All of these agencies and organizations promise to ensure quality & safety of medical care… do they actually do this for MRI safety? And if they don’t, what can we do to help make sure that the people we love are getting MRI exams at places that take our safety seriously?
In this episode our hosts change the focus from the MRI death of Mr. Keith McAllister and Nassau Open MRI to each of us, and what we, as MRI patients, can do to help protect ourselves or our loved ones, helping to assure MRI safety at the hospital or imaging center where we seek care.
Are the signs from MRI state licensure, or MRI accreditation, that are good indicators for us to find safe MRI providers? Should we be getting our MRIs at hospitals instead of outpatient imaging centers? Should we only be going to MRI providers who have MRI safety officers (MRSO) on staff?
Show Notes:
Incident leaked security camera video
ACR Manual on MR Safety (the MRI Safety standard-of-care defining document)
Hospital Accreditation Standards: ACHC, CIHQ, DNV, TJC
MRI Scanner Accreditation Standards: ACR, IAC, RadSite
Transcript:
“…And we follow the best criteria when developing our accreditation standards, not only for MRI.”
“And once you have that body of MRI accreditation standards, how do you confirm that they’re providing the safety benefits that you intend them to?”
“I’m not sure I understand what you’re asking.”
“Well, let’s just take MRI injury accidents. How often do you look at how people are actually getting hurt in MRI? Say, injury accidents from the FDA database, for example. How often do you look at those and evaluate whether your standards are specific or concrete enough that if they were followed, they would interrupt those injury accidents?”
“Are you there? Did the call drop?”
“No, no, no. I’m still here… I, uh, I want to assure you that we develop the highest quality standards for safety that are possible.”
“O-Okay, I get that. I’m asking if you actually validate the performance of those safety standards in MRI. … Hello?”
Hello, and welcome back to the Invisible Force Podcast. This podcast series is built around exploring MRI incidents and accidents that often get described incorrectly in local TV news or online stories as quote unquote freak accidents.
Our entire first season is dedicated to an accident you’ve heard about in the news and on this podcast, a man who died in an MRI accident out on Long Island, New York, just a few months ago in July of 2025. In this accident, Mr. Keith McAllister died after he got pulled into an MRI scanner by a 20-pound chain that was around his neck. This happened at Nassau Open MRI.
But before we pick up this episode story from our prior episodes, this is a great time to reintroduce you to the co-hosts for our podcast.
I’m John Posh, MRI technologist, educator and long-time advocate for MRI safety practices. I’m also adjunct faculty at two universities and teach MRI safety multiple times per year.
And I’m Toby Gilk, certified MRI safety officer, certified MRI safety expert, MRI facility architect, safety consultant and co-author of a new MRI safety textbook, The Technologist’s MRI Safety Handbook.
For those of you who’ve been with us for the past 10 episodes, you’ve heard about the accident in which Mr. Keith McAllister died, the individual people involved, the false starts, the deception in stonewalling, and our efforts to get information. In our last episode, we talked about what we thought could happen with both the lawsuits and whether or not there was a real possibility of criminal charges associated with this incident. If you’re a listener who’s just joining us, not only do you have a bunch of episodes to binge to catch up, but you’ve also joined us at just the right time in this first series for the subject to pivot from them to you.
For this episode, we’re going to focus on what you can do to be an educated consumer of MRI services, helping you in this wild west unregulated safety marketplace that we all live in, help you make sure that you’re making the best decisions for safe and effective MRI care. Because the things we think are going to guarantee quality and safety, well, they don’t always work the way we would expect when it comes to MRI.
In the first half of this episode, we’re going to identify for you some of the ways you can ask a few questions or observe a few telltale signs to get a sense of an MRI provider’s attention to your safety or the safety of your loved ones.
