The ABMRS: What Does Credentialing Really Mean for MR Safety?

Join us for a 3 part series on the ABMRS: What does credentialing really mean for MR Safety?
 
In our first episode in this series, host and MR Safety Expert, Kellye Mantooth, sits down with the current chair of the ABMRS, Bill Faulkner. Tune in as they discuss why the ABMRS was founded, what their mission is, and what progress they've made since their development. Bill shares his experiences with MR Safety through the years, both as an educator and expert witness, and he offers valuable insight into why credentialing is so critical for MR Safety.

Transcript

Kellye Mantooth (00:01)
Hello everyone and welcome to MRI Safety Talks. I'm your host Kelly Mantooth. And today we are starting a very exciting series on the ABMRS. And I thought for the start of this series, what better person to have on than Bill Faulkner. Bill, thank you for joining.

Bill Faulkner (00:17)
my pleasure. Thanks for asking for me.

Kellye Mantooth (00:21)
So to get started today, I wanna start with a little introduction on you. How long have you been in this field? How long have you been doing MRI or been involved with MRI?

Bill Faulkner (00:32)
And next year will be 40 years. I started in late 1985, 86 with the first MRI system in Chattanooga, Tennessee. So, it was the first one to sit in front of a console in Chattanooga. And I've had, you know, like anybody in MRI over the years, sold the imaging center. sold, the radiologists sold the imaging center and went to work for

the company that bought it. And then I went to work for another one of the doctor groups in town. And over, you know, over that time, I've been doing a MR education and operations consulting, and it's just been a real enjoyable career for me.

Kellye Mantooth (01:21)
Yeah, essentially the sky is the limit, right? It's not just to get into being an MR tech and that's all you can do. There's so much more that you can expand past that. So right now your current role with the ABMRS is that you're the chair of the ABMRS. Is that correct? Okay.

Bill Faulkner (01:25)
yeah.

I am. I am. This year will wrap that two-year stint up. yeah, I've been the chair for the last couple of years.

Kellye Mantooth (01:42)
And you've accomplished a lot within the ABMRS. But before we dive into that, maybe you can give us a background. How was the ABMRS founded and why was it founded?

Bill Faulkner (01:57)
Well, Dr. Manny Canal founded the ABMRS back in 2014. I was fortunate enough to be asked to be on the founding board. you know, in the short time that we were founded, we formed committees for each one of the exams. The ABMRS is the one that

created those terms in our safety officer and my medical director and my safety expert and we set about Creating credentialing exams for that. In fact, that's the mission of the ABMRS is to credential these people that are you know Assigned the task of performing MRI exams and and for the safety of the patient our first exam was in 2015

We had a couple of hundred people sit for that one and it's grown over time. And that's, you know, kind of where we started and where we are today. You know, eventually we were all the exams were offered on paper. You had to be at a certain facility and the little bubble sheets and that sort of thing. And, you know, that there were even some international exams done.

Kellye Mantooth (03:14)
you

Bill Faulkner (03:19)
that way, but that's that's extremely cumbersome. You know, expensive and not real convenient for anyone involved. And so I think a major advancement that we've been able to do is get the exams now offered electronically in testing centers run by Prometric and there's over 250 or something like that. And

in the U.S. and typically wherever you live there's probably a testing center within a couple hours drive from you if not right in your own town. And so this of course allows you to take the exam anytime pretty much that they've got a seat for you. So you know register through the ABMRS and then it takes you over to the Prometric site where you'll pick a center and pick a time and a date.

And you know, the other nice thing about this with the electronic exam, as soon as you finish, you'll know whether you were successful or not. And then a few hours after the exam, you'll get a report. And again, because of the capabilities through the Prometric site, you can get some feedback in terms of how you performed, kind of a unitless feedback, but you know, how well you did.

in each of the domains so that if you were not successful the first time retest 60 days later and you know, have some time to study up all that information stuff's available on the ABMRS website. So, I guess we'll get the commercial for the ABMRS out of the way there, but, that's, that's kind of, you know, what, how I've been involved and what we've been doing and how we, how we evolved, I think.

Kellye Mantooth (05:02)
You

Yeah.

Bill Faulkner (05:13)
in those years to now. Now we have over 3800, getting close to 4000 individuals in the US credentialed by the ABMRS. We have probably several hundred international

which is, I guess the other big thing is starting to offer the exam. The MRSO and the MRSE are now currently available in the UK, an international version of the exam, and MRMD will follow shortly thereafter. And so we feel that it's important to, we've had requests for this and we feel it's important to expand internationally. So I think that's.

Kellye Mantooth (05:50)
Yeah.

Mm-hmm.

Yeah, yeah. I love it. I love it. We're shifting to an electronic testing and trying to offer that internationally. So for anyone who doesn't know, previously, like Bill mentioned, when you would go and sit for these tests, it would be what was it three weeks, I think, before you would find out whether or not you passed.

