Basic requirements for equipping an MRI room. Sanitary and hygienic requirements for magnetic resonance imaging scanners and organization of work
Intensive development of technology, development of new materials, improvement computer equipment have led in the last three decades to the emergence of a number of fundamentally new non-invasive methods studies that allow one way or another to see a cross-section of organs and study them anatomical structure, relative position and take the necessary measurements. Such methods, in particular, include magnetic resonance imaging (MRI), based on the phenomenon of nuclear magnetic resonance (NMR).
MRI technology is quite complex: it uses the effect of resonant absorption of electromagnetic waves by atoms. A person is placed in a magnetic field created by the device. In this case, molecules in the body unfold according to the direction magnetic field. After this, scanning is carried out using a radio wave. The change in the state of the molecules is recorded on a special matrix and transmitted to a computer, where the received data is processed. Unlike computed tomography
MRI provides an image pathological process in different planes.
Limitations in using MRI for patients
MRI is prescribed according to strict indications in cases of controversial diagnosis or failure of other research methods. MRI cannot also be performed on people whose bodies contain various metal structures - artificial joints, heart pacemakers, defibrillators, orthopedic structures that support bones; pregnant women should not be examined.
Main unfavorable factors that can have a harmful effect on the body of those working with MRI are:
Constant magnetic field; electromagnetic radiation created by a PC; noise created by a tomograph, PC, printing device and cooling and ventilation systems; light environment, illumination, pulsation coefficient); microclimate (air temperature, relative air humidity, air speed).
Requirements for accommodation and work organization
The magnetic resonance imaging unit must be located on the first floor of an isolated compartment of the existing medical and preventive building or in an extension to it, or in an isolated building constructed specifically for this unit. It is allowed to place MRI as part of the X-ray diagnostic department. It is prohibited to install MRI on the first floors of residential buildings, as well as in any basement or underground premises. To place the tomograph, a room must be selected whose load-bearing structures are capable, with an established safety margin, of withstanding the load created by the equipment included in the product, taking into account the load from service personnel, patients, etc. Diagnostic MRI rooms (departments) are not may be placed adjacent (horizontally and vertically) to wards for pregnant women, children and cardiac patients.
Shielding is carried out using a Faraday cage, taking into account the power of the tomograph.
The design of the walls, ceiling, floor, doors, and windows in the diagnostic room must ensure that the electromagnetic field levels in adjacent rooms are reduced to acceptable values. Sound insulation of walls, ceiling, floor, doors, windows of the technical room and diagnostic room must be carried out in accordance with calculations of the acoustic influence of the equipment and ensure hygienic requirements on noise in adjacent rooms.
A typical set of premises should be provided for the MRI department:
diagnostic 40 - 46 m2; control room 14 -17 m2; technical 20 - 24 m2; photo room 10 m2 (if necessary); staff room 12 m2 (maybe moved outside the production premises); doctor's office 12 m2; toilets for staff and visitors - 3X2; dressing rooms with individual lockers.
The diagnostic area can be taken according to the passport data of the tomograph, but not less than 12 m2.
When performing angiography, a procedural area of 10 m2 is required, in which it is necessary to comply with the sanitary and epidemiological regime of aseptic premises.
The technical room (which is the main source of noise) should not be located in adjacent rooms to the control room, doctor's office and patient rooms. When placing air or water cooling equipment, noise and vibration protection measures must be taken to ensure noise and vibration levels within the remote control room in all adjacent rooms.
The control room must be located in a separate room with natural light. The control room is not allowed to be used to receive patients. To protect against direct sun rays it is necessary to provide sun protection devices (film with a metallized coating, adjustable blinds with vertical slats, etc.).
General lighting should be provided in the form of continuous or broken lines of lamps located on the side of workstations, parallel to the user’s line of sight with video display terminals (VDTs) arranged in a row. With the perimeter arrangement of computers, the lines of lamps should be located above the desktop closer to its front edge, facing the doctor.
The use of luminaires without diffusers and shielding grilles is not permitted.
Calculation of air conditioning systems is carried out based on heat excess from cars, people, solar radiation, and artificial lighting sources. The operating mode of air conditioners should provide standard microclimate parameters in the premises of the MRI department.
In the main functional production premises and at the work places of service personnel, standard parameters of the air environment (temperature, humidity, air speed, as well as standard air exchange) must be ensured.
Sanitary premises consisting of dressing rooms with individual double-leaf lockers (according to the number of workers), a shower room can be located as part of the sanitary premises of health care facilities, but the distance to them should not exceed 100 m from the MRI department.
