That gruesome Magnetic Resonance movie scene from “Final Destination: Bloodlines” – is it possible?

In the new movie “Final Destination: Bloodlines,” one of the franchise's most harrowing death scenes features two brothers suffering a disastrous accident in a hospital Magnetic Resonance (MR) Imaging suite. The scene involves the MR machine’s intense magnetic field violently attracting metal earrings, piercings, a wheelchair, and part of a vending machine, causing fatal injuries.

The scene has been viewed by millions and is generating buzz online. It inspired some patients to wonder, could that really happen? So, we asked a device safety expert at ECRI. His insights should be reassuring for patients heading to get MR imaging done soon.

Q: Could that MR scene from the movie actually happen?

A: That’s a bizarre scene. The conditions of the accident depicted in the movie are incredibly far-fetched.

When a patient is harmed in healthcare, it’s usually the result of numerous failures in the safety system, not just one single error. That’s certainly the case in this movie scene: many, many safety protocols and principles of Total Systems Safety were ignored. From preparing the patient for the MR study, to placing ferrous objects in proximity to the strong magnetic field of a MR machine, there were dozens of system-breakdowns (plus Hollywood fabrications) along the way.

So, fear not, if your doctor wants you to get an MR, rest assured that the imaging technician is trained to ensure the imaging study will be performed under safe conditions.

Q: What about the stuff in the MR room getting “magnetized” – could that happen?

Technically, yes. ECRI named Ferromagnetic Objects in the MR Environment the #9 Health Technology Hazard 2010. Ferromagnetic objects are made from materials that can become magnetized in the presence of a magnetic field and can be attracted to magnets (either permanent or superconductive electromagnets like MR scanners).

Even seemingly harmless objects mistakenly brought too close to the MR system can begin to accelerate toward the magnet, becoming projectiles. There have been reports of wheelchairs pinning patients or nurses against the MR machine. This is extremely rare but warrants protective measures, such as using metal detectors before leaving the patient’s dressing/holding room and the use of only MR conditional devices beyond that room.

There are multiple layers of protection in MR environments designed to keep patients and healthcare workers safe. MR devices have a fixed magnetic field strength when in use. The machines don’t increase their field strength suddenly or unpredictably, like in the movie.

The American College of Radiology (ACR) manual on MR safety recommends the use of a ferromagnetic detection system (FMDS) prior to entering the MR controlled area to prevent objects that could be attracted to the MR magnet from entering MR rooms, and to avoid objects becoming projectiles.

The ACR also calls for screening procedures to control access to areas of the MR suite and  prevent accidents with magnetic objects accidentally being brought in.

Most manufacturers include tools that will assist the medical imaging professional in adjusting the parameters of the imaging system so that they do not exceed the limits stated in their MR conditional designation.  

Q: If the “projectiles” issue doesn’t happen frequently, what is the most common problem reported regarding the use of MR machines?

A: Although it’s rare, patients can be burned if safety protocols aren’t followed. This happens when certain devices on or inside the patient become hot. In some cases, it has to do with inappropriate padding around the patient. Patients can be burned by currents induced in electrically conductive materials, like medical device cables. Certain implants can also heat up.

ECRI placed MR imaging burns on our Top Ten Health Technology Hazards lists twice in 2008 and 2009. To prevent MR burns, we advise hospitals to:

• Make sure conductive cables aren’t looped and that cables don’t cross one another
• Place sensors (e.g., for pulse oximetry) as far as possible from the radio-frequency coils
• Use manufacturer-supplied padding, instead of blankets or sheets, to keep patients from contacting the magnet bore
• Regularly check all sensors, cables, and MR accessories for any breaks in insulation.

Q: What should the patient – and the MR technician – do to stay safe?

A: The imaging technician should go over the list of things that need to be removed from the patient’s body during screening before moving the patient from the preparation room. Any piercings need to be removed. One of the men in that movie skipped that important step.

The patient needs to undress and put on a provided hospital gown to avoid having any metal in their clothes. Some clothing, such as yoga pants or athleisure, has copper or other metals in the fabric for odor control. Plus, some bras contain underwire. Patients should also remove fake eyelashes that contain small magnetic strips that grip onto the lashes. It is recommended, when possible, to schedule an MR study around when a patient continuous glucose monitor needs to be changed, since it might need to be removed before the imaging study. After that, the technician should do a final check of the patient with a ferromagnetic detector before they step into the MR control room.

If the patient has any medical device implants, it’s important to tell the imaging technician. The patient’s medical record should contain information about the implant. Some implants can heat, move, or malfunction when exposed to an MR system's magnetic field. Implanted devices, like aneurysm clips, can migrate or move inside the patient if the parameters described in their MR conditional designation are exceeded during the imaging procedure. The technician should adjust the MR scanner using parameters prescribed by the device or implant manufacturer to safely image the patient.

The #8 health technology hazard we identified for 2020 was “Missing Implant Data Can Delay or Add Danger to MR Scans.” Sometimes it’s hard to identify when a patient has an implanted device if it’s buried in medical records or not consistently documented. Sometimes patients don’t remember or disclose they have an implant. If the clinicians need to search for implant details before conducting the MR, that can delay treatment. If the scan is conducted without awareness of the implant, patient harm could occur.

A few other cases come to mind: a patient went into an MR with a personal toy that they thought was made of only silicon but had a metal core that was attracted to the magnet, causing severe injuries. In another case, a patient took a concealed handgun into the MR suite, which was discharged during the scan.

It’s important to put these bizarre cases into context. Millions of MR studies are conducted in the U.S. each year. The vast majority are safe and harmless if the required guidelines and procedures are followed.

Q: Getting an MR imaging study can be stressful for some patients. Being in a tight space with loud noises can be overwhelming. What advice do you have for patients worried about the experience?

It’s important that patients follow through with the medical tests and scans their clinicians recommend, like MRs, even if they’re apprehensive about the process. We recognize having an MR scan can be an uncomfortable experience, especially for patients with anxiety or claustrophobia.

Some doctors could provide a prescription to help relieve anxiety, depending on the patient, to help patients remain still during the scan. The imaging facility will provide earplugs or headphones for hearing conservation. Some MR manufacturers have created audio-visual environments that create immersive experiences to help patients overcome anxiety.

Technological advances have enabled manufacturers to make the opening of MR machines wider and the length of the device shorter. Another positive development is that the use of AI is significantly reducing the time required for scanning, which means that patients will be able to get in and out of the MR suite faster.

Q: Tell us about your experience and expertise in MR safety.

A: I am a Magnetic Resonance Safety Officer (MRSO) and Magnetic Resonance Safety Certified (MRSC™) from the American Board of Magnetic Resonance Safety. At the University of Pennsylvania, I used MR imaging to perform image-guided neurosurgeries in auditory research. I have been involved in the technology management of MR scanners at other institutions.

Recently I was featured in ICE magazine (a publication for imaging professionals), talking about the need to think beyond implantable devices for MR safety, since many other everyday items can pose risks during scans, including cosmetics, augmented clothing fabrics, and even body art.

Francisco is one of the device safety experts that operate ECRI’s independent device evaluation lab.