Since posting this a new official national MRSE course and certification scheme has been developed in Australia and New Zealand. Read about it here.
On 12th May 2018, the American Board of MR Safety (ABMRS) exam for certification as MR Safety Officer (MRSO), MR Medical Director (MRMD) or MR Safety Expert (MRSE) is being offered in Sydney. What does this mean for ANZ MR healthcare professionals? The views here are my personal opinions. Please feel free to comment below.
Do I need to have certification to act as an MRSO/MRSE/MRMD?
No. These roles existed in Europe well before the formation of the ABMRS. The roles are defined in the Inter-Society Working Group on MR Safety: Recommended responsibilities for management of MR safety. I have functioned as an MRSE for over 20 years. It is up to employers to both designate these roles and to appoint to them. I firmly believe that medical imaging employers should follow this model.
Is the ABMRS Certification recognised in Australia and New Zealand?
As far as I know it is not recognised by any national or international professional society or regulatory body. It was introduced to address a specific need in the USA. Should it be recognised by, e.g. ASMIRT, RANZCR, NZMRTB? Well, that is a different question, and one for our professional societies, health departments and education providers.
Surely MR safety is international and independent of location?
The principles of MR safety are. After all, they depend upon physics, engineering and physiology. However medical practice, custom, perception of risk, regulations and standards may vary by country, and in my experience they do.
How will certification benefit me?
The exam has been set by an international panel of experts in MR safety and is sound. Gaining certification as an MRMD or MRSO demonstrates a certain level of knowledge of MR safety. It’s not yet clear if this will give you a competitive edge in a job interview or towards promotion.
Will it empower me to make decisions on individual patient safety?
If you are a radiologist with MRMD certification: yes, but you already had that right – but you can now provide evidence that you are better informed to discharge that duty.
If you are a radiographer/technologist with MRSO certification, then my opinion is: no– you must still scan within the conditions, or obtain a positive benefit v risk decision from your radiologist. However, you can now provide evidence of a level of knowledge regarding understanding or meeting the conditions and also appreciating the risks.
What about MRSE certification?
This is where the Board and I part company. Under the ABMRS certification, there are no professional requisites to gaining MRSE or MRSO certification. You don’t have to be a registered healthcare professional, hold or have any relevant degrees, qualifications or experience.
So what do you need to be an expert in MR safety?
I would include appropriate professional registration, specific degree requirements, advanced understanding of electromagnetic theory, medical electronics, physiology, biomagnetism, MR engineering, a peer-reviewed professional portfolio or structured training programme, participation in relevant research, knowledge of the current literature and significant practical experience. The UK’s Institute of Physics and Engineering in Medicine has published a knowledge-base and competencies for the MR Safety Expert.
So should I take the exam?
That’s up to you. It’s not clear what personal professional benefits this may bring you, but it may be useful to gauge your knowledge of MR safety. For this reason the Essential MR Safety course now includes a self-marked assessment, as does the UK’s Eden Learning course.
So what do you think? Please comment below. Comments will be moderated.
REFERENCES
The American Board of MR Safety www.abmrs.org
The Inter-Society Working Group on MR Safety: Recommended responsibilities for management of MR safety
Fernando Calamante, Bernd Ittermann, Emanuel Kanal, The Inter-Society Working Group on MR Safety, and David G Norris.
J Magn Reson Imaging. 2016 Nov; 44(5):1067-1069
Institute of Physics and Engineering in Medicine
I agree with the way you have summed up the points. There are questions people and professional communities need to answer amongst themselves. What ABMRS offers is an examination and a certificate in a commercial package, developed largely out of sight of the professional community. There is still a long way to go to find the context in the Australian scene.
I’m not sure what you mean by “developed largely out of sight of the professional community,” Greg. The content of the exams was developed with representation from IPEM, FDA, MHRA, RANZCR, ISMRM (among others), and this included *you* as a representative of SMRT. What professional community members ought to have been invited who weren’t?
I’m also curious of your choice of phrase, “an examination and a certificate in a commercial package.” It seems designed to suggest to the reader a financial motivation. Yes, there is a charge to sit for the exam, but the ABMRS is non-profit (which you know), the work of the Board is all volunteer (which you also know), and the ABMRS is prohibited via its bylaws from providing commercial training, removing a commercial motivation for the exam or training from the ABMRS and leaving it to third-party commercial providers (e.g. the two commercial training options offered by Donald and mentioned in Donald’s original post).
