Perceptions of Indian Radiographers about Patient Care and

Perceptions of Indian Radiographers about Patient Care and Safety In MRI
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Abstract
Since the 1990s, MRIs have gained significant popularity in healthcare settings and
research. However, is not properly conducted, MRI procedures may have significant
adverse effects on the patients, or the imaging personnel. Therefore, adequate safety
measures must be adhered to. The aim of the study is to explore the perceptions of
Indian radiographers about patient safety and care in MRI. Descriptive and survey
research designs were applied to address the research objectives. Data was collected
from 29 radiographers working with MRIs, who were selected from different health
imaging facilities within India. The findings of the study indicated that radiographers
perceive patient safety and care as a priority in their practice. Also, demographic factors
apart from education did not affect the radiographers’ view of patient health and safety.
Education determined the levels of skills and knowledge regarding MRI safety
procedures and standards. Further, the work environment was a key determinant of
adherence or radiographers to safety guidelines. The radiographers understand and
uphold the importance of safety and care of the patient before, during and after the
imaging procedures.

Table of Contents
Abstract..............................................................................................................................2
CHAPTER ONE: INTRODUCTION...................................................................................5
1.Introduction..........................................................................................................5
1.1 Preventing Decontamination, Infection and Hospital-Acquired Infections..................6
1.3 Objectives..........................................................................................................8
CHAPTER 2: LITERATURE REVIEW.............................................................................10
2.Introduction.........................................................................................................10
2.1 Risks Associated with MRI.....................................................................................10
2.2 Prevention of MRI ..................................................................................11
2.2.1 Prevention by Restriction and Access Control................................................12
2.2.2 Risks Related To the Refrigerant.....................................................................13
2.2.3 Risks Related To Magnetic Field Gradients....................................................14
2.2.4 Risks Related to Antennas...............................................................................15
2.3 Responsibilities of the Radiologist.........................................................................17
CHAPTER 3: RESEARCH METHODOLOGY.................................................................20
3.Introduction........................................................................................................20
3.1 Research Design..............................................................................................21
3.2 Population of the Study........................................................................................22
3.3 Sampling Technique...........................................................................................22
3.4 Instruments......................................................................................................23
3.4.1 Questionnaire...................................................................................................23
3.4.2 Interviews.........................................................................................................24
3.5 The validity of Instruments (Pilot study).................................................................25
3.6 Data Collection Procedures...................................................................................25
3.7 Methods of Data Analysis......................................................................................26
3.7.1 Quantitative Data Analysis...............................................................................26
3.7.2 Qualitative Data Analysis.................................................................................27
3.8 Ethical Consideration...............................................................................28
CHAPTER 4. RESULTS AND FINDINGS.......................................................................28
4.0 Demographic Characteristics.................................................................................28

4.1 Findings from the Questionnaire............................................................................31
4.1.2 Part A...............................................................................................................31
4.1.3 Part B...............................................................................................................32
4.1.4 Part C...............................................................................................................32
4.2 Interview Findings...............................................................................................32
4.2.1 Phase 1: Planning the MRI examination.........................................................33
4.2.2 Phase 2: Producing Correct Images................................................................35
4.2.3 Phase 3: Evaluating the MRI examination.......................................................36
CHAPTER 5. DISCUSSION............................................................................................38
CHAPTER 6. CONCLUSION..........................................................................................39
References.......................................................................................................................41

CHAPTER ONE: INTRODUCTION
1.Introduction
In the recent two decades, the safety and care of patients have managed to garner a lot
of attention. The Institute of Medicine report published in 1999, "To Err is Human",
indicated that between 44,000 and 98000 patients die in American Hospitals as a result
of preventable errors (Lark, Kirkpatrick, and Chung, 2018). Notably, many broad
epidemiological types of research have claimed that a made or the increased level of
risk is mainly because of mistakes that occur within the current medical environment
(Hartwig et al. 2009; Ko and Yu, 2015; Mello and Hemenway, 2004 and; Hiivala et al.,
2016). Improving the safety level of patients has become paramount within all
healthcare services and procedures. A recent case study revelation of medical
misconduct involving MRI, in a Taiwan hospital, clearly states that the risk sources tend
to lack adequate clinical training and inaccurate and insufficient communication
amongst the MRI staff and clinical team (Lee, Lin and Chan, 2015).
There is a rising consideration of MRI by practitioners due to the exquisite soft-tissue
delineation provided by the imaging modality. The MRI process involves exposure to
powerful static magnetic fields and gradient fields and radiofrequency energy. Without
going into the details and technical aspects of its operation, an MRI machine generates
magnetic fields to provide high definition images of all parts of the human body (Kanal
et al. 2007; Sammet 2016). The advantage compared to other imaging devices, it emits
no radiation that could harm patients or professional users. Its major drawback is that it

