Normalising high-stakes innovation: insights from Hong Kong’s first intraoperative magnetic resonance imaging service

BackgroundIntraoperative magnetic resonance imaging (IoMRI) represents a substantial advancement in neurosurgical precision, but it introduces serious safety challenges, particularly concerning ferromagnetic hazards.Recent global incidents underscore the gravity of these risks.In 2018 in India, 1 a patient fatality occurred when an oxygen cylinder, inadvertently introduced into the MRI suite, became a projectile during a routine scan; subsequent analysis revealed failures in prescreening protocols and zone enforcement.In 2023 in Brazil, 2 during IoMRI-guided brain tumour resection, a ferromagnetic aneurysm clip dislodged mid-scan, resulting in catastrophic haemorrhage attributed to mislabelling of the clip's magnetic resonance-conditional status.In 2025 in the United States, 3 a fatal incident involved a man being drawn into an MRI machine while wearing a heavy metal necklace.The American College of Radiology 4 reports that 70% of IoMRI adverse events involve ferromagnetic objects, whereas 80% arise from human factors, including inadequate training and communication failures.Against this backdrop, Hong Kong's first IoMRI service at Tuen Mun Hospital, launched in March 2025, confronted challenges within the constraints of a public healthcare system, balancing innovation with stringent safety requirements.Its developmentfrom early planning to service implementationwas framed not merely as a technical installation but as an organisational transformation, aiming to balance improved resection accuracy with the management of inherently high-stakes risks in a resource-conscious public healthcare setting.Adopting a two-room configuration, on one hand, enhances safety through double-door security and magnetic shielding; on the other hand, it facilitates modular scheduling of the scanner room for different purposes.