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4. Staffing of MR units

The SCoR receives many enquiries regarding the staffing of MR units, primarily relating to the suitable skill mix and minimum staffing levels. Generally, SCoR tends not to be prescriptive about staffing levels as configurations will very much vary to meet local circumstances and service delivery model; rather we would suggest an approach that considers certain principles in order to provide a quality, safe and effective service for patients and staff.12

Under the Health and Safety at Work Act,13 employers have a general duty to ensure the health, safety and welfare at work of all employees. Employers are also obliged to carry out risk assessments into all aspects of working including systems and patterns of work. When considering the staffing requirements of an MR unit, managers should take into account the following:

4.1 Safety of patients and staff

Patient safety is paramount. There are particular safety issues associated with MRI: strong magnetic fields, time varying magnetic fields and radio frequency pulses.
Staffing levels and competencies should be such that there are no compromises to patient safety. Staffing levels should take account of the fact that MR operators must maintain visual and audio contact with the patient throughout the scan and should not leave the control room during the scan unless it is to enter the scan room.2

The MRI safety screening questionnaire is an essential component in ensuring patient safety. Staffing levels should take account of this process.

4.1.1 Lone working

The MHRA advises that staff should not work alone, especially out of hours.  Where it is considered essential that staff do work alone, the Lone Worker policy of the Trust should be considered.2

The Health and Safety Executive (HSE) advises: ‘Risk assessment should help employers decide on the right level of supervision. There are some high-risk activities where at least one other person may need to be present. Examples include: working in the health and social care sector dealing with unpredictable client behaviour and situations.’ 14

4.1.2  MR safety training

Many categories of staff are required to have contact with the MR unit during the course of their duties.  It is essential that these staff receive a level of training in the hazards associated with MRI appropriate to their role. The MHRA 2 defines what that training should consist of using the categorisation of staff as defined in section 2.5 of this document.

Further information on training requirements can be viewed in section 4.17.1 of the MHRA Guidance Document.2

4.1.3 MRI safety knowledge

SCoR and BAMRR have recommended that all staff working in a clinical or clinical support role in MR units should have as a minimum:

  • knowledge and understanding of the threats posed by the static magnetic field
  • understanding of the MR controlled access area and MR environment   
  • awareness of MR authorised personnel
  • understanding of the screening process and access rights
  • emergency procedures within the MR environment
  • understanding of the nature of a magnet quench and when a system may need to be quenched by the operator
  • understanding the labelling system for MR equipment
  • understanding the requirement for hearing protection and correct positioning
  • understanding the correct use and positioning of the coils and cables and ancillary equipment.

Radiographers require further post-registration knowledge and understanding in the following areas:

  • bio effects of the static magnetic field
  • projectile and attractive forces
  • bio effects of time varying gradient magnetic fields
  • bio effects of RF radiation
  • recommended exposure value limits
  • sequence selection and parameter manipulation to minimise all of the above
  • conditional implants and devices
  • contrast agents and other drugs.

4.1.4 All staff should have adequate training in departmental emergency procedures

4.1.5 When considering staffing using a radiographer working alongside a non- clinically trained helper then provision must be made for adequate rest periods for the radiographer, this would include a review of the bookings and case type .The helper must be suitably trained as indicated above and authorised by the MR Responsible person.

4.2 Equitable service provision

Managers should consider if the service being offered is of the same quality and safety for the patients and staff throughout the whole day ie will there be any difference in the service delivered to a patient attending at 9am than one attending at 9pm?

4.3 Skills, experience and knowledge of staff

When considering staffing using radiographers working with either a non-clinical helper or an assistant practitioner grade then the radiographer should be appropriately experienced:

  • with post registration skills and knowledge in MRI
  • with skills in clinical decision making eg appropriate actions for incidental findings
  • in taking responsibility for the episode of care, particularly in the absence of other staff trained in MRI.

4.4 Assistant practitioners in MR units

The role of an assistant practitioner in MRI is related to providing support for other registered healthcare practitioners eg radiographers and radiologists, and for aspects of patient care.4

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