Breaking Down MRI Safety: An Interview with Tobias Gilk

On this episode of A Couple of Rad Techs Podcast, our host Chaundria welcomes special guest Tobias Gilk to discuss the fascinating world of MRI safety. Tobias, an architect by training, found himself immersed in the field of radiology and MRI safety 20 years ago and has since made a significant impact on the industry.

Chaundria and Tobias delve into the challenges and advancements in MRI safety, highlighting the importance of education, collaboration, and the implementation of proper protocols and screening measures. They discuss the misconceptions surrounding MRI safety, emphasizing the need for comprehensive training and understanding of different implants and devices used in MRI.

Tobias also shares his work as a consultant, offering trainings, facility consulting, and manufacturer consulting/expert witness work to improve MRI safety. He stresses the downstream revenue implications and improved patient throughput that come with fixing MRI safety.

Throughout the episode, Chaundria and Tobias touch on the evolving landscape of MRI safety, including international efforts to establish regulations and best practices. They also explore the potential impact of remote operation and AI in MRI practice, discussing the safety concerns and the need for standardized safety practices across hospitals.

This episode is packed with valuable insights and highlights the crucial role of MRI safety in the medical profession. Join Chaundria and Tobias as they navigate the fascinating world of MRI safety and its impact on patient care and technologist well-being.

Make sure to check out the links provided by Tobias for more information, leave a review of the podcast, and have a great day!

Tobias Gilk is an architect who stumbled into the field of radiology and quickly developed a passion for MRI facility planning and design. He started his career working for a local community hospital after graduating with a Master's in Architecture in 1997. During his first architecture job, he fell in love with radiology and began designing various radiology projects, including an MRI suite. Through this experience, he learned the skill of focusing on the essential aspects of a project without needing to know every detail about the client's business. This skill allowed him to adapt to different architectural projects easily. In his 25-year career, Tobias dedicated himself to the field of radiology, specifically MRI. His initial interest in the physical environment and facility design expanded to encompass economics, reimbursements, modalities, clinical services, and operations. He also developed a strong interest in MRI safety, realizing the lack of regulations in comparison to ionizing radiation standards. Tobias has since dedicated his professional life to improvi

Buzzsprout - Let's get your podcast launched!
Start for FREE

The Infinity Hoop For the Win!
Do you struggle with working out because you aren't motivated or you have bad knees?

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Transcript

0:40

You welcome. I am Chandra Singleton of let's Chitchat and Travel and Wellness. I am so excited again to bring you all another episode of our radiology edition. And you're going to be surprised because this time, no, I do not have a radiology professional. But he is his own professional in his own right, and he has made a really big impact on the radiology field. So who is my guest today? Well, I'm going to let him tell you his self, but let me just tell you a little bit about who Tobias Gilk is and some background, and he's going to tell you the rest. So originally he was trained as an architect and he got involved in MRI safety 20 years ago. Well, through his growth and understanding of the physical environment of MRI safety and standards, he was invited to serve on the ACR's MRI Safety Committee about 16 years ago. And there he realized there was so much more to his understanding and to the understanding of the community's professional understanding of it. He has now been co author of three ACR Mr. Safety Committee publications. He's going to tell you all about those. He even travels and does seminars in Dubai. You guys. So I want to welcome Mr. Tobias Gilk of Gilk Radiology Consultants. Welcome to our podcast. Thank you very much for having me. 20 years. Boy, it's making me sound old right. There with you, because I was surprised that I've been in the field for that long as well. I remember kindergarten. So yeah, I think it's all in how you feel, right? Yeah. Well, we look good, so that's what we have to go by. We look good. Well, you do. I don't know about me, but we're both going there. So tell us, Mr. Guilt, tell us from you. We want to hear from you. Who are you, what it is that you do, and how did you get into MRI safety? Well, I'll start with the last question. How did I get here? A long series of unplanned left hand turns in my career. It's one of those things where follow your bliss kind of thing. So I graduated with my Master's in Architecture in 1997, and almost immediately, the first 1st architecture job that I had, I started working for a local community hospital, and the architecture firm I was working for essentially sort of gave me to the hospital and said, here, do