Download MRI Program Curricullum

MRI Program
Curriculum
Licensed by the Commission for Independent Education,
Florida Department of Education
325 West Gaines, Suite 1414
Tallahassee, Fl 32399
License # 4218
Med Academy
3420 W 84th Street Hialeah, FL 33018
(786) 271-0987
Published:
01/01/2016
1
Table of Contents
Topic
Page #
Program Officials
-------------------------------------------------------------------- 3
Program Objectives
-------------------------------------------------------------------- 3
Program Description
-------------------------------------------------------------------- 3
Program Goals
-------------------------------------------------------------------- 3
Admission Requirements
-------------------------------------------------------------------- 3
HCC
4 - 27
Medical Terminology
-------------------------------------------------------------------- 4 - 5
Patient Care
-------------------------------------------------------------------- 5 – 14
Medical Ethics, Law & Cultural Diversities
---------------------------------------------------------- 15 - 16
Introduction to Digital Imaging
-------------------------------------------------------------------- 16 - 21
Human Anatomy & Physiology
-------------------------------------------------------------------- 22 - 27
MRI Core
28 - 65
MR Fundamentals
-------------------------------------------------------------------- 28 - 38
MR Image Formation
-------------------------------------------------------------------- 38 - 46
Sectional Anatomy
-------------------------------------------------------------------- 47 - 52
MR Procedures
-------------------------------------------------------------------- 52 - 56
Clinical Education
-------------------------------------------------------------------- 56 - 62
MR Registry Review
-------------------------------------------------------------------- 62
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Program Officials
Program Director
Clinical Coordinator
Juan Revuelta, MHA, RT, (R), (MR) PARCA
Tometra Meadows, MS, RT, (R), ARRT
Program Objectives
The objective of the Magnetic Resonance Imaging (MRI) program offered by Med Academy is to train individuals to
become certified Magnetic Resonance Imaging Technologists. At the completion of this course students will be able to
sit for American Registry of Radiologic Technologist (ARRT) or to the American Registry Magnetic Resonance
Imaging Technologist (ARMRIT) certification examinations in Magnetic Resonance Imaging.
Program Description
The Magnetic Resonance Imaging (MRI) program offered by Med Academy includes didactic classes and clinical
training in the discipline of Magnetic Resonance Imaging.
Didactic Classes (630 Hours)
Candidates must successfully complete coursework addressing the topics listed in the America Registry of Radiologic
Technologist (ARRT) Content Specifications for the Examination in Magnetic Resonance Imaging. These topics may
also be covered in curricula published by organizations such as the America Society of Radiologic Technologist
(ASRT) or Section for Magnetic Resonance Technologist (SMRT).
Clinical Education (1050 Hours)
As part of their educational program, candidates must demonstrate competence in the clinical activities identified in this
document. Demonstration of clinical competence means that the program director or designee has observed the
candidate performing the procedure, and that the candidate performed the procedure independently, consistently, and
effectively. Candidates must demonstrate competence in the sixteen Magnetic Resonance Imaging (MRI) procedures
including general patient care activities. The school uses the ASRT curricula and the clinical competency requirements
are those stated by the ARRT specifications.
Program Goals
In support of this mission, the school pursues the following goals:
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Recruitment of individuals who prove to be qualified to train as Diagnostic Imagers;
Provide an educational setting that promotes student cognitive, psychomotor and affective skills;
Develop students knowledge in producing quality medical images;
Encourage student professional attributes such as compassion, empathy and dependability in reference to
patient care;
Encourage students to seek continuous education beyond this program;
Uphold ethical standards of the profession as stated by the Medical Professional Code of Ethics;
Prepare students to successfully take certification examinations, when applicable, provided by the American
Registry of Magnetic Resonance Imaging Technologist (ARMRIT).
Admission Requirements
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Have a high school diploma or a general education diploma equivalent (GED)
Be at least 18 years of age
Complete an application and submit appropriate application fee
Submit official and/or translated copies of transcripts validating completion*
Submit to a background check within ten (10) business days receiving letter of conditional acceptance
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Health Career Core (HCC)
The HCC includes courses of:
 Medical Terminology
 Patient Care
 Medical Ethics, Law, and Cultural Diversities
 Introduction to Digital Imaging
 Human Anatomy and Physiology
Medical Terminology
Course Description
This course provides an introduction to the origins of medical terminology. A word-building system is introduced and
abbreviations and symbols are discussed. Also introduced is an orientation to understanding radiographic orders and
diagnostic report interpretation. Related terminology is addressed.
Course Objectives
At the completion of this course students will be able to:
1.
Divide medical terms into component parts including prefixes, suffixes and combining forms
2.
Analyze, pronounce and spell medical terms using common combining forms, suffixes and prefixes
3.
Name the body systems and their functions
4.
Identify body cavities and specific organs within them
5.
List the divisions of the back
6.
Identify three planes of the body
7.
Analyze, pronounce, and spell terms related to organ systems
8.
Identify and define useful diagnostic and procedural terms as related to body systems
9.
Describe training process of physicians
10.
Identify medical specialist and describe their specialties
11.
Identify combining forms used to describe medical specialties
12.
Decipher medical terminology written in case reports
13.
Identify and use common medical abbreviations, acronyms and symbols
Content
I. The Word-building Process
A. Basic elements
1. Root words
2. Prefixes
3. Suffixes
4. Combination forms
B. Parts of speech
1. Nouns
2. Verbs
3. Adjectives
4. Adverbs
C. Translation of terms into common language
D. Correct pronunciation of medical terms
II. Medical Abbreviations and Symbols
A. Role in communications
B. Abbreviations
1. Examples
2. Interpretations
C. Pharmaceutical symbols and terms
III. Radiologic Technology Procedures and Terminology
A. Radiography and other imaging modalities
B. Radiation oncology
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IV. Understanding Orders, Requests and Diagnostic Reports
A. Radiographic orders and requisitions – components
1. Procedures ordered
2. Patient history
3. Clinical information
B. Diagnostic reports
1. Content
2. Interpretation
Patient Care
Course Description
This course is designed to introduce students to the fundamentals of patient care functions in the MR clinical
environment. There is a brief review of professionalism, ethical and legal issues involved in medical imaging as it
relates to patient confidentiality, security of medical information, and emerging software components used to save and
retrieve images. The core of the course involves attention to professions in imaging and professional credentialing,
patient vital signs, responding to medical emergencies, pharmacology, laboratory values pertinent to MR studies, and
proper handling of medical equipment and patient lines and suction devices. Infection control and medical aseptic and
surgical aseptic methodologies will be discussed. Special attention is also given to patient assessment, screening, and
documentation. Students will also be provided with an overview of basic x-ray concepts.
Course Objectives
Upon completion of the clinical education, the student will:
1. Maintain a safe work environment for patients, visitors and health care workers.
2. Properly schedule and prescreen patients.
3. Communicate professionally with patients and staff members.
4. Use standard protocols to perform routine MR examinations.
5. Use Digital Imaging and Communications in Medicine (DICOM) to archive and send images.
6. Identify when to modify a protocol and successfully perform the modification.
7. Identify the probable cause of image quality problems and recommend an appropriate solution.
8. Perform and monitor quality assurance tests.
9. Power up and shut down the system.
10. Correlate the requested exam with clinical history and reported physical exam findings.
11. Ensure patient safety by correlating surgical, accident and occupational history.
12. Properly screen patients for contraindications to MR.
13. Monitor the patient to ensure proper attire and that no unauthorized metals enter the exam room.
14. Maintain a clean, comfortable and safe environment.
15. Employ proper precautions to prevent disease transmission.
16. Monitor linens and supplies and restock when necessary.
17. Demonstrate how to properly prepare a patient for the requested exam.
18. Demonstrate the actions required if a patient requires sedation.
19. Demonstrate the actions required if a patient requires contrast media.
20. Demonstrate the actions required for allergic reactions.
21. Demonstrate the actions required if a patient is claustrophobic.
22. Demonstrate how to use earplugs or headphones to reduce possible acoustic damage.
23. Ensure proper setup of MR coils, equipment, table accessories and cushioning.
24. Demonstrate an understanding of a patient’s cultural, ethnic or value system differences.
25. Speak with patients in a professional and empathetic manner to alleviate any concerns they express.
26. Demonstrate professional ethics by preserving the patient's modesty.
27. Demonstrate how to give proper instructions to optimize patient comfort and cooperation.
28. Respond appropriately in emergency situations.
29. Recognize patient adverse reactions during MR procedures to contrast administration and act
appropriately.
30. Identify and report equipment problems.
31. Adhere to national, organizational and departmental standards, protocols, policies and procedures
regarding MR exams and patient care.
32. Ensure that professional performance and competence is reflected throughout an exam.
33. Critique images for appropriate clinical information, image quality and patient information.
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34. Demonstrate the appropriate corrective actions to improve inadequate image information.
35. Consistently maintain patient confidentiality standards.
36. Perform safe, ethical and legal practices.
37. Discuss the different members of the health care team and related to imaging.
38. Identify the role of the varying federal, state, and local agencies that provide accreditations,
credentialing, or licensures in health care.
