to make sure that safety best practices are implemented at the point of care, and that we’re protecting our patients and our staff appropriately. And then the safety expert, which is, as the name suggests, somebody who has a higher level of understanding of the physics behind MRI safety issues and can lend that expertise for clinical decision-making. So ISMRM and a bunch of other alphabet soup organizations established those three roles and the criteria behind them.
As I say, I think that was like 2014, 2015, something like that, and then I belong to a group called the ABMRS, the American Board of Magnetic Resonance Safety. And the ABMRS took those roles that had been defined by all of these international groups and essentially developed certification exams. Minimum competencies for each of the three roles, right? So the ABMRS administers these certification exams. I’m one of the founding board members. I’m a past chair of the ABMRS and one of many people who helped to develop the exams for each of the three credentials. I can’t hold the MRND credential because that’s limited to licensed physicians, but through my work with ABMRS and developing the exams, the exam specification committees for each, the MRSO and MRSE exams essentially conferred the certificate, the credential on me for having demonstrated proficiency. I can’t really go and sit for the exam since I write the exams or parts of the exams. So instead, there’s an alternative compliance for the members who sit on the Exam Writing committees. I’ve been awarded both the MRSO MR safety officer and MRSE credentials.
Jennifer Callahan: Okay, great. So to go back into your architecture background, and when you got started into that and then looking at present day, what are the changes that you see in terms of MRI safety from when you first got in? Because you said there really was, no rules, there was no regulations, and now you know yourself that you’ve helped develop these rules and regulations and even have helped to develop the tests that you have to take to be an officer of that. What are the changes that have happened?
Tobias Gilk: I think we can look at the changes both in the plus and minus columns. Right. So on the minus side of things, pretty much every change in MRI over the last 20 years has somehow added incrementally to the risk. If we look at changes in MRI technology, stronger magnets, well, stronger magnets mean things. Get attracted to them with greater force, faster pulse sequences. The way that we do faster pulse sequences is we put more energy into the patient. For any given exam, some of those energies turn into heat. Some of those energies turn into induced voltages that potentially interfere with active implanted medical devices. So the technology associated with MRI scanners, a lot of the advancements, almost all of the advancements, incrementally increase risk in one way or another. And then if we look at who our patients are in MRI, 20, 25 years ago, every MRI manufacturer had big, bold print legal disclaimers in their operators manual that said something along the lines of under no circumstances do you put any patient who has any metal, any implants, any devices into this MRI scanner today, those patients make up, depending on where you’re scanning, somewhere, probably between 3,040% of your total patient cohort. So we’ve increased the potential for negative interactions between implants and devices. And the MRI just by who we allow to get MRI scans these days. And then thirdly, if we look at how we use MRI, it used to be 25 years ago to a large extent walkies talkies, knees, and heads.
A patient would walk in the room, hop up on the table. We would scan them, they’d hop off the table, walk away. Two days later, they’d get a call from their physician with the results. But today, anesthesia heavy sedation cases, ICU. And while it’s still a very small fraction of total imaging, emergent and trauma imaging. So the devices introduce more risk are general patient cohorts, introduces additional risks. And then the implants, devices, and foreign bodies that are in our patients introduce new risk. It’s difficult to pick one of those risks because most patient studies actually take a few of the risks from column A and a few from column B and a few from column C, and then just mix everything up and compound the risks. So the thing that I think is really important to recognize in the big picture of MRI safety is that MRI risk isn’t standing still. A lot of the advancements in MRI also come with advancements in the risks associated with MRI. So over time, MRI is riskier. Now, over that same time period, we have learned an awful lot and we have changed some practices. The problem, however, is we don’t actually require the practices that would prevent the most frequent forms of accidents and injuries. There are a lot of very strong, very well-informed, best practice recommendations. But if you look at state regulation, if you look at accreditation regimes, whether we’re talking in a whole hospital accreditation like joint Commission or whether we’re talking about modality-specific accreditation like the ACR, and there are others of each of those organizations, but those are the ones that people tend to be most familiar with.
