Ensuring the Safety of MRI Patients With Medical Implants or Devices In Situ: A Snapshot in Time of the Role and Responsibilities of New Zealand and Australian MRI Technologists (Radiographers)
Funding: This work was supported by The University of Auckland Graduate Student Support and New Zealand Society of Medical Imaging and Radiation Therapy.
ABSTRACT
Introduction
Poor clinical decision-making in MRI can lead to significant patient injuries and, in some cases, prove fatal. With the ever-increasing range and numbers of MR-conditional implants and devices, the complexity of decision-making in this environment has increased. While historically performed by radiologists, this decision-making is becoming integrated into the MRI technologists' (radiographers') role. The aim of this paper is to document the evolving role and responsibilities of MRI technologists (MRITs) in New Zealand (NZ) and Australia when scanning patients with medical implants.
Methods
Utilising a mixed-methods case study research design, quantitative and qualitative data were collected via an online questionnaire and semistructured interviews. The questionnaire was completed by 235 MRITs, 12 of whom were also interviewed.
Results
Findings confirm that the MRIT role in NZ and Australia in 2018 had evolved over the preceding decade from one focused on technical proficiency to a role involving a higher level of cognitive function and competency relating to MRI safety. Participants identified that all MRITs must be responsible for MRI safety clinical decision-making, not just a select few. Some concerns were raised that radiologists are no longer sufficiently educated in MRI safety, supporting the need for a team effort instead.
Conclusion
Aligning with recent global calls to standardise MRIT education and regulation requirements, this study provides evidence to support a separate registerable MRI scope of practice. This will enable MRI-specific knowledge and continuing professional development (CPD) in MRI safety to be mandated and audited so that clinical decisions are informed and safe.
1 Introduction
Studies from around the world continue to emerge that acknowledge the changing landscape within magnetic resonance imaging (MRI) as technology evolves and safety issues increase [1-5]. Within this environment, the MRI technologist (radiographer) is increasingly responsible for having a thorough knowledge of the underlying physical principles and applying these in clinical practice to ensure a safe workplace culture is developed and maintained [6-8]. They are at the frontline when it comes to making decisions regarding patient safety and are responsible for the safe care of the patient in the MRI environment [9-12].
A study by Young et al. [13] in 2008, into potential role extension opportunities for MRI technologists (MRITs) in New Zealand (NZ), identified tasks that are now typically considered a routine part of the job. Results of that study indicated that activities previously predominantly the responsibility of the radiologist (such as venepuncture, gadolinium-based contrast agent administration and image postprocessing) were becoming routinely integrated into the MRIT role in most workplaces in NZ. MRI reporting, as being performed in the United Kingdom (UK), was suggested as the main area of role extension to pursue for the future [14]. MRI safety-specific tasks were not even considered as potential role extension opportunities in this study, instead firmly remaining the responsibility of the radiologist.
A decade later, the study undertaken in 2018 and reported here sought to investigate who was performing MRI safety related tasks in workplaces across NZ and Australia. The study aimed to provide an updated assessment of the role of the MRIT, particularly through a safety-focussed lens. With the ongoing development and upgrade of many medical implants and devices enabling them to be scanned within MRI, an emerging role of the MRIT was to investigate manufacturer specified guidelines for MR-conditional implants and devices to ensure the safety of the patient in the MRI environment. Determining whether such devices can even enter the scanner room requires complex decision-making to avoid patient injury or device malfunction [1, 4-8, 10]. Similarly, the responsibility for assessing and determining each condition defined by the MR-conditional status within a particular clinical setting, and interpreting and applying the necessary technical specifications during scanning is complex and requires expert knowledge [11, 15]. Literature was beginning to emerge that advocated for a team approach in this decision-making involving both the radiologist and MRIT [6, 9, 11, 16-18].