whatever you want with him. And very quickly I kind of fell in with radiology, and I started designing a bunch of their radiology projects. And I kind of fell in love with radiology largely in terms of facility planning and design and architecture and that kind of thing. And within a few months, I was designing an MRI suite for the hospital. And that project went really well. During that project, there's a skill that architects learn on the job. They don't teach you this in architecture school because architects are kind of generalists. This month, you may be working on a hospital project. Next month, you may be doing an office building, the month after that, a church, and the month after that, a sandwich shop. And so architects really need to develop a set of skills that allow them to bounce from very different projects, one to the next to the next, which means and here's where the skill comes in. You have to learn what you don't need to know about your client's business to be able to kind of laser focus in on. Here are the things I need to do to produce a set of code compliant drawings that will get a building permit and that the builder can build without a whole bunch of changes. So if I knew those things, if I had those skills when I first started out and first was sort of thrown into radiology, all of the stuff that I fell in love with about radiology and clinical services and the technology, particularly around MRI, MRI is the reason that you have all of these advanced physics stuff. And people who historically we would have described as having the pocket protectors and having the pull out slide rules sort of running this industry is because they're essentially magic. What an MRI is capable of doing is so advanced from sort of a physics standpoint that to those of us who don't come from a physics background, it looks like magic. So had I had the skills that an architect who's been practicing for ten years has, I would never have sort of thrown myself in the deep end of radiology and MRI. I would never have discovered enough about it to just become completely entranced by it, and I wouldn't have wound up coming down this path. So that was 1997. So here we are 25 years later, and I've essentially dedicated my entire professional career to radiology in general and MRI in particular. As you described, it started out with just sort of the physical environment, the bricks and mortar of the facilities. But as I became sort of more and more interested and invested, I started trying to figure out, well, what are the economics of providing radiology care to patients and what are reimbursements and what are challenges for billing? And then it was, okay, what are all of the different modalities and how do they work, and why does this one require lead for the shielding, and this one require copper foil for the shielding? And then it became clinically and operationally. What types of services are provided here as opposed to there this modality as opposed to that modality? How does that change sort of the physical environment? And all of that kind of was a whirlwind swirling around an interest that developed really quickly in MRI safety. And because I was working across radiology, across nuclear medicine, I became really familiar with the amount of codes and standards and requirements related to ionizing radiation, x ray CT, fluoro, nuke, med. And then when I was doing projects in MRI, they were like, do whatever you want. I was like, Wait a minute. How are there this many regulations on the ionizing radiation side and this many on the MRI side when because I'd thrown myself in the deep end, I was aware of projectile accidents and burn accidents and all of the things where patients and oftentimes caregivers can be put into jeopardy by just by virtue of the fact of the way the MRI works. Why aren't there similar standards with respect to MRI safety? So that's to make a short story long, that's how I got into MRI safety. And it has been, as I say, probably the work of my professional life to date. Well, I think it's so good because I think you're perfect for it because you come from an architectural background. I know for me going into MRI, I think I told you this when we were talking. I went through radiology school at Emory University, worked in radiology CT for a long time. Ionizing radiation. Yeah, we know all the dangers and the safety precautions. But when I went into MRI, the first thing I was just told, five gauss lines. That was the most safety. And there was no school when I went to MRI, went into MRI, there was no schooling. Nobody was teaching it in school that I knew of. And this was probably about 1617 years ago. So it was like just five gauss line. That's all I knew. And they didn't have the oxygen tanks that have the colors on it that tell you if it's MRI safe. They really didn't have a lot of stickers for things that were MRI safe. You just didn't bring certain things back in the MRI department. So I understand how things used to be, like you've seen them, but for new technologies coming into the field. And I think it's different that we because things are a little different too, because everybody doesn't go through X ray school who's an MRI tech. I don't know if it's good or. Bad, but I think it's bad. Because