Interventional Radiologists May Benefit from Dedicated MRI Safety Guidelines
Narrative review of MRI-guided interventions indicates need for broader education, training
As MRI-guided interventions become increasingly common, researchers are calling for dedicated safety guidelines to help reduce adverse events and improve patient and staff safety.
In a narrative review published in Cureus, researchers from Hong Kong found that existing recommendations for MRI-guided procedures remain limited and largely principle-based. The authors suggest that adherence to key safety principles could help reduce adverse events. One UK-based study estimated that adverse events occur in approximately 0.05% of examinations—about one event per 1,987 patients scanned.
“A comprehensive understanding of the fundamentals of MR safety hazards, proper device selection, meticulous screening and safety checks, comprehensive training and application of standardized safety protocols form the cornerstones of safe and effective MR practice,” said lead author Pan Pan Ng, MBChB, associate consultant in the Department of Diagnostic and Interventional Radiology at Queen Elizabeth Hospital in Hong Kong.
MRI-guided interventions are growing rapidly, due to the technology’s superior tissue contrast and ability to provide real-time imaging guidance without ionizing radiation. However, the technology remains a specialized tool that is typically reserved for cases in which MRI offers a clear advantage.
“From an interventional radiology perspective, the vast majority of IR procedures are still dominated by ultrasound, fluoroscopy and CT,” Dr. Ng said.
She noted that wider adoption of MRI-guided interventions is limited by the cost of MR-compatible equipment, competition for MRI scanner time and the specialized training required to safely perform the procedures.
Even with those barriers to adoption, expanding use increases safety risks to both medical personnel and patients. Dr. Ng and her coauthors highlighted concerns including projectile incidents, radiofrequency (RF)-induced heating and burns, and time-varying gradient field effects such as nerve pain and hearing damage.
Current Literature Offers Limited Guidance for Interventional MRI
The researchers wanted to see how quickly organizations are adopting MRI-guided interventions while the safety framework supporting that growth continues to evolve. They conducted a comprehensive search of literature published from January 1995 through August 2025 using international databases such as PubMed and ScienceDirect.
The study team included interventional radiologists and an MR safety officer, two of whom have been involved in the establishment and day-to-day practice of MRI-guided interventions.
Dr. Ng said she and her team were surprised by the scarcity of literature on MRI safety in interventional suites, relative to the growing volume of MRI-guided procedures.
“The imbalance was more pronounced than we had expected,” she said. “Although the most recent international guidelines do address the interventional environment, their recommendations tend to be broad and principle-based, rightly emphasizing the need for site-specific tailoring, but leaving a practical gap for day-to-day clinical guidance. This suggested that safety literature is still catching up with the pace of clinical adoption.”
Dr. Ng said she and her team were also surprised by the continued prevalence of preventable MRI-related safety incidents
“This reflected the gaps in institutional infrastructure, training and safety protocol adherence,” Dr. Ng said. “These findings inferred the added complexity of an interventional setting, which likely carries even greater risk due to more non-MR personnel, more equipment, longer procedure times and often anesthetized patients.”
Preventing Common Adverse Events With Operational Safety Measures
RF burns represent the most reported adverse MRI events. A 10-year review of reports to the U.S. Food and Drug Administration concluded that RF-related burns accounted for 32% of reported adverse events after root-cause analysis. A review in the Journal of Medical Radiation Sciences estimated that proper safety protocols could prevent as many as 97% of those thermal injuries.
Other reported hazards include projectile incidents, which the researchers note make up between 4.8% and 9% of adverse events from MRI-guided procedures. In addition, at least 6% of patients experience nerve stimulation, involuntary muscle contractions, pain, or temporary or permanent hearing damage.
To reduce these risks, the American College of Radiology (ACR) recommends conducting at least two separate screenings before either patients or non-radiology personnel enter the MRI scanner room. The ACR also recommends zone access control: dividing MRI facilities into four conceptual zones, progressing from Zone I (freely accessible to the general public) to Zone IV (equivalent to the MR scanner room).
Dr. Ng and her team also suggested labeling MR equipment, having MRI personnel communicate hazards to other personnel, and conducting multidisciplinary team training and regular evacuation drills. They also noted that MR technologists should follow positioning guidelines for patients and continuously monitor vital signs, to prevent adverse events.
“MRI-guided interventions are inherently team-based procedures, and the training needs to extend well beyond the interventional radiologists,” Dr. Ng emphasized.
Advances in Robotics and AI May Enhance MRI Safety
Beyond existing safety protocols, the authors note that advances in robotics systems for MRI could improve procedural efficiency while reducing MR exposure for both patients and clinicians. For example, fully automated or assisted needle-insertion systems can provide automated needle-realignment guidance, minimizing the need to reposition a needle and shortening procedure times.
The authors also highlighted potential safety implications for AI. AI-based systems have demonstrated accuracy in detecting implants from chest radiographs, while AI models may be able to simulate procedural elements, such as tissue heating before the procedure takes place.
Safety Committees, Ongoing Training Offer Keys to Reducing Adverse Events
Dr. Ng and her co-authors believe their review can serve as a reference for radiology teams establishing or expanding MRI-guided services.
“We hope it helps teams think through safety considerations from two angles,” Dr. Ng said. “One is the procedural angle—addressing the unique risks that arise during MRI-guided interventions themselves. The other is the institutional angle, including the value of establishing a dedicated MR safety committee with clearly defined roles for overseeing the introduction of new procedures, equipment procurement and ongoing personnel training.”
Beyond individual institutions, Dr. Ng hopes the review will also contribute to wider efforts to advance MRI safety guidance. “At a broader level, we hope this work highlights the need for—and contributes to—building momentum among professional societies and clinical expertise to develop dedicated MRI-guided intervention guidelines and safety registries, to generate the evidence base for continuous improvement."
For More Information
Access the Cureus study, “MRI Safety for Interventional Radiologists: A Narrative Review for MRI-Guided Interventions.”Read previous RSNA News stories on safety: