1 Introduction

Magnetic resonance imaging (MRI) stands as a highly valuable tool in medical imaging, offering a noninvasive means to diagnose a wide range of medical conditions without exposing patients to ionising radiation [1]. Unlike other imaging techniques, MRI can provide any imaging plane and employs various sequences to enhance the differentiation of bodily structures [2, 3]. Recent advancements, such as stronger static magnetic fields, higher gradient performance and more potent radiofrequency transmission coils, have significantly improved the capabilities of MRI technology [4]. However, these advancements increase potential safety risks. The powerful static magnetic field can attract ferromagnetic objects, posing a danger to individuals within its vicinity [5]. Moreover, the high radiofrequency output can potentially cause burns, while the higher performance gradient fields may result in stimulation of peripheral nerves, and hearing impairment presenting additional safety concerns [6].

Despite established safety protocols, numerous MRI accidents have been reported worldwide in recent years. For instance, the US FDA documented 419 cases from 1997 to 2009, with a notable increase to 849 cases between 2008 and 2017 [7, 8]. In Japan, a study reported 50 cases of medical accidents related to ferromagnetic objects being brought into the MRI room [9]. Additionally, 247 out of 1290 cases in the United States experienced adverse effects from contrast media [10]. However, research by Kihlberg et al. suggests that these figures may not fully capture the actual number of accidents, as approximately one-third of MRI incidents are likely underreported, indicating the possibility of many more unreported cases [11].

The prevalence of these incidents, coupled with potential underreporting underscores the critical need to enhance MRI safety measures. This involves implementing stricter protocols and ensuring comprehensive training for all healthcare personnel, ranging from MRI technologists to individuals accompanying patients, such as nurses and doctors.

The existing literature provides convincing evidence that individuals employed within MRI environments exhibit a good level of understanding regarding MRI safety practices [12, 13]. This expertise could be attributed to the comprehensive orientations they receive upon joining the MRI department, coupled with the inclusion of MRI-specific modules in their undergraduate training programs. However, unlike imaging counterparts, nonimaging healthcare practitioners may not have received specialised training or orientation specific to MRI safety during professional development. Consequently, they may lack the necessary understanding of the unique hazards and precautions associated with MRI procedures. This gap in knowledge among nonimaging health practitioners could significantly contribute to the increasing incidence of MRI safety accidents on a global scale.

Saudi Arabia's healthcare sector is made up of a diverse network of hospitals, including 274 public hospitals, 152 private hospitals and 44 quasigovernmental hospitals [14]. Each of these sectors operates under distinct organisational frameworks, funding models and training environments, which may contribute to differences in healthcare practices, including safety protocols. Previous research has indicated that awareness of safety practices can vary significantly between these sectors, largely due to differences in resource allocation, training opportunities and staff specialisation [15]. Public hospitals, for instance, may focus more on general safety protocols, while private hospitals, with their access to more advanced technology and specialised staff, might offer more targeted training, such as MRI-specific safety practices. However, despite this sectoral variation in safety awareness, there has been no research exploring the specific knowledge of MRI safety among healthcare providers across these different hospital types.

Intensive care unit (ICU) patients frequently need to be escorted to the radiology department for examinations that are unable to be conducted in ICU [16, 17]. A study has shown 22%–52% of ICU patients are transported to other departments such as radiology [18]. These patients' illness severity varies greatly, ranging from stable individuals requiring minimal monitoring to critically ill patients needing intensive medical support [19]. Consequently, transporting patients to radiology often necessitates qualified nonimaging personnel, including nurses and physicians, to ensure their safety and provide necessary care during their transfer to the MRI unit.

It is imperative to recognise that the MRI unit poses significant safety risks due to the intense magnetic field generated by the machine. Therefore, it is crucial for nonimaging healthcare practitioners, such as physicians and nurses, to have a thorough understanding of MRI safety measures to prevent MRI accidents. While the literature extensively explores MRI safety knowledge, it primarily focuses on MRI technologists, university students, radiologists and patients, rather than specifically addressing nonimaging healthcare practitioners [12, 20-25]. Moreover, there is a lack of studies investigating the knowledge of nonimaging healthcare practitioners regarding MRI safety measures in Saudi Arabia. For instance, a study by Alghamdi et al. evaluated nurses' knowledge and attitude toward MRI safety protocols, revealing that approximately half of the respondents had poor knowledge about MRI safety measures and exhibited a minimal adherence to safety practices [26]. A recent cross-sectional study involving 194 nonimaging health practitioners indicated that nurses demonstrated a higher level of knowledge regarding MRI safety measures compared to physicians, laboratory specialists, dentists and physiotherapists (OR: 4.60, 95% CI: 0.67–31.76) [27]. Additionally, Hussin et al. attempted to assess the level of knowledge among healthcare workers at King Abdullah Medical City regarding MRI safety, finding that doctors exhibited a high level of knowledge regarding the fundamental principles of MRI safety [28]. However, these studies are limited by their sample sizes, which may not be sufficiently large to draw definitive conclusions.