I've worked with both types of tech, but I talked to the ones who went through X ray school. And I'm not trying to say that techs who didn't go through X ray school are bad techs. I'm just saying that we should have a standard way of training people who we're putting behind the console of an Mr machine, and maybe there should be two or three or five different pathways to get there, but it shouldn't be, hey, you want to work in MRI? Go ahead and sit down. That should not be a standard pathway for training Mr techs. Yeah, I agree. Totally. Great point. I love how you cleared that up, but yeah, that is definitely how I feel. But talking to those who went through X ray school, I understand the focus on radiation safety, ionizer radiation safety versus MRI safety because there is a big difference. We've seen a lot of accidents, small and great. I've seen them with doctors who have forgotten to take at one of the best hospitals where they have detectors before you walk in a door, everybody's winded down, mistakes happen. But the education was not there on MRI safety. So for new technologist coming into the field who are trained with the idea for two years or four years, radiation safety, alara, again, in a synopsis, why is this so important? What things can they do to make sure before they start sitting down just to scan, to really focus on MRI safety? Because it's such a blip in education. So let me give sort of a comparison, right? If we have in diagnostics, I'm setting aside therapeutics for right now. But in a diagnostic setting, if we have a really bad day in terms of an accident and a patient gets overexposed, right, a really horrible overexposure means what to that patient? It probably means that they might have erythema, they might have sort of surface skin burns that probably like a bad sunburn will heal up in a week or two. It may mean that that patient has a low single digit additional lifetime risk of developing a cancer 20, 30, 40 years after that significant overexposure, right? And I don't mean to downplay those as negative consequences, but a really bad day in MRI is something goes flying at the patient, strikes the patient, pins them, crushes them, kills them. And unfortunately, we've done that a number of times in MRI. It may mean that the magnet interferes with an insulin pump or medication pump or a pacemaker or another implanted medical device causes that to malfunction, which harms the patient. Again, we've done that a number of times in MRI. It could mean that we're giving a patient first degree, second degree, third degree, fourth degree burns resulting in amputation. It could mean that the benign, if you want to call it that, in air quotes, injuries involve, you know, either temporary or permanent hearing damage, hearing loss. So there are all of these things that we can do to harm patients in the moment that are long term debilitating injuries or we kill people, thankfully, very infrequently. So for the people coming up through X ray school and kind of may take an off ramp to get into MRI when it comes to an appreciation of MRI safety, if you simply start from the position of how can the Mr patient get harmed? And you just do a comparison of that with Xray or CT or something like that, that should kind of instill in anyone, everyone, an appreciation for, okay, this is what the stakes are. This is what my job is to try and prevent. When you start getting into the complexities of patients who have this kind of implant or this foreign body or that sort of thing, it can get really complicated really quickly. And if training programs or residencies for our radiologist, by the way, we're talking about how a lot of techs come up and don't necessarily have the exposure to the training for this. Don't think that just because the radiologist wears a white coat that their med school or residency program actually gave them this information either. We have lived in the shadow of MRI safety PR campaign we have marketed for the last 30 plus years. MRI is the safe modality because it doesn't have ionizing radiation. And so everybody just kind of walks around not everybody. Too many people walk around as if nothing bad can happen in MRI because we've labeled it the safe modality. And it really takes and this is probably the hardest part, it takes unlearning the things that you have been told about why MRI is safe and we don't need to worry about it. And instead learning an alternative truth that is there are risks. There are risks that we can, in fact, effectively manage, but we by and large, don't train our techs or our radiologists to appreciate what those risks are and what the management approaches are. Yeah, I totally agree. And if you've been in the field anytime, as technologies, we definitely aim in what you just said, because we've all been in situations where we hear the door open behind us and doctors coming in, or somebody's coming in and they haven't been screened yet, and there aren't protocols placed in certain I mean, places are getting better, technologies are realizing. I mean, I did X ray and CT for years, and I think with Mr, especially when I work in a facility where they're cranking them out all the time, hospitals, and you get people with different types of implants. Like every stent is not