Nursing staff must be provided with: special clothing(robes, etc.); replacement shoes; when performing angiography or other parenteral interventions - by individual means protection (masks, gloves); at elevated noise levels in the diagnostic room - personal hearing protection (headphones, earplugs), selected in accordance with the spectral characteristics of the noise and the required protection efficiency. Change of special clothing should be carried out at least twice a week, when angiography is performed daily. Washing of special clothing should be centralized.
Hygienic requirements to ensure protection against PMF
Ensuring the protection of workers from the adverse effects of primary health care is carried out through organizational, engineering, technical and therapeutic measures.
Organizational measures for the design and operation of MRI include: identification of areas affected by PMF (areas with PMF levels exceeding the maximum permissible limit, where operating conditions do not require even short-term presence of personnel, must be fenced off and marked with appropriate warning signs); in order to reduce harmful effects PMP for personnel; when laying the patient down, the latter should not be at a distance closer than 0.5-2.0 m (depending on the power of the tomograph) from the front panel of the tomograph and place their hands in the magnet hole.
When conducting research, personnel should not be constantly in the diagnostic room (only when laying the patient down and at the end of the examination - with the exception of cases of examination of seriously ill patients who require constant presence medical personnel). Monitoring the condition of the subject should be carried out through the window from the control room.
Organization of the location of workplaces and routes of movement of service personnel at distances from the MRI, ensuring compliance with the regulations;
The placement of equipment and its operation must be carried out in accordance with the rules of safety and labor protection.
Engineering and technical measures involve the use of collective and individual protective equipment, as well as the introduction of new technologies or design changes (including remote control of the movement of the patient table and scanning).
Therapeutic and preventive measures require the following conditions:
The most sensitive to the effects of PMF are systems that perform regulatory functions (nervous, cardiovascular, neuroendocrine, etc.). Domestic scientists have described changes in the health status of people working under conditions of exposure to PMF of 20-100 mT. These changes appear in the form vegetative-vascular dystonia, asthenovegetative and peripheral vasovegetative syndromes or their combinations and are characterized by vegetative, trophic, sensitive disorders in the distal arms, occasionally accompanied by mild motor and reflex disorders. For those working in conditions elevated levels PMP is characterized by subjective complaints of an asthenic nature, functional changes in the cardiovascular system (bradycardia, sometimes tachycardia, change in ECG wave T), tendency to hypotension. The blood picture shows a tendency to a decrease in the number of red blood cells and hemoglobin content, as well as moderate leuko- and lymphocytosis.
Regular exposure to noise levels above 80 dBA on the human body is primarily manifested by specific changes in the organ of hearing (slow progressive hearing loss similar to cochlear neuritis). Noise levels below 80 dBA do not cause hearing loss, but have an irritating and tiring effect, which is combined with the effects of work stress and, with increasing work experience in the profession, can lead to the development of extra-aural effects, manifested in general somatic disorders and diseases.
Noise, being a general biological irritant, can affect all organs and systems of the body, causing a variety of physiological changes. In particular, noise is considered the cause of a number of disorders that occur in the central and cardiovascular systems, in the state of homeostasis and immunobiological reactivity of the body. Exposure to noise may cause circulatory hypoxia of the brain due to spasm arterial vessels. Noise disrupts the function of the cardiovascular system. Changes in the ECG were noted in the form of shortening the Q-T interval, lengthening the P-Q interval, increasing the duration and deformation of the P and S waves, displacement T-S interval, change in T wave voltage. Noise may cause an increase in the level blood pressure And arterial hypertension. Convincing evidence has accumulated on the effects of noise on the immune system. Exposure to noise leads to stimulation of the anterior pituitary gland and increased secretion by the adrenal glands steroid hormones and as a consequence of this - to the development of acquired (secondary) immunodeficiency with involution of lymphoid organs and significant changes in the content and functional state T- and B-lymphocytes in the blood and bone marrow. Emerging defects in the immune system relate mainly to three biological effects: a decrease in anti-infective immunity, the creation favorable conditions for the development of autoimmune and allergic processes, decreased antitumor immunity. There is generally an increased incidence of respiratory diseases. Immunosuppression correlates with the degree of increase in plasma corticosteroid levels. With increasing experience of exposure to elevated noise levels, noise disease is formed, that is, a polymorphic symptom complex, including pathological changes in the organ of hearing in combination with vegetative-vascular dysfunction. Vegetative-vascular disorders appear earlier and prevail over hearing impairment.