Despite ongoing anecdotal evidence of the increasing responsibility of MRITs in the evaluation and management of patients with medical implants and devices on international Facebook groups such as ‘MRI Safety’, ‘UK MRI Safety Group’ and ‘MRI Australia New Zealand’, there remains a paucity of literature defining this aspect of the MRIT role. However, a recent commentary by a group of European and American MRI practitioners and researchers advocates for further evidence-based research to help guide MR practice [19]. In particular, it is suggested that work should progress towards an international consensus establishing minimum education and training standards, and defining the role and responsibility levels for MRITs to enhance MRI safety [19]. This approach is supported by a 2025 call to action by a group of radiologists and researchers from across the Asia-Oceania region, demonstrating the global attention turning towards this issue [20]. This group propose a range of key focus areas, including increased education and expertise, development of certification standards, fostering collaboration and establishing national safety boards, to promote a culture of responsibility and accountability with the aim of enhancing MRI safety. MRI safety expert Tobias Gilk concurs that there is an urgent need to establish regulatory boards specifically to oversee and assume responsibility for MRI safety at a national level [21].
This article records a snapshot in time to provide evidence of the changing role and responsibilities of NZ and Australian MRITs, with the aim of informing education and registration requirements so that they can continue to align with and support this role. This information is particularly important for medical imaging regulatory bodies to consider as MRI remains a registerable separate scope of practice in only a few countries [12, 22], even though the knowledge required to ensure safety in this environment is distinctly different to that acquired when training in other imaging modalities [15, 23-26].
2 Methods
Case study research methodology was used to generate an in-depth understanding of the topic [27]. Both qualitative and quantitative data were collected via an online survey utilising a voluntary response sampling technique. Online interviews were subsequently conducted to elicit more detailed qualitative data. This mixed-methods approach was employed to maximise the validity and reliability of results by enabling triangulation of data. This approach provides a more complete picture, allowing findings to be cross-referenced and supporting the development of the analysis [27, 28]. This is of particular importance when conducting qualitative research to address any concerns of researcher bias [28]. Ethics approval was obtained from the University of Auckland Human Ethics Committee in July 2018 (reference number 021721).
A Qualtrics-hosted online questionnaire was distributed in 2018 via the NZ MR Users Group and the MRI Australia NZ Group Facebook sites. Further dissemination of the questionnaire link was made via relevant professional bodies requesting participation from technologists/radiographers currently working in MRI in NZ or Australia. Snowball sampling was encouraged by requesting the URL link to the questionnaire being shared with MRI colleagues.
The questionnaire was created by two of the authors based on personal clinical MRI experience, as well as a review of the literature on MR safety, education and certification requirements at the time of writing. As part of the questionnaire, 14 common workplace MRI safety tasks were listed, and participants were asked to select which members of their department contributed to performing each of these on a routine basis. Seven of these tasks were related to the process of determining the presence of any implants or devices within the patient and establishing the safety of scanning any patients with these in situ. This subgroup of tasks will be the focus of the results reported here and the corresponding discussion of the role of the MRIT in this process.
Semistructured interviews were also conducted online to explore some topics raised in the questionnaires in more depth (see interview questions in Table 1). Purposive sampling for interviewees was used to identify a range of respondents from the online questionnaire who volunteered for a follow-up interview. Selection was made to include participants with a range of MRI clinical experience and education levels, as well as representation of employment in public and private sectors, and differing roles within departments. Interviews were conducted until data saturation was reached, resulting in 12 completed interviews. This number aligns with the literature which confirms that qualitative studies can reach data saturation at relatively small sample sizes, stating that on average, studies reach saturation at 12–13 interviews [29].
| (1) Could you describe the role of the MRI technologist? What skills and knowledge do you need to be able to perform MRI competently? |
| (2) In MRI, we discuss ‘MR safety’. What does this mean to you? |
| (3) How do you make decisions with regard to MR safety? |
(4) What type and level of safety education do you think the MRI technologist should have to practice safely?
|
| (5) Who is responsible for MR safety in your radiology department? |
| (6) Who is accountable for MR safety in your radiology department? |
(7) Do you think MRI should be a separate registered scope of practice?
|
| (8) Have you any other comments with regard to MR safety education or MR safety within your workplace? |
Qualtrics was used to analyse the quantitative data and produce the basic descriptive statistics presented here. Qualitative data were thematically coded using NVivo software to assist with analysis. Themes identified were clinical decision-making, knowledge, education, responsibility and safe practice. Interrater agreement and reliability were ensured by comparison and discussion of two researchers' independent coding.