the same. Me personally, I don't consider every some people are like, oh, it's a stent. It's been in six, eight weeks. It's good. I just look up everything. I've never heard anybody and that is my goal is just to treat MRI as the modality that it is. And it is not just the safe modality. There's danger in everything. And I think if it was me on the table, I would want someone to go to these levels and make sure that they're trained and they understand. They take the time to look up things because you never know what person or what company put what into. Each one is just not the same. So I love how Gilcora Radiology Associates Consultants is really trying to train not only technologist, but to stay up to date on the things that are changing. Because now we're doing pacemakers. And we talk about it in a field that I remember when they first started doing these certain type of pacemakers by maker and they were all safe, but all the doctors heard, oh, we're doing pacemakers now. And we were getting tons of people coming with older pacemakers scheduled for MRI. And we're like, no. And we literally had get a policy in place, cardiologists had to step in and really talk to the doctors that no, this is not all pacemakers. Everybody doesn't qualify. We're not giving away pacemaker. MRIs here now. So it's an education of not only the radiology department, but the hospital itself when it comes to MRI, because you have everyone that comes to the department, nurses, families, other, they'll tour MRI departments, but the safety needs to still be there and everybody needs to be aware of it. So I just love what you're doing. Now, I want to ask this question. What motivated you to tackle this topic? You talked about it a little bit, but not really. So not to give up on educating the masses on MRI safety. If you have a story you like to tell, because I know you probably hit some roadblocks or the architect coming into the field, I'm sure they just didn't roll out the red carpet. They're probably like, who is this guy? What stories. Or maybe they did, I don't know. I'm just making it a good conversation. But I really would like to know because we all hit roadblocks and we don't see because you talked about earlier, you started this in 17 years ago and it's 2022 going to 2023. And as long as I've been doing it, I'm starting to see more people. You have the MrsO, the MRI safety officers should have been in long time ago, but they weren't taking this many years to see it. Why did you never give up? I think because I saw the opportunity to make a positive change. There have been in my sort of professional development, there have been some folks who have really been amazing mentors and and supported, supportive of me. And I gotta give a shout out to Dr. Emmanuel Canal who really kind of saw some potential in me and helped me develop that. But by and large, most of the radiology community, at least at first, treated me like the guy who drives the ice cream truck was coming up to your house and offering to do bypass surgery on you. It's like, what the hell do you know about bypass surgery? What does an architect know about MRI safety policies or procedures or protocols? And so, yes, no, I have indeed encountered quite a number of obstacles and quite a number of folks who think this guy's got no place being here. And the way that I've kind of overcome that is first and foremost just a bull headed stubbornness and not willing to let go. But more than that, it's really been keep your eye on the prize. For me that has been identify what steps could make this practice could make MRI, you know, safety, but not safer in a way that, you know, I think anybody who's worked anytime in a hospital has seen somebody come through and say, you know, well, Risk now says that, you know, you have to spin around three times on your left foot and check these 17 boxes before you do anything to this patient. We see lots of safety protections that are really just sort of box checking. They don't really integrate with care. We develop this sense that there is an inherent conflict between somebody's going to come along and they're going to tell me something I have to do for safety, and it's going to make patient care slower, and it's going to drag me down, and then people are going to be yelling at me because I'm not getting x number of patients through in a day. And all of that is true and all of that in my opinion, are examples of poorly implemented safety policies. The thing that I think most people in MRI safety world don't really appreciate very well is that safety today is apart from patients simply not showing up on time for their studies. Safety is probably the number one drag on throughput and productivity. The patient shows up, oh, they didn't declare prior to their appointment that they have a shrapnel or they have an implant or device or something. So we're going to set that patient aside and we're going to be looking them up. Meanwhile, the patient following them hasn't shown up yet. So the magnet is sitting empty for 30 minutes. Now all of a sudden we clear that patient and now we've got two patients trying to get in one magnet in one appointment slot and the whole thing cascades from the rest of the day onward. Right? And the reason that we have throughput