The first thing that we advise you to not take as a good indicator of safety is how confident and reassuring the MRI department staff is. There are at least two reasons for this. One is that agitated patients are harder to manage and as a result, one of health care workers’ biggest jobs, apart from running the scanner, is to keep you calm. One of the most successful ways to do this is to project confidence even if you don’t really have it. Oftentimes, health care workers are trained to reassure patients that everything is just fine. The second reason is the Dunning-Kruger effect, which is where people with a little bit of knowledge of a complicated thing, they often overestimate their own knowledge. In other words, people can know just enough to be dangerous while thinking that they’re hot stuff, and this winds up putting themselves and others in danger. Confidence is not the indicator that you might want to think it should be.
Next, take the MRI screening questions seriously. If you’re nervous about the exam, and your imaging provider has an online option for you to complete the screening form, do it at least a day before the exam, or whatever instructions they give you is fine. It is vitally important that you answer their questions fully, even if the information would make you embarrassed if it were shared with your coworkers. Healthcare workers are legally required to keep your information private, and those piercings, that surgery, that drunken incident where you fell out of a pickup truck and got a bunch of debris embedded in your leg. All of that is stuff the imaging provider will want to know. Fill out the form when your mind can be fully present, and err on the side of oversharing as opposed to undersharing.
One of the best indications of a site that takes MRI safety seriously is one that has people appointed to MRI safety-specific roles. There are three different safety supervisory roles, which will rank from the most likely to find to the least likely for you to find. The first of these is an MRI safety officer or MRSO. This is often filled by a more experienced MRI technologist. This role will probably have the most impact on what you see happening when you enter the MRI facility. MRSOs tend to be in charge of the implementation of safety practices at the hospital or the imaging center where they work.
The next of these three roles is the MRI medical director or MRMD. This is a physician, almost always a radiologist, who has demonstrated specific MRI safety knowledge. Believe it or not, in 2026, MRI safety training is still not a minimum training requirement for radiologists, meaning that a radiologist can be practicing today without ever having been required to study MRI risks or risk management. The MRMD designation generally means that the radiologist group, that serves the hospital or imaging center, has identified a colleague from their group with the strongest MRI safety knowledge and skills to be the point person for these questions and issues.
The third role is that of MR safety expert or MRSE. This is a person whose skills hopefully you’ll never need. Think of this as the phone a friend resource when you’re completely stumped. The MRSE is often a medical physicist with good understanding of the mechanisms that can cause MRI safety issues. When a patient has four or six different implants, or has something in their body with really poor documentation, or requires a specially adapted MRI exam to help protect their safety, the MRSE is the person who the MRSOs and the MRMDs call when they need them.
You absolutely want to find imaging providers who have an MRSO. It’s really good to find one who also has an MRMD. And if you have a highly complex MRI safety situation, you may want to seek out a provider who has both the MRSO and MRMD, plus an MRSE.
Call your imaging provider as soon as you get scheduled, and ask them whether they have people designated for any of these three roles. But here’s the thing, anybody can throw a bunch of letters behind their name and claim to be in one of these roles, and in the USA at least, it’s almost impossible to stop them from doing that. I used to have a presentation where I made a half joke that my dog could be identified as an MRSO. So to make sure that you’re getting someone who not only likes putting letters behind their name on their name badge, but somebody who really knows this material, you can ask if the people in those roles are certified by the International Board of Magnetic Resonance Safety, IBMRS. It’s a brand new name. The organization has been around for more than a decade, and it used to go by the American Board of Magnetic Resonance Safety, or ABMRS.
And speaking of certifications, one of the professional societies that registers radiographers in the United States, the ARRT, has a new imaging assistant or IA certification that they’ll start offering sometime later this year. The IAs are not MRI technologists, and might be better described as a tech aid supporting the MRI tech. They’re actually minimally required to have more MRI safety training than MRI techs, and are required to have more MRI safety specific continuing education than MRI techs. It may seem weird that a registered tech aid slash imaging assistant is a recommended differentiator, but in terms of minimum levels of MRI safety training, they’re actually one of the better indicators.
There’s also consideration that perspective MRI patients should be keeping in mind depending on what your needs are. As an example, if you have an active implant, now this might be a pacemaker or a neurostimulator, any device that are called stimulators, I would suggest that you should prefer to get your MRI done at a hospital as opposed to an outpatient imaging center.