3 Results and Discussion
Poor clinical decision-making in relation to MRI safety can lead to significant patient injuries [30-32] and, in some cases, prove fatal [33-35]. Traditionally, the role of an MRIT was task-oriented, focusing primarily on image acquisition. This study has captured a snapshot in time of the role and additional responsibilities that MRITs in NZ and Australia assumed in 2018 to ensure safety when scanning patients with medical implants. While data were collected by means of both a questionnaire and interviews, the results reported and discussed here will focus on analysing the questionnaire's quantitative data, using a small selection of quotes from both sources as supporting evidence. In addition, the themes that emerged from the questionnaire and interviews' qualitative data will be explored further in the current context.
A total of 312 participants took part in the survey, with 246 surveys being fully completed. The 66 noncompleted surveys were excluded from further analysis. A further 11 participants were excluded as seven were not currently working in MRI, three were working in the United Kingdom and one was working in South Africa. Of the remaining 235 participants, 89 (38%) were employed in NZ and 146 (62%) in Australia. With 322 MRI technologists registered with the Medical Radiation Technologists Board (MRTB) at this time (280 in the MRI scope of practice and 42 in the MRI trainee scope) [36], this represents a response rate of 28% of eligible MRITs in New Zealand. Because Australian MRITs are not separately registered and participants were recruited via social media, website and newsletter dissemination, it is not possible to calculate a response rate for this group. More than half of the respondents (57%; n = 134) were from the private sector, 35% (n = 83) were from the public sector and 7% (n = 17) worked in both the private and public sectors. One respondent did not answer this question. Seventy-four per cent (n = 173) of the participants were female and 26% (n = 62) male, with no participants identifying as gender diverse.
Common MRI safety-specific tasks were listed, and participants were able to select which members of their department contributed to performing these safety tasks on a routine basis. Seven tasks were related to the evaluation and safe scanning of patients with implants or devices. MRITs were shown to be predominantly responsible for six of these tasks, with the only exception being that radiologists were deemed to be predominantly responsible for the final decision on whether to scan these patients (Table 2).
| MRIT/radiographer | MRI trainee/student | Radiologist | Physicist | Nurse | Reception | MRI assistant | |
|---|---|---|---|---|---|---|---|
|
Patient screening (n = 232) |
100% (n = 232) |
30% (n = 70) |
3% (n = 7) |
0% |
12% (n = 28) |
30% (n = 69) |
19% (n = 43) |
|
Obtaining medical notes (n = 231) |
91% (n = 211) |
14% (n = 32) |
3% (n = 8) |
1% (n = 2) |
2% (n = 4) |
45% (n = 104) |
5% (n = 11) |
|
Interpreting medical notes (n = 233) |
99% (n = 232) |
7% (n = 17) |
48% (n = 113) |
2% (n = 4) |
1% (n = 2) |
3% (n = 6) |
0.4% (n = 1) |
|
Searching implant websites (n = 234) |
100% (n = 234) |
11% (n = 25) |
8% (n = 18) |
0.8% (n = 2) |
0.4% (n = 1) |
0.8% (n = 2) |
2% (n = 4) |
|
Interpreting MRI conditions (n = 233) |
100% (n = 233) |
7% (n = 17) |
33% (n = 76) |
2% (n = 4) |
0% | 0% |
0.4% (n = 1) |
|
Interpreting spatial gradient magnetic field maps (n = 221) |
90% (n = 200) |
3% (n = 7) |
10% (n = 23) |
15% (n = 33) |
0% | 0% | 0% |
|
Final decision to scan (n = 234) |
72% (n = 168) |
0.4% (n = 1) |
86% (n = 201) |
3% (n = 6) |
0.4% (n = 1) |
0% | 0% |
3.1 MRI Safety Tasks: A Snapshot in Time
The following commentary discusses the tasks being performed by MRITs in NZ and Australia in 2018. It is evident that technologists are increasingly responsible for MRI safety-related tasks including providing recommendations such as whether or not to proceed with the scan and, if so, how to manage MR conditions safely. Historically being performed by radiologists only, these tasks also used to be relatively more straightforward as many implants and devices were considered to be absolute contraindications and patients with these were typically refused MRI altogether [37, 38].
