Tobias Gilk is one of the leaders in the MRI Safety Industry. So when we had the chance to interview him we were very excited. His depth of knowledge in the MRI safety industry is phenomenal as is his dedication to helping the MRI industry develop more uniform standards for safety.
This is is our interview with Tobias Gilk as well as some links on where you can find out more about his MRI Safety courses and MRSO and MRMD education and certification.
1. Why are you so passionate about MRI Safety?
It began 20+ years ago when I was stunned by the absolute lack of physical safety minimums for MRI, particularly as compared to the ionizing radiation modalities, and I was determined to develop some set of standards for MRI suite design. I was pretty successful at that, but those efforts led me to see that -though vitally important- physical safety was but one small part of the ‘big picture’ MRI safety. Really since about 2005 / 2006 I’ve been vigorously pursuing personal knowledge and advocacy on MRI safety best practices. Part of that pursuit has had me studying MRI accidents and I’ve found that the overwhelming majority of these accidents in which patients, caregivers, or companions are injured are entirely avoidable through existing best practices. Every near-miss and -in particular- every MRI injury accident is its own senseless tragedy and I’m the Don Quixote character out here convinced he can stop these tragedies from continuing.
2. How did you get started teaching MRI Safety courses?
It’s really an outgrowth from speaking at conferences. I’ve been fortunate enough to have been invited to present to meetings, societies, and groups around the world, but I was discovering that there are sites out there that need more than a 45-minute talk, squeezed in among a few dozen other talks at a 4-day conference… they needed direct coaching. I started doing that, providing intensive review / training / coaching around 2015. But one of me working with one hospital at a time, while incredibly potent for that one hospital, was not helping me see the scale of change I want to see in our profession. So in 2022 I added my Advanced MRI Safety Seminar to the mix. Now I can continue to speak at conferences, and work one-on-one with hospitals, and teach my courses.
3. Do you think safety is getting better at MRI facilities?
In short, yes. MRI safety is getting better at many MRI facilities. The problem isn’t that we’re not advancing, because we are. The problem is that we’re not advancing uniformly across the industry… there are still providers practicing cavalierly, basing decisions on 30-year-old ‘rules of thumb,’ or the grossly over-simplified cardiology journal paper title that they read the abstract of six years ago. There are effectively no minimum standards on MRI safety that compel the laggards to keep up with everyone else. If a chain is only as strong as its weakest link, we need to recognize that there are quite a number of MRI safety ‘weak links’ out there in the world. Also, while we are getting better I think we need to recognize that the overall profession-wide speed of our improvement is slower than the growth in MRI risks and adverse event reports. To date our efforts have not been enough to keep pace with the growth in risks, to say nothing of actually making MRI safer.
4. What do you think is causing the rise in MRI incidents?
I think it’s like the analogy of the frog in the pot of cold water… heat the pot slowly enough and the frog doesn’t realize that it’s getting hot, and will stay in the pot until the frog is dead. One of the challenges with MRI risk is that there hasn’t been a singular ‘bolt-from-the-blue’ change in risks… it’s been a long series of subtle increases in risk. Think about the MRI scanners, and increases in magnetic field strength, better active shielding, faster acquisitions, and greater spatial resolution… Until AI tools, pretty much every one of those technological innovations came with slight increases in different risk factors. And then look at MRI patients; twenty-five years ago all MRI manufacturers had big, bold-print legal disclaimers in their product manuals that said ‘don’t put any patient with an implant, device, piercing, or tattoo into our MRI scanner.’ Today’s MRI patient cohort is between 30% and 40% those who were previously expressly forbidden from getting MRIs. Lastly, look at workforce… Both cuts in reimbursement and COVID-related strains have meant fewer MRI staff, trying to do more tasks associated with MRI patient care, with even more emphasis on workflow. So for the implant / device patient getting high-resolution scans, at an understaffed MRI department in a hospital trying to boost their throughput, that particular study is compounding a number of these modest increases in risk. In the analogy we’re the frog and the water is heating around us.
5. What do you recommend the first or most important thing clinics & hospitals do to improve their MRI safety?
The first thing to recognize is that hospital or modality accreditations, contrary to what their marketing would have you believe, are not proof that your site is practicing in accordance with best practices, or really even that you’re meeting minimum expectations. Once you realize that the gold window-sticker isn’t the assurance of safe practices that you might have thought it was, then the real journey can begin. From there, hospitals should put individuals in charge of MRI safety by designating a radiologist as an MRMD, and a senior radiographer as an MRSO, and - if they have one - a medical physicist as an MRSE. With individuals assigned with MRI safety oversight and authority, the organization will likely get a never-before realized picture of their MRI safety structure and practice.
6. How can we find out more about your courses?
I have a website set up for my courses, MRIsafetycourse.com. In 2024 I hope to be running at least three courses in different parts of the world. If anyone has a particular interest in brining the Advanced MRI Safety Seminar to them, they should feel free to reach out to me through the website to express their desire to bring a course to them.
7. I was reading through the course you had in Dubai and noticed the participants receive CE credits are those applicable towards MRSO or MRMD certification? I would like to give any readers links to be able to become the MRSO or MRMD. Do you recommend any organization in particular?
There are a few different notions here… First is that the group of letters MRMD, MRSO, or MRSE, aren’t copyright, so anyone who wants to can throw them up after their name (I actually did a presentation where I had a picture of my dog with a tag that read “MRSO” to make this point). Now I would highly advise against anyone using alphabets that suggest a certain expertise (particularly in safety) when they don’t have that actual expertise, but there are no ‘minimums’ for a facility to name a person to one of these safety roles. Which brings us to knowledge… If you’re going to be in one of these safety roles, I believe it’s really important to have training commensurate with the responsibilities you have. For that I encourage training… and not just a collection of free 1 hour CE / CME articles or webinars here or there, but a comprehensive curriculum on MRI safety. There are seminars and asychronous online learning programs out there. I’m not familiar with them all, so I don’t know that I can say which one(s) are better. Which then brings us to certified credentials… Certification is right now the only objective indicator that a person has adequate mastery of the minimum subject matter for their safety role. At present only the ABMRS offers certification for each MRMD, MRSO, and MRSE. They just moved to electronic exams at testing centers, and (in early-October, 2023) the exams are available at nearly 300 testing centers in North America, and will be made available in other countries, swiftly.
We thank Tobias for his time and his dedication to MRI Safety along with his time to participate in this interview. We couldn't agree more that the need for certified Safety Officers in MRI facilities is vital for the industry and for the safety of the staff and the patients.
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