Similarly, if you’ve got a complicated medical history with different implants or devices or prosthetics, evaluating you or a loved one as an MRI patient will be more complicated and demanding. You’re generally not going to want to have the minor league team doing those evaluations. You’re going to want a better trained and better resource provider managing your MRI care. To the extent that you can with whatever insurance coverage you have, we would strongly recommend a preference for a hospital-based MRI provider over an outpatient imaging center.
We also want to make clear that our preferences for hospital providers over outpatient imaging centers are based on general national capabilities. There are outpatient providers who are great at MRI safety, and there are hospitals where the two of us have each been counting the seconds until we can leave the building because we can tell it’s only a matter of time before somebody gets hurt there. In other words, your mileage may vary. But if you’re looking for some general rules of thumb, we’d say that the more complicated the patient or the more complicated the set of implants or foreign bodies, the better off you are getting your MRI in a hospital setting.
But that’s what you can be looking for in the days or weeks before your MRI exam. What sorts of things should make your safety sense tingle when you’re at the provider on the day of your exam?
One of the things is if the control room area isn’t locked off from the rest of the radiology department. That, for me, is a red flag. A number of years ago, I went with my wife who was having an MRI at a local hospital. She’s really claustrophobic and needs to essentially be knocked out to be able to undergo an MRI exam, which meant anesthesia staff, which meant doing it at a hospital as opposed to an outpatient imaging center. Now, at the time, this hospital had a door from the hallway, for the main radiology corridor, into the control room that they left just barely open at all times, which that door to the hallway was right next to the door into the MRI scanner room. There was enough room for a chair between those two doors and that’s about it. After they got my wife positioned on the MRI scanner table, they came and said, oh, you’ll be more comfortable in the waiting room trying to usher me out. I sat right down in that chair between the corridor doorway and the entrance to the MRI scan room, and I declared that I was going to be right there until my wife came out of that room.
Many MRI providers, especially at the hospital level, they just love to put the type of scanner that the person works on on their ID badges. So if you see lots of people walking through the door that secures the MRI area and their badges don’t say MRI, that’s at least worth a question or two. The same is true if you see all sorts of equipment parked in the MRI control room, from wheelchairs to IV poles to medical equipment on wheels. Those devices should all have conspicuous markings to indicate their safety and MRI.
Mostly, we depend on the licensure and accreditation of healthcare facilities as some sort of assurance of safety. Now, in the second half of this episode, we’re going to go through several of the accreditation organizations who may accredit either hospital-based or outpatient-based MRI providers. And we’re going to let you know what we think about their MRI safety protections. For you, when you’re the MRI patient or when your loved one is.
The season one sponsor of the Invisible Force podcast is cairereporting.org. That’s CAIRE, spelled C-A-I-R-E. cairereporting.org is a confidential MRI adverse incident reporting system, available to you, the public, as well as offering an enterprise level solution to hospitals and imaging centers for secure, confidential reporting of MRI incidents, accidents, and near miss events. If you have direct knowledge of any MRI accident that you think may have been swept under the rug, or if you work for a hospital and you want information about how CAIRE could be set up as a private internal reporting tool for your imaging service, carereporting.org can help you with either or both of those. CAIRE has an assembled panel of international experts in MRI safety and accidents, reports submitted either through the public website or through the enterprise system get reviewed by their experts who then deliver insights into the contributing causes of how accidents or near-miss events happened and, more importantly, the steps that could prevent similar accidents in the future. For more information, please visit cairereporting.org. That’s CAIRE, spelled C-A-I-R-E.
Before the break, we gave you a few suggestions of what you can look forward to keep yourself or your loved ones getting an MRI safe. And in the second half of this episode, we’re going to look at the organizations that exist ostensibly promising assurances of quality and safety, the accreditation orgs. How much can we really depend on them to offer us assurances of MRI safety?
Before we start looking at the individual accreditation organizations, we need to recognize that accreditation is a necessary step for federal reimbursement from programs like Medicare, Medicaid, Tricare, etc. CMS, the federal agency that administers these programs, requires different types of accreditation for hospitals, called enterprise-level accreditation, than it does for outpatient imaging centers called modality-level accreditation. A provider is only required to have one type or the other, but a fair number of hospitals elect to have one of each. They’re just showing off, but that should be a good thing, right?