If you look at the accreditation requirements, we don’t require the actions that actually prevent accidents and injuries in these environments. So risk has increased. We know more in terms of best practice, but we don’t actually require the best practices. So over time we’re seeing growth in accidents, near-misses, projectile events, pictures of stuff stuck onto the face of magnets. There’s isn’t that silly kind of initial reaction, but you have to recognize that the only way that that object gets in the room is if there’s a person there with it and if the position of the person relative to the object stuck to the magnet is changed just a little bit, that’s hitting somebody, that’s pinning and trapping somebody, those MRI accident porn pictures that get shared. And I’m guilty of this too, shared around pretty widely. And everybody is appropriately stunned by the power of the MRI to draw incredibly heavy things and lift them up off the ground. And what we have to remember is that in each and every one of those instances, that was probably just a question of a fraction of a second or a person in a. Slightly different position, that somebody would have been gravely injured or killed in those each and every one of those accident pictures.
Jennifer Callahan: So going from then till now, good changes have been made, but risks were always assessed going with them. Have you seen more development in terms of MRI-safe equipment?
Tobias Gilk: I suppose. Also good news, bad news. The good news is, for most pieces of equipment, there are conditional versions of wheelchairs and transfer gurneys and that sort of thing. The bad news is that we live under the shadow of the world’s most successful PR campaign. Mri is the safe modality, and the problem with that is that when we go to radiology managers or to hospital budget officials and we say, hey, we really need to buy this Mr. conditional anesthesia machine that unfortunately costs twice as much as a regular anesthesia machine. Well, why do you need to do that? Well, we have to buy the conditional one for Mr. Safety. All of a sudden, that budget request now is in competition with the MRI catchphrase. Mri is the safe modality. Well, if this is the safe modality, why are we spending twice as much on a special anesthesia machine? If it’s safe, you don’t need special safety equipment, right? So the equipment is out there. The challenge is that a lot of facilities, for multitudes of different reasons, don’t want to invest in the appropriate equipment, whether that’s infusion pumps. There are lots of hospitals that unfortunately that I’ve seen that bring an infusion pump down from the floors and simply park it outside the MRI room and leave the door to the MRI room slightly open so they can sneak the tubing from the infusion pump outside the room to the patient in. And those sorts of homebrew types of solutions to not having the appropriate equipment can lead to all sorts of problems associated with the wrong equipment, in the wrong environment kind of thing. So there are solutions. We just again, we don’t require that hospitals actually use the available solutions to protect their patients.
Jennifer Callahan: It brings me to thinking, as I was saying, the computer-based training that most health systems or anyone that’s working around MRI machines has you do. And it’s always talking about the zones for the MRI. You have zone one, two, three, four. And it talks about a zone one, where the waiting room is or is that zone four?
Tobias Gilk: Yeah. It goes from the least risk in zone one to the most risk in zone four. Yes.
Jennifer Callahan: All right. So yeah, it brings you to that where basically zone three is the hallway that leads into the MRI room or into the MRI suite. And then so four would be the actual MRI room. Why are you bringing something that close? That’s a potential risk into zone three because as you said you’re incrementally getting up in that.
Tobias Gilk: But I’m right now I’m wrestling with the whole annual renewal training programs. A lot of the ones that I see are droning narrated PowerPoint, and you’re supposed to get some critical piece of information in 15 minutes when staff are really not given time to sit down and pay direct attention and absorb this. It’s oh, by the way, you have ten charts you have to make notes on, and you have to get this done by the end of shift today. And the ways in which we go about training staff and sharing with them information that is so vitally important to their safety and the safety of their patients. We don’t give it the emphasis. We don’t give the staff the time that they would really require to allow it to have the appropriate emphasis. So there are a lot of people who walk around, oh, I’m MRI safety trained. And if you’ve sat down in front of a 15-minute narrated PowerPoint, in my opinion, you probably aren’t MRI safety trained. Not to a point where you should really be given safety responsibility inside the MRI suite. Absolutely. We need to make sure that the anesthesia or respiratory or nursing or whomever is coming with a patient to MRI and has patient care responsibilities within the MRI suite. Absolutely. We need to make sure that those people have appropriate levels of MRI safety training. In my experience, those 15-minute cables just really don’t do the trick. And in an area where it appears that the laws of physics change inside that room, things don’t fall down to the floor. They fly sideways and accelerate as they go in a room where the the laws of physics seem to change, we really need to do more in terms of communicating the risk information and the safe practice information to everyone and anyone who has patient care responsibility there.
Jennifer Callahan: So going off of that, you do do training, correct? You offer training to health systems and anyone that has an MRI machine, do you go and do this in person or looking at computer-based learning.