Bill Faulkner (06:22)
Yeah, I mean it was easily three weeks. Yes.

Kellye Mantooth (06:26)
Yeah, so now it's more convenient. You can go to a testing center and take it. And then like Bill said, you get those results relatively quickly.

Bill Faulkner (06:34)
Well, certainly a pass fail right then, right? Just like if you were taking the MR registry exam, you get it right then. And then you just get a little more detailed report a few hours later, my understanding.

Kellye Mantooth (06:46)
Yeah, yeah. Interesting enough that you brought up the MR registry exam. So when the ABMRS was founded, do you know was the ARRT exam, was it testing any on MR safety?

Bill Faulkner (07:01)
There were over the years, I'm trying to remember the exact numbers. In the very first, very first registry exam when we took it back in the nineties, when it first came out there, and I apologize for sniffing. It's the, I've got an autumn cold right here. We, some of us were kind of laughing at it.

Kellye Mantooth (07:20)
or

Bill Faulkner (07:30)
there were probably less than a dozen questions on safety or if there were a dozen, I mean, there weren't very many. And a friend of mine commented to me, they said, well, it doesn't matter if you kill somebody apparently, as long as you use an isotropic voxel, because there was all these questions about how you calculate voxel volume and all that kind of stuff.

And, you know, the safety questions were pretty, pretty softball. I mean, you know, it really didn't take much. This morning, actually this morning, I was answering an email for somebody and I was going to send them the content specifications and I went.

Fortunately went to the ART website. It's not the site I look at frequently, but I went to the ART website and lo and behold they have new content specs that they approved this year and will go into effect February 1st 2025. And so I was going through the topics and kind of highlighting things that I wanted to. I've got a registry review course in two weeks and so well, it's all.

update, you know, see if there's anything I need to update and looking through the topics and stuff. But I noticed on the first page of it, there were listed the topics and there are 21 questions now on safety. so yeah, don't get don't get too excited. And if you'll allow me here, I'm going to go over and call up this.

Kellye Mantooth (09:05)
you

Bill Faulkner (09:17)
call up the, here it is, the document and bring it over here. Let me look at it. And just looking through this for screening and safety, of course it takes up one page. There's, there's like four.

you have four main topics on it. know, implant and device research, you know, I'm sure it's again, very softball, you know, identify the device, look up the labeling and identify device specific parameters. Okay, that's, you know, kind of straightforward. A little bit here about, you know, tattoos and body piercings and, you know,

Kellye Mantooth (09:43)
Yeah.

Thank you.

Bill Faulkner (10:02)
Level one, level two, in our personnel zones. They're gonna expect you to know that.

They did add some stuff at peers, terminology, like conductive loops, proximity burn. That's a new one. they've never specifically mentioned borewall contact. they've added magneto phosphine. Okay. you know, I, you know, anyway,

Kellye Mantooth (10:33)
Is it safe, is it safe then Bill for me to assume that the ABMRS maybe realized that there was an insufficient level of MR safety training within the registry and try to fill that need.

Bill Faulkner (10:46)
absolutely. Yeah, I mean, absolutely. The MR registry is certainly not going to do it. There's in quite honestly about the interesting thing about this. I've talked to several radiologists, younger radiologists, and I've asked them again, I apologize. just got the little sniffles going.

and ask them about their experience in the American board, ABR, American Board of Radiology, the board certifying exams for radiologists. And, you know, the ABR, their stance is that anybody that's board certified is qualified to, know, radiologist is qualified to run a MR imaging center.

And these radiologists have told me there's, there's not even a dozen questions on MR safety, that they can recall, you know, five, six, seven, you know, something like that, maybe. And again, they, you know, very softball questions. and, and that's just, you know, unfortunate. that's, that's really the main, or that is a reason.

for the ABMRS to be in existence because, you know, there's nothing on this MR registry exam that shows the technologist, and I'm speaking from our standpoint as technologists, there's nothing that shows that that person is, you know, cognizant of MR safety procedures and policies and things that you need to be on the lookout for as

proof of that look on any social media and look at the number of mr accidents that incidents that are reported I like to term accidents incidents that are reported and you know especially stuff getting into an MRI you know in the room I mean

Kellye Mantooth (12:55)
Mm-hmm.

Bill Faulkner (13:04)
How inept does a site policies and practices and you know, how bad does it have to be so that that happens? I mean, that's to me, that's just almost I mean, it's the most common sense thing in MRI, but apparently it's sense is not common with it. So, you know, I do think this is this is why the

Kellye Mantooth (13:16)
Yeah.

you

Bill Faulkner (13:33)
credentialing process of the ABMRS is important. And, you know, I think there's a contrasting the two. Okay. I mean, obviously you and I are on the board. We can't speak to the content of the exam. But other than what's published on our ABMRS website, which if people aren't aware of that, there's a called an exam syllabus that lists topics.

that one could expect questions on on the exam. So that's, you know, that's certainly available. And, you know, the big, the big difference is you have this MR registry exam. And in this, in this email that I was writing, technologist that was getting into MRI and, you know, just starting to do some scanning, you know, teach them the buttonology, which is

Kellye Mantooth (14:04)
Thank you.

