Patient Care
Do MR Safety Policies Support Care — or Limit It?
January 23, 2026 - Kellye Chia
Editor’s Note: This article was originally published by Kellye Chia via LinkedIn and is being republished with permission.
Just before Christmas, I read a comment on LinkedIn that stopped me in my tracks: “We don’t have policies and procedures because they’re too black and white.”
Once I picked my jaw up from the floor, I challenged myself and my own assumptions. Could that be true? Why would someone believe that? I have always felt that I am able to practice most safely when a Magnetic Resonance Medical Director (MRMD) has clearly defined how they expect my team and me to deliver care. I kept coming back to the same question: What is it about policies and procedures that makes some people feel like they limit patient care instead of supporting it?
After sitting with that for a while, this is where I landed. Not every policy is going to apply to every imaging center, and that may be where some of the frustration comes from. But what I’m even more convinced of is this: every MR site should have policies and procedures.
The policies outlined below are what I consider foundational. I wanted to explain why I believe they matter — and why, when done thoughtfully, they don’t restrict care at all. They actually support it.
Appointing an MRMD
I believe every MR department should have a dedicated — and in my personal opinion, credentialed — MRMD.
According to the American College of Radiology Manual on MR Safety, the MRMD is responsible for ensuring that MR safe-practice guidelines are established and maintained as current and appropriate for the facility.
I can already hear the response: “But Kellye, we only scan walkie-talkie patients. We don’t scan implants. We don’t need an MRMD.”
But what if I told you the most common adverse event in MRI isn’t implant-related? It’s burns. And those burns can (and do) happen even when there’s no device or implant involved.
MR safety isn’t just about managing devices or equipment that enters the MR environment. Sure, that’s part of it. But it is so much more involved than that, and that’s why the MRMD role matters. The MRMD oversees the entire safety picture in the MR environment.
Another rebuttal I hear often is: “Our manager/supervisor/director writes our policies and procedures.”
Policies and procedures should absolutely be a partnership. Leadership should be involved. Your Magnetic Resonance Safety Officer (MRSO), Magnetic Resonance Safety Expert (MRSE), safety committee, and even risk management all have an important role to play. But prescribing how technologists provide care is practicing medicine, and that responsibility ultimately belongs to someone with a medical license.
Leadership involvement isn’t the issue. Direction is. The ship still needs a captain — and in MRI, that captain is the MRMD.
MR Safety Training (And Who Gets What)
Having policies and procedures around MR safety training helps remove ambiguity. Roles and responsibilities are easier to understand when it’s clearly defined who gets what type of training, when that training happens, how often it’s required, and when there’s a clear plan for moving someone from Level 1 to Level 2. There’s far less second-guessing about what’s within your scope versus someone else’s, or who should be making a particular decision.
When those expectations are clear, teams are better supported. Safety stays at the forefront because no one is left wondering whose call it is, and patient care is strengthened — not restricted.
This is another place where MRMD oversight is essential. Among many other responsibilities, the MRMD defines site-specific safety training requirements and sets expectations for MR personnel and anyone else who accesses the MR environment.
Appointing an MRSO
If the MRMD is the captain of the ship, the MRSO is the first officer.
Their job is to ensure the day-to-day execution of policies and procedures, oversee safety as the boots on the ground, and maintain accountability of safe practices.
While the MRMD sets the direction, the MRSO makes sure that direction is carried out correctly and consistently. They identify issues as they arise, address them in real time, and escalate concerns as needed. In many ways, the MRSO is the link between defined policy and real-world practice, ensuring safety expectations don’t just exist in a binder that collects dust but are applicable and followed in day-to-day operations.
The MRSO’s responsibilities further support their inclusion in the development of policies and procedures. They understand how the work actually gets done, where workflows break down, and where unintended risks can creep in. When the MRSO has a seat at the table, policies are more likely to reflect real-world practice, be consistently followed, and hold up when safety decisions need to be made under pressure.
Controlled Access
Over a year ago, I read an article describing a law enforcement raid where an unsecured rifle was pulled into an MRI scanner. Thankfully it didn’t discharge, but the magnet was reportedly quenched to release it.