Tobias Gilk: So my strong preference is to do in-person learning. And yes, I have done will go to individual hospitals or hospital groups and provide training for Rad techs or radiologist or residency programs. I have also worked with large distributed imaging networks where I’ve worked with them to develop video training, which is not as good as being in person, but in my opinion, a whole lot better than just your 15 20-minute cables, essentially multi-part. And I worked with one imaging center group that essentially we developed a series of training videos that would be administered quarterly. And every quarter, everybody who had certain designations of MRI safety training would get a quarterly update. And that way we’re not number one. We’re not waiting an entire year before we reinforce training. They get a little slice of it every three months. And then number two, because we’re breaking it up into smaller pieces, we can give folks a 30-minute, 45-minute, 60-minute course every quarter. And over the course of the year, they’re actually getting a meaningful quantity of training that covers sort of the breadth of issues that need to be covered to help make sure that folks are current on their training and have a more comprehensive understanding of what the risks are and what best practices are.
Jennifer Callahan: Okay, you have been part of helping out with legal and insurance issues on this, and have you been called before as an expert witness?
Tobias Gilk: The expert witness work that I’ve done has really it is pretty substantially informed the way that I teach, what I teach, what I guide client facilities to do because I have seen firsthand how not paying attention to protecting liability can really circle around and bite somebody hard. So yes, by looking at both the ways in which accidents are allowed to happen and what has been successful in terms of facilities. Controlling the potential liability that they might face as a result of an accident once it’s happened. Both of those things have really informed how I teach and how I consult facilities. Just one example of that. Probably 15 years ago, I thought that policy and procedure manuals were really exercises and checkbox compliance. And I’ve done a complete 180 on that. I used to think as long as you had smart, intelligent, nonsociopathic, caring people working for you, you really didn’t need policies and procedures because everybody really knew what the right thing to do was. The expert witness stuff has really shown me that’s not enough, that yes, that should be the minimum in terms of who you bring on and how you run your shop. But you really need to have as an institution, as an enterprise, you need to have very clearly defined practices. You need to do a really good job in terms of communicating those clearly defined practices to your staff, to the folks who implement it at the point of care. And those things will go an extremely long way, both in preventing the bad thing from happening in the first place. And if God forbid, the bad thing actually does happen, being able to demonstrate that you are proactive in trying to prevent the bad thing will reduce any potential liabilities that the organization may face. So I am now captain Policy and Procedure Manual, and I advocate for that with my clients very strongly.
Jennifer Callahan: Do you ever receive any like pushback or resistance from staff or clinicians or anyone in terms of what you try to help implement into the department?
Tobias Gilk: That’s the single biggest part of my job. It can be really difficult for folks who feel that making a change in the way that we do things is somehow an implicit acknowledgment that we were doing it wrong before. And that can be an ego hit. Helping people to understand that there are always better ways to do things. And it’s changing from the way we did things yesterday to the way we’re doing things today, does not necessarily mean you are doing them wrong yesterday. It just means that we recognize that over time, we’re going to uncover better ways to get things done. And if we hold on with a death grip on the way, we’ve always done things. As the world shifts, as risks change in MRI, as we face new challenges with staffing, as we get a newer, faster, stronger, better MRI scanner, as we get a different referral base and they change the types of patients that get referred to MRI. All of those things are changing. The risk patterns for MRI. And if you have the death grip on the way we’ve always done things, you’re actually regressing in terms of your ability to stay current with the contemporary challenges. So the way we’ve always done things, the way we did things last week, last year, ten years ago wasn’t necessarily wrong. But holding on to that refuses to acknowledge the fact that the world is changing around us and that there are probably better ways today. And oh, by the way, there’ll probably be a better way tomorrow. And we need to accept and to some degree embrace the fact that change really needs to be persistent. We need to continuously kind of review are the way we’re doing things today. Is it really serving the best interests of our patients and our staff and our referring physicians and our allied clinicians? Those questions need to be asked on a regular basis, because the world is changing and because the risks are changing, and we need to change with them and continuously update and refine our practices and our policies.
Jennifer Callahan: Looking at tomorrow and the future, I guess with emerging technologies that are coming out, because this field is ever-changing, and it’s actually I feel like at this point where we are so many different developments are being made across the board with radiology. So with emerging changes, with technology and a different practices, how do you think that MRI safety is going to change for the future or how will it be shaped?
