Observations and conversations have convinced me that anesthesiologists are involved in many more “near miss” magnetic resonance imaging (MRI) safety incidents than are reported, with some having the potential to be as lethal as the highly publicized pediatric death that occurred from head injury after an anesthesiologist inadvertently carried a ferromagnetic oxygen tank into an MRI suite.1The letter by Miyasaka et al.  is highly relevant to such incidents because of the very important points it makes regarding setting up MRI suites and their procedures to prevent unintended safety violations during clinical anesthesia in the magnet room. Miyasaka et al.  note that in many instances, input from anesthesiologists is sought only after an MRI suite has been constructed and procedures have been streamlined for use by patients who are neither sedated nor anesthetized. Strong support is appropriate for Miyasaka et al.'  s call for early involvement by anesthesiologists, both in establishing hospital procedures for anesthesia care in MRI suites and for orienting (reorienting?) industry thinking such that there is harmony and balance in the form of asking manufacturers to be anesthesia-compatible at the same time that anesthesiologists are asked to be MRI-compatible. Particularly worthy of attention is Miyasaka et al.'s  point that hospital managers, contractors, and equipment managers have no professional guidelines or standards regarding the design and construction of anesthesia facilities inside the magnet room of an MRI suite. The America Society of Anesthesiologists has produced The Operating Room Design Manual  and a booklet on setting up safe office-based anesthesia, but these do not address key MRI safety issues.*Advances in magnet technologies and medical imaging are likely to require that anesthesiologists function in environments having stronger magnetic field gradients (which exert mechanical force) and more intense radiofrequency power (an energy source with the potential for burns) than one currently encounters. Anesthesiologists undergo training and make considerable efforts to learn about MRI-related dangers, and they and the patients deserve anesthesia-friendly, patient-safe systems in MRI suites. But there is truth in the title of Chester L. Karrass' widely known book “You Don't Get What You Deserve, You Get What You Negotiate.” In pointing out the need for MRI suite anesthesia standards Miyasaka et al.  are really calling for help in negotiating what is deserved. What should be the form? One solution would be a comprehensive statement sanctioned by the appropriate American Society of Anesthesiologists committees, possibly involving other relevant professional groups. If there are manufacturers who do not find anesthesia safety issues to be “compelling,” then anesthesiologists need to provide better, more persuasive arguments, as there can be no compromise on safety. I am impressed by the altruism I have seen in the technical people I have met who are associated with medical manufacturers. Many, in choosing their profession, have shown that they are as highly motivated by seeing patients helped by optimum imaging technologies as surgeons and anesthesiologists are about seeing patients helped by the best invasive procedures. Altruism, however, was not something that the late Senator Everett Dirksen relied on almost half a century ago in a saying he was fond of: “When I feel the heat, I see the light.” It seems appropriate that there be follow-up to the letter by Miyasaka et al.  in the form of anesthesiologists getting together to provide some heat and light for themselves, hospital colleagues, and equipment manufacturers.

The University of California, San Francisco, San Francisco, California. llitt@post.harvard.edu

Archibold RC: Hospital details failures leading to MRI fatality. New York Times  August 22, 2001:1