3.2 Patient Screening
With the increasing number of medical devices and implants that are classified as MR-conditional, comprehensive patient screening is essential to ensure that these are accurately identified and further evaluation of their safety in the MRI environment is enabled [39, 40]. The Royal Australian and New Zealand College of Radiologists (RANZCR) emphasises that this evolution of technology results in ‘…placing the responsibility for safety on the operator’ (p20) [41].
RANZCR [41] recommends that a three-stage screening protocol be followed, firstly at the time of booking (typically by administrative staff), then on presentation at the MRI site through a thorough written screening questionnaire and then finally verbally before admittance into the MRI scanner room. The latter two stages are expected to be performed by MRI personnel, at least one of whom must be Senior MR Personnel. All participants in this study identified within the questionnaire that the task of patient screening is performed by MRITs (see Table 2), and that other staff members may also be involved, aligning with the multistep process endorsed by RANZCR.
3.3 Obtaining and Interpreting Patient Medical Notes on Biomedical Implants and Devices
Obtaining a thorough and accurate patient medical history is necessary to assess past operations, determine the presence of any implant or device and assess the safety of proceeding with the MRI examination [39, 42]. As seen in Table 2, the MRIT was reported to have the main responsibility for obtaining relevant patient medical notes on biomedical implants or devices, with frequent assistance from reception staff.
However, those responsible for the interpretation of patient medical notes must have sufficient knowledge to evaluate these and establish any potential MRI safety risks. Table 2 demonstrates that MRITs are principally responsible for interpreting medical notes and providing MRI safety recommendations in most workplaces. While a small number of participants (n = 6; 3%) suggested that reception staff could perform this task and provide recommendations, it is possible that participants may have misunderstood the question. Fortunately, no respondent identified that this task was purely the reception staff's role.
An Australian technologist working in the private sector was the only participant to designate the tasks of interpreting notes and providing recommendations regarding MR safety solely to the radiologist. Historically, it would have been far more common for the radiologist to be responsible for these tasks. However, with the increasing demand for MRI examinations and greater workloads of radiologists, it had become more commonplace in 2018 for the MRIT to take on this responsibility, thereby demonstrating how this role was extending to incorporate more cognitive elements. In fact, only 48% (n = 113) indicated the radiologist having any responsibility for interpreting this information, suggesting that many radiologists are fully reliant on MRITs to provide accurate information and informed recommendations to enable the radiologist to decide whether to scan or not.
3.4 Manufacturer Implant Website Search, Interpreting MRI Conditions and Providing Recommendations
It is essential that correct and current MRI safety information on implants and devices is accessed via a thorough investigation of manufacturers' websites to accurately determine these conditions [40]. All participants indicated that MRITs were responsible for ensuring correct details were retrieved (see Table 2). The interpretation of manufacturers' MRI conditions is a skill that requires in-depth knowledge of MRI technical parameters and protocols, as well as the exact factors within the clinical environment to which the implant or device will be subjected. MRITs also performed this role in all participants' workplaces, although 7% (n = 17) permitted trainees to perform this task, and one private facility in Australia also nominated the MRI assistant (see Table 2). However, it is noted that all participants who designated this task to these other roles also selected the MRIT, presumably in a supervisory (and ultimately responsible) capacity.