Additionally, the study by Alghamdi et al. [26] exclusively focused on nurses, making it difficult to compare their knowledge with that of other healthcare professionals. Furthermore, the exclusion of radiology nurses, who typically have a higher understanding of MRI safety measures compared to nurses in other hospital wards, introduces a potential selection bias that could compromise the accuracy of the findings from these studies. Moreover, prior research neglected the influence of education on MRI safety knowledge among nonimaging healthcare practitioners. Examining educational roles, such as attending scientific seminars, having training orientations and completing undergraduate or postgraduate MRI modules, could offer valuable insights into how these factors impact knowledge and adherence to safety protocols. Therefore, this study aimed to add to the existing literature by specifically assessing the knowledge of nurses and physicians regarding MRI safety measures using a larger sample size. Also, this project will identify areas where nonimaging healthcare practitioners may need more education and training to ensure safe and effective MRI safety measures.

2 Materials and Methods

3 Results

A total of 387 out of 500 participants responded to the survey (response rate: 77.4%). Among the participants, 78.5% fell within the age range of 25–44 years, while 58.9% identified as female. 226 of the respondents were from the public sector, and 53.2% of the participants had a bachelor's degree qualification. Half of the participants (54%) were nurses and 30% of individuals had experience in the medical field ranging between 6 and 10 years. A higher percentage of participants (85.8%) reported that there was no MRI module included in their undergraduate and postgraduate curriculum programmes. Only 8% of individuals participated in MRI workshops, with half of this subgroup reporting that the workshops took place last year. Frequent or regular visits to the MRI department were reported by 33.6% of those surveyed (see Table 1).

Participants demonstrated a limited understanding of fundamental MRI concepts, with a domain knowledge score of only 31.8%. Knowledge regarding MRI risks and zones was shown by 27.6% of participants, while 35.9% grasped the purpose of the MRI screening questionnaire, and 35.1% had knowledge of the noise levels during MRI examinations. One-third of participants (30.7%) recognised the ‘MRI safe’ labelling symbol, and 37.7% of individuals grasped the overall concept of MRI safety (see Table S1). Participants displayed a weak understanding of how projectile objects could affect MRI safety, as indicated by their low domain knowledge score of 33.7%. Of those surveyed, 26% of participants lacked awareness of proper procedures if a patient with a metallic object enters the MRI suite, and only 30% of respondents understood the risks associated with implanted hardware in the MRI suite. Among the respondents, 43.2% of individuals demonstrated a good understanding of contraindications for MRI scans, and 38.5% knew how to mitigate the risk of projectile objects. Concerning the handling of ferromagnetic objects and familiarity with the guidelines for patients who have implanted devices prior to MRI procedures, 38.2% of the participants displayed knowledge in these areas (see Table S2).

The comprehensive assessment of knowledge about contrast media hazards in MRI revealed a domain knowledge score of 32.3%. Participants demonstrated limited understanding regarding the purpose of contrast media usage in MRI scans (24.3%), and recommended courses of action for gadolinium contrast media in lactating women (25.6%) and infants (28.4%). Only 36.2% of participants demonstrated an understanding of managing patients with allergic reactions to contrast media, and half of the participants (53%) demonstrated knowledge of the contraindications associated with gadolinium contrast media (see Table S3).

Participants who were employed in the government sector, had completed an MRI course during their undergraduate or postgraduate studies, attended MRI workshops and held a higher educational qualification (PhD degree) demonstrated higher overall mean scores for knowledge across all MRI safety domains compared to their peers (p values ≤ 0.05) (see Figures 1a,b and 2a,b).

Individuals with over 10 years of experience in the medical field demonstrated higher overall mean scores in the domains of projectile items (p < 0.001) and the basics of MRI (p = 0.002) (see Figure 3a). There were no significant differences in the overall mean score knowledge across different occupational statuses (see Figure 3b), genders (see Figure 4a) or age groups (see Figure 4b), with all p values being ≥ 0.19 (see Tables S4–S11).