Bill Faulkner (14:29)
You know, the way everybody tends to learn and it's not a bad way to learn at first, but anyway, you know, I was telling him that this exam, MR registry exam, and I've used this, analogy before the MR registry exam is not a flight simulator. The, the MR registry exam for the technologist does not test your

Kellye Mantooth (14:48)
See ya.

Bill Faulkner (14:59)
ability to scan. It doesn't test your talent as a technologist in front of the scanner. doesn't test your artistic ability to use all those parameters and you know how you modify for various scanning, you know, conditions and it doesn't test that it's strictly and you know, and it's got to be, you know,

it has to be pretty top level because it's got to cover things that are common among all scanners and types of scanners and field strength. You know, so it's basically like playing Jeopardy, you know, they'll give you a definition and you name that term what that definition is. So it's really a memorization process. The ABMRS exam is a credentialing exam.

Kellye Mantooth (15:47)
Yeah.

Bill Faulkner (15:59)
credentialing exam is going to ensure that the person sitting for the exam has a deep understanding of not only the principles and in our safety the risk and the protocols associated with with all these different environments and and how this knowledge is used in one of the comments that I've heard from people one

Kellye Mantooth (16:21)
Yeah.

Bill Faulkner (16:27)
person in particular early on, you know, when he friend of mine, when he walked out of the exam, said, what'd you think? He goes, well, it wasn't a walk in the park. he said, but it's, it's clinically relevant. And I've heard that term more and more from people, you know, feedback from the exam, it's clinically relevant. And, and that's the difference between a credentialing exam and one that's just going to test your ability to memorize terms and definitions.

Kellye Mantooth (16:41)
Yeah.

Yep.

Mm-hmm.

Bill Faulkner (16:57)
That's all well and good, but how you apply it is what makes you an MRI tech. what, you know, what the ABMRS credentialing is going to do for, for all of those, for the MRMD, MRSOs, MR safety experts, that what knowledge do you have and understanding do you have of that and how that can be applied in the situation, clinical situation.

Kellye Mantooth (17:27)
Mm-hmm.

Bill Faulkner (17:27)
that that you're you're in. And that's why I think it's important for, you know, from a safety standpoint, I don't mean to ramble on here, but you asked me so I'm rambling. The people, you know, one of the problems in MRI safety is that there's there really knows there are standards, there are guidelines, there are there are concepts that are well known.

Kellye Mantooth (17:40)
you

Mm-hmm. Yeah.

Bill Faulkner (17:57)
and well established in the field. But in terms of actual enforcement of that, there's very little enforcement. Enforcement is a tricky thing. In medicine, of the things that kind of makes it difficult is, fact, I was doing a safety course this past week and one of the things that you talk about is risk and medicine is not without risk.

Kellye Mantooth (18:06)
Yeah.

Bill Faulkner (18:26)
And the determination of whether to expose a patient to an MRI exam in large part is a risk benefit decision, which is why the radiologist is kind of being right there with us for it. But you know, the fact that there are risks and so it's kind of hard to regulate something where you've got where the physician has to make risk benefit decisions for the patient.

Kellye Mantooth (18:34)
Mm-hmm.

Bill Faulkner (18:54)
You know, I mean, it's not a cut and dried. Yes, no, it's not binary. It's not a binary decision. And the one of the ways then to increase the importance of focus, importance of MRI safety is for people to become credentialed. If you're passionate about this and you, you know, people get angry and goes, well, they ought to, they ought to enforce this. They ought to make facilities do this thing. Not all safety.

Kellye Mantooth (18:57)
my

Bill Faulkner (19:25)
mechanisms or the way things are done, you know, work at every center, you know, depends on your setup and stuff like that. But again, credentialing is what professionals can do. It's a critical step. But like I said, it ensures that you, you have this deep understanding and know how to apply it. And it validates your knowledge and demonstrates that you can do this and that you've got a commitment.

to these high safety standards. sets you apart from a professional that, you know, knows what buttons to push and knows, you know, how to modify parameters and things like that. But because there's always a risk, then you want to, in medicine, you want to mitigate those risks. And to do that, I think credentialing is a step in

Kellye Mantooth (19:57)
Yeah.

Bill Faulkner (20:23)
mitigating those risks. And it provides, it should provide assurance to your colleagues, to the patients and providers that you're very much equipped to handle this very powerful modality with significant safety risk. I mean, it's a risky environment. And, and I don't think

Kellye Mantooth (20:25)
Mm-hmm.

Right.