and productivity issues in many facilities is because we manage safety of the patients poorly. And in fact, if we improve the management of patient safety, one of the unintended consequences is this thing that is one of the biggest bottlenecks that we can actually control begins to go away and we get better productivity out of it. Those kinds of things really aren't well known and well understood throughout the industry. You made the comparison between radiation safety and MRI safety. In radiation safety, you're going to get shut down by the state or slammed by joint commission or whoever your accrediting organization is if you don't have a radiation safety officer, right? If you have a nukes program, you don't have a radiation safety officer. NRC is going to come in and they're going to pull your radioactive materials license in a heartbeat. There will not be a discussion. There won't be a well yes, but we were going to get to that. No conversation. They're coming in, they're pulling your Ram license immediately and you are shut down. Why don't we have anything sort of similar on the MRI side in terms of accreditation or licensure or regulation? You mentioned the MrsO. Thing. So one of the things that I've been involved with is the Abmrs, the American Board of magnetic resonance safety. It has medical in the name, but really sort of the focus is universal. It's looking at how people get injured in MRI and what practices prevent harm, patient harm, patient injury, delays in patient care related to MRI safety. And so the Abmrs, which I was one of the founding board members in 20 14, 20, 15, 20 16, the Abmrs actually took the structure that was developed by an international group of professional societies defining the MRI safety roles of the physician, the MRMD. Mr medical director, sort of MRI safety supervising physician, the MrsO. MRI safety officer, which is pretty much a direct analog to a radiation safety officer and then an Mr safety expert, because a lot of the MRI safety questions really hinge on an understanding of the physics of Mr scanners interaction with the patient's own tissues or with foreign bodies or implants or devices that might be there. Sometimes it's it's helpful to have the expertise of a medical physicist or somebody who has experience in that to be able to phone a friend and be able to give guidance to the supervising physicians and the Mrsos to help resolve some of those complexities, because Mr patients are getting much, much more complex. I don't know. People who've just been in Mr for the last 1015 years may not be aware, but I think it was about 20 years ago and longer when every single Mr operator's manual had big, bold print disclaimers on them that essentially said, whatever you do, do not put a patient who has any foreign body, any implant of any kind do not put that patient in this magnet. Period. End of statement. Now, when Mr conditional implants and devices came around, eventually the Mr manufacturers, your GES, your Phillips's, your Siemens, they recognized that they can no longer really effectively have those absolute blanket prohibitions. So it's really only in the last couple of decades that the Mr system manufacturers have even opened the door to the possibility of scanning patients with implants devices and foreign bodies today. And it's weird being in the middle of this, because oftentimes I think we don't appreciate just how quickly and how dramatically things have changed in this last 20 year time frame. But today, doing patients with Mr conditional pacemakers, at some institutions, that's Thursday, right? 20 years ago, the idea you were going to put a patient with a pacemaker into a magnet was essentially like playing Russian roulette, and nobody wanted to even contemplate doing that. And like I say, today it's Thursdays in some facilities. So the degree that we have shifted is really remarkable. One of the things that that means is the degree to which Mr depends on hand me down knowledge, which is really from an Mr safety standpoint, that's been the predominant model of how young Techs radiology residents that's kind of how they learn is they get taught by the person who trains them, who learned from the person who trained them. And it's this long series of hand me down knowledge, the practice, the industry, the profession has changed so dramatically that if we don't stop, pause and take an objective look at what is the knowledge that we are handing down to the folks who we're training today. We need to break the cycle of handing down information, knowledge training that is substantially out of date with the MRI system technology and the implants and devices and the changes in our patient populations and cohort and the introduction of image guided procedures and that sort of thing. Everything about MRI, apart from the fact that the shape of the magnets, that's really the only thing that's remained consistent. Over the last 20 years, everything around it has changed from reimbursement rates to staffing to clinical applications of mr. We need to not necessarily throw out everything we learned before, but we need to be able to stop and look at current practice objectively. And I think that's important because things change. That's just life. Things change, and we have