Content
I. Clinical Practice
A. Code of ethics/professional behavior
1. Scope of practice
2. Incident reporting mechanisms
3. Standards for supervision
a. Direct
b. Indirect
B. Professional communication
1. Patient
2. Patient’s family and friends
3. Health care team
C. Role of health care team members
1. Technical
2. Professional
3. Patient’s Bill of Rights
D. Scheduling and sequencing exams
II. Procedural Performance
A. Order/requisition evaluation and measures
B. Facilities setup
C. Patient assessment, education and care
1. Patient monitoring – emergent and nonemergent
a. Vital signs – ranges and values
2. Temperature
a. Fahrenheit
b. Celsius
3. Pulse
4. Respiration
5. Blood pressure
6. Normal values
7. Interfering factors
8. Terminology
9. Adult vs. pediatric
10. Documentation
11. Pain assessment
12. Body type
D. Acquiring and recording vital signs
1. Procedures
2. Demonstration
E. Review of laboratory data
1. Normal ranges for:
a. Blood urea nitrogen (BUN)
b. Creatinine
c. Hemoglobin
d. Red blood cells (RBCs)
e. Platelets
f. Oxygen (O2) saturation
g. Prothrombin
h. Part thromboplastin time
i. Glomerular filtration rate calculation (GFR)
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F. Patient chart
1. Aspects of patient chart
2. Retrieving specific information
3. Proper documentation in the chart
III. Infection Control
A. Terminology
1. Nosocomial
2. Communicable
3. Infectious pathogens
4. Human immunodeficiency virus (HIV)
5. Hepatitis
a. Hepatitis A Virus (HAV)
b. Hepatitis B Virus (HBV)
c. Hepatitis C Virus (HCV)
d. Hepatitis D Virus (HDV)
e. Hepatitis E Virus (HEV)
f. Others
B. Centers for Disease Control and Prevention (CDC)
1. Purpose
2. Publications and bulletins
C. Cycle of infection
1. Infectious pathogens – blood-borne and airborne
2. Reservoir of infection
a. Direct
b. Indirect
D. Preventing disease transmission
1. Transmission-based precautions
2. Health care worker
a. Immunization
b. Booster
c. Post-exposure protocols
E. Asepsis
1. Medical
a. Definition
b. Procedures
1) Hand washing
2) Chemical disinfectants
2. Surgical
a. Definition
b. Growth conditions for microorganisms
c. Methods used to control microorganisms
1) Moist heat
a) Boiling
b) Steam under pressure
2) Dry heat
a) Incineration
b) Dry heat sterilized
3) Gas
4) Chemicals
d. Procedures – demonstrate
1) Opening packs
2) Gowning/gloving
3) Skin preparation
4) Draping
5) Dressing changes
e. Packing
f. Storage
g. Rules for surgical asepsis
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F. Environmental asepsis
1. Handling linens
2. Wound care
a. Cleansing
b. Dressing
3. Techniques
a. Dress
b. Hair
c. Handwashing
d. Gloves
e. Eye protection
f. Cleaning and proper disposal of contaminated waste
4. Practice
G. Isolation techniques and communicable diseases
1. Category-specific
2. Disease-specific
3. Standard precautions
4. Examples
a. HIV virus (acquired immunodeficiency syndrome or AIDS)
b. Hepatitis
1) Type A
2) Type B
3) Type C (non-A or -B)
4) Type D
5) Type E
c. Tuberculosis (TB)
d. Respiratory syncytial virus (RSV)
e. Other
H. Isolation patient in the imaging department
1. Procedure
a. Gowning
b. Gloving
c. Masking
2. Patient transfer
3. Cleaning and proper disposal of contaminated waste
4. Cleaning of imaging equipment
I. Precautions for compromised patient (reverse isolation)
1. Purpose
2. Procedure
J. Psychological considerations
IV. Medical Emergencies
A. Terminology
B. Emergency equipment
C. Latex reactions
D. Shock
1. Signs and symptoms
2. Types
a. Hypovolemic
1) Hemorrhage
2) Plasma loss
3) Drugs
b. Disruptive
1) Anaphylactic
2) Neurogenic
3) Septic
3. Medical intervention
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E. Diabetic emergencies – signs, symptoms and interventions
1. Hypoglycemia
2. Ketoacidosis
3. Hyperosmolar coma
F. Respiratory and cardiac failure – signs, symptoms and interventions
1. Adult vs. pediatric
2. Equipment
G. Airway obstruction – signs, symptoms and interventions
H. Cerebral vascular accident (stroke) – signs, symptoms and interventions
I. Fainting and convulsive seizures, signs, symptoms and interventions
1. Types
a. Nonconvulsive (petit mal)
b. Convulsive (grand mal)
2. Reasons for fainting
J. Other medical conditions
1. Epistaxis
2. Nausea
3. Postural hypotension
4. Vertigo
5. Asthma
6. Psychiatric
K. Unique situations and trauma
1. Head injuries
2. Four levels of consciousness
3. Symptoms
4. Medical intervention
5. Adult vs. pediatric
L. Spinal injuries
1. Assessment
2. Symptoms
3. Medical intervention
4. Transportation
M. Extremity fractures
1. Types
2. Symptoms
3. Splints
4. Casts
5. Positioning
6. Adult vs. pediatric
N. Wounds
1. Symptoms
2. Medical intervention
O. Burns
1. Burn classifications
2. Medical intervention
P. Reactions to contrast agents
1. Signs and symptoms of mild, moderate and severe contrast reactions
2. Medical interventions for each type of reaction
3. Vasovagal reactions
V. Contrast Studies
A. Patient education
1. Technologist’s responsibility
2. Standard procedure
B. Preparation for examination
1. Diet
2. Bowel preparation
a. Laxatives
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b. Enemas
3. Care during the procedure
4. Follow-up care
C. Procedure
1. Monitoring and care during invasive procedures
a. Preparation for MR-conditional cardiac monitoring
b. Electrocardiogram (ECG) rhythms
1) Normal
2) Abnormal
c. Patient care considerations
1) Adverse reactions
a) Reactions to contrast media
2) Other medical conditions
a) Nephrogenic systemic fibrosis (NSF)
VI. Tubes, Catheters, Lines and Collection Devices
A. Terminology
B. Function of devices
C. Nasogastric/nasointestinal
D. IVs, butterflies, angiography catheters and power injectors
E. Suction
1. Adult vs. pediatric
2. Special precautions
F. Tracheostomy
1. Suction techniques
2. CPR with tracheostomy
G. Chest (thoracostomy) tube
1. Purpose
2. Location
H. Central venous lines
1. Purpose
2. Types
I. Tissue drains
J. Oxygen administration using MR-conditional equipment
1. Values
2. Oxygen therapy
3. Oxygen delivery systems
a. Low-flow systems
b. High-flow systems
4. Documentation
5. Special precautions
K. Urinary collection
1. Procedure
a. Male
b. Female
2. Alternative methods of urinary drainage
3. Documentation
L. Other
1. Ileostomy
2. Ureteroileostomy
VII. Health Science Professions & Professional Credentialing Agencies
1.The Health Science Professions
A.
Radiologic technology
a. Radiology Technologist
1.
Diagnostic radiography
2.
Computed tomography
3.
Mammography
4.
Cardiac-interventional radiography
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5.
Vascular-interventional radiography
6.
Bone densitometry
7.
Quality management
8.
Radiologist assistant
9.
Multiskilled
b. Radiation therapy
c. Nuclear medicine technology
d. Diagnostic medical sonography
e. Magnetic resonance imaging
f. PACS administration
g. Education
h. Management
B. Health care professions
C. Health information technology
D. Medical laboratory sciences
E. Occupational therapy
F. Pharmacy
G. Physical therapy
H. Respiratory therapy
I. Social services
J. Nursing
K. Other
2. The Health Care Environment
A.
Health care systems
a. Hospitals
1. Veterans Administration/military
2. Not-for-profit
3. For-profit
4. System/network
5. Independent facilities
6. Mental health facilities
7. Long-term/residential facilities
8. Hospice
B. Health care delivery settings
a. Outpatient/ambulatory care
b. Inpatient
c. Long-term care
d. Preventive care
e. Home health care
f. Telehealth/telemedicine
C. Payment/reimbursement systems
a. Self pay
b. Indemnity insurance
c. Entitlement/governmental programs
d. Medicare
e. Medicaid
f. Managed care
3. Hospital Organization
A. Philosophy
B. Mission
a. Role within the community
b. Commitment to education within the profession and community health
C. Administrative services
a. Governing board
b. Hospital administration
c. Admissions
d. Information systems
e. Procurement
f. Accounting
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g.