In order to prevent and early detect changes in health status, all persons professionally associated with the maintenance and operation of the tomograph must undergo preliminary upon entry to work and periodic preventive medical examinations, as provided for by order of the Ministry of Health and Social Development of the Russian Federation No. 302N dated April 12, 2011.
Persons under 18 years of age and women who are pregnant or breastfeeding are not allowed to work under conditions of exposure to PMF from a tomograph and EMF from a PC.
CT tomograph device
A CT scanner is a large machine that looks like a cube or short cylinder with a hole or small tunnel inside. The main component of a computed tomograph is a cathode ray tube located in the body of the device (gantry). Gantry is a movable, usually annular, part of a tomography or mammography apparatus containing scanning equipment. System of multifield rotational irradiation of a lying patient. Also connected to the body is a special movable “couch” (table), which moves inside the tomograph tunnel when the device is activated. Considering that a computed tomograph emits X-rays, the device is usually located in a special shielded (protected) room or is part of the structure of the premises of the radiology department. The device is controlled automatically from the adjacent office, which houses the tomograph’s computer unit, monitors and equipment for monitoring the patient’s condition.
According to the operating principle CT scan little different from standard x-ray examination. In both cases, X-ray radiation is generated by a cathode ray tube, which is then sent through the human body to a device that reads the change in radiation. During a CT scan, several X-ray sensors rotate around a patient located on a sliding table, and noise arises due to the operation of the rotor unit in which these sensors are mounted. At the same time, the patient moves inside the tunnel, which makes it possible to conduct research at several levels at once. Computer program, receiving an image, processes it to form two-dimensional (in two planes) cross sections or pictures.
Construction of a CT room
X-ray room = CT room
The X-ray department (office) is not allowed to be located in residential buildings and children's institutions. It is allowed to operate X-ray rooms in clinics built into residential buildings if the vertically and horizontally adjacent rooms are not residential. It is allowed to place X-ray rooms in an extension to a residential building, as well as in the basement floors. In this case, the entrance to the X-ray department (office) must be separate from the entrance to the residential building.
It is advisable to place X-ray rooms centrally, as part of the X-ray department, at the junction of the hospital and the clinic. X-ray rooms for infectious diseases, tuberculosis and obstetric departments hospitals and, if necessary, fluorography rooms in emergency departments and outpatient departments
A newly constructed X-ray department, serving only a hospital or only a clinic, should be located in the end parts of the building. The department should not be walk-through. Entrances to the X-ray department for inpatient and outpatient department patients are separate.
It is not allowed to place X-ray rooms under rooms where water can leak through the ceiling (swimming pools, showers, restrooms, etc.). It is not allowed to place the procedural x-ray room adjacent to the wards for pregnant women and children horizontally and vertically.
In the treatment room of the X-ray room, it is not allowed to place equipment that is not included in the project, as well as to carry out work that is not related to X-ray examinations. In the treatment room for children's research, the presence of toys that can be treated with soap and soda solution and disinfection, as well as distracting design, is allowed.
The area of the treatment room can be adjusted in agreement with the territorial agency of state sanitary supervision, taking into account the following requirements: the distance from the personnel workplace behind a small protective screen to the walls of the room is at least 1.5 m; the distance from the personnel workplace behind a large protective screen to the walls of the room is at least 0.6 m; the distance from the rotating tripod table or from the imaging table to the walls of the room is at least 1.0 m; the distance from the photo stand to the nearest wall is at least 0.1 m; the distance from the X-ray tube to the viewing window is at least 2 m (for mammography and dental X-ray machines - at least 1 m); technological passage for personnel between elements of stationary equipment - at least 0.8 m; the area where the gurney is placed for the patient is at least 1.5 x 2 m; additional area if there is a technological need to bring a gurney into the treatment room - 6 m 2.
The composition and area of the premises of the RCT room are specified by the organization that manufactures the computed tomograph in the form of a design proposal, which is taken into account when developing the room design, but does not replace it. This clause also applies to the placement of other types of foreign-made X-ray machines, the documentation for which contains the company’s design proposals.
The height of the X-ray treatment room must ensure the functioning of technical equipment, for example, ceiling mounting of an X-ray emitter, tripod, television monitor, shadowless lamp, etc. X-ray equipment with a ceiling suspension of the emitter, screen-imaging device or X-ray image intensifier requires a room height of at least 3 m. The height of the treatment room the radiotherapy room in the case of rotational irradiation should be at least 3 m.