MRSO certification as a radiographer has helped me better understand MR safety and be able to demonstrate I have some understanding which adds credibility to my support role within our organisation.
I think it could be useful in the UK to support rads who take on the MR Responsible persons role within departments (or something similar). Especially where sites/organisations may lack MRSE support.
In the UK rads increasingly have more understanding on the physics and safety than our radiologists, and often take ultimate accountability for our patients (increasingly where radiologists are more remote from where the scanning is occurring – teleradiology etc). Although as mentioned, this does still need to be in collaboration with our radiologists where risk-benefit and clinical discussion making is needed. Therefore it is a team effort but with rads playing a pivotal role in explaining and managing the risks posed from MR.
I am an advocate of some form of generalised MR accreditation for rads in the UK, not just MR safety, but so we can recognise specialist practitioners having an expected level of competence. We do have PgCerts but they aren’t standardised necessarily in content and evidencing performance compared with say U/S….
“In the UK rads increasingly have more understanding on the physics and safety than our radiologists, and often take ultimate accountability for our patients’..”
I’m not sure myself where it would stand legally for UK Radiographers to take ‘*ultimate* accountability for our patients’ as you state here. My understanding in the UK is that we have legal responsibilities as MR practitioners, but that the ultimate accountability is with an MD, or possibly jointly with a designated operationally-responsible MR Responsible Person (if not an MD). I do appreciate your point – that very few sites have an accredited MRSE and they can feel they are put in a very difficult position as a result of this fact. But the fact that many MDs, including some Radiologists, may or may-not have more MR physics knowledge than their practicing MR Radiographers, doesn’t change the legal framework of responsibility and accountability, in my opinion.
The point you make of possibly having specialist MR Practitioners (or MR Radiographer Consultants) is interesting. To me this seems a reasonable aspiration for the UK and might possibly help to resolve the point I made above. But the legal clarifications of this would be complex and I’m not sure the legal framework as it currently stands would allow a clinician to be unnecessary, or for MDs to not take ultimate responsibility for safety decisions in MR safety decision-making (via a safety policy they have approved, or directed under documented individual clinical risk-benefit analysis). As it stands, my own understanding is, MR Radiographers cannot actually legally make individual MR safety status decisions alone, (although it appears in essence that this is what we appear to do in daily practice), but that they must always follow a, MR safety policy created and approved by their department clinical lead/MD, and operationally implemented by Radiographer practitioners. Radiographers in practice must always be able to: demonstrate they have met MR-conditionality; are acting under strict authorisation of a carefully considered and documented risk-benefit decision by an MD if there is over-riding clinical benefit to the pt; that they have acted in the patient’s best interest at all times; reduced risk of harm to a practicable minimum where MR-conditionality cannot be met. That’s quite different to us taking, ‘ultimate accountability’.
I do fully appreciate and understand the issue you raise. The real apparent dilemmas and difficulties many clinical MR Radiographers feel in many clinical sites – that they feel they might be taking decisions only because they feel unsupported, or have more MR safety experience that their clinical colleagues. It’s important though to remind ourselves of our own scope limits of practice, against that of a referring or the Responsible clinician.
I think Dr McRobbie makes many excellent points here. The fact that MR Techs/Radiographers will understand the mechanisms behind MR safety (which we know are are very complicated) through this particular training and certification can only be of benefit* to overall MR safety in my view. *But as Dr McRobbie importantly states (although legal frameworks are quite different around the world) this does not legally empower Techs/Radiographers to make individual MR safety decisions on patients or participants (I am sure this point is made in their certification training). I’m hopeful that the Non-US countries will/are also endorse a more standardised approach to MR Tech/Radiographer certification in MR practice. But I think to work and be successful it must take into account a realistically-levelled and affordable programme that takes into consideration the many many practicable and financial limitations of the country in which it applies e.g. that a significant proportion of clinical MR Radiographers only practice in the field of MR a few years, or practice in other modalities too, and won’t necessarily achieve the same level of understanding as those who have decades of full-time MR practice experience.
Since this was published the situation in Australia and New Zealand (and it was always about ANZ) has moved on. Our pan-national medical physics college, the ACPSEM, has introduced a MRSE Certification and training programme to address local needs. See my recent blog post for details.
Thanks to all for your comments.