Support services
1. Facilities management
2. Environmental services (housekeeping)
3. Security
h. Personnel
D. Medical services
a. Medical director
b. Medical staff
c. House staff
d. Medical residents
e. Interns
f. Medical students
g. Nursing services
h. Clinical services
i. Internal medicine
j. Surgery
k. Mental health
l. Geriatrics
m. Pediatrics
n. Clinical support services
o. Dietary
p. Medical laboratories
q. Oncology
r. Pastoral care
s. Rehabilitation
t. Social services
u. Risk management
v. Pharmacy
4. Radiology Organization
A. Professional personnel
a. Radiology director/chair
b. Radiologists
a. Attending
b. Fellow
c. Resident
d. Intern
c. Radiation physicist
d. Technologists
1. Administrative director
2. Chief/senior technologist
3. Staff technologist
4. Quality control/assurance officer/technologist
e. Radiologist assistant
f. Radiology nurses
B.
Support services
a. Clerical staff
1. Administrative assistant
2. Receptionist
3. Medical secretary
b. Financing/accounting
c. Patient transportation services
d. File room/image management
e. Information systems manager
1. RIS
2. PACS
C.
Patient services
D.
Educational personnel
a. Educational/program director
b. Clinical coordinator
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c. Didactic instructor
d. Clinical instructor
e. Clinical staff
f. Students
5. Accreditation
A. Definition
B. Programmatic accreditation
a. Joint Review Committee on Education in Radiologic Technology (JRCERT)
C. Institutional accreditation
a. Degree granting regional (college/proprietary)
b. Health care organization(s)
1. The Joint Commission
2. American Osteopathic Association
3. American College of Radiology (ACR)
4. Intersocietal Accreditation Commission (IAC)
5. American Medical Association (AMA)
D. Regional Continuing Education Evaluation Mechanism (RCEEM)
a. American College of Radiology (ACR)
b. American Healthcare Radiology Administrators (AHRA)
c. American Institute of Ultrasound in Medicine (AIUM)
d. American Society of Nuclear Cardiology (ASNC)
e. American Society of Radiologic Technologists (ASRT)
f. Canadian Association of Medical Radiation Technologists (CAMRT)
g. Radiological Society of North America (RSNA)
h. Society of Diagnostic Medical Sonography (SDMS)
i. Section for Magnetic Resonance Technologists (SMRT)
j. Society of Nuclear Medicine Technologist Section (SNMTS)
k. Society for Vascular Ultrasound (SVU)
6. Regulatory Agencies
A. Federal
B. Reimbursement
C. State
7. Professional Credentialing
A.
Definition
a. Certification
b. Registration
c. Licensure
B.
Agencies
a. National
1. American Registry Magnetic Resonance Imaging Technologist (ARMRIT)
2. American Registry of Radiologic Technologists (ARRT)
3. Nuclear Medicine Technology Certification Board (NMTCB)
4. American Registry of Diagnostic Medical Sonographers (ARDMS)
5. American Healthcare Radiology Administrators (AHRA)
6. Radiology Administration Certification Commission (RACC)
7. State – licensure
8. Professional Organizations
A. Purpose, function, activities
B. Local organizations
C. State organizations
D. National organizations
a. American Society of Radiologic Technologists (ASRT)
b. American Healthcare Radiology Administrators (AHRA)
c. Association of Collegiate Educators in Radiologic Technology (ACERT)
d. Association of Educators in Imaging and Radiologic Sciences Inc. (AEIRS)
e. American Registry for Diagnostic Medical Sonographers (ARDMS)
f. Nuclear Medicine Technology Certification Board NMTCB)
g. Magnetic Resonance Managers Society (MRMS)
h. American College of Healthcare Executives (ACHE)
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E. International
a. International Society of Radiographers and Radiological Technologists (ISRRT)
b. International Society for Magnetic Resonance in Medicine (ISMRM)
c. Section for Magnetic Resonance Technologists (SMRT)
F. Related associations and organizations
a. American Board of Radiology (ABR)
b. ACR
c. RSNA
d. AMA
9. Professional Development and Advancement
A. Continuing education and competency programs
a. Definition
b. Rationale/benefits
c. Requirements
1. ARMRIT
2. ARRT
3. State
4. Institutional
B. Continuing education opportunities
a. Postprimary certification
b. Collegiate/educational programs
c. Self-learning activities
d. Professional conferences
C. Employment considerations
a. Geographic mobility
b. Economic factors
c. Manpower issues
D. Advancement opportunities
a. Education
1. Administration
2. Faculty
b. Administration
c. Physics
d. Research
e. Industrial
f. Medical informatics
g. Sales/applications
VII. Introduction to Basic X-Ray Concepts
A. X-Ray Science
a. basic physics
b. x-ray production
c. principles of exposure and image quality
B. Equipment
a. introduction to radiographic equipment
b. x-ray circuit and tube heat management
c. screen/film imaging
d. digital imaging receptors
e. formulating technique
C. Radiobiology & Radiation Safety
a. radiation measurements
b. biological effects of radiation exposure
c. patient protection measures and safety
D. Positioning Techniques
a. upper extremity and shoulder girdle
b. lower extremity and pelvis
c. spine and bony thorax
d. chest and abdomen
e. skull and facial
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Medical Ethics, Law, and Cultural Diversities
Course Description
Content provides a fundamental background in ethics. The historical and philosophical bases of ethics and the elements
of ethical behavior are discussed. The student examines a variety of ethical issues and dilemmas found in clinical
practice. An introduction to legal terminology, concepts and principles also are presented. Topics include misconduct,
malpractice, legal and professional standards. The importance of proper documentation and informed consent is
emphasized. Also included is a perspective on human diversity, human interactions and their relation to the patient care
setting.
Course Objectives
At the completion of this course students will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Explain the ethics involved in the health care profession
Differentiate between the systems of ethics, laws, and morals
Explain the four step problem solving process of ethical analysis
Explain the two sources of moral judgment that underline ethical decision making
Identify the moral dilemmas encountered in patient relationships
Identify the moral dilemmas encountered in physician relationships
Identify the moral dilemmas encountered in relationships with other health professionals
Recognize the values associated with ethical decision making in the practice of diagnostic medicine
Apply critical analysis to ethical decision making.
Identify the major health information management department functions
List the key components of a patient health record in acute care
List the key components of a patient health record in an alternate health care setting
Describe how health record documentation affects hospital and physician reimbursement
Describe prospective payment systems including DRG’s groups and coding classifications
Identify coding as it relates to radiographic procedures and the reimbursement impact they have within the
health care system
Differentiate between confidential and non-confidential information.
Discuss the procedure for correcting or amending documentation errors in a patient health record
Differentiate between various types of laws
Outline how standard of care is established for radiographic technologist
Discuss the compact of tortuous conduct and causes of action that may arise from the behavior of a health
care practitioner
Argue the importance of privacy of records and the relation between privacy of records and patient
confidentiality issues
Explain negligence and the four elements necessary to meet the burden of proof in a medical negligence
claim.
Explain the legal theory of re ipsa loquitur and how it may be used by an attorney in a claim of medical
negligence.
Illustrate how a hospital may be liable under the docturine of respondeat superior.
Justify the need for informed consent.
Outline the information a patient must have before an informed consent may be given.
Understand to duties outlined with the job scope of a radiographer and legal ramifications for practicing
outside of that scope.
Differentiate between certifications and licensure.
Understand the common policies and procedures of major health care facilities.
Explain the purpose of labor relations, unions and other workforce entities.
Discuss cultural differences that will affect relationships with patients.
Content
I. Ethics and Ethical Behavior
A. Origins and history of medical ethics
B. Moral reasoning
C. Personal behavior standards
D. Competence
E. Professional attributes
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F. Standards of practice
G. Self-assessment and self-governance
H. Code of professional ethics
I. Ethical concepts
1. Ethical principles
2. Violation process
J. Systematic analysis of ethical problems
II. Ethical Issues in Health Care
A. Individual and societal rights
B. Cultural considerations
C. Economical considerations
D. Technology and scarce resources
E. Access to quality health care
F. Human experimentation and research
G. End-of-life issues
H. Ethical research
1. Institutional review board approval
2. Data collection
3. Data reporting
I. Radiology-specific
1. Dose creep
2. ALARA
III. Legal Issues
A. Parameters of legal responsibility
B. HIPAA
1. Confidentiality of patient medical records (written and electronic)
2. Electronic communication (e.g., cell phones, social networking sites, e-mail,
photography)
C. Torts
1. Intentional
2. Unintentional
IV. Legal doctrines
A. Legal and professional standards
B. Medical records
1. Accuracy of documentation
2. Radiographic images as legal documents
C. Legal risk reduction/risk management
V. Patient Consent
A. Definition
B. Types
C. Condition for valid consent
D. Documentation of consent
E. Right of refusal
Introduction to Digital Imaging
Course Description
This course introduces knowledge in computing and information processing. It presents computer applications in the
radiologic sciences related to image capture, display, storage and distribution. Additional content is designed to provide
the basic concepts of patient information management. Medical records management concerns, including privacy and
regulatory issues, are examined. The role of the technologist is identified and discussed. In addition, this content
imparts an understanding of the components, principles and operation of digital imaging systems found in MR, image
data management, storage and data manipulation (postprocessing). Factors that impact image acquisition, display,
archiving and retrieval are discussed.