Bill Faulkner (20:52)
Well, we, we're our own worst enemy when we talk about how safe MRI is, right? But you know, if those risks, unfortunately can just lay latent for so long and not noticed. And then when everything lines up, boom, you know, you have a bad incident. so again, I think this, my belief, my way I truly feel is this credentialing,

Kellye Mantooth (20:56)
Okay.

Bill Faulkner (21:21)
ensures, helps ensure that we do a better job of providing a safe environment for the patients.

Kellye Mantooth (21:29)
Yeah, so you you mentioned a little bit about this, the ABMRS certification credentialing, how that's different than ARRT. And you touched a little bit on radiologists, young radiologists reaching out to you, chatting about MR safety. What, I guess, encouragement would you offer to them? We know that like residency, or at least I believe, correct me if I'm wrong, residency, there are some residencies that have like robust MR safety

Bill Faulkner (21:43)
Mm-hmm.

Kellye Mantooth (21:58)
training in it and then there are some residencies where it kind of is non-existent. Is that an appropriate understanding on my end Bill? It's kind of up to their discretion what they want to do with that.

Bill Faulkner (22:09)
Sure, sure. I don't have any really first-hand knowledge, but other than just talking with some radiologists. I remember one radiologist that's the MR medical director at a large medical facility, a hospital facility here in Chattanooga. He was in an MR safety class a couple of years ago.

Kellye Mantooth (22:15)
Mm-hmm.

Bill Faulkner (22:35)
And in introducing myself to him, I actually used to manage the MRI there at that hospital as my last real job some years ago. And this was way before he was there, probably before he was born the way everybody's looking nowadays to me. anyway, you know, was talking with him about him and kind of joke was he was voluntold to be the MR medical director. And I understand he's still in that position. But

Kellye Mantooth (22:56)
No.

Bill Faulkner (23:02)
within probably two or three hours of going through the safety course, two day safety course, one of the techs was sitting next to him turned to him and said, so how much of this stuff do you all get in your, in your residency or in your, in your training? And he said, not a bit. I mean, that was his words, not a bit. I mean, they go over stuff, but it's very, I'm sure it's very top level. And you know, the thing of it is, and this is, think a real,

Kellye Mantooth (23:28)
Yeah.

Bill Faulkner (23:33)
real worrisome point is that in large part, MR safety in facilities is assumed very top upper level management assumes nothing's happening. They assume it's going to be taken care of. You go down to the next level, they assume it's going to be taken care of by who's ever under them and so on and so forth. And then, you know, in many cases it goes all the way down to

Kellye Mantooth (23:41)
Yeah.

Bill Faulkner (23:58)
Whoever is directly in charge of MRI, you know, from an operations standpoint, assumes the MRI technologists know what they're doing, assumes that they're going to handle the safety things. And, and unfortunately I've seen that from radiologists as well. One of the last people, one, one of the persons in this last safety class, at the end of it, on her, verification of attendance and evaluations, she, and

Kellye Mantooth (24:09)
Yeah.

Bill Faulkner (24:27)
This was an interesting, I did not know that she was, she was attending remotely. So I really had no way to, you know, talk with her, you know, person to person chat box and other stuff. But you know, not right in front of me. This lady was a, for all intents and purposes, a scheduler. She had no, no medical, you know, no technology background.

Kellye Mantooth (24:53)
Mm-hmm.

Bill Faulkner (24:54)
She was recommended this course by one of the MR technologist friends because she's concerned because in this facility that she works in, they have begun to offer MRI services by a mobile service. A third party mobile company would come in and bring in a mobile. The technologist is essentially different every time, you know, the truck rolls in.

Kellye Mantooth (25:16)
you

Mm-hmm.

Bill Faulkner (25:23)
They rely on her to, you know, schedule the patients and if they've got any implants or devices to look up the implants and devices, you know, as, you know, aside from this course, I don't know what safety training she's had. She obviously, she said she was extremely worried about the operations there was going to send a big lengthy email to her manager telling her why she's now concerned. The radiologist.

Kellye Mantooth (25:50)
Yeah.

Bill Faulkner (25:52)
she said in her note she wrote me the radiologist say to her something to the effect of the text know what's safe and what's not safe so that kind of scenario scares me you know it

Kellye Mantooth (26:08)
Yeah. And how frequently though do you think that that scenario occurs or scenarios similar to that bill where there's not really an onus of this is mine and I'm going to say this is how we should practice to maintain a safe environment.

Bill Faulkner (26:23)
I wish I had thought to get some of these numbers for you. And I think it's well, I have some actually. Some years ago, well, couple of actually we did it last year, we're gonna do it again this year. And I don't think it's a problem to mention this because it's think it's conflict interest here. I've done some work for many years with applied radiology and

We have done myself, Chris and Harrington, Frank Shellock together have done MR safety webinars annually. We're to do another one, I think later this year, or maybe we got, we got things got in the way and maybe it's going to be early next year. But as part of the last one we did, we had a safety survey and I forget how many people filled this out. A lot of people filled this out prior to the doing the webinar.