The width of the doorway in the procedure room of the X-ray diagnostic room, X-ray CT room and X-ray operating room must be at least 1.2 m with a height of 2.0 m, the size of the remaining doorways is 0.9 x 1.8 m.
The orientation of the windows of the X-ray room for fluoroscopy and the control room is preferably in the north-west direction.
The treatment room window for fluoroscopy, if necessary, is equipped with light-protective devices to darken it from natural light (direct sunlight).
When the office is located on the first or ground floors, the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the level of the building's blind area. When the X-ray room is located above the first floor at a distance of less than 30 m from the treatment room to the residential and office premises of the neighboring building, the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the floor level. A radiation hazard sign and the name of the room must be placed on the entrance doors to the treatment room.
At the entrance to the procedure room of the X-ray diagnostics, fluorography room and to the control room of the X-ray therapy room, at a height of 1.6 - 1.8 m from the floor or above the door, a light sign (signal) “Do not enter!” should be placed. white-red color, which lights up automatically when the anode voltage is turned on.
The control panel of X-ray devices, as a rule, is located in the control room, except for mobile, ward, surgical, fluorographic, dental, mammography and osteodensitometry devices. In the control room it is allowed to install a second x-ray television monitor, automated workstations for a radiologist and an x-ray technician. When there is more than one X-ray diagnostic device in the treatment room, a device is provided to block the simultaneous activation of two or more devices. To ensure the possibility of monitoring the patient's condition, an observation window and a speakerphone intercom are provided. Minimum size protective viewing window in the control room 24 x 30 cm, protective screen - 18 x 24 cm. It is allowed to use television and other video systems to monitor the patient.
Mobile, ward, surgical, fluorographic, dental, and mammography devices are controlled in the X-ray examination room using a remote control panel at a distance of at least 2.5 m from the X-ray emitter.
The X-ray department (office) is equipped with an autonomous supply and exhaust ventilation system. In the treatment room of the X-ray room, inflow should be carried out into the upper zone, exhaust - from the lower and upper zones in a ratio of 50+/-10%. In the remaining rooms of the X-ray room, inflow and exhaust are carried out to the upper zone. When using an automatic developing machine in a darkroom, local exhaust ventilation is additionally equipped at the place where it is installed. If there is no natural light in the treatment room, bactericidal lamps are installed in it at the rate of one lamp per 10 m 2.
Ventilation of X-ray rooms general purpose must be autonomous. Additional equipment of X-ray rooms (departments) with air conditioning is permitted.
In the treatment room, in addition to the treatment room for fluorography and the X-ray operating room, provision is made for the installation of a sink with a supply of cold and hot water.
Every day, before starting work, the personnel checks the serviceability of the equipment with mandatory registration of identified faults in the technical control log. If malfunctions are detected, it is necessary to suspend work and call a representative of the organization carrying out Maintenance and equipment repair.
After the end of the working day, the X-ray machine, electrical appliances, table lamps, electric lighting, and mechanical ventilation are turned off. Wet cleaning of floors and thorough disinfection of elements and accessories of the X-ray machine that come into contact with patients are carried out daily. Wet cleaning of the treatment room and control room of the X-ray room is not allowed immediately before and during X-ray examinations.
25 Construction of a modern room for MRI and MRI scanner.
Magnetic resonance imaging has 2 rooms,
The main components of any MRI scanner are:
magnet, creating a constant (static), so-called external, magnetic field in which the patient is placed
gradient coils, creating a weak alternating magnetic field in the central part of the main magnet, called gradient, which allows you to select the area of study of the patient’s body
RF coils- transmitting, used to create excitation in the patient’s body, and receiving - to register the response of excited areas
computer, which controls the operation of the gradient and radio frequency coils, registers the measured signals, processes them, writes them into its memory and uses them for MRI reconstruction.
It is very important to remove objects containing metal from yourself before an MRI. Metal objects may interfere with the magnetic field used during the examination and the quality of the images may be poor. In addition, the magnetic field can damage electronics. introduced into the magnetic field of an MRI scanner electronic devices and magnetic cards are irreversibly damaged, and metal jewelry that is not removed can cause serious burns. High-speed magnetic resonance imaging (MRI) machines are shorter and wider, so most of your body is in an open state during the scanning process. Newer MRI machines are open on all sides, which can reduce image quality, but such equipment is widely used for claustrophobic patients and children. To conduct the study, the patient is isolated from all other sources of radio signals in order to minimize the influence of interference. It is placed in a powerful, but harmless to humans, magnetic field. Then, using very sensitive antennas, the radio signal is received, processed by a super-fast computer and an image is obtained. It reflects the distribution of cell radio signals human body in various planes and ratios
Magnetic resonance imaging is the most accurate, informative and safe method functional diagnostics. The use of MRI is allowed for examining children and pregnant women, for dynamic monitoring during treatment.