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Course Objectives
Upon completing the course, the student will be able to:
1. Apply knowledge base to use computerized systems.
2. Identify various types of computers.
3. Explain the way a computer operates.
4. Identify various terms related to computer fundamentals and components.
5. Describe how to apply various types of software.
6. Describe the various types of hardware applications.
7. Distinguish between analog and digital signals.
8. Define analog-to-digital conversion and digital signal processor.
9. Describe the major functions of the central processing unit (CPU).
10. Differentiate among the various input and output devices.
11. Give examples of various types of memory.
12. Use technology to retrieve, evaluate and apply information.
13. Describe computer care and preventive maintenance.
14. Distinguish among the Internet, intranet and other online services.
15. Apply The Joint Commission/HIPAA standards regarding accountability and protection of patient information.
16. Explain RIS, HIS and PACS applications as they relate to radiology.
17. Describe how the Internet affects distribution of health information.
18. Define digital imaging and communications in medicine (DICOM).
19. List the requirements of a patient consent document.
20. Identify the challenges in protecting patient information.
21. Distinguish between various types of patient records.
22. Explain the contents of a medical record.
23. Apply protocols to properly chart patient information.
24. Explain the procedures for document administration.
25. Discuss privacy and regulatory issues related to patient information.
26. Assess how HIPAA is applied to patient information systems.
27. Define medical informatics and describe examples of informatics systems found in today’s patient care setting.
28. Identify potential abuses related to using confidential patient information.
29. Describe methods of complying with HIPAA.
Content
I. Computer Fundamentals
A. Terminology
1. Analog
2. Digital
3. Binary
B. Types of computers
1. Supercomputer/mainframe
2. Minicomputer
3. Microcomputer
C. Digital fundamentals
1. Binary coding
a. Bits
1) Bit depth
b. Bytes
1) Information content
2) Megabytes/image
2. Digital signal processor (DSP)
a. A-D conversion
b. D-A conversion
D. Considerations
1. Environmental conditions
a. Temperature
b. Humidity
2. Computer catastrophes
3. Ethical/legal concerns
4. Preventive maintenance
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5. Security
a. Passwords
b. Limited access
c. Firewalls
II. Computer Components
A. Hardware
1. Computer
a. Mainframe
b. Hard drive
2. Monitor
3. Keyboard
4. Mouse
B. Software
1. Word processing
2. Database
3. Spreadsheet
4. Desktop publishing
5. Graphics
6. Integrated application programs
7. Image manipulations
a. DICOM
b. Joint photographic experts group (JPEG)
C. Central processing unit (CPU)
1. Arithmetic logic unit (ALU)
2. Control unit (CU)
D. Input and output (I/O) devices (peripherals)
1. Input
a. Keyboards
b. Nonkeyboard devices
c. Touch screen
d. Voice activation
2. Output
a. Printers
b. Video monitors
c. Graphic displays
d. Voice output
3. Storage/memory
a. Primary memory
1) Random access memory (RAM)
2) Read-only memory (ROM)
b. Secondary storage
1) Magnetic tape
2) Magnetic disk
3) CD-ROM
4) DVD
5) Off-site storage
III. Computer Operations
A. Programming
1. Definition
2. Purpose
3. Languages
4. Software
B. Computer Functions (for Imaging)
1. Image acquisition
2. Image processing
3. Image display
4. Image storage
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C. Implementation
1. Definition
2. Purpose
IV. Radiology Applications
A. Patient information and image manipulation
1. Seamless patient/image information
a. Scheduling
b. Image/patient evaluation
c. Billing/coding
2. Documentation
a. Completeness
b. Quality control
c. Quality assurance
B. Patient information systems
1. Patient information
a. Personal information
b. Clinical information
c. Other
2. HIS
3. RIS
4. DICOM
C. Image information systems
1. PACS
a. Terminology
b. System components and functions
c. Image manipulation
d. Access to report information
e. Access from multiple locations
f. Image retrieval
g. PACS issues – contingency plans
h. DICOM
2. Image display and manipulation
a. Viewing
b. Postprocessing
c. Measurements
3. Teleradiology
D. Technologist responsibilities
1. Access order (worklist)
2. Image acquisition
3. Postprocessing – image manipulation
4. Annotation issues
5. Transmitting an image(s) to PACS
6. HIPAA and patient confidentiality
V. Digital Imaging
A. Digital image characteristics
1. Picture elements – pixels
2. Pixel size
a. Field of view (FOV)
b. Matrix
3. Voxel size
a. FOV
b. Thickness
c. Matrix
4. Matrix size
5. Image quality characteristics
a. Spatial resolution
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b. Temporal resolution
c. Image contrast
d. Data size
B. Digital image acquisition
1. MR image acquisition
a. Protocol/parameter selection
1) Resolution (FOV, thickness, matrix)
2) Contrast – repetition time (TR), echo time (TE), inversion time (TI), and flip
angle (FA)
3) Other parameters
b. System requirements
1) Hardware requirements
2) Software requirements
c. Anatomical considerations
1) Anatomy of interest
2) Plane/baseline reference
3) Anatomical variations
4) Body habitus
5) Pathology
d. Positioning aids
e. Special concerns
1) Age
2) Patient condition
3) Positioning
2. MR image formation
a. K-space
b. Analog to digital converter
c. Fourier transformation
C. Imaging standards
1. Protocol selections
2. Parameter selections
3. Problem-solving process
4. Role of the MR technologist
D. Artifacts
1. Determining the cause(s) of artifacts
2. Optimizing acquisition parameters to reduce artifacts
VI. Quality Assurance and Postprocessing
A. Image display
1. Window/level
2. Brightness/contrast
3. Reconstruction algorithms
B. Image evaluation
1. Image quality (signal-to-noise ratio, or SNR)
2. Image quality (image contrast)
C. Postprocessing
1. 3-D
2. Maximum intensity projection (MIP)
3. Region of interest (ROI)
a. Measurements
b. Signal intensity
4. Image display
a. Brightness
b. Contrast
VII. Display
A. Monitor
1. Liquid crystal display (LCD)
2. Cathode ray tube (CRT)
20
B. Film
1. Dynamic range
2. Degraded thermal film
3. Film storage
C. Image display
1. Image quality display
a. Contrast
b. Recorded detail/spatial resolution
c. Distortion
2. PACS
a. Terminology
b. System components and function
c. PACS operation
1) Image manipulation
2) Access to report information
3) Access from multiple locations
4) Image retrieval
5) Contingency plans
d. DICOM
D. Procedural factors display
1. Image identification
a. Patient information
b. Date of examination
c. Parameters and options
d. Institutional data
2. Documenting an ordered exam
a. Prescription
b. Patient chart
c. Telephone orders
d. Faxed orders
e. Electronic orders – computerized physician order entry (CPOE)
f. Contrast agent
g. Pre-examination preparation
3. Artifacts
a. Image acquisition errors
b. Corrective action
4. Equipment
a. Spatial resolution
b. More contrast resolution
E. Image evaluation
1. Contrast
a. Appropriate for exam
b. Evidence of processing error
2. Spatial resolution
3. Distortion
4. Artifacts
VIII. Computer Advancements for Imaging
A. The Internet
1. History
2. Internet vs. intranet
B. Intranets
1. Access to information
2. Security of patient information
C. Enhancer to customer service
1. Referring physician
2. Patient
21
Human Anatomy & Physiology
Course Description
These courses establishes a knowledge base in anatomy and physiology. Components of the cells,
tissues, organs and systems are described and discussed. The fundamentals of sectional anatomy
relative to routine radiography are addressed. This course covers a general survey of human anatomy and physiological
function. It will begin with a discussion of cells, tissues, and organizational levels of the body. Students will have a
detailed review of the respiratory, digestive, urinary, endocrine and reproductive systems. This course will also include
terminology and pathological considerations for each system.
Course Objectives
At the completion of this course, students will be able to:
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Discuss the basics of anatomical nomenclature.
Describe the chemical composition of the human body.
Identify cell structure and elements of genetic control.
Explain the essentials of human metabolism.
Describe the types and functions of human tissues.
Classify tissue types, describe the functional characteristics of each.
Give example of tissue types and their location within the human body.
Describe the composition and characteristics of bone.
Identify and locate the bones of the human skeleton.
Identify bony processes and depressions found on the human skeleton.
Describe articulations of the axial and appendicular skeleton.
Differentiate the primary and secondary curves of the spine.
Summarize the functions of the skeletal system.
Label different types of articulations.
Compare the types, locations and movements.
Name the different types of articulations.
Examine how muscle is organized at the gross and microscopic levels.
Differentiate between the structures of each type of muscle tissue.
State the function of each type of muscle tissue.
Name and locate the major muscles of the skeleton.
Differentiate between the structure and function of different types of nerve cells.
State the structure of the brain and the relationship of its component parts.
Describe brain functions.
List the meninges and describe the function of each.
Outline how cerebrospinal fluid forms, circulates and functions.
Describe the structure and function of the spinal cord.
Determine the distribution and function of cranial and spinal nerves.
Summarize the structure and function of components that comprise the autonomic nervous
system.