Is a policy alone enough to prevent something like that? Maybe not. But clearly defined, controlled access to the MR department would have, I believe, at least slowed entry and quite possibly prevented it altogether.
When access is controlled and MR personnel are appropriately safety trained, teams feel empowered to enforce those controls. That includes stopping visitors, redirecting unwanted guests, and ensuring anyone entering the MR environment is properly screened before crossing the threshold.
Screening (And Yes, That Includes More Than Patients)
“When you fail to prepare, prepare to fail.” I can’t say I’ve always loved that quote, but I can say it’s true.
Here’s the thing: you can tell me you only scan walkie-talkie patients. That you don’t scan implants. Or that you handle foreign bodies on a case-by-case basis, with no real consistency behind how those decisions are made. And I’m going to tell you that I’ve seen firsthand facilities that say exactly those things — and without fail, a patient is transferred in by ambulance with altered mental status, who can neither walk nor talk, and who may or may not have an implant or foreign body.
I can also tell you this: I don’t want you, your colleagues, or your radiologists sitting in a courtroom trying to explain that you usually handle these situations case by case, with no clear rationale for why this particular patient was declined care.
This is a prime example of why policies matter. When situations change — and they inevitably will — having policies and procedures in place helps ensure safety is not bypassed, no one is left second-guessing what to do, and patients who could reasonably receive care aren’t denied the care they so desperately need.
Screening policies shouldn’t only apply to patients. They should also address personnel, visitors entering Zones III and/or IV, unconscious patients, poor historians, and those with altered mental status. If it can happen, having a clearly defined policy for how to handle it removes confusion and supports safe, consistent decision-making.
Equipment Testing and Labeling
While we’re on the topic of screening, clearly defined policies around equipment screening, testing, and labeling also support a safer MR environment. It removes the guesswork and the stories that start with, “Well, I took it into Zone IV before and didn’t have any issues.” Or worse, introducing an untested item into Zone IV and seeing how close it can get before it becomes a problem.
When expectations are clearly defined and equipment is tested and appropriately labeled, it’s no longer introduced based on assumption or past luck.
Patient Prep and Gowning
Patient prep and gowning philosophies can be heavily debated. I’m not even going to get into changing clothes, jewelry, or, God forbid, cat eye nail polish. Those decisions are for the MRMD to define through your policies and procedures.
What I will argue is that expectations around how a patient is prepared for their MR exam should be clearly defined. I would also encourage MRMDs to consider policies that address removable metallic items, jewelry, cosmetics with metallic particles, drug patches, wound dressings, face masks, and clothing.
When expectations are clear, technologists are better supported in practicing safely. Just as importantly, they’re supported when explaining to patients why certain items need to be removed. That clarity helps foster a safer environment and trust throughout the entire exam. (And let’s be honest, I don’t know a single technologist who enjoys hearing, “Well, at so-and-so facility they didn’t make me do this,” or “The last tech here let me keep this on.”)
Full Stop/Final Check
The time-out procedure in surgery was created for one simple reason: to prevent avoidable, catastrophic errors before they happen. And just like a surgical time-out, entry into Zone IV shouldn’t happen without a deliberate pause, or what we call a full stop/final check.
Errors don’t typically happen because MR technologists lack care or skill. They happen because of time pressure, assumptions, and communication gaps that exist in clinical environments. Taking the time to pause before entering Zone IV — to verify patient name, date of birth, and exam to be performed; ensure everyone entering has been appropriately screened and properly prepped; and confirm equipment has been tested and approved for entry — helps reduce the risks created by those assumptions and gaps.
And if you tell me you don’t have time to pause, I’d ask you to revisit your workflows. I, personally, don’t want a surgery performed without a time-out, nor do I want an MRI performed without a full stop or final check.
Closing
MR safety policies and procedures aren’t meant to replace critical thinking. They’re meant to support it. They’re meant to give us direction, create consistency, and a shared understanding of how safety is expected to look at our site. When we are faced with an unexpected situation, policies help ensure our decisions are intentional, defensible, and safety-centered.
I agree that safety isn’t “black and white.” It’s often complex and different depending on the patient, exam, and implant or device. And that’s exactly why clearly defined policies and procedures matter.
Safe outcomes don’t happen by accident. They happen when we are intentional about how safety is defined, supported, and practiced.