to change with it. And patients have changed, like you said. So really quickly, where do you see the modality advancing? Because so many advances with AI and. Everything, where do you see so one of the things that I'm looking at right now that I think could be a real game changer in terms of making Mr practice ten years, 20 years from now, look substantially different from the way it does now is remote operation. Well, I'll do remote operation and AI So remote operation today, if you have a technical problem with your magnet, you're getting an artifact that you can't explain, or you think maybe a coil element is out, or you can essentially pick up the phone and call whoever your magnet manufacturer is if you're under service contract. And a service person can essentially remote into your console and see exactly what you see from doing a patient or doing a phantom or whatever. And that is growing that the technology for somebody remotely to come into your system has existed for the last 1015 years. But today, all of the Mr system manufacturers are commercializing products that essentially allow a technologist located off site to essentially run your Mr scanner for you. And there are really kind of two models for doing that. One is you have a complex patient. We're going to do a cardiac study, and we've got kind of a junior tech who's not really all up to speed on doing cardiac. Well, that's okay because we got a tech at the other site across town who is a whiz at cardiac. We're going to get Tim across town to essentially remote in and run this study, and then Tim's going to go back and take care of his patients at his other location. And whoever Susan, who's doing the scan locally will take over after that. So that sort of expert model we're going to have somebody come in, execute a single study, go away, operations return to normal. But that means for that study, you're essentially paying the salary of two techs to do a single study. Right. So the expert model comes with additional costs. What if instead we had Tim working remotely at some sort of air traffic control center, right? And Tim is running MRI scans, maybe two or in some cases I've heard, three or four magnets running those simultaneously or kind of interleaved. As one patient gets off the table, they're scanning at a different patient. That full remote operational model really throws from a safety standpoint, it puts everything on its head. Because if you look at safety best practice documents like the ACR 2020 manual on Mr safety and the ACR is talking about releasing a new version of this very shortly. But if you look at that and you look at all of the safety doubt shalls right that are kind of built into that document they all assume implicitly or explicitly that it's the scanning techs who is taking responsibility for double checking the patient's screening form, making sure the patient is positioned correctly the correct coil selection padding for the patient. Do we have Mr conditional leads for our EKG, for our cardiac gating, all of those sorts of things. Those responsibilities are ascribed to the scanning MRI tech. What happens when that scanning Mr tech is across town? And now we have a tech aide who is providing that care. At the point of care, we don't really have systems that describe how that's supposed to happen. So with the really significant rebound uptick in demand for Mr services, post COVID, anybody who is tracking this, we were slowly growing year over year COVID came demand for Mr just fell off a cliff. And what happens to all of those hospitals when Mr demand falls off a cliff? They let a bunch of Mr techs go, right? Well, now all of a sudden we find ourselves in what we describe as a kind of post COVID world. And Mr volumes are just whipsaw returning not back to where they were before, but on their way there. And now these hospitals no longer have sufficient Mr tax to be able to do this. There is a massive labor crunch in Mr tax, and so remote operations seems like it's one of the ways to address that crunch, because we're not also not seeing trainees entering Mr training programs in sufficient numbers to essentially make up for the techs who got lost because they left the profession during COVID So remote operation is one of the potential solutions. AI is a complicating factor. There are a very limited number of studies, but there are studies today that we can put a patient on the table and 15 minutes later their study is done. They're walking out with AI, or the promise of AI being able to do reconstructions behind the scenes. You run one sequence. And it essentially gives you the visuals for two or three or five different pulse sequences, reducing total exam time, doing automatic slice selection angulation and slice selection based on AI tools, so the tech doesn't have to spend an extra 60 seconds setting up this individual set of slices. All of those things hold the promise of taking standard 40 minutes appointment times for Mr. We're not going to get down to CT twelve minute, 15 minutes patient times, but we're going to get close. And all of the infrastructure associated with bringing patients to MRI, getting them through Mr, discharging them on the backside. What about all of that infrastructure that was designed for 40 minutes