Describe the structures and functions of the components that comprise the human eye and
ear.
List the component body parts involved in the senses of smell and taste.
List the somatic senses.
Define endocrine.
Describe the characteristics and functions of the components that comprise the endocrine
system.
Describe the hard and soft palates.
Describe the structure and function of the tongue.
Identify the structure, function and locations of the salivary glands.
Describe the composition and characteristics of the primary organs of the digestive system.
Describe the function(s) of each primary organ of the digestive system.
Differentiate between the layers of tissue that comprise the esophagus, stomach, small intestine, large intestine
and rectum.
Differentiate between peritoneum, omentum and mesentery.
List and label the accessory organs of the digestive system and describe their function.
Identify the secretions and function of each accessory organ of the digestive system.
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Explain the purpose of digestion.
List the digestive processes that occur in the body.
Describe the composition and characteristics of blood.
List the types of blood cells and state their functions.
Differentiate between blood plasma and serum.
Outline the clotting mechanism.
List the blood types.
Explain the term Rh factor.
Explain the antigen/antibody relationship and its use in blood typing.
Label the parts of the human heart.
Describe the flow of blood through the body and identify the main vessels.
Describe the structure and function of arteries, veins and capillaries.
Differentiate between arterial blood in systemic circulation and arterial blood in pulmonary
circulation.
Outline the major pathways of lymphatic circulation.
Correlate cardiac electrophysiology to a normal ECG tracing.
Differentiate between nonspecific defenses and specific immunity.
Explain antibody production and function.
List the different types and functions of T- and B-cells and explain their functions.
Label the components of the respiratory system.
Describe the physiology and regulation of respiration.
Label the parts of the kidneys, ureters, bladder and urethra.
Describe the function of each organ of the urinary system.
Describe the composition and formation of urine.
Explain micturition.
Label the anatomy of the male and female reproductive organs.
Analyze the function of each of the male and female reproductive organs.
Content
I. Anatomical Nomenclature
A. Terms of direction
1. Anterior/posterior
2. Ventral/dorsal
3. Medial/lateral
4. Superior/inferior
5. Proximal/distal
6. Cephalad/caudad
B. Body planes
1. Median/midsagittal
2. Sagittal
3. Coronal
4. Transverse
5. Longitudinal
C. Body cavities – structural limits, function, contents
1. Cranial
2. Thoracic
3. Abdominal/pelvic
II. Chemical Composition
A. Atoms
B. Chemical bonds
C. Inorganic compounds
1. Acids
2. Bases
3. Salts
4. Acid-base balance
5. pH maintenance
D. Organic compounds
1. Carbohydrates
2. Lipids
23
3. Proteins
4. Nucleic acids
5. DNA
6. RNA
7. Adenosine triphosphate (ATP)
8. Cyclic adenosine 3’, 5’-monophosphate (cyclic AMP)
III. Cell Structure and Genetic Control
A. Cell membrane
1. Chemistry
2. Structure
3. Physiology
4. Types of transport processes
a. Diffusion
b. Osmosis
c. Filtration
d. Active transport/physiological pumps
e. Phagocytosis and pinocytosis
B. Cytoplasm
C. Organelles
1. Nucleus
2. Ribosomes
3. Endoplasmic reticulum
4. Golgi complex
5. Mitochondria
6. Lysosomes
7. Peroxisomes
8. Cytoskeleton
9. Centrosome and centrioles
10. Flagella and cilia
D. Gene action
1. Protein synthesis
2. Nucleic acid (RNA/DNA) synthesis
3. Transcription
4. Translation
E. Cell reproduction
1. Mitosis
2. Meiosis
F. Aberration/abnormal cell division
IV. Metabolism
A. Anabolism
B. Catabolism
C. Enzymes and metabolism
D. Carbohydrate metabolism
E. Lipid metabolism
F. Protein metabolism
G. Regulation and homeostasis
V. Tissues
A. Types of tissue
1. Epithelial
2. Connective
3. Muscle
4. Nerve
B. Tissue repair
VI. Skeletal System
A. Osseous tissue
1. Structural organization
a. Medullary cavity/marrow
b. Compact bone
c. Cancellous bone
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d. Periosteum
e. Cartilage
2. Development and growth
a. Physis
b. Diaphysis
c. Diaphysis/epiphyseal line
d. Metaphysis
3. Classification and markings
a. Long
b. Short
c. Flat
d. Irregular
e. Processes and bony projections
f. Depressions/openings
B. Divisions
1. Axial
a. Skull
b. Hyoid bone
c. Vertebral column
d. Thorax
2. Appendicular
a. Pectoral girdle
b. Upper extremities
c. Pelvic girdle
d. Lower extremities
3. Sesamoids
4. Functions
C. Articulations
1. Types
a. Synarthroses, fibrosis
b. Amphiarthroses, cartilaginous
c. Diarthroses, synovial
2. Movement
VII. Muscular System
A. Types and characteristics
1. Smooth
2. Cardiac
3. Skeletal
B. Functions
VIII. Nervous System
A. Neural tissue – structure and function
1. Neurons
2. Neuroglia
B. Central nervous system – structure and function
1. Brain and cranial nerves
2. Spinal cord
C. Peripheral nervous system – structure and function
1. Sympathetic nerves
2. Parasympathetic nerves
IX. Sensory System
A. General senses
1. Nociperception
2. Chemoreception
3. Thermoreception
4. Mechanoreception
B. Special senses – structure, function
1. Vision
2. Hearing and equilibrium
3. Olfaction
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4. Gustation
5. Tactile
X. Endocrine System
A. Primary organs - structure, function and location
B. Homeostatic control
C. Endocrine tissue and related hormones
1. Pituitary (hypophysis) gland
2. Pineal gland
3. Thyroid gland
4. Parathyroid gland
5. Adrenal (suprarenal) glands
6. Heart and kidneys
7. Digestive system
8. Pancreas
9. Testes
10. Ovaries
11. Thymus
12. Placenta
XI. Digestive System
A. Primary organs – structure, function and location
1. Oral cavity
2. Esophagus
3. Stomach
4. Small intestine
5. Large intestine
6. Rectum
B. Accessory organs – structure, function and location
1. Salivary glands
2. Pancreas
3. Liver
4. Gallbladder
C. Digestive processes
1. Ingestion
2. Peristalsis
3. Digestion
4. Absorption
5. Defecation
XII. Cardiovascular System
A. Blood
1. Composition
2. Clotting system
3. Hemopoiesis
4. Function
B. Heart and vessels
1. Anatomy
2. Function
C. Electrocardiogram (ECG) tracings correlated to normal cardiac rhythm
XIII. Lymphatic System and Immunity
A. Lymphatic system
1. Lymph vessels
2. Lymphatic organs
a. Thymus
b. Lymph nodes
c. Spleen
3. Lymphatic tissue
a. Tonsils
b. Peyer’s patches
B. Immune system
1. Nonspecific defenses
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a. Physical barriers
b. Leukocytes
c. Immunological surveillance
2. B-cell response
a. Production
b. Types of immunoglobulins
c. Function
d. Regulation of B-cell response
3. T-cell response
a. Production
b. Types
c. Function
d. Regulation of T-cell response
4. Passive and active immunity
XIV. Respiratory System
A. Components, structure and function
1. Nose and sinus cavities
2. Pharynx
3. Larynx
4. Trachea
5. Bronchi
6. Lungs
7. Thorax
B. Physiology
1. Pulmonary ventilation
2. Alveolar gas exchange
3. Transport of blood gases
4. Tissue gas exchange
5. Control and regulation of respiration
XV. Urinary System
A. Components, structure and function
1. Kidneys
2. Ureters
3. Bladder
4. Urethra
B. Urine
1. Physical characteristics
2. Chemical composition
C. Micturition
XVI. Reproductive System
A. Male – structure, function and location
1. External organs
2. Internal organs
B. Female – structure, function and location
1. External organs
2. Internal organs
3. Mammary glands
C. Reproductive physiology
1. Ovarian cycle
2. Menstrual cycle
3. Aging and menopause
27
Magnetic Resonance Imaging Core (MRI Core)
Students willing of enroll in the MRI Core must successfully complete all HCC courses with a grade C minimum.
The MRI Core includes courses of:
 MR Fundamentals
 MR Image Formation
 Sectional Anatomy
 MR Procedures
 MR Registry Review
 MR Clinical Education
MR Fundamentals
Course Description
Content of this course covers the history and development of MRI as a diagnostic tool. This course provides the student
with a comprehensive overview of MR imaging principles. Topics include the history of MR, magnetization,
precession, resonance, relaxation, and MR signal production. During the course students will be equip with an
understanding of the physical components of an MRI scanner. Students will learn the functionality of the MRI hardware
components are used during the acquisition of a MR Image. Content reinforce knowledge in computing and information
processing. Students will also learn the safety aspects of MRI including the static magnetic field, time varying
magnetic field, and radio frequency field as well as the behavior of mechanical and electronic implanted devices and
metallic foreign bodies. In addition, students will be instructed on how to respond to an emergency in the MRI
environment.
