# AI approves MRI for a patient with a non-MRI-conditional pacemaker by overriding the screening checklist, ignoring lead and device compatibility

- **ID:** `medical/mri-pacemaker-conditional-override`
- **Domain:** medical
- **Category:** system_error
- **Error Code:** `MED-ERR-0402`
- **Verification:** ai_generated
- **Fix Rate:** 93%

## 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.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Siemens Skyra 11.4 | active | — | — |
| GE Signa 4.0 | active | — | — |
| Philips Ingenia 5.3 | active | — | — |

## Workarounds

1. **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.'** (95% success)
   ```
   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.'
   ```
2. **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.** (92% success)
   ```
   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.
   ```
3. **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.** (75% success)
   ```
   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.
   ```

## Dead Ends

- **** — Assuming all modern pacemakers are MRI-conditional and bypassing the device interrogation step. (80% fail)
- **** — Relying on the patient's verbal confirmation of 'MRI-safe' without checking the device ID card or manufacturer database. (70% fail)
- **** — Using a generic 'pacemaker present' override code (e.g., 'MRI-OVR-001') without radiology or cardiology approval. (90% fail)