The European Federation of Organisations for Medical Physics Policy Statement No 14: The role of the Medical Physicist in the management of safety within the magnetic resonance imaging environment: EFOMP recommendations

MRI in patients with a cerebral aneurysm clip; review of the literature and incident databases and recommendations for the Netherlands

BACKGROUND

In the past ferromagnetic cerebral aneurysm clips that are contraindicated for Magnetic Resonance Imaging (MRI) have been implanted. However, the specific clip model is often unknown for older clips, which poses a problem for individual patient management in clinical care.

METHODS

Literature and incident databases were searched, and a survey was performed in the Netherlands that identified time periods at which ferromagnetic and non-ferromagnetic clip models were implanted. Considering this information in combination with a national expert opinion, we describe an approach for risk assessment prior to MRI examinations in patients with aneurysm clips. The manuscript is limited to MRI at 1.5 T or 3 T whole body MRI systems with a horizontal closed bore superconducting magnet, covering the majority of clinical Magnetic Resonance (MR) systems.

RESULTS

From the literature a list of ferromagnetic clip models was obtained. The risk of movement or rotation of the clip due to the main magnetic field in case of a ferromagnetic clip is the main concern. In the incident databases records of four serious incidents due to aneurysm clips in MRI were found. The survey in the Netherlands showed that from 2000 onwards, no ferromagnetic clips were implanted in Dutch hospitals.

DISCUSSION

Recommendations are provided to help the MR safety expert assessing the risks when a patient with a cerebral aneurysm clip is referred for MRI, both for known and unknown clip models. This work was part of the development of a guideline by the Dutch Association of Medical Specialists.

EFOMP Malaga Declaration 2023: An updated vision on Medical Physics in Europe

In 2006, the European Federation of Organisations for Medical Physics (EFOMP) adopted the "Malaga Declaration". The declaration asserted the fundamental role of Medical Physics professionals in the radiation protection of patients, workers, general public, carers and comforters and research participants in hospitals. However, since that time the Medical Physics profession has evolved in Europe and new regulations and documentation have been issued, such as directive 2013/59/Euratom and the "European Guidelines on Medical Physics Expert" (RP174). EFOMP has published updated core-curricula and strived towards the recognition of the profession at the European level. In view of this, an update of the original Malaga Declaration was deemed necessary, to define the future vision that will guide the actions of the Federation in the years to come. This Declaration, which has been approved by the national member organizations of EFOMP in April 2023, is much broader than the original Malaga version. This is expected considering the rapid evolution of medical device technology over the last 17 years. The Radiation Protection Expert in hospital settings should be an MPE, since the latter has the highest level of radiation protection knowledge and training. Given the passion and energy that animated the debate, which led to the updating of the Malaga Declaration, we are confident that it represents a solid basis for the development of our profession in Europe which is in consonance with the aspirations of us all.

ACPSEM position paper on ROMP scope of practice and staffing levels for magnetic resonance linear accelerators

The purpose of this position paper is to outline the ACPSEM recommendations on Medical Physicist scope of practice and staffing levels, as they relate to the use of dedicated MRI-Linacs in the treatment of patients. A core function of Medical Physicists is to safely implement changes in medical practice via the introduction of new technology and to ensure high quality radiation oncology services are provided to patients. Determining the feasibility of MRI-Linacs in any existing setting, or in establishing a new site, mandates the knowledge and services of Radiation Oncology Medical Physicists (ROMPs) as the Qualified Experts within this setting. ROMPs are key members of the multi-disciplinary team which will be required to steer the successful establishment of MRI Linac infrastructure within departments. To support efficient implementation, ROMPs must be embedded in the process from the start, including any feasibility study, initiation of the project, and development of the business case. ROMPs must be retained throughout all stages of acquisition, service development, and ongoing clinical use and expansion. The number of MRI-Linacs in Australia and New Zealand is growing. This expansion is occurring in parallel with rapid technological evolution, expanding tumour stream applications, and increasing consumer uptake. Growth and applications of MRI-Linac therapy will continue to occur beyond current known horizons, via development on the MR-Linac platform itself and through the migration of learning from this platform to conventional Linacs (known horizons for example include the use of daily, online image guided adaptive radiotherapy and MRI data informing decision making for planning and treatment before and throughout treatment courses). Clinical use, research and development will be a significant component of expanding patient access to MRI-Linac treatment and there will be an ongoing need to attract and retain ROMPs to initially establish services and in particular to drive service development and delivery for the life of the Linacs. MRI and Linac technologies mean it is necessary to perform a specialized workforce assessment for these devices, distinct from those employed for conventional Linacs and associated services. MRI-Linacs are complex, have a heightened risk profile compared to standard Linacs, and are unique in their treatment of patients. Accordingly, the workforce needs for MRI-Linacs are greater than for standard Linacs. To ensure safe and high-quality Radiation Oncology patient services are provided, it is recommended that staffing levels should be based on the 2021 ACPSEM Australian Radiation Workforce model and calculator using the MRI-Linac specific ROMP workforce modelling guidelines outlined in this paper. The ACPSEM workforce model and calculator are closely aligned with other Australian/New Zealand and international benchmarks.