What is MRI?
Magnetic resonance imaging is based on the action of a magnetic field, more precisely, on measuring the responses of hydrogen atoms under the influence of a magnetic field. The signals are collected and processed by a computer, resulting in a three-dimensional three-dimensional image of the body or parts of the body in the form of multiplanar slices. Some two-dimensional parts of the image can be displayed on a computer monitor and images can be obtained in planes.
MRI images are taken in three projections: frontal, sagittal and axial, and differ highest quality Images.
MRI images can be obtained using intravenous contrast. Contrasting greatly increases the accuracy and information content of the method, its diagnostic capabilities, when it is possible to detect not only the slightest pathological and structural changes in the object under study, but also to thoroughly examine the state of physical and chemical processes. Contrast method is used for diagnosis rare pathologies with an unclear or unexpressed clinical picture.
MR imaging devices are classified according to several parameters. The main thing in a tomograph is a magnet, so all devices differ in the power of the magnet: the stronger it is, the better the images will be and the shorter the examination time.
Based on the magnet power, MR tomographs are divided into 5 classes: from ultra-low tomographs with an ultra-weak magnetic field (below 0.1 Tesla), to ultra-high tomographs with an ultra-high magnetic field (up to 4 Tesla).
MRI scanners come in closed (tunnel) and open type, more comfortable for patients.
Requirements for MRI room equipment, equipment
The MRI room is part of the department radiology diagnostics or located in a separate room, usually on the ground floor of the building. The main equipment is a magnetic resonance imaging machine.
Existing equipment standards allow, upon request, the installation of two magnetic resonance imaging scanners of different power in one room, depending on the volume and types of examinations. Included in the package basic set radio frequency coils (for examining the head, neck, abdominal and pelvic organs, back, limbs) and additional profiles.
Additional equipment for the MRI room:
- automatic syringe injector,
- a set of non-magnetic instruments for interventional procedures performed under MRI guidance (ablation, biopsy),
- medical multi-format laser camera for printing images onto film,
- automated workplace doctor with a personal computer with a software package.
The syringe injector is used for automatic dosed injection of a radiocontrast agent during MRI. The injector is made entirely of non-magnetic components. The injector operation can be controlled from the operator's cabin.
Modern models of laser cameras for printing are easy and safe to use. The image is obtained in very high resolution. The camera has a wide range of capabilities and various convenient functions, a touch control panel and WEB service function, and high performance.
All equipment in the MRI room must be made of special non-magnetic materials. All devices and means for anesthesia, resuscitation, injection needles, catheters, etc. must be compatible with the tomograph. All additional research MRI-guided examinations are performed only using non-magnetic instruments.
Some categories of patients require anesthesia during an MRI examination. Typically this is general anesthesia, since it is necessary to turn off the patient's consciousness. In conditions of a powerful magnetic field that can disrupt the functioning of normal anesthesia machines, special anesthesia-respiratory and monitoring equipment is used, 100% compatible with MRI. Magnetic-resistant sensors are attached to the patient’s body, which are necessary for remote monitoring of his condition by an anesthesiologist located in the next room.
To carry out two-way voice communication between the patient and the doctor located in the next room, transmitting commands and monitoring the patient’s condition, the MRI room must be equipped with an intercom system. It is part of the medical workplace.
The room where scanning occurs must be surrounded by a RF shield to prevent RF pulses from escaping. high energy outside the room and protecting the tomograph from radio frequency signals from the outside. The office is also surrounded by a magnetic shield to prevent the spread of the magnetic field into the clinic area. In modern tomographs, superconducting magnets are equipped with a built-in shield.
There is no special preparation or dietary restrictions required, and if you are prescribed any medications, they should be taken as normal.
What should the doctor performing the MRI be warned about?
Be sure to tell your doctor before the test if you are pregnant, if you have any metal structures, grafted implants or electronic devices in your body, and especially a pacemaker. In the latter case, MRI is contraindicated. If you are pregnant, you may be advised to postpone the test or choose another possible method, since the effect of the magnetic field on the fetus has not been fully studied.