4 Discussion

This study aimed to explore the knowledge of MRI safety among nonradiologic medical staff; physicians and nurses, who are working at Jeddah hospitals and medical centers.

Findings from this study demonstrated significant knowledge gaps in all aspects of MRI safety, from basic concepts to projectile hazards and contrast media risks. Additionally, factors including the type of healthcare sector, participants' qualifications, work experience, workshop attendance and involvement of MRI safety in the curriculum of undergraduate and postgraduate programmes may impact participants' MRI safety knowledge.

Previous studies investigating MRI knowledge among nonimaging healthcare professionals including physicians, nurses, medical assistants, physiotherapists, pharmacists, medical physicists, anesthesiologists and respiratory specialists have consistently reported varying levels of understanding, with knowledge ranging from low (39.4%) to moderate (60%) [26, 27, 31]. For instance, Abd Aziz and colleagues conducted a cross-sectional study involving 132 healthcare providers, revealing a lack of understanding regarding MRI fundamentals [31]. This deficiency was evident as participants inaccurately responded to questions concerning tattoo pigment interference with MRI images and the necessity of removing transdermal patches before undergoing an MRI. These crucial safety considerations were not addressed in the current study. Similarly, Alghamdi et al. [26] found that more than two-thirds of the 105 nurses surveyed had a low level of knowledge regarding MRI safety. Another study conducted by Alelyani and colleagues surveyed 194 nonimaging healthcare practitioners including laboratory specialists, respiratory specialists, nurses, dentists, physicians, nutrition specialists, anaesthesiologists, physiotherapists and pharmacists [27]. Participants achieved an average score of 60% on a knowledge questionnaire, indicating a moderate understanding of MRI safety.

In alignment with these documented trends, our study findings also underscored a widespread lack of knowledge across all aspects of MRI safety, spanning from basic principles to potential hazards like projectiles and risks associated with contrast media. MRI safety encompasses not only the risks associated with magnet hazards but also those related to the use of contrast media. While gadolinium-based contrast agents are generally considered safe, there is still a possibility of patients experiencing adverse reactions to it [32]. Therefore, non-MRI healthcare providers must be aware of the potential adverse effects of contrast media. In the current study, it is observed a relatively higher level of knowledge among participants regarding contraindications associated with gadolinium contrast media. This suggests that participants were well-informed about the risks and precautions related to the use of gadolinium-based contrast agents in MRI procedures. The findings are consistent with those of the study conducted by Hussin et al. [28] study which reported that nonimaging healthcare practitioners, such as doctors and nurses, demonstrate a good understanding of the adverse effects of contrast media and how to handle them if they occur. The increased awareness among physicians and nurses could be a result of their continuous exposure to requests for MRI contrast procedures and their participation in preparing patients for these procedures.

The present study found that individuals working in the public sector had a significantly higher mean knowledge score regarding MRI safety compared with those in the private sector. This might be due to stricter regulations in the public sector within Saudi Arabia. Public healthcare centers often undergo rigorous accreditation processes, prioritising comprehensive training and providing abundant resources, including access to continuing education and standardised protocols.

These accreditation standards not only stress the importance of maintaining high safety and quality standards in medical imaging but also mandate ongoing education and competency assessments for healthcare professionals. As a result, individuals employed in accredited public institutions may possess a more structured and comprehensive understanding of MRI safety protocols and procedures compared with their counterparts in nonaccredited private facilities.

Participants in the current study were queried about whether they had received MRI modules during their undergraduate or postgraduate studies. Interestingly, 85% of them reported not having such modules. This finding is likely to contribute to the observed low level of knowledge regarding MRI safety in the study.

In the present study, it is observed that participants with PhD qualifications generally had higher overall mean scores in MRI safety knowledge. This finding aligns with the results of Alelyani et al. [27] study which found that healthcare workers with PhDs were more likely to have basic MRI knowledge compared to those with diplomas. This finding is reasonable because PhD holders are generally engaged in continuous learning and staying updated with the latest advancements in their fields. This ongoing educational process may enhance their awareness of safety standards within the medical field, including MRI safety. However, there are contrasting findings in the literature. Duymuş et al. [33] study, for example, reported an insignificant relationship between MRI safety knowledge and education status, while Abd Aziz et al. [31] study found that individuals with lower qualification levels, such as diplomas, exhibited more knowledge about MRI safety compared to those with higher education levels.