3.5 Interpreting Spatial Gradient Magnetic Field Maps
One MRI condition usually identified by manufacturers is the maximum spatial gradient magnetic field (SGMF) that an implant has been tested to and has been determined safe. This SGMF is an inherent characteristic of the main magnetic field (B0) and describes how the magnetic field varies in intensity over distance [8]. MRI vendors provide a map that MRI personnel can use to establish the maximum SGMF that any implant or device will be exposed to when in the MRI room. It is crucial that those responsible for MRI safety are suitably educated in interpreting this map [10]. Table 2 demonstrates that MRITs are now taking significant responsibility for assessing the MRI safety of implants, with 90% of them interpreting SGMF maps.
3.6 Final Decision Regarding Safe to Scan
Table 2 shows that the responsibility for the final decision regarding safe to scan was evenly divided in most workplaces between the radiologist and MRIT. New Zealanders are more likely to consider this as a team effort, with 61% (54/89) of NZ participants indicating both the MRIT and radiologist are responsible. By comparison, 56% (82/146) of Australian participants co-share this responsibility. If only one person was assigned this task, data suggest that it is more commonplace for the radiologist alone to be responsible for the final decision, with 28% (65/235) indicating this option. The 30 participants (13%) who solely listed this task as the MRIT's responsibility included 17% (25/146) of Australian participants and 6% (5/89) of NZ participants. The reason for this remains unclear, although one reason warranting further investigation may be differing workplace cultures between the two countries.
3.7 MRI Safety: Whose Responsibility?
The above findings demonstrate that MRITs in NZ and Australia are now making clinical decisions on a daily basis that directly impact the safety of their patients. In addition, it is estimated that 10%–20% of all MRI patients have implanted medical devices [43], reflecting the increasing prevalence of this cohort. Consequently, MRITs' knowledge base has had to expand, and quality and ongoing MRI safety education has become even more imperative [19, 44].
When this study was completed, these responsibilities were not formally acknowledged as a routine part of the MRIT role in NZ or Australia. Indeed, the 2018 NZ MRTB's competence standards [45] and the 2019 draft revision of the Medical Radiation Practice Board of Australia's (MRPBA) professional capabilities [46] failed to articulate clearly these increasing cognitive functions of MRITs. More recently, however, the updated competency documents from both boards now include competencies/capabilities that specifically address MRI safety considerations in more detail (see Table 3) [47, 48], therefore, better reflecting the current and evolving role.
| New Zealand MRTB competence standards 2024 [47] | Australian MRPB professional capabilities 2020 [48] |
|---|---|
|
Domain 4: Magnetic resonance imaging practice Competency 4.3: Deliver safe and quality MRI services (p30) [47]. Behaviour 4.3.2: Identify and manage safety requirements, including those related to the static magnetic field, radio frequency field, time-varying fields, implants and devices, thermoregulatory compromise, acoustic noise and biological effects (p30) [47]. Guidance: MRI practice Delivery of safe and quality MRI services requires practitioners to apply their knowledge of the physical principles of MRI and the surrounding environment to ensure the safety not only of the patient, but also themselves and other personnel (p32) [47]. Assessment of implants/foreign bodies is an important element of safe MRI practice (p32–33) [47]. |
Domain 1: Medical radiation practitioner* Key capability 9: Perform magnetic resonance imaging (p11) [48]. Enabling components: a. Operate MRI systems safely and effectively (P11) [48]. b. Apply knowledge of the principles of MRI physics and surrounding environment to ensure patient/client and others' safety (p11) [48]. Notes: MRI safety includes, but is not limited to:
*Australia does not currently have a separate scope of practice for MRI practitioners. |