And it's amazing how many people don't have an MR medical director, don't have MR safety officers, not sure if they've got a MR safety committee policies and procedures are even not hardly a hundred percent. Who's in charge, who makes decisions? the, the results are all over the place and it's really concerning. And again,

Unfortunately, there's just way too many facilities out there that aren't that are just assuming, assuming because I've not had any really thing big major yet, then we must be doing everything okay.

Kellye Mantooth (28:07)
Yeah, yeah, that's scary. So given that those numbers and how like, how much, how many assumptions are made about MR safety bill? What do you, what would you recommend to these facilities who don't have any of these personnel? they're, if, you know, let's say you're a technologist in a facility like this and you recognize that there's this gaping hole and we need to fill it and there needs to be a captain of the ship. What, what recommendations do you have for them?

Bill Faulkner (28:37)
Well, you know, you can.

You can write memos, can express what you feel, you know, let people know where you feel there are weaknesses in the safety. Unfortunately,

they may or may not listen to you. I've read a quote, I forgot who it was attributed to, but some years back that said, it's hard to get someone to understand something when their salary relies on them not understanding it. And so, you know, it's people look at what you're going to, what you can do to improve safety, for example, implementing appropriately and,

correctly implementing ferromagnetic detection. You know, and I know you're working in that field. It's like you see it, they'll they'll buy it that checks a box, but they don't use it appropriately. You know, I mean, if you don't, if you don't use it appropriately, it's really can have even a negative effect.

Kellye Mantooth (29:45)
Yeah.

Bill Faulkner (29:48)
But that's about all, unfortunately, as technologists, I mean, that's really about all we can do until you, if you can convince somebody that's got the purse strings, because again, they see this as an expense. Why do I need to expend an expense? We've not had an incident. And so most of what I see when we get called in to do a side audit and risk assessment in many times, it's not every time, but in many cases it's been because there have been incidents.

Kellye Mantooth (30:01)
Mm-hmm.

Yeah.

Yeah, it's reactive instead of a prolact.

Bill Faulkner (30:19)
You know, very, it's very much reactive. And what a lot of people do when they, when they do reaction is they, okay, we had this incident, what happened? Okay. They find maybe what it was that happened. we changed something that in that instance, it won't happen again. In other words, they changed something. if all these follow stars align in the exact same way that they aligned this time, we'll fix it where that will happen.

Kellye Mantooth (30:47)
Mm-hmm. Mm-hmm.

Bill Faulkner (30:49)
but that doesn't address the root cause of it. And again, it's, it's because it's reactive. Most, most of the stuff that I've seen in years over, you know, in MRI, particularly is involved. Safety is, is reactive and that's expensive. Okay. You know, that's what's expensive.

Kellye Mantooth (30:53)
Yeah.

Costly on multiple levels, your equipment, if you're involved in litigation, your reputation, it's costly on so many levels to be reactive to something.

Bill Faulkner (31:18)
yeah.

Right. I'm aware of a recent incident of relatively recent, a patient receiving a significant burn due to bore wall contact. And, you know, it took several years to go through the legal system and this burn so significant that it was a full thickness burn all the way to the Elna. And this case just recently settled. was told for multiple, I don't know how much, but multiple millions of dollars and

that's just unfortunate that, you know, the causes of this aren't obviously, obviously it's not in, it was not in these people's trainings, training or processes to prevent this. And the cost it would have taken to prevent it is much less than it would be to pay for the results of

Kellye Mantooth (32:06)
Yeah.

Yeah.

Yeah, yeah, I agree. So I want to transition just a little bit. We've been talking about facilities that maybe don't have robust MR safety programs. You know, you mentioned earlier, there are three certifications within the ABMRS. There's MRSO, MRSE, and MRMD. Maybe you can start from a top level. We'll start with MRMD because I see that as captain of the ship and kind of explain what

Bill Faulkner (32:36)
Mm-hmm.

Kellye Mantooth (32:48)
what would be some of the incentives or benefits other than like knowing how to adequately provide care for your patients to being an MRMD? Like if you had a resident come to you and they're very green and they said, hey, like we didn't get a lot of MR safety training, should I consider getting certified with the ABMRS? What would you tell them?