appointments? When those appointments become 20 minutes, you think we have productivity and throughput pressures. Now, when your scanner promises to do that study in half the time, it does right now, you think the C suite is not going to be putting patients on a conveyor belt to run them into Mr. They absolutely are. So that presents sort of its own safety problem, particularly when we couple it with the remote operation, full on remote operation, technologically MRI crystal ball gazing has for me personally, an incredible history of me being wrong more often than I'm right. But if we just look at the direction that the technology, the Mr scanner technology, is moving, the changes that are afoot, that respond to absolute, real clinical and operational customer hospital demand needs, those things are going to create follow on MRI safety concerns. That really worries me because we don't have a good grasp on MRI safety throughout our profession. Across all of the different hospitals, there absolutely are hospitals that are doing amazing jobs. And I don't mean to suggest that everybody is really struggling because there are some folks who are doing amazing, amazing work, right? It is so unequal. It is so where's radiation is across. The board, like you say, MRI, nuclear medicine is across the board. Radiation, all of those are across the board. So Mr is not. And I've worked in several different states in several different type of facilities, and it's not so. I definitely agree with you on that. Yeah, I think the next ten years are going to be really challenging for MRI from a safety standpoint. Some amazing, mind blowing technologist innovations. But most of the technological innovations, from stronger magnets to more powerful gradients, to better active shielding, which compresses the magnetic field, which means higher spatial gradients, the attractive force component of the magnetic field, all of these technological innovations that have made magnets stronger, better, produce more images, higher quality images, faster, those sorts of things. Each and every one of those innovations comes with a downstream safety implication. And the AI and remote operations ones come with some really huge downstream safety implications. My concern is that if we fail to be proactive enough, if we try and play catch up with these changes that I imaging, are coming. We're going to take what today just trying to get to uniform, safe practice with today's technologist and today's operation. Five years from now, we may be staring up a very steep cliff in terms of how do we get from where we are now to where we want to be. That's why Guilt Radiology Consultants is so great, because you're here to help us, not have to try to play catch up. And I think it's very important to I just am a believer in having outside eyes look in whenever you're trying to. It's good. It's like we like to get patient surveys done to see where we can do better in hospitals. I think it's really good that you don't have any connection to Xray school or radiology school or anything like that. Your outside eyes and your perspective coming in is actually very beneficial and can help us to put together working together, we can accomplish so much more. And I know globally, you do a lot. So can you tell us briefly, like globally, when it comes to MRI safety, what are some of the differences that you've seen or maybe similarities from the States? Yeah, I'll start with the similarities. So in my experience, every country, for the most part, really sort of they fall victim to the MRI is the safe modality. MRI doesn't have ionizing radiation, therefore it must be safe. That over reductive simplification of describing MRI safety that I think has gone viral. I think that's everywhere there are some countries that are taking active steps to try and implement MRI safety requirements. Italy passed legislation probably two or three years ago. That from what I understand, because I don't read Italian, it's aspirational in terms of saying we want to establish rules or structures that reduce the risks for MRI. It doesn't really lay out what those rules or structures are in a lot of detail, but to the best of my knowledge, it's the first sort of national law or national initiative that seeks to push practice towards safer elements closer to home. In the US. The US FDA for the longest time didn't require implant or device manufacturers to get Mr conditional labeling unless they wanted to market the product as being safe in Mr. You want to make claims about the safety for Mr, you have to get Mr conditional labeling. Well, the proliferation of implants and devices in our patients, pretty much anything you put in anybody at this point is likely to wind up in a magnet or that patient's going to get referred for an Mr. And so only very recently, the US FDA has been it's not a formal rule, as I understand it. It's sort of an administrative procedure, but they are pushing implant and device manufacturers to indeed get testing and labeling for identifying the safe conditions for use in Mr. Now, obviously, we have an enormous backlog, a historic legacy of implants devices that weren't compelled to do that. And it will probably take a very long time before we tip the scales. And the majority of