Before undergoing the test, be sure to remove all electronic and metal objects (even if they contain a small amount of metal) and wear a robe or gown without a metal zipper. You should also remove all accessories - from watches, jewelry and hairpins, to dentures, hearing aids or a wig.
As the name implies, the magnetic resonance imaging procedure is based on the action of a magnetic field and the resonance of atoms, and the metal can disrupt the action of the magnetic field, thereby distorting the resulting images, and in the case of pacemakers and grafted electronic implants, affect the operation of the device. In addition, a distorted magnetic field can negatively affect the operation of an expensive tomograph.
What to expect during an MRI?
The MRI procedure is completely painless. As a rule, diagnostics are carried out in a large magnet tunnel, but if you suffer from a fear of closed spaces or are overweight, it is also possible to undergo examination using an open tomograph. Some types of photographs are taken with intravenous administration special contrast. This is also a painless procedure that does not cause allergies or any other negative reactions.
To ensure that you are not disturbed by extraneous sounds produced by the MRI scanner, you will be given ear plugs or pleasant music will be played. You can talk to the doctor who is conducting the study through the built-in microphone. As a rule, MRI diagnostics do not take more than 15 minutes, but in some cases, for example, when performing an MRI of the spine, the study can take about an hour. During the entire examination, lie quietly, without moving or turning your head, and breathe calmly. Any unnecessary movement can affect the quality of the resulting photo.
Instructions for eating or drinking fluids before an MRI vary depending on the type of test. Unless you are given special instructions, you can follow your normal daily routine and take your medications as usual. No preparation is required for MRI of the brain, spine, or joints.
Preparing for MRI of the pelvic organs
(bladder, prostate gland, uterus, appendages)
The study is carried out at medium filling Bladder. Before the study, you must not urinate for 2-3 hours and drink 0.5 liters of non-carbonated liquid 1 hour before the procedure. On the eve of the study, we recommend cleansing the intestines - laxatives with a mandatory cleansing enema at the end of the day. We recommend taking an antispasmodic (No-shpa, Drotaverine) 30–40 minutes before the test. It is important for women to indicate the day of their menstrual cycle.
Preparing for an MRI of the abdominal organs
(liver, gall bladder, pancreas, spleen)
MRI of the abdominal cavity is performed on an empty stomach. If the study cannot be carried out in the morning, it is allowed light breakfast. 2-3 days before the examination, it is necessary to switch to a slag-free diet: exclude from the diet foods that increase gas formation in the intestines (raw vegetables rich in plant fiber, whole milk, brown bread, legumes, carbonated drinks, as well as high-calorie confectionery- pastries, cakes). To reduce flatulence during this period of time, it is advisable to take enzyme preparations (Festal or Mezim-Forte) and enterosorbents ( Activated carbon at the rate of 1 tablet. per 10 kg of weight or “Espumizan” 1 tablet. 3 times a day). We recommend taking an antispasmodic (No-shpa, Drotaverine) 30–40 minutes before the test. All medications should be taken in the absence of contraindications.
Pregnancy and MRI
If you are pregnant, be sure to inform your doctor before the test. Pregnancy is not a contraindication to MRI, but it is not entirely clear what effect the magnetic field has on the fetus. MRI is not recommended in the first 3 months of pregnancy - it is better to postpone the examination or choose an alternative method.
DECISION OF THE MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS
About approval Sanitary standards and rules “Requirements for working conditions medical workers occupied in magnetic resonance imaging rooms"
Based on Article 13 of the Law of the Republic of Belarus dated January 7, 2012 “On the sanitary and epidemiological welfare of the population”, paragraph two of subclause 8.32 of clause 8 of the Regulations on the Ministry of Health of the Republic of Belarus, approved by Resolution of the Council of Ministers of the Republic of Belarus dated October 28, 2011 No. 1446 “On some issues of the Ministry of Health and measures to implement the Decree of the President of the Republic of Belarus of August 11, 2011 No. 360", the Ministry of Health of the Republic of Belarus DECIDES:
1. Approve the attached Sanitary Norms and Rules “Requirements for the working conditions of medical workers employed in magnetic resonance imaging rooms.”
2. This resolution comes into force 15 working days after its signing.
Sanitary norms and rules “Requirements for working conditions of medical workers employed in magnetic resonance imaging rooms”
CHAPTER 1
GENERAL PROVISIONS
1. These Sanitary Norms and Rules establish requirements for the layout, placement, equipment of magnetic resonance imaging rooms, organization of workplaces for medical workers, organization of magnetic resonance imaging, control of factors production environment magnetic resonance imaging room, as well as measures to protect the health of medical workers working in these rooms.