is a very powerful electromagnet which necessarily requires perfect control of the
environment near the installation. It is essential for staff, visitors and patients to
understand the primary hazards associated with the environment and select the safest
and rigorously protection procedures to follow (Durbridge 2011). Within the Indian
context, key safety considerations that are related to the patients are associated with
magnetic resonance imaging (MRI) should always consider the following aspects
(Durbridge 2011).
 The associated behaviour of ferromagnetic objects when they are exposed to a
robust magnetic field as the forces can react over the ferromagnetic implant
thereby, resulting in it to transit in a different direction causing injury or potential
death. Additionally, many external ferromagnetic objects might also get
influenced by the strong magnetic fields and tend to become airborne and will
transmit rapidly towards the isocenter of the magnetic. This situation might also
cause injury or death (Durbridge, 2011).
 Gradient or static magnetic fields might also have an impact over other medical
devices, whether external or implanted and can cause them to malfunction
(Durbridge 2011).
 Acoustic sounds that are associated with frequently switching gradient coils can
also be a severe risk for the patients. This can be avoidable through
appropriately using noise reduction and hearing protection technologies
(Durbridge 2011).
 The risks associated with radiofrequency (RF) include heating up of tissues
because of RF energy deposition, which can be measured as the specific

absorption rate (SAR). Resultantly, this is more evident because of the
increasing field strengths mainly because of the increased frequency of the RF
pulses. Additionally, the energy of RF can also be deposited within wires, cables,
tattoos and skin patches causing these elements to get heated and potentially
result in burns to the patient (Callaghan et al. 2019; Durbridge 2011; Takahashi,
Fujimoto, Hamada, Tezuka, and Tanaka, 2016).
1.1 Preventing Decontamination, Infection and Hospital-Acquired Infections
As per a study undertaken by the Centres for Disease Control and Prevention (CDC),
basic control over infections within hospitals must include all the general principles to
avoid transmission within all patient care, as well as specific ways for preventing that,
are suspected or known to be infected within a transmittable microorganism (Centers for
Disease Control and Prevention, 2017). General principles to be applied by healthcare
professionals include:
 Using personal and protective equipment at the time of exposure to that of
infectious material (Centers for Disease Control and Prevention, 2017);
 Performing hand hygiene and using all five moments (World Health Organization,
2018) before and after touching the patient and appropriately using the solutions
for washing hands or disinfection (Centers for Disease Control and Prevention,
2017);
 Assure staff awareness about issues that are related to patients in isolation
particularly, the contact and respiratory types of isolation (Centers for Disease
Control and Prevention, 2017);

 Assuring safer procedures for injections and follow the rule 'one syringe, one
needle and one use' (Centers for Disease Control and Prevention, 2017).
 Handling laundry garments and textiles very carefully and dispose of them off per
the hospital policy (Centers for Disease Control and Prevention, 2017);
 Ensuring cleanliness of the materials related to sterilization and disinfection as
well as the environment of the patient (Centers for Disease Control and
Prevention, 2017).
Transmission prevention processes should also be used within patients who have been
infected or occupied with particular infectious agents and which include (Centers for
Disease Control and Prevention, 2017):
 Precautions undertaken during contact in case of contact transmission occur in a
patient. This is achieved through isolating the patient, making use of personal
protective equipment, making use of disposable equipment and assuring
surfaces are appropriately cleaned.
 Airborne precautionary measures in case infectious microorganisms transmit
through airborne routes like measles, tuberculosis or chickenpox. Droplet
precaution can be used along with restricting susceptible healthcare
professionals to access the room by immunizing all susceptible people.
 Droplet precautions can be used for agents that are transmitted by respiratory
droplets such as talking, coughing or sneezing. This can be attained through the
continuous usage of facemasks, using personal protective equipment as well as
limiting patient transport and movement.