Bill Faulkner (33:10)
Well, I would tell them that at least my understanding the way it works in the U.S. is when a patient walks into an MRI facility, they become the patient of the radiologist. Radiologist is going to bill for the services that they provide. Therefore, they've got that contractual kind of a relationship with the patient to provide this service. The patient comes in for a procedure. We as technologists,

we don't determine safety, we implement safety. But the determination of safety is going to have to be that risk benefit decision, you know, which is kind of, I mean, it's not obvious in a lot of patients. But I mean, you know, obviously, when you have implant or device or some sort of an unknown item in the body, you know, then that's when that gets more complicated. But just even in the routine practice, even without a pay, even in a patient that has no

implants or devices. You know, the patient comes in, again, they're a patient of the radiologist, the technologist is going to take that patient and look at the exam order. If the exam order seems inappropriate, they're going to go to the radiologist. If the exam seems appropriate, they've got to, you know,

actual order there. It's actually a requisition. heard somebody, Dr. Howard Raleigh, I heard him say it's a requisition, they're requesting an exam. And so if everything seems to be, you know, like it should be the textologist is going to go ahead and go on with the exam. If something happens, the other technologist has got a liability in that because the technologist is also expected to provide the exam in a safe and safe manner.

But the technologist is under essentially under the direction supervision of the radiologist, because again, we don't practice independently. And so it's kind of joined at the hip here sort of. so for the, for my saying to the radiologist, you know, if you're the captain of the ship, do you trust your, do you trust your pilots? You know, I mean, because, because they're doing things for you and you know, that for you.

Kellye Mantooth (35:23)
Yeah.

under your supervision.

Bill Faulkner (35:32)
through your supervision and you know, whatever capacity. And so that's why I think it's important then to understand the safety and certainly if there's anything that doesn't seem to fall in line with routine, they're going to come to the radiologist. so, but the other thing I would say the radiologist is not only is important for you to have an understanding of safety,

Kellye Mantooth (35:34)
Amen.

Mm-hmm.

Yeah, yeah.

Bill Faulkner (35:59)
But your technologist to have a really deep understanding of safety as well, because there's, it's not unusual, nor do I think it's inappropriate. Where in many cases, the technologist, particularly if they're credentialed in our safety officer, having this knowledge and understanding, may know a little bit more of the minutiae details from a safety standpoint, so that the radiologist can say, what do you think?

Kellye Mantooth (36:23)
Mm-hmm.

Bill Faulkner (36:29)
Okay, here's my opinion. And then they're going to have to proceed from there. If you want, can give you an example of that. Radiologists called me up and said, want to ask your opinion on something. Sure. Where's exactly what you're paying for it. And so he said, you know, I've got a guy coming, I think it was a lumbar spine. And he had, and I'd never heard of this, but you know, things, there's always something.

Kellye Mantooth (36:32)
Mm-hmm.

Bill Faulkner (36:56)
He said he's got an MR conditional pacemaker, but it's non functional. And he said, so, you know, my question is it's MR conditional. So does, you know, follow conditions of use, but because it's non functional, does that create any risk? I said, well, let me give you my opinion on that. Most people are aware of when you have these MR conditional pacemakers, there's a

There are steps you take to place them in a particular mode. People are calling it MRI mode. And there some processes, minimal today, thank goodness it's gotten a lot better, processes that are going through to place this device in the MRI mode. Part of that mode is, yes, pacing the heart at a certain rate, but also part of that mode is enabling capabilities on this device to kind of

put a safety net around it, if you will, for interference from the time varying gradient magnetic fields, for example, in MRI. If this thing is not functioning, then you can't place it in that mode. And I said, my opinion would be, I would be concerned that if I couldn't place it in the mode, then I wouldn't have all the safeguards I would have if it's functioning.

Kellye Mantooth (38:18)
Yeah. Right.

Bill Faulkner (38:20)
And so, and I didn't tell him whether it's scanned it or not. said, if you're just asking me, I think it presents a little higher risk. And that's all I said. I think the risk is elevated for that reason. And so it's up to them then to make that decision, you know.

Kellye Mantooth (38:30)
Yeah.

Yeah. So let me ask you, if you can share this, was this radiologist a certified MRMD?

Bill Faulkner (38:42)
I have no idea. I do know that whenever we've been around his facility doing safety training for the technologists, he's been there. That's how I met him. And, you know, and it's, it's kind of interesting when we do safety training on sites and things like that, it's interesting how many radiologists we don't see, you know, yeah, just in general, you know, in general.

Kellye Mantooth (39:06)
Yeah, just just in general working in MR. So do you think Bill, if this radiologist, let's just say, we'll assume for this conversation that he wasn't a credentialed MR. Do you think if he was that he would have had more insight or maybe thought differently about this himself? Is that what you would say that the MRMD certification does? Is it kind of teaches you how to think about things to mitigate risk?

Bill Faulkner (39:20)
Hmm?

I think so. think he would be, I think he would, and for all I know he is grins because he had that sense that something, isn't different. And then the other thing is you got to understand. in this particular scenario, this radiologist, because this is not what he does, really doesn't have any direct knowledge of what goes into placing something in an MRI mode. Does that make sense? So, you know, in that scenario, but again,

Kellye Mantooth (39:46)
Yeah, yeah.

Right? Right?