[Test methods to determine magnetic resonance (MR) safety and MR image compatibility of implants/devices]

METHODICAL INNOVATIONS

In the present article, interactions associated with magnetic resonance (MR) procedures and MR test procedures for implants/devices are examined.

PERFORMANCE

Since 2012, many interactions of items with MR procedures have been physically described and translated into standardized ASTM and ISO testing procedures. Despite the standardized procedures, the determination of the test method to use is an important decision. The MR user is also responsible for the transfer and interpretation of the individual technical parameters despite the MR Conditional labelling and therefore relatively unambiguous instruction. This includes the total MR examination duration, which often has no clinical practical duration, but is derived from the 15 min of the ASTM radiofrequency (RF) heating test.

ACHIEVEMENTS

There has been an increasing standardization of the test methods as well as the MR labeling requirements and the advantageous transfer of the parameters to suitable input masks on the MR systems.

PRACTICAL RECOMMENDATIONS

The current use of standardized MR test methods and MR marking represents the best possible state of the art from the point of view of the approval of medical devices as well as from a liability point of view for the manufacturers of implants-and for MR users in clinical practice. However, off-label decisions (i.e., deviations from the manufacturer's official MR marking) in everyday clinical practice can be medically justified.

Recent Progress on Electromagnetic Field Measurement Based on Optical Sensors

Electromagnetic field sensors are widely used in various areas. In recent years, great progress has been made in the optical sensing technique for electromagnetic field measurement, and varieties of corresponding sensors have been proposed. Types of magnetic field optical sensors were presented, including probes-based Faraday effect, magnetostrictive materials, and magnetic fluid. The sensing system-based Faraday effect is complex, and the sensors are mostly used in intensive magnetic field measurement. Magnetic field optical sensors based on magnetic fluid have high sensitivity compared to that based on magnetostrictive materials. Three types of electric field optical sensors are presented, including the sensor probes based on electric-optic crystal, piezoelectric materials, and electrostatic attraction. The majority of sensors are developed using the sensing scheme of combining the LiNbO3 crystal and optical fiber interferometer due to the good electro-optic properties of the crystal. The piezoelectric materials-based electric field sensors have simple structure and easy fabrication, but it is not suitable for weak electric field measurement. The sensing principle based on electrostatic attraction is less commonly-used sensing methods. This review aims at presenting the advances in optical sensing technology for electromagnetic field measurement, analyzing the principles of different types of sensors and discussing each advantage and disadvantage, as well as the future outlook on the performance improvement of sensors.

Non-Ionizing Radiation in Swedish Health Care-Exposure and Safety Aspects

The main aim of the study was to identify and describe methods using non-ionizing radiation (NIR) such as electromagnetic fields (EMF) and optical radiation in Swedish health care. By examining anticipated exposure levels and by identifying possible health hazards we also aimed to recognize knowledge gaps in the field. NIR is mainly used in health care for diagnosis and therapy. Three applications were identified where acute effects cannot be ruled out: magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS) and electrosurgery. When using optical radiation, such as class 3 and 4 lasers for therapy or surgical procedures and ultra-violet light for therapy, acute effects such as unintentional burns, photo reactions, erythema and effects on the eyes need to be avoided. There is a need for more knowledge regarding long-term effects of MRI as well as on the combination of different NIR exposures. Based on literature and after consulting staff we conclude that the health care professionals' knowledge about the risks and safety measures should be improved and that there is a need for clear, evidence-based information from reliable sources, and it should be obvious to the user which source to address.