With the continuously growing number of MRI examinations and the enormously rapid application of new technical developments, patient monitoring and safety aspects become an increasingly important issue. The vendors of MRI systems and the legislation tend to underestimate and ignore these problems. Therefore the institutions which operate MRI units have to find solutions by their own initiative. Not only due to forensic reasons a monitoring concept should be developed with suitable equipment and careful documentation in any institution operating an MRI unit. This article discusses the planning, implementation and conduct of adequate patient monitoring during MRI examinations.