Tobias Gilk: I think they’re again, looking at sort of the technology of MRI and looking at how we use it and the patients that we have. If we look at each of those three categories, right? So we have, over time increased the patient acuity in terms of using MRI as a diagnostic tool for a broader cross-section of patients. And I think that’s going to continue. We will continue to find really beneficial clinical uses for MRI in emergent medicine, in high acuity medicine, post-surgical, or even concurrent with surgery, inter-operative, MRI systems, those sorts of things. I think that the proliferation of implants and devices that are just in the general public, who at some point or another, will likely need an MRI, we’re going to see a greater variety proliferation of implants and devices in people, which will add potential contraindications, or at least complications for MRI studies. And then on the technology side, there are some things that I’m excited about that might be technological innovations that actually reduce some of the risks. And I’m thinking specifically of like eye image reconstruction, where we can collect less data, less signal from the patient exam, and through I still be able to construct diagnostic images, high-quality diagnostic images. And if we can reduce the timeframe or the amount of signal that we need to get from the patient to produce a set of images, we can reduce some of the associated risks with that.
So that’s a technological innovation that may have some significant safety advantages. One of the things that’s from a safety standpoint, a very big question mark technologically in the future is the deployment of remote scanning, just like radiologists have been able to read in their bedroom slippers from their extra bedroom or office at home. And really, all you need is a reading station and a high-speed internet connection. MRI scanners can do the exact same thing in terms of the operator. The operator doesn’t have to be sitting at the point of care. They can be in a different part of the building. They can be in a different state, a different country, which really throws a wrench in the works in terms of how we have defined best practices from a safety standpoint, everything up to this point presumes that the master radiographer is at the point of care. And so we have made explicitly or implicitly, we’ve built the entire MRI safety regime around the presence of the master radiographer. What happens when that person is no longer at the point of care? A lot of the standards that we have built, in terms of how we assure safety at the point of care don’t mean to suggest that they’re weak or flimsy, but if you take the central core of the master radiographer technologist, you take them away from the point of care and everything else crumbles like a house of cards.
Tobias Gilk: So we don’t currently have standards or best practices defined for how we’re going to make sure that patients are safe, that allied clinicians are safe, that we have appropriate supervision for non-technologists, non-radiographer personnel at the point of care. None of those things are very clearly defined when you take the radiographer out of the picture. So I think that there are some amazing potential benefits from remote operation. But unless and until we have a very clear picture as to what the minimum safety expectations are, who gets trained to what level? Who do we have? Staffing? How many people do we have? Staffing? Do we allow anesthesia cases, or do we allow the physician or tech to come in and do patient monitoring in the master suite when there’s no master tech that’s present? All of these questions are really circling around the remote operation model. And while there are individual providers that have built their own internal, proprietary, you know, policies and procedures on this, there’s no yardstick. There’s nothing against which we can measure. Are you doing this the way that really ought to be done? Because nobody to date has really defined how it ought to be done to make sure that we maintain minimum acceptable levels of safety and quality of patient care.
Jennifer Callahan: What advice would you give to someone who is? In healthcare, working with MRI, or even someone who is interested in getting into working in the field of MRI safety. What type of advice would you give to that person?
Tobias Gilk: The first piece of advice would be, please, we need more people that were committed to MRI safety, the technological and the patient care innovations that are coming. If we’ve been caught flat-footed or behind the rate of change that this industry has faced in the last 20 years, my concern is the next 10 or 20 years, we’re going to see significantly greater rates of change, which means if we’re already behind, we need to not only catch up, but we need to accelerate in terms of our rate of deploying best practices. With the case of remote scanning, we need to develop the best practices and then deploy them. So we need talented people. We need folks who are involved in MRI patient care, MRI safety, who can help push this specific modality, push it faster further than has been pushed in the recent past to again make sure that we’re providing safe and effective patient care. I think that while harped on the PR campaign, MRI is the safe modality. One of the really interesting things is that it could be it can be MRI. Unlike ionizing radiation, where every study we have some minuscule percentage chance we’re going to induce a cancer that appears in the patient 20, 30, 40, 50 years later. We don’t have that risk in MRI, which means if we injure people, it really comes down to us human beings not following the best practices.