While the terms responsibility and accountability are often used interchangeably, responsibility generally applies to the person completing the work, whereas those accountable ensure the work is completed to a satisfactory standard and make the final decisions [49]. When asked who had ultimate responsibility (and was, therefore, accountable for MRI safety decision-making) at their workplace, 51% of the respondents (118/232 who answered this question) identified the radiologist, 24.5% (n = 57) the MRIT, 17.5% (n = 41) the Charge MRIT and 7% (n = 16) the MRI Clinical Director. This differed slightly to who the participants thought should be ultimately responsible, with 41% (95/233 who answered this question) identifying the radiologist alone, and 37% (n = 87) identifying MRITs (either all MRITs, 24%, n = 56; or designated/charge MRITs, 13%, n = 31) without inclusion of the radiologist. The remaining 22% (n = 51) suggested a combination of both radiologists and MRITs. This difference may be because participants could only select one option when identifying who had ultimate responsibility in their workplace, while they could select multiple options when identifying who they believed should be ultimately responsible. It is possible that the second question may better reflect what is happening in practice, with shared responsibility and accountability being regularly commented on throughout the study.MR safety …is not an extension or advanced practice. It is my job as a competent, practicing [sic] MR tech to know all I can know about MR safety. (P237)
However, most responded that although the radiologist may hold legal accountability, their decisions often rely heavily on teamwork, drawing on the experience of the MRIT involved to provide the relevant information for informed decisions to be made. Several comments confirmed that the radiologist depends on this input.Ultimate safety decisions will always come down to clinical need over safety risk. For this reason a Radiologist must be involved. (P202)
In addition, a lack of MRI safety knowledge was a common justification for not relying solely on the radiologist to make educated decisions.Our radiologists are legally responsible but rely very heavily on our knowledge, input and research if difficult decisions need to be made, so in reality we are responsible and make the day-to-day decisions of implant scanning. (P206)
This view was further agreed with by the interviewees, with 83% (10/12) making specific mention that in 2018, radiologists were believed to be inadequately trained in MRI safety.Historically it has been the radiologist who confirms MRI safety, and this department still abides by this. However, many radiologists are now unaware of spatial gradient field maps, the risk of heating, and more in-depth MRI safety concerns. (P192)
3.8 MRI Scope of Practice
It is evident from the results of this study that the MRITs' role in NZ and Australia has evolved from one of technical proficiency to a role that involves a higher level of cognitive function and competency. Furthermore, the complexity of the associated decision-making continues to grow and with the increase in the numbers and range of MR-conditional implants and devices over recent years, it has become increasingly important to gain and maintain current knowledge so that clinical decision-making is safe [5, 10, 23, 24, 50, 51]. The separate MRI scope of practice necessary for registration in NZ requires technologists to undertake postgraduate level MRI-specific education (or provide evidence of equivalency). This ensures that all MRITs working in the NZ healthcare system demonstrate that they meet the required MRI-specific competencies as set by the NZ MRTB [47]. It also ensures mandatory continuing professional development (CPD) in MRI is completed, although a requirement to include MRI safety as a component of this is yet to be implemented. The MRI trainee's scope of practice ensures that all technologists working in MRI in New Zealand are either fully registered or are working towards completing a postgraduate qualification in MRI and demonstrating evidence of clinical competency under the supervision of a named clinical supervisor [52]. In combination, these scopes provide sound evidence of regulated practice and consequently ensure the safety of the NZ public when having an MRI examination.
