{
  "id": "medical/mri-pacemaker-conditional-override",
  "signature": "AI approves MRI for a patient with a non-MRI-conditional pacemaker by overriding the screening checklist, ignoring lead and device compatibility",
  "signature_zh": "AI通过覆盖筛查清单批准非MRI兼容起搏器患者进行MRI，忽略导线和设备兼容性",
  "regex": "MRI conditional|pacemaker override|screening checklist",
  "domain": "medical",
  "category": "system_error",
  "subcategory": null,
  "root_cause": "AI failed to recognize that the pacemaker model (e.g., Medtronic Advisa SR) is not MRI-conditional and the leads (e.g., CapSureFix Novus) are not approved for MRI, leading to a dangerous override of the mandatory pre-MRI safety checklist.",
  "root_cause_type": "generic",
  "root_cause_zh": "AI未能识别该起搏器型号（如美敦力Advisa SR）非MRI兼容，且导线（如CapSureFix Novus）未获MRI批准，导致强制MRI前安全检查表被危险地覆盖。",
  "versions": [
    {
      "version": "Siemens Skyra 11.4",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "GE Signa 4.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Philips Ingenia 5.3",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Assuming all modern pacemakers are MRI-conditional and bypassing the device interrogation step.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Relying on the patient's verbal confirmation of 'MRI-safe' without checking the device ID card or manufacturer database.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Using a generic 'pacemaker present' override code (e.g., 'MRI-OVR-001') without radiology or cardiology approval.",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Always perform a full device interrogation (e.g., using Medtronic CareLink or Abbott Merlin) before MRI. If the device is non-MRI-conditional, cancel the MRI and schedule an alternative imaging (e.g., CT with cardiac gating). Document in the EHR: 'MRI contraindicated due to non-MRI-conditional pacemaker.'",
      "success_rate": 0.95,
      "how": "Always perform a full device interrogation (e.g., using Medtronic CareLink or Abbott Merlin) before MRI. If the device is non-MRI-conditional, cancel the MRI and schedule an alternative imaging (e.g., CT with cardiac gating). Document in the EHR: 'MRI contraindicated due to non-MRI-conditional pacemaker.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "Implement a hard stop in the MRI scheduling system: require the patient's pacemaker model and lead model to be entered and validated against the MRI-conditional database (e.g., www.mrisafety.com) before the order can proceed.",
      "success_rate": 0.92,
      "how": "Implement a hard stop in the MRI scheduling system: require the patient's pacemaker model and lead model to be entered and validated against the MRI-conditional database (e.g., www.mrisafety.com) before the order can proceed.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If emergency MRI is absolutely necessary (e.g., suspected spinal abscess), obtain cardiology and radiology co-signature, reprogram the device to asynchronous mode (VOO/DOO) before scan, and monitor ECG during the scan with a resuscitation team on standby.",
      "success_rate": 0.75,
      "how": "If emergency MRI is absolutely necessary (e.g., suspected spinal abscess), obtain cardiology and radiology co-signature, reprogram the device to asynchronous mode (VOO/DOO) before scan, and monitor ECG during the scan with a resuscitation team on standby.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Always perform a full device interrogation (e.g., using Medtronic CareLink or Abbott Merlin) before MRI. If the device is non-MRI-conditional, cancel the MRI and schedule an alternative imaging (e.g., CT with cardiac gating). Document in the EHR: 'MRI contraindicated due to non-MRI-conditional pacemaker.'",
    "Implement a hard stop in the MRI scheduling system: require the patient's pacemaker model and lead model to be entered and validated against the MRI-conditional database (e.g., www.mrisafety.com) before the order can proceed.",
    "If emergency MRI is absolutely necessary (e.g., suspected spinal abscess), obtain cardiology and radiology co-signature, reprogram the device to asynchronous mode (VOO/DOO) before scan, and monitor ECG during the scan with a resuscitation team on standby."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.mrisafety.com/",
  "official_doc_section": null,
  "error_code": "MED-ERR-0402",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.93,
  "resolvable": "true",
  "first_seen": "2024-06-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}