So let’s start on the hospital side, or enterprise-level accreditation. There are four CMS-sanctioned enterprise-level accreditation organizations, and alphabetically, they are the Accreditation Commission for Healthcare, or ACHC, the Center for Improvement of Healthcare Quality, or CIHQ, DNV Healthcare, and the Joint Commission, or sometimes referred to as TJC. We’re going to set aside the Joint Commission for just a few minutes, both because they’re a bit different than the others when it comes to MRI safety, but also because in the hospital accreditation space, Joint Commission is something of a default choice for hospital accreditation in the US. Their market dominance means that we can do a slightly deeper dive into them, and it’ll cover a disproportionate majority of the hospitals in the USA.
ACHC and CIHQ, in their hospital standards, have taken the general guidance from CMS about what hospital accreditation ought to accomplish. There are differences between the two, but there are large chunks of CMS publications that are, quite literally, copied and pasted into the accreditation criteria for both of these organizations. CMS, in their basic descriptions of what hospital accreditation ought to accomplish in radiology, barely mentions MRI and offers precisely zero minimum MRI safety best practices. And, lo and behold, ACHC and CIHQ similarly don’t have a single, explicit, thou shouts statement about minimum MRI safety standards for hospitals they accredited.
DNV, the other hospital accreditation org, they didn’t copy and paste the CMS guidance and call it their hospital accreditation standards. DNV has historically marketed themselves as something like the kinder, gentler, hospital accreditation organization, less focused on prescriptive rules and more willing to accommodate alternative ways of solving problems. Their accreditation regime is somewhat patterned after the ISO 9000 manufacturing standard, which allows manufacturing organizations to define their own quality and safety standards and their own means of measuring their performance. In theory, as long as you’re doing what you say you are going to do, you’re meeting the standard. The emphasis is more on what you’ve defined for yourself and less on complying with an external set of minimum rules.
Now, to be fair, this isn’t a complete choose-your-own-adventure version of accreditation. It’s not the Wild West. Hospitals are supposed to develop their own standards that meet or exceed the standard of care. But when DNV’s written minimums don’t even mention the safety of MRI, it isn’t exactly clear where the hospitals are supposed to go to identify the MRI safety standards of care, much less develop their own policies or practices that follow that standard of care.
For all accreditations, MRI departments in both hospitals and imaging centers often have policy statements like, Our policies are informed by the ACR manual on MR safety, which is the MRI safety standard of care defining document. But when you actually dive in and read what they say they will do, it oftentimes doesn’t even have a real passing similarity to the ACR manual. Sometimes they invoke these policies as if they’re some sort of standard, but then they’re so bad at giving you the specifics, it’s kind of like having a boiling pot of water and showing it a picture of a chicken and then calling it chicken soup. Simply invoking the name of the standard document doesn’t, or shouldn’t, get you a free pass from the specific performance criteria that help keep patients and staff safe, even though we’ve seen it happen repeatedly. Well, they said they were following the ACR. Well, did you look to see what of the ACR’s performance criteria were actually in their policies? Were they actually doing those?
So these are the lesser players in the hospital accreditation world, and not one of them have any specific minimum performance criteria for MRI safety. In one way or another, they generally let the hospitals define their own way of doing things, and they have nothing explicit which requires a cross-reference with the provision and the actual standard of care. This means that sometimes they can get hung up on seemingly trivial elements. For a number of years, accreditation organizations were all hot and bothered about seeing certain warning signs up on the wall, while failing to recognize large potential hazards right under their noses. Oftentimes for many accredited organizations, MRI safety becomes about a series of performative check boxes and not about the actual risks themselves. Zone signs, check. Zip tie on the fire extinguisher tag, check. But nothing on specific burn prevention practices or the deployment of ferromagnetic detection systems or whether the supervising radiologist understands MRI risks.