implants and devices have this labeling. But it's a start, it's a move in the right direction. So there are small sort of isolated success stories or positive developments. But by and large, internationally, MRI safety regulation is pretty weak. I will throw out a kudos. The Ministry of Health in Saudi Arabia actually has developed a safety checklist that they're now using at government MRI facilities that is really remarkable, quite honestly. It blows the stuff that Joint Commission and ACR blows the stuff that they're doing out of the water. So we are beginning to see sort of sprinkled across the globe, organizations, national structures, beginning to address this. And I'm hoping that those efforts continue and become sort of more uniform and cohesive internationally. And so that the smart stuff that we know. Reduces accidents, reduces injuries, increases and improves patient access, whether that's advanced MRI safety training, whether that's certification for these various Mr safety roles, whether it's the development of policies and procedures that really reflect international best practices from a safety standpoint, hopefully we begin to see more and more of that really, as I say, become uniform standard throughout our profession. Well, I believe with all the work that Yoke Radiology Consultants has been doing over the years, we see what is happening in the field and everybody working together. I know that it is going to just go up from here. So I want to thank you so much, but I know you just finished hosting a three day event in Dubai. How can people work with Guilt Radiology Consultants and what do you have upcoming? My consulting work really kind of breaks into three categories. You mentioned the course. So I do trainings. That was a you come to the training. I also work with facilities where I essentially bring training to the facilities, to the text, to the Rads, to both. I will do facility consulting where I will essentially come in and do analysis, evaluations of operations and policy, how effectively or ineffectively in some cases facilities manage MRI safety questions or concerns. And again, the safety bottleneck is one of the biggest delay errors in patient care and has some really significant downstream revenue implications. So fixing MRI safety, often collaterally, means fixing patient throughput fixing some of the revenue related things. So I can do those facility assessments, evaluations either separate from or in conjunction with onsite training. And then the third thing that I do through the consulting arm is I do sort of manufacturer types of consulting or even some expert witness stuff where, for example, one of my long standing relationships right now is with a company called Metrosense. Metrosense makes ferromagnetic detection systems and I work with them on the integration of ferromagnetic detection systems, both architecturally. Where do we want to put them, how do we want to lay out the suite how is the function supposed to be captured in the design of this MRI facility, but then also sort of education and operation models of what do people really need to know about how to integrate this with their model of operation? How is an outpatient imaging center going to use these products differently than a level one trauma center? Because there are going to be some real significant functional differences that need to be to get the most out of those products or services. You really need to kind of tweak your operational model, your policies to take full advantage of these products or services. And then I also do some expert witness consulting when things go badly in MRI. Hate to do that kind of work because that means somebody screwed up pretty badly, and oftentimes somebody got hurt or something got damaged. But it's an important piece to kind of help clean up our messes, in addition to the proactive stuff of trying to make things better as we go forward. Well, this is amazing. Thank you so much for being a guest on my podcast. I've been watching you for my 20 years in the field, and it's been a pleasure to see what you've done and to finally get to talk to you and hear from you what it is that you do for our community. We are the third largest medical profession in the nation, and MRI is growing, as you have said, and we want to bring safety not only to the patients, but for technologists as well. I think that's one of the pieces that we forget about is keeping the technologist safe and everybody in that room, everybody walking to those different zones, and we have to educate ourselves, and we have to all work together and continue to grow because technology is growing. People are imaging for good and for bad, health wise. So we have to be able to take care of not only our patients, but ourselves, too. So thank you, Mr. Gilk, for joining us today on let's Chitchat radiology edition of Wellness and Travel. You guys, please check out Mr. Gilk's links. You'll find them in the description. Gain more insight, gain more knowledge of what he does and what he not only does for the radiology community, but an architect as well. I mean, just we can all learn from each other. And again, thank you for your time. And thank you time to listen to this podcast. Please leave a review and have a wonderful day. Bye.