We understand what the risks are, by and large, we understand really effective ways to prevent harm, to prevent the risk from turning into the bad thing. So when we hear of an accident or an injury or a near-miss event, 99.999% of the time, it’s because of us. If we can identify policies, procedures, practices that prevent the bad thing from happening, we can fulfill the promise. We can make MRI the safe modality. The problem is that really today, because we don’t have minimum regulatory standards for patient safety in MRI, because the accreditation regimes don’t really mandate the practices that would stop accidents and injuries from happening today falls to each individual hospital. And if the hospital’s really not strong in terms of policies or procedures or oversight, then it falls to each individual technologist, each individual radiologist, which leads to enormous variability in how we care for patients from day shift to night shift to weekends. Whoever is on call, that patient’s going to receive a different level of care than the Monday through Friday weekdays. By establishing standards, establishing minimum requirements for patient safety and quality, we can fulfill the promise of MRI as the safe modality. In my estimation, we’re a long way from that today, and we need people who want to get into this field, who have that as a personal mission to get there or get closer to it.
Jennifer Callahan: Was thinking myself, I’m an X-ray technologist and working with ionizing radiation. We have our like basic principle that’s the most important. And it’s Alara as low as reasonably acceptable. Does MRI have something similar to that in terms of for safety and best practice?
Tobias Gilk: Unfortunately, MRI risk assessment risk mitigation training is really not a minimum part of the training of radiographers or radiologists. In my estimation, it’s really an embarrassment for the profession. Let’s start with the fact that most states and is ample to allow you to operate an MRI scanner. I don’t mean in any way reduce the knowledge or the skills or competency of x-ray radiographers, but x-rays and ionizing radiation really don’t prepare you the skills, and the knowledge there are not very transferable to the very peculiar set of risks in the MRI environment. So if an RTR gets you in that seat and allows you to be, according to the states, an operator for an MRI scanner and really doesn’t need to have really any meaningful MRI safety training, then we, in terms of building structures for making sure that the patients and the staff are safe, we’ve fallen down on the job. We need to look at what really is effective training, both in terms of sitting down in that seat for the very first time. What do you need to know before you are an MR Staffer of any sort? And then what do we need to do in terms of ongoing and persistent training to make sure that those skills not only don’t atrophy but that we build you up, as we talked about, as the risks change over time, we also need to make sure that we do this with our radiologists as well. Today in 2023, it is not a requirement for radiology residency to have any training in MRI safety. So a radiologist who is legally responsible for the safe execution of the MRI study isn’t minimally required to have any training in MRI risk assessment or risk mitigation.
Tobias Gilk: Now, there are lots of residency programs out there that do provide some sort of training on MRI risks and risk mitigation, but that’s not a requirement, which means your radiologists, especially the ones that maybe came out of residency ten years ago, 20 years ago, they may be reading these studies, they may be the supervising physician for the MRI study, and they may not have had any formal training in MRI risk. I think every radiographer has in their own sort of little mental Rolodex. Here’s the radiologist that I can call to get approval for this study. The radiologists who will simply defer to whatever the tech suggests to them. And largely that’s because in many cases, the radiologist really are uncomfortable with their own level of knowledge in terms of making these decisions. We need to reconsider the entire education and training structure in MRI, and that applies to the Rad techs. If we’re going to do remote scanning, the tech aids or Paratek or patient care tech at the point of care, who has no responsibility for running the scanner, but has responsibility for every other aspect of patient care and safety in that environment, and the radiologists. And we need to work really across the spectrum at building minimum acceptable levels of MRI safety training, minimum levels of annual update, and expansion of that knowledge. Otherwise, we’re fighting against the tide in terms of the increasing risk factors that we’re seeing in MRI. Education is an enormously important part of this.
Jennifer Callahan: Good point everybody. This is Tobias Gilk sharing with us the importance of MRI safety and how important it is to be educated with what’s going on with the MRI machine, what’s going on around it, and then what you should really know. Pay attention to your computer-based learning. Don’t just look through your screens. I really want to thank you for your time and sharing the information that you have, and your wealth of knowledge, and your expertise in this field of MRI safety, because it is so important.
Tobias Gilk: Thank you for having me. I’m thrilled to have the opportunity to step up on the soapbox and share what I think is vitally important for our profession.
Jennifer Callahan: Yes. All right, everybody, well, this is Jan Callahan and Tobias Gilk here on the Skeleton Crew. Thank you for being with us today. Make sure that you check out our other episodes that we have, and please leave us some valuable feedback, likes, or anything like that that you want to share with us to help us along in this journey of delving into the world of radiology.
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