2. These Sanitary norms and rules are mandatory for compliance government agencies, other organizations, individuals, including individual entrepreneurs.
3. State sanitary supervision over compliance with these Sanitary norms and rules is carried out in accordance with the legislation of the Republic of Belarus.
4. For violation of these Sanitary norms and rules, the perpetrators are liable in accordance with legislative acts The Republic of Belarus.
5. For the purposes of these Sanitary norms and rules, the basic terms and their definitions are used in the meanings established by the Law of the Republic of Belarus of January 7, 2012 “On the sanitary and epidemiological welfare of the population” (National Register of Legal Acts of the Republic of Belarus, 2012, No. 8, 2/1892), Law of the Republic of Belarus dated 01.01.01 “On Health Care” as amended by the Law of the Republic of Belarus dated 01.01.01 (Vedamastsi Vyarkhonaga Saveta Republic of Belarus, 1993, No. 24, Art. 290; National Register of Legal Acts of the Republic Belarus, 2008, No. 159, 2/1460), Law of the Republic of Belarus dated January 1, 2001 “On labor protection” (National Register of Legal Acts of the Republic of Belarus, 2008, No. 158, 2/1453), Law of the Republic of Belarus dated January 5, 2004 “On technical regulation and standardization” (National Register of Legal Acts of the Republic of Belarus, 2004, No. 4, 2/1011), as well as the following terms and their definitions:
magnetic resonance imaging (hereinafter referred to as MRI) is a diagnostic research method used to obtain high-quality images of human body organs and functional data, based on the principles of nuclear magnetic resonance;
magnetic resonance imaging (hereinafter referred to as tomograph) is a medical equipment consisting of the following main blocks: a magnet, gradient, shimming and radio frequency coils, a cooling system, systems for receiving, transmitting and processing data, a radio frequency shielding system;
magnetic resonance imaging room - a specially equipped room (set of rooms) in which the tomograph is located;
extremely permissible levels physical factors(hereinafter referred to as MPL) – levels of physical factors established by hygienic standards.
CHAPTER 2
REQUIREMENTS FOR LAYOUT AND PLACEMENT OF MRI ROOMS
6. MRI rooms are part of the radiology department of healthcare organizations and other organizations carrying out medical activities in the manner established by the legislation of the Republic of Belarus (hereinafter referred to as the healthcare organization).
7. When designing, constructing or reconstructing an MRI room, it must be located on the first floor of the diagnostic and treatment building of a healthcare organization or in an extension to it or in an isolated building.
8. Architectural, planning and design solutions for MRI rooms should provide optimal working and rest conditions for workers.
9. The minimum set of premises for an MRI room should include:
scanning, or procedural, or radio frequency cabin (hereinafter referred to as diagnostic) – 40–46 m2;
patient preparation room – 12 m2;
cabin for undressing patients – 4.5 m2;
research processing room – 20 m2;
technical room – 20–24 m2;
specialist doctor’s office – 10 m2;
office of the head of the MRI department – 15 m2;
room for meals – 10 m2 (can be moved outside the production premises of the MRI room);
personal hygiene room for medical workers – 5 m2; it is allowed to place sanitary premises as part of dressing rooms with individual double-leaf lockers (according to the number of medical workers), a shower room as part of the sanitary premises of a healthcare organization;
material – 10 m2;
spare parts storeroom – 8 m2;
storage room for cleaning items – 4 m2.
Angiography is allowed for diagnostic purposes, subject to aseptic conditions.
10. The composition and area of the premises of the MRI room must be determined in accordance with the legislation of the Republic of Belarus, taking into account the recommendations of the tomograph manufacturer and the induction of the magnetic field created by the tomograph.
11. Diagnostic MRI rooms are not allowed to be placed in an adjacent room (horizontally and vertically) with wards for children, newborns, pregnant women, patients with cardiac diseases, as well as wards of anesthesiology and intensive care departments.
12. Permanent workplaces are not allowed in the room located on the lower floor in relation to the MRI room.
13. To locate the tomograph, a room must be selected whose load-bearing structures are capable, with an established safety margin, of withstanding the load created by the equipment included in the tomograph, taking into account the load from medical and other workers and patients.
14. The height of the diagnostic unit must ensure the functioning medical equipment and be at least 3 m.
15. All ducts or ducts for air conditioning and for electrical panels in the diagnostic room must be made of non-magnetic materials.