Course Objectives
Upon completion of the course, students will be able to:
1. Introduction to MRI.
2. MRI Requirements.
3. Describe various nuclei in a magnetic field.
4. Explain why the Hydrogen atom is the element of choice in MRI.
5. Explain what precessional frequency is and how calculated.
6. Explain the radiofrequency spectrum and what type of radiofrequency is used in MRI.
7. Understand the difference between ionizing and non ionizing radiation.
8. Understand the behavior of various nuclei in the magnetic field and/or during the application of the radio
frequency pulse.
9. Understand the concept of resonance and excitation in MR.
10. Understand the concept of relaxation in MR.
11. Describe T1 relaxation
12. Describe T2 relaxation
13. Explain how an MR signal is produced and detected.
14. Understand the dephasing mechanisms.
15. Describe radiofrequency rephasing, and gradient recall rephasing
16. Understand magnetism and magnetic properties.
17. Define gauss (g), tesla (T) and the electromagnetic spectrum.
18. Describe the three basic types of magnets and give the advantages and disadvantages.
19. Discuss the differences in low-, mid-, high- and ultra-high field systems.
20. Describe field strength in relation to image quality (image contrast, SNR and artifacts.
21. Explain the functionality of the radio frequency system in MR imaging.
22. Explain the functionality of the gradient system in MR imaging.
23. Explain the functionality of the shim system in MR imaging.
24. Explain the functionality of the ancillary equipment in MR imaging.
25. Compare MR instrumentation to other imaging modalities.
26. Discuss the elements of safety management that ensure an MR facility operates safely.
27. Demonstrate proper screening and preparation of patients for MR.
28. Monitor patients during procedures.
29. Describe when and how to handle emergencies in the MR environment.
30. Mention the different brands of gadolinium based contrast agents and their main differences
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31.
32.
33.
34.
35.
36.
37.
38.
39.
Review of recommended dosage of gadolinium
Explain gadolinium safety guidelines
Review safety of gadolinium in End Stage Renal Disease
Gadolinium and Nephrogenic Systemic Fibrosis
Describe what action to take in case of a gadolinium extravasations
Explain the different levels of contrast reactions and how to treat them
Mention the off label uses of gadolinium
Describe Iron oxide safety
Describe the applications of contrast agents
Content
I. History of MR
A. Scientific discovery of the principles of nuclear magnetic resonance (NMR)
b. Felix Bloch (Bloch equations)
c. Edward Purcell
d. Sir Peter Mansfield
B. Scientists associated with MR
a. Nikola Tesla
b. Jean Baptiste Fourier (Fourier transformation)
c. Richard R. Ernst (Ernst angle)
d. Joseph Larmor (Larmor equation)
e. Michael Faraday (Faraday’s law of induction)
f. Charles Dumoulin (MRA)
C. Early MR images
a. Raymond Damadian
b. Paul Lauterbur
II. Matter
A. Periodic table of elements
a. MR active nuclei
b. Hydrogen (1H)
c. Water( H20)
d. Fat (CH3)
e. Soft tissue structures of the body
f. Other MR active chemicals (uneven mass number)
g. Chemicals that are not MR active (even mass number)
B. Atom
a. Nucleus
b. Proton
c. Neutron
d. Electron
III. Nuclear Magnetism
A. Definitions
a. Approach/methodology
b. Quantum
c. Classical
d. Frames of reference
e. Laboratory frame of reference
f. Rotating frame of reference
B. Nuclei in a magnetic field
a. Nuclear alignment
b. Magnetic moment
c. Vectors
d. Magnitude
e. Direction
f. Energy states
g. Low energy state
h. Spin up
29
i.
j.
k.
l.
Parallel
High energy state
Spin down
Antiparallel
IV. MR Signal Production
A. Thermal equilibrium
a. Magnetization
b. Longitudinal magnetization
c. Transverse magnetization
d. Net magnetization
e. Spin excess
B. Precession
a. Precessional frequency
b. Larmor frequency
c. Hertz
d. Megahertz
e. Larmor equation
f. Field strength
g. Gyro-magnetic ratio
C. Resonance
a. Excitation
b. RF pulse (B1)
c. 90° RF pulse
d. 180° RF pulse
e. Flip angle
f. Bioeffects for RF pulses
g. Heating tissues
h. Measured by SAR
i. Limited by the FDA
D. Relaxation characteristics that relate to MR image contrast
a. T1 relaxation
b. Longitudinal recovery
c. Spin-lattice
d. T1 recovery (exponential relaxation/recovery)
e. In one T1 time, 63% of longitudinal magnetization recovers
f. In one T1 time, 37% of longitudinal magnetization remains
g. T2 relaxation
h. Transverse decay
i. Spin-spin
j. T2 decay (exponential relaxation/decay)
k. In one T2 time, 63% of transverse magnetization decays
l. In one T2 time, 37% of transverse magnetization remains
V. MR Signal Induction
A. MR signal induction
a. FID
b. Chemical shift
c. Magnetic susceptibility
d. Magnetic field inhomogeneities
e. Receiver coil
f. Spin echo signal
g. GRE signal
VI. Magnetism
A. Magnetic properties
a. Diamagnetism
b. Paramagnetism
c. Superparamagnetism
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d. Ferromagnetism
B. Magnetic field strength (units of measure)
a. Gauss (g)
b. Tesla (T)
VII. Magnets
A. Types of magnets/magnet configurations
a. Permanent
a. Characteristics
b. Temperature dependence
c. Ferromagnetic materials
c. Resistive
a. Characteristics
b. Temperature dependence
d. Superconductive
a. Characteristics
b. Temperature dependence
1. Cryogens
2. Quench
e. Hybrid
a. Characteristics
1. Field strength
2. Configuration
B. Field direction
f. Horizontal field
g. Vertical field
C. Field configuration
a. B0
b. Static field
c. Safety considerations for static magnetic fields
D. Field strengths and imaging systems
a. Ultra-low field (for example: 0.01T)
b. Low field (for example: 0.3 T)
c. Mid field (for example: 0.5 T)
d. High field (for example: 1.0 T to 2.0 T)
e. Ultra-high field (for example: 3.0 T and greater)
E. Field strengths and imaging considerations
a. SNR and field strength
b. Image contrast and field strength
c. Artifacts and field strength
F. Field strengths and safety considerations
a. FDA regulations
b. Forces
1.
Translational force
2.
Rotational force
3.
Bioeffects
G. Magnetic field shielding
a. Regulations
1.
5 gauss
2.