Bill Faulkner (40:07)
I think this, certainly got, spent time studying and looking this up and researching it and stuff like that. but I think that's what credentialing does. you know, if you told me he wasn't credentialed, I'd be surprised, but you know, that's

Kellye Mantooth (40:17)
Mm-hmm.

So what do you think might be the consequences of appointing someone as an MRMD without formal training? Let's just say you've got an MRMD or you have a radiologist who says, I've been doing this 20 years. I know everything there is to know. You can appoint me as the MRMD, but they're not credentialed or certified. Are there any consequences that you think would come with that?

Bill Faulkner (40:25)
no, that's fine. Go ahead.

I would say no more or less than not having an MRMD. You know, mean, it's, it's what it's, it's a name only, right? Checks a box, checks a box. Does it really, you know, if you've got, and it goes all the way down the line, but if he, then you have technologists that aren't credentialed or something that I mean, yeah, he's named him our medical director. Okay. Great.

Kellye Mantooth (41:00)
Yeah. Yeah.

Mm-hmm.

Yeah.

Bill Faulkner (41:19)
know, but then medical directors responsible for defining the training, defining the policies, the procedures, right? And then if you don't have anybody underneath that knows how to implement those policies and procedures, it's, you know, it's really no difference whether he's named or not named. that make sense? I mean, I, you know, I can't see that it does.

Kellye Mantooth (41:30)
Yeah.

Mm-hmm.

Yeah, yeah, yeah.

Bill Faulkner (41:46)
thing. And there are sites that have MR safety officers, but there's really no MRMD, or the MRMD is not involved. There are sites that have an MRMD, but they don't really have any MR safety officers, or maybe there's somebody named, but then again, maybe not. Again, it's, it's, it's got to be a fully functioning organizational plan for how to how to manage safety in an environment.

Kellye Mantooth (41:51)
Yeah.

and

Yeah. Yeah.

Yeah, it's almost like if you have one without the others, we have a piece of the puzzle, but you've not fit all the other pieces together. You don't have an entire puzzle. You just have one small piece of it. Yeah.

Bill Faulkner (42:23)
Right, right, and which does nothing to solving the puzzle, right?

Kellye Mantooth (42:27)
Yeah, yeah, I'm very curious about these facilities that have an MRSO but not an MRMD because my understanding of an MRMD is here, let me outline how I think we should practice safely. And then you as the MRSO, you're on the ground and you're gonna implement this and you're gonna be the one to say, hey, our policies and procedures say this is what we're going to follow. So it's almost like having an MRSO without an appointed MRMD is like, who is defining?

how we practice safely, who do we answer to if there's some, you know, I'm curious how those facilities, how do they operate without an MRMD, without an appointed MRMD to say this is what we're gonna do, this is the direction we're gonna go.

Bill Faulkner (43:10)
One of the things at least I've heard from attendees at safety courses and things like that is that sometimes technologists are put in the position of, we'll just do whatever you think's best. That's not an appropriate, that's not an appropriate approach because as a technologist, I don't make a risk benefit decision whether or not to scan a patient.

Kellye Mantooth (43:37)
Yeah.

Bill Faulkner (43:37)
Right. mean, and that's what I tell people that basically tell the radiologist is I don't practice medicine, sir or ma'am, you know, and that's a medical decision. And so I don't know, I don't know how I mean, I think techs are put in sometimes awkward positions. And you know, the thing of it is, is that if you say no, if you turn an exam down,

Kellye Mantooth (43:48)
Right.

Bill Faulkner (44:03)
that can have negative consequences. Not making a decision is making a decision. and to not perform an exam that may be very clinically critical for a patient can have detrimental consequences. And so I think a lot of times the without it doesn't take any not offered mannequin. I'll say this doesn't take any knowledge or education to say no. And

Kellye Mantooth (44:08)
Yeah, exactly.

Mm-hmm.

Bill Faulkner (44:32)
without this kind of knowledge and understanding, I think a lot of patients go underserved because the easiest thing is to say no and saying no does not eliminate the problem. Right. It doesn't, doesn't really address, address the issue. I want to bring up something if, if I may, I don't know how long we've got here, but something, that I think is coming down the road that people ought to be very, interested in and on the lookout for.

One of the things that has happened over the last couple of years is the there's a very, very real lack of MRI technologists lack of trained MRI technologists and in the job space. And this is I think I've heard 75 80 % capacity, something like that. And this has really been an issue.

It's been around actually for quite some time through service and other things like that, but it's evolved now into where you can scan remotely. And Dr. Canal wrote a paper and kind of kind of defined it like this. It's kind of like the way some people use this is scanning with you. So for example, you've got a technologist that's not real familiar with say how to do cardiac.

Kellye Mantooth (45:40)
Mm-hmm.