These discrepancies may be attributed to the characteristics of the targeted populations in each study. For example, Duymuş and colleagues primarily focused on patients rather than healthcare workers [33]. Patients typically have less exposure to MRI safety information compared with healthcare workers, which could potentially impact their understanding of the subject. As a result, the differences in knowledge levels observed between studies may be influenced by the different levels of exposure and experience with MRI safety information among the study participants. Additionally, Abd Aziz et al. study had a limited number of participants with advanced degrees, such as PhDs or masters [31]. As a result, their findings may be more applicable to individuals with lower educational qualifications. The lack of representation from individuals with higher degrees could influence the overall findings and skew the results toward lower educational levels.

Experience in the medical field could influence healthcare providers' understanding of MRI safety. As professionals spend more time in healthcare settings, they gain practical knowledge and exposure to patient care, including MRI scans [34]. This hands-on experience helps them grasp the complexities of ensuring patient safety during MRI examinations. Our research findings support this theory. It was observed that healthcare providers with longer experience in the medical field tend to have a higher mean score of knowledge regarding MRI safety. This finding is consistent with the findings of Hussin et al. [28] study, which identified better MRI safety knowledge among nonimaging medical staff with longer durations of practice in the field.

Attendance at regular scientific seminars is important in increasing knowledge and awareness regarding MRI safety. By attending these seminars, healthcare providers can ensure compliance with the Joint Commission's requirements, which mandate that healthcare organisations adhere to MRI safety standards. These requirements are primarily designed to protect patients and individuals from accidents and injuries related to MRI systems [35]. In the present study, it was noted that those who attend seminars for MRI safety have higher scores in knowledge about MRI contrast media hazards compared with their counterparts. This is likely because MRI safety seminars cover topics such as contrast agent safety, which is a critical aspect of MRI safety.

In the current study, no significant differences in MRI safety knowledge by profession were depicted. This aligns with the conclusion drawn by Abd Aziz et al. [31] who similarly reported no notable differences in MRI safety knowledge across different professions.

In the current study, significant knowledge gaps in MRI safety among healthcare practitioners were found. To enhance patient safety, targeted educational interventions are necessary. By tailoring training based on factors like work sector, experience and qualifications, healthcare organisations can effectively address knowledge gaps and foster a culture of MRI safety.

Although the current study was conducted across multiple centers, its applicability to a wider population may be limited as it was restricted to Jeddah city. Therefore, further research covering major cities in Saudi Arabia and other countries is necessary to generalise the findings. Another limitation is the use of a survey with closed-ended multiple-choice questions, which may not fully capture participants' knowledge on MRI safety. Conducting thorough interviews can help gain a more comprehensive understanding of fundamental issues like the lack of awareness and knowledge. Moreover, self-reported knowledge can be biased. Studies that rely on self-evaluation might allow participants to exaggerate their perceived expertise to avoid appearing less knowledgeable.

However, the study has several strengths. It evaluated the effects of incorporating MRI safety education into healthcare curricula at both undergraduate and postgraduate levels, along with the impact of attending MRI safety workshops on MRI safety knowledge. These elements were not previously addressed by earlier research. Furthermore, the study's focus on nonimaging healthcare providers offers a distinct contribution to the existing literature. While previous studies have often centered on patients, radiologists or MRI technologists, the current study specifically targets nonimaging healthcare practitioners, including physicians, and nurses who may play a critical role in patient care during MRI procedures. Unlike previous studies with limited question scopes, the comprehensive survey used in the current study provides a more holistic view of MRI safety knowledge. By examining multiple domains, the study identified specific areas where participants require additional education or training. This detailed approach provides a deeper insight into the specific gaps in MRI safety knowledge.

5 Conclusion

In conclusion, this study revealed significant knowledge gaps across various dimensions of MRI safety, encompassing fundamental principles, projectile hazards and risks associated with contrast media. Moreover, factors such as the type of healthcare sector, participants' qualifications, work experience, workshop attendance and integration of MRI safety education into undergraduate and postgraduate curricula were identified as potential influencers of participants' MRI safety knowledge. These findings underscore the importance of targeted educational interventions and ongoing training initiatives aimed at enhancing MRI safety awareness among healthcare professionals.

Ethics Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Unit of Biomedical Ethics (protocol code 443–23 and Date: Monday, October 2, 2023).

Consent

Informed consent was obtained from all subjects involved in the study.

Conflicts of Interest

The author declares no conflicts of interest.