Shielding
b. Mechanisms for magnetic field shielding
1. Passive shielding
2. Active shielding
H. Zoning
I. Levels of training‖ (ACR white paper)
J. Magnetic field production
a. Power supply (for resistive)
b. No power for superconducting
c. No power for permanent magnets
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VIII. Shim Systems
A. Types of shim systems
a. Passive shimming
b. Active shimming
B. Shim function
a. Maintain homogeneity
b. Performed by Technologists
c. Performed by Service engineers
C. Shim field production
a. Power supply
IX. Radio frequency Systems
A. Types of RF coils (Transmit-receive)
a. Transmit coils
b. Receive
c. Transmit-receive
B. Types of RF coils (Shape)
a. Volume
b. Partial volume
c. Surface
d. Intra-cavitary
C. Types of RF coils (Design)
a. Linear
b. Quadrature
D. Types of RF coils (Number of Channels)
a. Single Channel
b. Phase Array
E. RF field configuration
a. B1
b. Oscillating field
F. RF field production
a. Power supply
b. Amplifiers and preamplifiers
c. Receivers
X. Gradient Systems
A. Types of gradients/gradient configurations
a. Wire configurations determine gradient slope
B. Gradient characteristics
a. Strength/amplitude
b. Rise time
c. Amplitude and rise time
d. Duty cycle
C. Gradient fields and safety considerations
a. FDA guidelines
b. Bioeffects
c. Other safety considerations
D. Gradient function
a. Spatial encoding
b. Gradient refocusing
E. Gradients
a. Physical gradients
b. Logical gradients
XI. Ancillary Equipment
A. Additional instrumentation for scanning
a. ECG leads for gating
b. Respiratory bellows for respiratory triggering
B. Power injectors
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a. Contrast media
b. Syringes
c. Tubing
d. Safety considerations
C. MR-conditional supplies
a. Patient monitoring
b. Oxygen tanks
c. Patient transportation
d. Intravenous supplies
e. Step-stools
f. Other MR-safe supplies
D. Remote workstations (imaging manipulation)
a. Archiving and data storage (PACS)
b. Windows and levels
c. Region of interest (ROI)
d. Annotations
e. Postprocessing
1. Maximum intensity projection (MIP)
2. Simple sum of squared difference (SSD)
3. Vascular segmentation
4. 3-D surface (volume) rendering
5. Multiplanar reconstruction
f. Other functions
XII. Computer Systems
A. Characteristics
a. Memory
b. Speed
c. Capabilities
B. Components
a. Technologist interface
b. Keyboard/mouse
c. Monitor
C. Capabilities
a. Protocols
b. Parameters
c. Data manipulation
D. Array processor
a. Fourier transform
b. Half and partial Fourier
c. 2-D/3-D imaging
XIII. Operational Flow
A. Image/system selection
a. High-field vs. low-field vs. ultra-high
b. Mobile vs. fixed
c. Traditional bore vs. open systems
d. Permanent, resistive, superconducting
C. Site selection
a. Environmental considerations
b. Magnetic field impact
c. Radio frequency (RF field impact)
d. Safety considerations
D. Facility design
a. New construction
b. Integration into existing structure
c. Shielding
d. Zoning
E. Government regulations, certificate of need
33
F. Ancillary equipment
G. Staffing and staff training (when required/where applicable)
a. Physician
b. Radiologic technologist
c. Clerical/support
d. Nurse
e. Anesthesiologist/anesthetist
f. Physicist
IX. Imager Maintenance
A. Maintenance contracts
B. Preventive maintenance
C. Repairs
D. Quality assurance (testing)
X. Facility Operational Equipment
A. Patient scheduling
a. Scanning schedule/registration (scheduling system)
b. Request forms
c. Patient history/screening forms
d. Patient instructions
e. Medications and sedation
B. Patient/visitor comfort at scan facility
a. Patient waiting area
b. Patient changing area
c. Accommodating for delays in schedule
1. Claustrophobia
2. Sedation
3. Pharmacology
4. Emergency response (code cart)
d. Monitoring
e. Post sedation instructions
C. Patient/physician/health professional education
a. Patient brochure
b. Physician education
c. In-service education of ancillary personnel
d. FDA guidelines
XI. Introduction to Safety
A. Magnetic fields in MR
a. Static Magnetic Field
b. Radio frequency field flips spins
c. Gradient field is used for spatial encoding of the image
B. MR safety concerns
a. Force and torque on magnetic materials from the static magnetic field
b. Heating caused by the RF magnetic field used to flip spins
c. Nerve stimulation caused by gradient magnetic fields used for spatial encoding
d. Implanted medical devices affected by the static magnetic field, RF magnetic field and gradient
magnetic fields
C. MR safety organizations
a. International Electrotechnical Commission (IEC)
b. U.S. Food and Drug Administration (FDA)
c. National Electrical Manufacturers Association (NEMA)
d. American Society for Testing and Materials (ASTM)
e. American College of Radiology (ACR)
f. International Society for Magnetic Resonance in Medicine (ISMRM) Safety Group
g. Institute for Magnetic Resonance Safety Education and Research (IMRSER)
34
XII. Static Magnetic Field
A. Force and torque on magnetic materials caused by the static magnetic field can cause projectile hazards
a. Potential dangers in a hospital setting with examples of projectiles
b. Force vs. distance from magnet: The force increases very rapidly as distance to magnet decreases
B. Magnetic shielding: active and passive
C. Designing MR guidelines for safety
a. Provide written safety policies and procedures
b. Enforce vigilance in controlling access to the MR suite to trained MR personnel
c. ACR guidelines regarding MR suite safety zones I through IV
d. Lock MR suite door when trained MR personnel are absent
e. Provide safety education to all staff that could potentially work near the magnet, including the local
fire department
f. Post warning signs citing examples of potentially dangerous projectiles
D. Field strength relevance to safety
E. Status of high-field MR safety studies
XIII. Radio Frequency (RF) Magnetic Field
A. Theory of RF heating in MR
a. Faraday's law
b. Factors that affect the amount of heat produced
c. Most heat is deposited on perimeter of body where it can be more easily dissipated
B. Regions with high resistance can cause focal heating
C. RF heating in clinical MR
a. Use SAR to estimate temperature increase
b. SAR = absorbed power/mass (e.g., watts/kg)
c. Concerns are for core (whole body) and localized heating
D. Responsibilities of technologist concerning patient safety in avoiding RF heating
a. Position patients properly
b. Position monitoring equipment properly
c. Screen patients for electronically conducting jewelry, tattoos, cosmetics, medication patches, etc.
d. Monitor patients with physiological conditions that are unable to dissipate heat
e. Monitor patients who are unable to respond due to sedation or mental status
f. Limit pregnant individuals from being present in the RF field
E. How a scanner estimates SAR
a. Scanner calibration routine
b. Determines energy needed to get a 90° flip and 180° flip
c. Adds energy of all RF pulses in a sequence and divides by pulse repetition time (TR) to calculate
power
d. Divides by patient weight to calculate whole body SAR
F. IEC/FDA limits for whole-body heating
a. Normal mode limit (suitable for all patients)
b. First level controlled mode (medical supervision)
XIV. Gradient Magnetic Fields
A. Gradient coils and current waveforms
a. Linear magnetic fields for spatial encoding
b. Echo planar imaging pulse train
B. Effects on patients
a. Nerve stimulation
1. Orientation of field gradient with respect to the body
2. Location in the body
3. Duration of the gradient pulse
C. Hearing damage caused by dangerously loud sound pressure levels
D. Hyperbolic relationship between pulse duration and stimulation threshold
a. Nerve stimulation
b. Variations in patient response to nerve stimulation
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XV. Patient and Personnel Safety Screening in MR (Technologist Responsibilities)
A. Obtain documentation and consent in the form of an MR safety screening questionnaire completed by the
patient or guardian
B. Obtain any necessary special consent documentation for non-FDA approved MR scanning for the following
instances:
a. Pregnancy
b. Injection of contrast to a pregnant patient
c. Implanted device
d. Cardiac stress agent
C. Patient and personnel safety — contraindications for entering the MR suite
a. Implanted electronic devices
b. Implanted metallic objects at risk of deflection
c. Indications for plain film radiography for safety screening include intraocular foreign bodies, shrapnel
and bullets in the body
XVI. Equipment Safety Screening in MR Environment (Technologist Responsibilities)
A. Screen all equipment before allowing entrance to the MR suite
B. Properly label MR-safe equipment
C. Keep all MR conditional and MR unsafe equipment clear of the MR suite and anteroom
D. Recognize table stop and emergency shut-down switches that control electricity to the scanner, and quench or
magnet run-down switch
E. Monitor, record and report cryogen levels
F. Monitor the cryogen exhaust vent line for blockages
G. Monitor the cryogen fill line for ice blockages
H. Maintain awareness and marking of gauss lines in MR area
I. Display warning signs prominently
a. Strong magnetic field
b. This magnet is always on
c. Radio frequency field
d. Hearing protection necessary
e. Hazardous material including phantom liquids and helium dewars
f. Laser light in use
J. Display signage that prohibits items and implants
a. Implants susceptible to electromagnetic fields
b. Open flame
c. Electronic media
d. Ferrous objects
e. Credit cards
XVII. Monitoring of Ancillary Equipment
A. Perform quality measurement of the RF coils
B. Perform quality measurement of software
C. Perform and report cryogen levels
D. Perform checks on pulse receptor, ECG cables and disposable electrodes
E. Take measures if phantom fluid spills
a. First aid in case of contact with phantom fluid
b. Mandatory reporting to local fire department of phantom fluid contents in case of fire
c. Disposal as special waste
d. Gauss lines and their relationship to electronic equipment
XVIII. Emergencies in the MR Environment Requiring Technologist Action
A. Code blue: Remove patient from the MR suite
B. Fire emergency
a. Evacuate patients and others
b. Suspend all electricity to the MR scanner
c. Follow institution's fire emergency procedure
d. Employ MR safe fire equipment
e. Local fire department should be trained by MR personnel
f. Follow procedures when the fire cannot be contained
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C. Metallic items pinned to the magnet
a. If a person is in immediate danger
b. If equipment only is pinned to the magnet
D. Quench
a. Causes
b. Procedure for evacuation
c. Removal of patient and staff from MR suite
d. Established procedure for gaining entry to the MR suite in case positive pressure is pinning the door
to the MR suite (if the door opens inward)
e. Maintaining the room
f. Notifying in-house maintenance personnel
g. Notifying vendor service of quench
h. Risks of cryogen boil-off during quench
1. Asphyxiation from displacement of oxygen
2. Frostbite
3. Fire due to condensation of oxygen
XIX. Safety in MR Contrast Administration
A. Patient history
a. Sickle cell (in crisis)
b. Severe asthma
c. Drug allergy
d. Adverse reaction to contrast media
e. Kidney function
B. Preparation
a. Ensure proper dose
b. Check for expiration date on contrast vial before administering
c. Keep the vial until patient has been released
d. Use sterile technique in preparing lines, tubing and needles
e. Obtain venous access
C. Contrast administration
a. Administration by hand
1. Check for integrity of venous access
2. Visualize access site during administration; watch for extravasation
b. Administration by power injector
c. Check for integrity of venous access site
d. Understand the relationship between the gauge of the angiocatheter vs. the rate of contrast media flow
and follow the guidelines of angiocatheter manufacturer
e. Follow guidelines for contrast administration through alternative sites such as venous access ports,
central lines, etc.
