MRI —
Training activity: 1

Details

Investigate MR safety conditions associated with different active and passive devices, including a pacemaker and a neuro-stimulator, and make recommendations on the scanning of patients with these devices

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Identification of hazards
• Understanding of control measures
• National guidance and legislation
• MR local rules

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• How will you demonstrate your ability to investigate MR safety conditions for devices like pacemakers and neuro-stimulators, and effectively make recommendations for scanning patients with them?
• Discuss with your training officer to gain clarity on the specific depth of investigation required and the format or criteria for making recommendations. What level of detail is expected in your report or advice?
• Think about what you already know about MR safety, different types of active and passive devices, pacemakers, neuro-stimulators, and the process for assessing device safety in an MRI environment. Have you encountered discussions about these devices in previous clinical observations?
• Consider possible challenges you might face during the investigation, such as accessing up-to-date device information, interpreting complex safety guidelines, or dealing with ambiguous device labelling. How might you handle these challenges?
• When investigating MR safety for these devices, at what point would you need to seek advice or help, and from whom (e.g., a senior physicist, radiologist, device manufacturer, or MR safety officer)?
• Consider the specific skills you want to develop, drawing upon any previous experiences e.g., observation of MR safety screenings or general MR safety training. Do you aim to improve your ability to critically assess device information, formulate clear recommendations, or effectively communicate complex safety data?
• Identify the specific insights you hope to gain from engaging with this activity. For example, do you want to understand the common pitfalls in assessing device safety, or gain a deeper appreciation for the interplay between device physics and patient safety in MRI?
• Consult any actions identified following previous experiences related to MR safety or device assessment. Did you previously note a need to improve your research skills for specific device types?
• Identify important information you need to consider before embarking on the activity. This could include reviewing departmental MR safety policies, understanding relevant regulatory requirements for medical devices, or familiarising yourself with common guidelines for scanning patients with implants.

In action

• During the investigation, is anything unexpected occurring regarding the MR safety conditions of a device or the patient’s reaction to the safety assessment?
• Is any information, or the interaction with a specific device/patient scenario, feel surprising or different from what was anticipated during this safety investigation?
• How is this specific experience comparing with previous experiences of investigating device safety conditions or similar patient assessments?
• How are you reacting to any unexpected developments during the safety investigation or recommendation process?
• How is this impacting on the actions taken; for example, is your response to an unforeseen safety concern appropriate? Do you adapt or change your approach to gathering information or making recommendations? Does it affect your ability to independently assess and advise on device safety?
• How are you feeling in the moment, for example, is it difficult to adapt to new safety information? Is it affecting your confidence in making recommendations?
• What is the conclusion or outcome of immediate actions you are taking while investigating and making recommendations on MR safety conditions?
• How are you working within your scope of practice when facing unexpected safety considerations for devices?
• What are you learning as a result of any unexpected development you are encountering during this safety investigation?

On action

• Begin by summarising the key points of your experience investigating MR safety conditions for pacemakers and neuro-stimulators. This might include the resources you consulted, the specific information you gathered, and the recommendations you formulated.
  • Consider specific events, actions, or interactions that felt important, such as challenges in finding definitive safety data for a particular device model, unexpected nuances in device-specific MR conditionalities, or discussions you had with colleagues or manufacturers.
  • Include any ‘reflect-in-action’ moments where you had to adapt your investigative approach or decision-making as new information unfolded. For example, did you initially assume a device was MR unsafe only to discover it had specific conditional parameters, and how did you adjust your thinking in that moment?
  • Did you feel confident in your ability to interpret complex safety data, or did you feel overwhelmed by the variety of device types and their associated risks?
• What strengths did you demonstrate, for instance, in critical information gathering or in communicating complex safety advice? Were there any knowledge gaps, such as unfamiliarity with specific device types, or skill gaps, like navigating manufacturer guidelines, that became evident?
  • Compare this experience against previous engagement with similar activities e.g., assessing MR safety for simpler implants or other patient considerations.
  • Were any previously identified actions for development related to MR safety assessment achieved? Has your practice in this area improved?
  • Identify any challenges you experienced during the investigation, such as ambiguous device labelling or conflicting safety information, and how you reacted to these. Did these challenges affect your ability to deal with the situation, and were you able to overcome them?
  • Did you need to seek advice or clarification from a senior physicist or a cardiologist regarding a specific device? Or did you need to escalate a safety concern to ensure you were working within your scope of practice?
  • Do you feel more confident in investigating and advising on MR safety for active and passive devices?
• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt. For example, what will you do differently next time you need to make recommendations on scanning patients with active or passive devices?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, such as how you would approach research or whom you would consult?
  • Do you need to practise any aspect of this activity further, perhaps staying updated on new device technologies or refining your communication of safety recommendations?

Beyond action

• Have you revisited the experiences of investigating MR safety conditions and making recommendations?
• Review your actions from your previous reflections for this activity. What specific actions did you identify you would need to take to improve your practice regarding understanding diverse devices e.g., pacemakers, neuro-stimulators or formulating clear recommendations for scanning patients? For example, did you identify a need to consult more manufacturer guidelines, or seek expert opinions on complex cases? Have you completed these identified actions?
• Are you ready to demonstrate this new learning into practice when encountering new or challenging MR safety scenarios with active and passive devices?
• Has discussing these experiences with others changed your view or understanding of the complexities involved, leading to a transformation in your approach?
• How have these experiences impacted upon your current practice in advising on MR safety?
• Consider how the learning from these investigations will support you in preparing for observed ‘in-person’ assessments where you might need to perform MRI safety screening or advise a radiographer on managing an MR conditional implant.
• Consider how your practice in assessing MR safety and making recommendations has developed and evolved over time across various device types and patient scenarios. Do you now more readily recognise when a device’s MR condition is beyond your current scope of practice and requires escalation?

Relevant learning outcomes

#	Outcome
# 3	Outcome Appraise and advise on the safe application of MRI in the clinical environment.