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3. Professional responsibilities

3.1 Referrals for MRI

3.1.1  Referrals for MRI examinations should include a detailed clinical history and clearly state what examination is being requested.
3.1.2  Referral forms should be signed and dated.
3.1.3  Referring clinicians should also complete the relevant safety section on the referral form and/or submit any safety information known to them about the patient (ideally at the time of referral, in consultation with the patient). However, the person taking the patient/volunteer into the MR Environment should be certain that all departmental safety checklists have been carried out and is entirely confident that it is safe to do so.2 See also section 3.2 of this document.
3.1.4  MR departments must ensure that the referral is from an authorised source.

3.2 MRI safety screening questionnaires

3.2.1  Risk/benefit decisions must be taken by the MRI team in consultation with the patient or their guardian. Before the patient is allowed to enter the MR controlled access area, a suitably trained authorised person (usually the MR operator) is responsible for ensuring that the risks  are made clear and that the evidence provided is based on the most current and up to date literature.

3.2.2  Written documentation, normally in the form of a questionnaire, regarding the risk assessment for each patient should be completed by the patient, and checked through with them by a suitably trained authorised person (usually the MR operator) Any discrepancies or queries should be discussed with the patient and the decision to scan should be made in conjunction with the local rules and employing authority policies.

3.2.3  The questionnaire should be signed and dated by the patient and countersigned as checked by the MR operator.

3.2.4  There may be occasions when it is not possible for the patient to be able to answer the safety questionnaire directly, for instance, in the case of the unconscious patient, or clients who do not speak English.

3.2.5  In the case of the unconscious patient, close reference should be made to the patient notes and, ideally, the next of kin may be asked to complete the questionnaire. Reference should be made to employing authority policy on consent, and this should be reflected in the local rules. Please also refer to 3.3.1.  Any doubt about patient status with regard to MR safety should be rigorously pursued; this may involve, for example, plain radiography to establish metallic intra-orbital foreign body (IOFB).

3.2.6  Patients who do not speak English as a first language should be accorded the same information and confidentiality as any other patient.  Ideally, an employing authority translation service, using an approved translator, should be utilised. This should ensure that the questions put to the patient, and the answers received, are accurate and not changed. A translator may be booked in advance, or a phone translation service, approved by the employing authority should be utilised.  If the translator is present they should sign the form to confirm that they asked the patient all the questions listed, and that the answers noted are a true record of those received. If the translator is not present, a note of their name or identification code should be made on the form. The safety of the patient, however, is the responsibility of the MR operator. It should not be common practice to use a relative for translation purposes, and it is inappropriate for minors to perform this function.

3.3 Consent

3.3.1 Duties

As a registrant with the Health and Care Professions Council (HCPC) it is a requirement to obtain consent from service users or other appropriate authority before providing care, treatment or other services.6 Radiographers undertaking a clinical imaging diagnostic exam have a duty of care to ensure that patients are fully aware of the procedure and have consented to it. The health professional carrying out the procedure is ultimately responsible for ensuring that the patient is genuinely consenting to what is being done: it is they who will be held responsible in law if this is challenged later.7

3.3.2 Consent and adults with impaired capacity

The SCoR advises that all reasonable steps must be taken to support a patient to make a decision. This involves taking extra time with the patient and using language appropriate to the level of understanding. 7

The patient’s carers may be able to help in this regard, but they cannot give valid consent on behalf of the patient, including the patient who lacks capacity. Acting in the best interests of the patient may involve the radiographer delaying or postponing the procedure if, in their opinion, more time needs to be taken to obtain consent.8 The referrer should be informed and discussions may include possible alternative procedures, if relevant.

If the employing authority has policies regarding consent which have been developed locally, these policies should be followed. If, after taking every practical step to achieve consent from the patient, consent is not achievable, the radiographer needs to be clear that, by providing imaging and/or treatment, they are acting in the best interests of the patient.

Radiographers must record decisions taken along with a brief explanation of why the decisions were taken.

3.3.4 Consent and the child

Consent for MR scanning in the case of minors should reflect employing authority policy.

3.3.5 Further information and advice on consent is published by SCoR.7,8,9

3.4  Decision to scan

3.4.1  There may be occasions where MRI is requested for patients with implants who are at particular risk such as:

  • those with implants where MRI is contraindicated. See also section 10.3
  • when there is insufficient evidence from the implant manufacturer that  MRI is safe to perform
  • the conditions for safe scanning of an implant cannot be met.

3.4.2   The decision to scan these patients should be made on a case by case basis, and following a risk assessment and risk benefit analysis .While essential that the referring clinician, patient and reporting clinician are instrumental in this; the decision should be made in consultation with all members involved in the process. This should include for example the MR safety expert, MR responsible person, and the MR operator.

3.4.3  The process for dealing with such patients should be clearly documented within the local rules.

3.4.4  The radiographer performing the scan should be satisfied that:

  • alternative imaging procedures have been considered
  • the patient is fully aware of what they are consenting to
  • a full risk assessment  and risk benefit analysis has been carried out in accordance with the process set out in the local rules
  • by proceeding with the scan, they are acting in the best interests of the patient
  • the decision to scan is clearly documented.

3.5  Reporting of incidents and near misses

All incidents and near misses related to patient or staff safety within the MR unit must be reported in accordance with local employers’ rules. Incidents and near misses involving MR diagnostic equipment should also be reported: this includes burns and overheating, projectile incidents and contrast injector failures.
A full list detailing what should be reported is available in Appendix 4 of the MHRA Guidance Document. 2 Incident forms and online reporting available from:
https://www.gov.uk/report-problem-medicine-medical-device

The above webpage also provides links for the reporting of incidents in Scotland, Wales and Northern Ireland.

For any queries contact the Adverse Incident Centre: aic@mhra.gsi.gov.uk

3.6 Knowledge, skills and competency

The science of MRI and technological developments in equipment and device implants evolves rapidly and radiographers must ensure that their knowledge, skills and competencies keep pace with these advances in order to ensure a quality and safe service.

The increase in the scope of MRI applications means that radiographers have extended their roles to incorporate advanced techniques.10

It is a requirement as a registered healthcare professional to ensure that knowledge and skills are kept up to date and that they act within the limits of their knowledge, skills and experience.6

3.6.1 Scope of practice

In identifying and communicating their individual scope of practice, radiographers must consider the roles and the environments in which they work and ensure that they are educated and competent to operate in their specific roles.11

Further information is available in the SCoR publication The Scope of Practice .11

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