Purpose/Objective(s):To describe requirements for facility design, training, procedures, and organizational culture to be established for safe operations in a Magnetic Resonance Image-guided Radiotherapy (MRgRT) facility.
Materials/Methods:A novel facility for Magnetic Resonance (MR) guided external beam radiotherapy and brachytherapy, as well as MR-simulation has been constructed using an MR on ceiling-mounted rails spanning three rooms. MR and radiation risks present unique challenges due to a lack of guidelines for development of safe clinical implementation strategies. Guidance from the Canadian National Safety Commission regulations and the American College of Radiograhpy (ACR) MR safety recommendations were incorporated for safe design. Operational procedures were devised to create a clinical 'microsystem' with many of the attributes of high reliability organizations (e.g. nuclear power operations and air traffic control), which have experience with high risk and complex environments. ACR guidelines for staff training were followed and supplemented with access and use privileges defined by existing institutional safety committees. Staff competency was developed through collaborative workflow development led by clinical experts, including failure scenarios, and a culture which emphasized safety.
Results:A conservative approach defined MR safety Zone 4 (traditionally the area synonymous with the MR scanner magnet room) as any room which may house the MR, regardless of the magnet’s location. Interlocks securing ferromagnetic equipment behind radiofrequency (RF) and radiation shielded doors limit magnet entrance into potentially hazardous space. A single entrance with controlled access to the MRgRT suite leads to a Zone 2 patient screening area. Staff training according to ACR guidance included training programs customized for the facility. An MRgRT duty officer has the authority to stop all clinical processes. All program staff underwent Level 1 MR safety training. Permission for staff to work within Zone 4 was granted following Level 2 safety training. Detailed workflows were developed by frontline experts for all clinical, quality control, and emergency applications and refined by simulation. A culture promoting MR and radiation safety was facilitated by the creation of a charter with patient and staff safety as the top priority.
Conclusions:A clinical 'microsystem' has been implemented to create a safety culture in a high-risk facility through customized design, training, detailed policies / procedures, new staff roles, and a charter that governs MRgRT operations in this unique facility.
Dickie, C,
Safe Clinical Operations for Magnetic Resonance Image Guided Radiotherapy. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/14043611.html