But for a moment, let’s switch from the hospital level accreditation to the modality level accreditation organizations. These are newer, made necessary by a 2008 piece of US federal legislation that requires CT, PET and MRI scanners in outpatient imaging facilities. The scanners need to be individually accredited. So if hospital wide or enterprise level accreditation organizations are supposed to be checking out everything from the helipad on the rooftop to the laboratories in the basement of the hospital and everything in between, it seems reasonable that an accreditation that focuses specifically on one type of radiology scanner would have more specific and more clearly defined safety minimums, right? Well, let’s test that theory.
As with enterprise level accreditation, there are three modality or scanner type level accreditation organizations which are alphabetically, the American College of Radiology or ACR, the Inter-Societal Accreditation Commission or IAC, and a newer accrediting organization called RADsite. Like we did in the first half of the show with enterprise level accreditation organizations, we’re going to pull out the big dog in the modality accreditation orgs, the ACR, and we’ll deal with them and the Joint Commission separately closer to the end of this episode.
We’re a couple of the hospital level accreditation groups chose to copy and paste entire chunks of the CMS general standard so that many of their standards were identical. The ones at the radiology level, the modality level, mostly have distinct standards. For MRI safety minimums, the only thing that they appear to share is a requirement that there needs to be some sort of physician oversight, that MR personnel should have some sort of site defined safety training, and that the people operating the MRI scanners should minimally meet state minimum standards for their qualification. Though we should note that about 90% of the US states don’t actually have minimum qualifications for MRI operators. For those that do, most don’t actually require MRI training to run an MRI scanner. Beyond those criteria, it’s really a thin patchwork with extraordinarily few MRI safety specific minimum accreditation criteria that match the elements of the standard of care document.
If you, like us, thought that MRI specific accreditation would have a number of shared basic MRI safety minimum performance criteria, like, I don’t know, minimum MRI safety training content or frequency or uniform screening or access control requirements, requirements for clinical or operational policy reviews and updates, or minimal safety governance structures, think again. In the first half of this program, we suggested finding MRI providers that have a designated MRI safety officer. So it’s probably worth noting that only one of the three MRI scanner type accreditation organizations requires this as one of their minimum criteria, RADsite. Like with the hospital level accreditation, when it comes to minimum MRI safety requirements, these MRI specific accreditation organizations don’t really have more or better MRI safety minimums.
As promised, let’s switch our focus to the two big dogs of accreditation. The Joint Commission on the hospital side and the ACR on the MRI scanner side. A few years ago, I counted up 143 distinct ‘thou shalt’ statements in what was then the standard of care document, the 2020 ACR manual on MR safety. Then I counted up how many of those 143 safety criteria appeared in each of the different accreditation organizations own standards. The Joint Commission had accreditation criteria that substantially met exactly two. Two of the ACR manual’s 143 items. Now, to be fair, there were a bunch of other partial credits where the ACR manual would say something like, had the patient in accordance with the manufacturer’s guidance to prevent burns, and the Joint Commission standard would say something like, train MRI technologists on heating risks. The Joint Commission’s criteria required training, but not the performance of the action that would protect the patient. There were around 55 of these partial credit Joint Commission accreditation standards.
So, since we’re using the ACR’s manual on MRI safety as the yardstick here, surely the ACR’s own MRI accreditation program scores much better, right? Actually, no. TJC substantially matched two of the MRI safety standard performance criteria, but the ACR’s own MRI accreditation program only substantially matches one of the 143 criteria from its own 2020 manual. The ACR does have a similar number of partial credit responses in their MRI accreditation requirements. But whereas the Joint Commission required training on a risk, but not the action that would address the risk in a real world situation, the ACR requires the existence of a policy on the subject of risk. But they provide no minimum policy content criteria.
Now, as an illustration of this, the 2020 ACR manual on MR safety, in that document, there are a couple of dozen ‘thou shalt’ statements about preventing thermal injuries. The ACR’s accreditation minimum is that a policy exists on the subject of thermal burns. There’s no minimum policy content. There’s not even any guidance from the ACR as to what specific policy elements should be in that section. We imagine that a policy entitled thermal burns that said something along the lines of, ‘we think RF burns are God’s will and punishment for the wicked, and it’s not our place to stand in the way of God’s judgment, so we take no preventative steps.’ We think that that would meet the ACR’s minimum criteria. The ACR’s MR accreditation program requires the existence of 18 policy topics and, quote, appropriate signage and access controls. There really are no explicit minimum MRI safety performance criteria in the ACR’s own MRI accreditation requirements.