In Australia, MRI is not a registered scope of practice. Postgraduate education is therefore not mandatory for Australian MRITs. The Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) provides opportunity for practitioners to acquire Level 1 or Level 2 certification in MRI, but this is voluntary and not a prerequisite for MRI employment. The different levels reflect the associated clinical requirements, including completion of a specific number of hours and examinations [53]. In 2020, the MRPBA introduced MRI-specific professional capabilities for all radiographers who use MRI as part of their practice [48]. Registration, however, still remains within the generic domain of medical radiation practitioner, so practitioners must self-identify if they are working in MRI and there is no mechanism to audit any associated learning. Consequently, Australian participants showed a more varied level of MRI education in comparison to their NZ colleagues, with less than half (41%; 61/146) continuing to postgraduate level or higher, compared to 99% (88/89) in NZ. Significantly, of the 146 participants working in Australia, 12% (n=17) had not completed any education specifically in MRI. Interviewees provided further professional insight into the importance of the MRI scope of practice, with all eight NZ interviewees strongly agreeing that it should remain as a separate scope for registration. Of the four Australian interviewees, one junior could not comment on the situation as they were unaware of the significance, one strongly agreed with the concept, one agreed that it worked in NZ and, along with the final senior Australian MRIT, suggested it could be beneficial for Australia. All five interviewees employed in the public health system stressed the risks involved with multiple technologists, with differing levels of experience, rotating through modalities.
This view was also supported by MRIT interviewees working in NZ with experience in other countries. Two of these interviewees had completed a postgraduate diploma upon immigrating to NZ and could see the direct impact this had on the quality of technologists with whom they worked and on the MRI safety standards in their departments. As one comments:‘I think it is a specialty and especially the risks that are involved, I don't think a general MRT when they are rostering through are really aware of all the challenges that lie ahead of them… So yeah I definitely think that the post grad should stay’ MRIT S6 NZ.
‘I do think it made me a better tech, there's an understanding now that I didn't have before… my personal feeling is that here in NZ, MRI techs are among the best in the world and I think that everywhere else should be trying to emulate what we do…’ MRIT S8 NZ.
4 Conclusion
This study documents the evolving nature of the MRITs' role in New Zealand and Australia. While the small sample population for the questionnaire is a limitation of this study, the results provide clarification of the role and identify emerging responsibilities. Evaluation and management of the MRI safety of medical implants and devices has been identified as a team effort that includes all MRITs, not just a select few. Further exploration of this role is warranted internationally to ensure that regulatory frameworks, underpinning education and ongoing CPD requirements remain aligned with the increasing responsibilities becoming routinely associated with this role. In addition, investigation of the current MRI safety knowledge of radiologists in New Zealand and Australia would be of value to determine if the concerns raised in 2018 by the participants of this study are still founded.
In New Zealand, having a separate scope of practice in MRI enables a minimum level of MRI-specific education to be mandated and ongoing CPD in MRI safety to be audited. In addition, the MRI trainee scope of practice ensures that all staff practising in MRI are either fully registered or are working under supervision towards meeting these competencies. Participants in this study supported the continuing need for separate registration based on the uniqueness of the MRI environment and the extent of education required by all MRITs to ensure patient safety as the complexity of decision-making continues to increase. In accordance with current literature [19-21], the development of a standardised MRI safety framework that includes minimum educational and training standards, clearly defines roles and responsibilities and supports MRITs to make more complex clinical decisions is recommended. Separate registration of MRITs is also recommended globally to ensure that MRI-specific education and ongoing professional development in MRI safety can be audited.
Acknowledgements
This research paper forms part of a master's degree by research at The University of Auckland. We thankfully acknowledge the support of funding provided by The University of Auckland Graduate Student Support. Open access publishing facilitated by The University of Auckland, as part of the Wiley - The University of Auckland agreement via the Council of Australian University Librarians.
Ethics Statement
An ethics application for this research was submitted to the University of Auckland Human Ethics Committee and approval was obtained on 26 July 2018, valid through to 26 July 2021 (reference number 021721).
Conflicts of Interest
The lead author is a Professional Teaching Fellow and MRI Specialisation Leader at The University of Auckland. This professional role may be perceived as a potential source of bias in the interpretation of findings supporting the compulsory inclusion of MRI education for clinical practice. The author affirms that the research was conducted objectively, and the conclusions drawn are based on the data collected through the survey, interviews and literature review, independent of any institutional or personal interests.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
