Summary: This white paper examines a critical but often overlooked safety gap in MRI environments: patient positioning inside MRI Zone IV. While MRI safety programs traditionally focus on implant screening, ferromagnetic risks, and controlled access, the paper argues that the physical demands placed on MRI technologists during patient positioning remain largely invisible within existing Safe Patient Handling and Mobility (SPHM), radiology workflow, and incident-reporting systems. The paper introduces the concept of the “continuity gap,” where pre-MRI documentation clearly identifies patients requiring mobility assistance, yet the MRI record frequently lacks documentation describing how positioning and stabilization were managed inside Zone IV. This absence is framed as “absence as evidence,” signaling a recurring and measurable operational exposure rather than a documentation failure. Technologists often rely on manual stabilization and non-load-bearing supports because conventional lift equipment cannot safely enter the MRI environment. The authors argue that this exposure contributes to cumulative musculoskeletal strain, workflow delays, repeat imaging, and compliance vulnerabilities. The paper calls for alignment between MR Safety, SPHM, and radiology operations through improved documentation, standardized positioning workflows, enforced access controls, and adoption of MR-conditional engineering controls. Ultimately, it presents MRI positioning risk as a measurable systems issue that can be proactively managed to improve staff safety, operational efficiency, regulatory compliance, and patient care outcomes.