Bill Faulkner (45:57)
So remotely you've got somebody that knows cardiac and so they can dial in and they scan along with this technologist to help them, you know, and you can use it for training purposes, you know, but that's scanning with somebody. But in the remote scanning, when you're looking at, because there's a lack of technologists, then you're entering into this realm of someone scanning for you again, to use Dr. Canal's terms, not mine. And when you do that, then

Kellye Mantooth (46:03)
Mm-hmm.

Yeah, yeah.

Bill Faulkner (46:27)
who's going to be responsible for the patient, right? Because you've got the technologist that's responsible for the scanning part of it. But then you've also got the responsibility of screening the patient, implants, devices, anything, positioning the patient, padding the patient, know, hearing protection, yada yada yada, you all that stuff that a tech does in addition to scan. So you've got somebody who's going to perform that function.

Kellye Mantooth (46:29)
Yeah.

minute.

Mm-hmm.

Bill Faulkner (46:56)
Well, you know, some say, well, you need an MRI tech to do that. Well, if I got an MRI tech, then I don't need remote scanning, right? I mean, it's kind of you know, like, okay. So, you know, what a lot of people are, and these, these positions been around for a long time, where we just call them like tech aids or something like that, where if you had one technologist and you needed another

Kellye Mantooth (47:05)
Yeah.

Bill Faulkner (47:23)
MR safety, you know, MR person, which is what you need, you know, to MR safety training personnel, they're attending the patient, where you can use a technologist aid and these, these people can be trained to, you know, assist the technologist and help them with the functions that the technologists would do. And a lot of sites have been using these for many years, but you know, only as a, you know,

Kellye Mantooth (47:44)
Mm-hmm.

Bill Faulkner (47:48)
an adjunct to the technologist. So if you had two scanners, you'd have a tech and a tech and a tech aid in between something like that. But now with remote scanning, you know, you could have a non MRI technologist person dealing with the patient on the remote side. And that person's got to have a lot of safety understanding as much as a technologist would, right. And so

Kellye Mantooth (47:50)
Right.

Mm-hmm.

Yeah.

Bill Faulkner (48:18)
Dr. Canale and I have been talking and we've got with some other members of the ABMRS. And the ABMRS is now going to look at developing a credentialing exam for a position which we're going to call MR safety technologist, someone that is knowledgeable and

Kellye Mantooth (48:45)
Mm-hmm.

Bill Faulkner (48:46)
understands principles risk and is able to apply that knowledge clinically for the safety of that patient. And so we think that is a need that because it's going to happen. It's I mean, it's happening now anyway. So we've got to assure that this person that's charged literally with the safety of that patient. I mean, that's that's

Kellye Mantooth (48:52)
Yeah. Yeah.

Yeah. Yeah. Yeah. Yep.

to your patient. Right.

Bill Faulkner (49:16)
That's their job, right? And so that these MR safety technologists, MRSTs need credentialing. And so that's looking at something, you know, what's down the line for the AVMRS. That's, you know, that's certainly something that we are actively looking at.

Kellye Mantooth (49:17)
Yeah

Mm-hmm.

that we're looking at. That's amazing news. Do you know Bill right now? Is it too early to say will there be so the MRSA and the MRSE test don't have any prerequisites. Joe Schmo from the street could go sit for those tests if you wanted to. I don't recommend it, but he could. But MRM, then the MRMD test, the only prerequisite for it is that you actually have to be in a physician. Are there any prerequisites?

Bill Faulkner (49:52)
They can sit for them where they pass it or not. It's a whole other thing, right?

Mm-hmm.

Kellye Mantooth (50:03)
that or is it too soon to tell for the MRST.

Bill Faulkner (50:08)
Well, I mean, if you take a look at it, if one were to develop an exam for an MR safety tech, then whatever topics of questions would be appropriate for this exam, it would seem to me like this person should have gone through some

educational course that would provide them with this information. You know, if, if you can, again, this isn't, you know, operating an MR system. And neither is the MRSO if you want to know the truth, well, with the exception of, know, you've obviously got to know how to modify parameters and stuff. But so they're, they're

I think courses will be developed for this. it's, you know, I would rather, I'd rather, you know, got to do it some way. And I think starting with the credentialing exam and who better to do that than the ABMRS who knows about MR safety and MR safety credentialing, who better than that to, to set this standard out there that if you're going to be charged with the safety of a patient.

Kellye Mantooth (51:04)
Yeah, yeah, yeah.

Bill Faulkner (51:31)
Yeah, this is what you're going to have to know.

Kellye Mantooth (51:34)
Yeah, I love that bill. The great news to end this podcast. Thank you so much for for coming on and talking about the AVMR s and just talking about MR safety in general with me. I'm very appreciative.

Bill Faulkner (51:48)
Well, it's been my pleasure. Thank you all very much for having me and ask me anytime. Don't mind a bit.

Kellye Mantooth (51:54)
I'll hold you to that. Thank you all so much for listening.

Bill Faulkner (51:57)
Okay, good deal.

Thank you. Take care.