All of the accreditation organizations have a similar marketing message, that their accreditation is some sort of assurance of both quality and safety in patient care. The fact of the matter is that for both the hospital level and the MRI scanner level accreditation organizations, they’re extremely weak on specific preventions that we know for a fact could help. For the Nassau open MRI accident, I think it’s fair to say that only the Joint Commission’s minimum explicit standards had a shot at stopping this accident, and even that’s up for discussion.
A year or two ago, I had a chance to talk with a couple of bigwigs at one of the larger accreditation organization, and I asked them how they verified the effectiveness of their MRI safety standards. They weren’t sure what I meant, so I said, ‘I mean, do you look at how MRI injury accidents happen and then compare the causes of those accidents against your standards to see if your minimum standards would actually interrupt the accident from happening?’ There was a long and awkward silence before they came back with something ambiguous like, ‘oh, we validate all of our standards,’ which I took as a non-answer. They wouldn’t engage any follow-up questions about this.
The sad fact about all this is that the accreditation products that are marketed to hospitals, imaging centers, and ultimately to you and me, on the promise of “the highest level of safety,” that’s actually a quote, by the way, pulled from the pre-written press release that one of the MRI accreditation organizations sends to their clients when they get MRI accreditation. That promise is largely empty. There are meaningful safety measures, they’re well-known, and have been documented and freely accessible for nearly 25 years. But none of the accrediting organizations have them as part of their accreditation minimums.
In the end, this means that when we’re looking for some sort of assurance of MRI safety, the accreditation window sticker at the entrance, or the gold seal badge on the provider’s website, really offers us very little in terms of assurances that the provider is actually following the standard of care.
“…And we follow the best criteria when developing our accreditation standards, not only for MRI.”
“And once you have that body of MRI accreditation standards, how do you confirm that they’re providing the safety benefits that you intend them to?”
“I’m not sure I understand what you’re asking.”
“Well, let’s just take MRI injury accidents. How often do you look at how people are actually getting hurt in MRI? Say, injury accidents from the FDA database, for example. How often do you look at those and evaluate whether your standards are specific or concrete enough that if they were followed, they would interrupt those injury accidents? … Are you there? Did the call drop?”
“No, no, I’m still here. I want to assure you that we developed the highest quality standards for safety that are possible.”
“O-okay, I get that. I’m asking if you actually validate the performance of those safety standards in MRI. … Hello?”
For our next and final episode, final at least for now on this series, we’re going to circle back around to the state of New York and get some indications on what, if anything, they’ve done in the intervening year to help make sure that accidents like this one don’t happen again in the Empire State. We’re also going to give you a bit of a tease on the next two series that we have coming up.
First of those is a short series on perhaps the most infamous MRI fatality, the death of Michael Colombini, followed by another long series. This one is going to be on an accident that occurred in 2023 in California, where a nurse got pinned against an MRI scanner by an ICU bed. With the ICU patient on the bed at the time.
For this week’s show, our sources were really the accreditation criteria of the various organizations, as well as the standard of care defining documents from the ACR. Our little radio play dramatizing that conversation I had with the accreditation organization. Well, that was voiced by me and Brandon Grugle.
If you have any information about this incident or any other MRI accidents, please reach out to us through our website, invisibleforcepodcast.com. There you’ll find episodes, show notes and tip line information. Also, you can leave us a voicemail with information about this incident or any other MRI accidents at area code 631-MRI-TIPS. The number again is 631-MRI-TIPS or 631-674-8477.
And as always, we ask you to like and share our podcast with your friends and colleagues and coworkers. Together with your help, we’ll unravel the mystery of what happened, and with a little luck, we’ll help make sure that accidents like this don’t ever occur again.