16. At a distance of at least 10 m from the diagnostic room, the presence of metallic masses should be excluded (elevators, X-ray computed tomographs, linear accelerators and others) affecting the electromagnetic field and magnetic field.
17. The technical room must have a water supply, a sewer drain, and emergency ventilation. The height of emergency ventilation is 2.5 m.
18. The entrance door to the diagnostic room must have hinged mechanisms and be constantly closed. The width of the doorway in the control room and diagnostic room must be at least 1.2 m with a height of 2.0 m.
19. To monitor the patient’s condition, the diagnostic room is provided with an observation window and a loudspeaker intercom; it is allowed to use a television or other video system.
20. The design of the walls, ceiling, floor, doors, windows of the MRI diagnostic room must ensure a reduction in the levels of magnetic and electromagnetic fields in adjacent rooms to an acceptable value in accordance with sanitary standards and rules, hygienic standards establishing requirements for the levels of magnetic and electromagnetic fields in workplaces.
21. Sound insulation of walls, ceilings, floors, doors, windows, technical rooms and diagnostic rooms must be carried out in accordance with calculations of the acoustic impact of medical equipment and ensuring the noise level in accordance with sanitary standards and rules, hygienic standards establishing the noise level in the workplace.
22. The control room should be located in a separate room with natural light. The control room is not allowed to be used to receive patients. The orientation of the MRI room windows should be in the northwest direction.
23. To decorate the walls and floors of the MRI room, materials that are waterproof, have an antistatic effect, resistant to detergents and disinfectants, approved for use in accordance with the legislation of the Republic of Belarus, must be used.
24. The walls and ceilings in the MRI room should be painted in light colors.
25. The surfaces of walls, floors, and ceilings of rooms in MRI rooms must be flat, smooth, and easily accessible for wet cleaning and disinfection.
77. Health care organizations should have psychological relief rooms with sessions to relieve fatigue and neuropsychic stress. Medical workers visit psychological relief rooms after the end of their work shift.
MRI ROOM MAP
1. Health care organization (or other organization carrying out medical activities in accordance with the established procedure).
2. Structural division.
3. Code and name of the profession (position) of office workers according to the national classifier of the Republic of Belarus OKRB “Professions of workers and positions of employees”, approved by the resolution of the Ministry of Labor and Social Protection of the Republic of Belarus dated 01.01.01 No. 125 / number of employees.
4. Number of work shifts / shift duration.
5. Regulated breaks are available (absent), their duration.
6. Number of employees in the largest shift.
7. Name of the tomograph model.
8. Manufacturer.
9. Year of manufacture.
10. Type of magnet used in the tomograph (permanent, resistive electromagnet, superconducting).
11. Induction of the magnetic field created by the tomograph (T).
12. Characteristics of the tomograph design (open, closed type).
13. Requirements for the placement of the installation, the installation is located (not located) in a separate room:
13.1. MRI diagnostic room area;
13.2. MRI control room area;
13.3. presence of warning signs on the doors;
13.4. presence of a zone, limited line 0.5 mT/size (length, width).
14. Dangerous and harmful factors associated with the operation of the installation, and protective measures.
There is (does not exist) a danger, protective measures are required (not required).
15. Conditions of exposure to PMF (general, local) along the total vector (X Y Z axis).
16. Monitoring the levels of tension (magnetic induction) of the PMF (mT) created by the tomograph in various areas where medical workers are located:
16.1 – zone in the center of the magnet (front panel of the tomograph);
16.2 – zone in the center of the magnet (rear panel of the tomograph);
16.3 – zone at the level of the table control panel for positioning the patient;
16.4 – area where the medical worker is located when centering the patient;
16.5 – area in the center of the table for positioning the patient;
16.6 – zone of the foot edge of the couch;
16.7 – storage area for accessories and reels.
***On paper
Rice. Tension control zones (magnetic induction) of the PMP and the route of movement of workers
17. Levels of intensity of primary health care in the areas where medical workers are located exceed (do not exceed) the levels of hygienic standards that establish the value of levels of primary health care in the workplace.
18. The presence of medical workers in the diagnostic room during scanning is required (not required).
19. The time an employee spends in the diagnostic room during scanning (in the case of examining patients who need constant monitoring, performing medical procedures, surgical interventions).
20. Personal protective equipment against radio frequency radiation (oversleeves, vests, boots) is required (not required).
21. Other dangerous and harmful production factors:
21.1. noise levels exceed (do not exceed) hygienic standards establishing noise levels in workplaces;
21.2. personal hearing protection (headphones, earplugs) is required (not required).
