With the rise in magnetic resonance imaging (MRI) in the pediatric population over the past two decades, safeguarding children undergoing MRI procedures has emerged as a top priority [1]. While MRI may provide benefit for children due to the elimination of ionizing radiation, studies indicate that MRI safety risks occur at a higher rate in children compared to adults. This is due to the fact that MRI introduces its own unique set of risks, including torque and translational forces leading to lethal projectiles, which tragically led to the death of Michael Colombini in 2001, and thermal injuries, a common MRI-related injury [2,3,4]. Pediatric populations represent the largest demographic requiring sedation during MRI procedures, thereby increasing their risk profile for adverse events [5]. Children are also more susceptible to developing anxiety during an MRI scan and may experience difficulties in following verbal commands or expressing their concerns. Thus, a focused MRI safety plan must be in place to support children, parents, or other healthcare providers present in the MRI environment during the imaging procedure [6, 7]. However, safety protocols, policies, and directives are often unsuccessful when a culture of MRI safety is not fostered among the stakeholders. This culture calls for adherence to stringent safety protocols, while establishing a mindset that prioritizes vigilance, collaboration, and continuous improvement in all aspects of MRI operations [8].

Establishing a successful MRI safety initiative hinges on an organized structure with well-defined roles and responsibilities [8, 9]. The Inter-Society Working Group on MR Safety published recommendations for an appropriate organizational structure for MRI safety [10]. The MRI Medical Director (MRMD) is typically a radiologist who oversees the MRI safety operations. The MRMD works alongside the MRI Safety Officer (MRSO) and MRI Safety Expert (MRSE) to structure safety protocols, supervise their implementation, and ensure adherence to regulations and guidelines [11]. The MRSO, typically a senior MRI technologist, implements safety procedures, educates staff, and reports safety issues. The MRSE, an MRI physicist, provides expert guidance on equipment safety and protocol modifications [12, 13]. This collaborative effort forms the core of MRI safety, representing the primary point of contact for all MRI safety issues [10]. The MRI safety initiative is further strengthened by the participation of a wider MRI safety committee, comprising key stakeholders (the MRMD, MRSO, and MRSE) in addition to representatives from various departments. Regular meetings are essential for reviewing and updating policies, discussing workflow optimization, and reporting safety events [7].

Ultimately, the goal of establishing an MRI safety culture is to ensure that safe practices are upheld by everyone by facilitating open and transparent communication channels between all stakeholders [7]. The establishment of MRI safety culture relies on adherence to regulations such as the American College of Radiology’s (ACR) Manual on MRI Safety, which sets the standard for safe MRI environments [14], and maintaining accreditation mandated by the Medicare Improvements for Patients and Providers Act to ensure facilities uphold strict safety and quality standards [15]. By creating a culture that prioritizes MRI safety throughout a health organization, providers can effectively mitigate safety risks associated with MRI use in children.

In this article, we explore important aspects of MRI safety and the ways in which safety culture influences each stage of the MRI workflow. From the initial screening of patients, to implementation of physical barriers, scanning procedures, emergency response protocols, policy development, and adverse event management, the culture within an MRI facility plays a pivotal role in determining safety outcomes [7].