# AI incorrectly approves MRI for a patient with a non-MRI-conditional pacemaker, ignoring lead and device compatibility requirements

- **ID:** `medical/mri-pacemaker-incompatibility`
- **Domain:** medical
- **Category:** config_error
- **Error Code:** `MED-MRI-005`
- **Verification:** ai_generated
- **Fix Rate:** 85%

## Root Cause

Only MRI-conditional pacemakers (specific models with MR Conditional labeling) are safe for MRI under defined conditions (e.g., 1.5T, specific SAR limits). Non-conditional devices can cause lead heating, pacing inhibition, or device malfunction due to RF fields and gradient magnetic fields.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Siemens Magnetom Vida 4.0 | active | — | — |
| GE Signa Premier 3.0 | active | — | — |
| Philips Ingenia 5.0 | active | — | — |

## Workarounds

1. **Implement mandatory device interrogation workflow: 1) Query EMR for device model and lead model numbers. 2) Cross-reference against FDA MR Conditional database (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/). 3) If not listed as MR Conditional, reject MRI order and suggest alternative imaging (CT, ultrasound, nuclear).** (95% success)
   ```
   Implement mandatory device interrogation workflow: 1) Query EMR for device model and lead model numbers. 2) Cross-reference against FDA MR Conditional database (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/). 3) If not listed as MR Conditional, reject MRI order and suggest alternative imaging (CT, ultrasound, nuclear).
   ```
2. **Add a pre-MRI checklist: verify (a) generator model is MR Conditional, (b) all leads are MR Conditional, (c) device is programmed to MRI-safe mode (e.g., VOO/DOO at fixed rate), (d) patient is monitored with pulse ox and ECG during scan. Example alert: 'Non-MRI-conditional device detected. MRI is contraindicated.'** (90% success)
   ```
   Add a pre-MRI checklist: verify (a) generator model is MR Conditional, (b) all leads are MR Conditional, (c) device is programmed to MRI-safe mode (e.g., VOO/DOO at fixed rate), (d) patient is monitored with pulse ox and ECG during scan. Example alert: 'Non-MRI-conditional device detected. MRI is contraindicated.'
   ```

## Dead Ends

- **Check only the patient's device manufacturer name, not the model number** — Many manufacturers produce both MRI-conditional and non-conditional models; model number is essential for compatibility check (70% fail)
- **Assume all pacemakers implanted after 2015 are MRI-conditional** — Many non-conditional devices were implanted after 2015; also, leads must be MRI-conditional separately (e.g., certain Medtronic leads are not MR Conditional even if generator is) (85% fail)
- **Perform MRI at 3T because 'higher field gives better images'** — Most MRI-conditional pacemakers are only approved for 1.5T; 3T increases RF heating and device interference risk significantly (90% fail)