D. Adverse reactions
a. Local events
1. Stop contrast administration
b. Treatment/follow-up guidelines
1. Provide compress (hot or cold)
2. Provide written instructions for patient to follow after discharge
3. Notify the physician in charge that the patient needs to be examined
4. Document/report the extravasation
c. Systemic events
1. Stop contrast administration immediately if dose is not complete
2. Remove patient from MR suite if treatment is required
3. Assess patient for breathing difficulty
4. Notify the physician in charge to examine the patient before he/she is released
5. Follow treatment/follow-up guidelines:
1. Appropriate health care provider administers medications if necessary
2. Give patient written instructions to follow after discharge
3. Document/report the contrast reaction
d. Keep epinephrine and asthma-related drugs in MR suite for emergencies
e. Have the respiratory therapy immediate response number available
37
f. Have code blue button available in the MR area
E. Gadolinium-based MR contrast and NSF
a. ACR guidelines regarding renal function and dialysis
MR Image Formation
Course Description:
Content of this course is designed to provide a comprehensive explanation of the physical phenomenon of Image
Formation in Magnetic Resonance Imaging. The subjects are formatted in individual outlines and can be sequenced
according to the level of knowledge desired. Topics include image weighting, spatial resolution, signal to noise ratio,
scan time, image acquisition and reconstruction, pulse sequences, flow phenomena and image artifacts. Participants in
this class will be instructed to the advance MRI techniques including perfusion, diffusion, fMRI, spectroscopy and
interventional MRI. Vascular and Cardiac imaging techniques will be cover.
Prerequisites
1. MR Fundamentals
Objectives
Upon completion of this course student will be able to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
Explain intrinsic parameters that affect image quality such as: MR tissue characteristics that include spin density, T1 and T2
relaxation.
Explain extrinsic parameters that affect image quality such as: TR, TE, TI, flip angle.
Describe image contrast appearance according to image weighting.
Describe the imaging parameters that determine image contrast.
Explain the mechanism of action of the gadolinium based contrast agents
Describe dipole–dipole interactions
Review magnetic susceptibility concepts
Explain relaxivity agents
Explain the use of the gradient in image formation.
Describe slice selection and slice thickness.
Explain image encoding along the phase axis.
Explain image encoding along the frequency axis.
Discus sampling time.
Describe principal characteristics of the K-space.
Explain data acquisition.
K-filling
Discuss the basic principles of Fourier Transformation.
Explain post processing techniques.
Explain what pulse sequences diagrams are.
Describe Spin Echo pulse sequences.
Describe the advantages and disadvantages of using Spin Echo pulse sequences.
Describe Fast Spin Echo pulse sequences.
Describe the advantages and disadvantages of using Fast Spin Echo pulse sequences.
Describe Inversion Recovery pulse sequences.
Define Inversion Time (TI)
Describe Short Tau Inversion Recovery (STIR) pulse sequence.
Describe the advantages and disadvantages of using Short Tau Inversion Recovery pulse sequences.
Describe Fluid Attenuation Inversion Recovery (FLAIR) pulse sequence.
Explain the importance of using Fluid Attenuation Inversion Recovery pulse sequences in clinical images.
Describe Gradient Echo pulse sequences.
Discuss how Gradient Echo differs from conventional Spin Echo and Fast Spin Echo.
Discus scan time in Gradient Echo pulse sequences.
Discuss how the K-space is filling in Gradient Echo pulse sequences.
Explain the importance of using Gradient Echo pulse sequences in clinical images.
Describe the advantages and disadvantages of using Gradient Echo pulse sequences.
Describe the different types of gradient Echo pulse sequences and their characteristics.
Describe the imaging parameters that determine image contrast.
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38.
39.
40.
41.
42.
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68.
69.
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71.
72.
73.
74.
Describe the imaging parameters that determine signal to noise ratio (SNR)
Describe the imaging parameters that determine spatial resolution on MR images.
Describe the imaging parameters that determine the scan time.
Describe the imaging parameters involved in MR image formation.
Apply MR imaging parameters in the clinical setting.
Describe many typical imaging options used to optimize image quality.
Mention the different types of blood flow and its patterns
Describe the entry slice phenomenon
Explain the factor and parameters that affect the entry slice phenomenon
Describe the time of flight phenomenon
Explain the factor and parameters that affect time of flight phenomenon
Describe the use of the pre-saturation pulses
Explain technique to reduce intra-voxel dephasing
Discuss gaiting technique and use
Describe magnetization transfer contrast technique
Discuss signal suppression techniques
Explain in-out phase technique
Explain the different types of flow compensation techniques
Understand parameters and imaging options to obtain diagnostic MR images with minimal image artifacts.
Identify the presence of image artifacts.
Explain the physics phenomena that cause image artifacts.
Explain the techniques use to compensate for an image artifact Discuss the importance of obtaining patient informed consent
Review of image weighting
Explain the normal diffusion phenomenon in the human body
Explain how MR is used to obtain diagnostic images from normal and abnormal diffusion pattern in the tissues.
Describe diffusion weighted imaging and the parameters use to obtain it.
Explain what apparent diffusion coefficient is, and how is obtained.
Describe diffusion tensor technique
Explain the clinical uses of diffusion techniques
Explain perfusion in the human body
Explain how MR is used to obtain diagnostic images from normal and abnormal perfusion pattern in the tissues.
Describe perfusion weighted imaging and the parameters use to obtain it.
Mention the different types of technique utilize to obtain perfusion weighted images
Describe the use of paramagnetic contrast agents in perfusion weighted imaging
Discuss spectroscopy and its development.
Discuss BOLD techniques
Explain how interventional procedures are done in MRI
Content
I. Intrinsic Contrast Characteristics (Tissue Characteristics)
A. Longitudinal regrowth (T1 recovery)
a. T1 relaxation
b. Spin-lattice interaction
c. Exponential recovery
B. Transverse decay (T2 Decay)
a. T2 relaxation
b. Spin-spin interaction
c. T2*
d. Exponential decay
C. Spin density
a. Actual proton density (total number of mobile water protons)
b. Relative proton density (spin excess during thermal equilibrium)
D. Flow and motion
a. Orders of motion
1. First order (constant velocity)
2. Second order (acceleration)
3. Third order (jerk)
b. Flow characteristics
39
1.
2.
3.
4.
Laminar flow
Vortex flow
Turbulent flow
Spiral flow
E. Diffusion
a. Restricted diffusion
b. Unrestricted diffusion
F. Magnetization transfer
II. Extrinsic Contrast Characteristics (User-selection Parameters for Image Contrast)
A. TR – repetition time
a. Time constant (time to repetition)
1. SE, FSE sequences
2. GRE, EPI sequence
3. IR sequences
b. Effects on image quality
1. T1 information on MR images
2. Scan time
3. SNR
4. Number of slice locations
B. Echo time (TE)
a. Time constant (time to echo)
1. For spin echo (SE)
2. For gradient echo (GrE)
b. Effects on image quality
1. T2 information on MR images
2. SNR
3. Number of slice locations
4. Susceptibility artifact
C. Inversion time (TI)
a. Time constant (time to inversion)
b. STIR
c. FLAIR
d. SPIR
e. Chemical suppression
1. Fat suppression
2. Water suppression
3. Silicone suppression
D. Flip angle
a. RF pulse
1. Duration of RF pulse
2. Power deposition
b. Effects on image quality
1. SNR (Ernst angle)
2. Image contrast (T1 information)
E. Imaging options for MR image contrast
a. PC-MRA
1. VENC
2. Flow direction
b. Diffusion imaging
1. Shots
2. b value
c. Flow imaging
1. Saturation pulses
2. Spatial presaturation
3. Spectral saturation
d. Gradient moment nulling (flowing vessels bright)
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III. MR Contrast Media
F. Types
a. Gadolinium
1. T1 (IV) agent (enhanced T1WI and MRA)
2. T2 (IV) agent (perfusion imaging)
b.
Manganese
1. T1 (IV) agent
2. Liver agent
c. Iron oxide
1. IV agent for liver
2. Oral agent for bowel imaging
G. Dosing for gadolinium
a. mmol/kg
b. cc/kg
H. Mechanism of action (gadolinium)
a. T1 shortening
b. T2 shortening
I. Effects on images
a. Bright on T1WI
b. Dark on T2WI
J. Safety characteristics
a. Few contraindications
b. Precautions
c. Nephrogenic systemic fibrosis (NSF)
IV. Pulse Sequences
A. Timing diagrams
a. RF pulse timing (image contrast manipulation)
1. TR
2. TE
3. TI
b. Physical gradients (associated with imaging planes)
1. Z – Slice selection
2. Y – Phase encoding
3. X – Frequency encoding
B. Pulse sequence configurations
a. Partial saturation
b. Spin echo
1. Single echo (90° to 180°)
2. Multiecho (90° to 180° to 180°)
c. Inversion recovery
1. Spin echo IR
2. FSE – IR
3. Double IR
4. Triple IR
5. Gradient echo – IR
d. IR sequence image contrast
1. STIR
2. FLAIR
3. SPAIR
e. Rapid acquisition recalled echo (RARE) or Fast spin-echo (FSE) or Turbo spin echo
1. Parameters
i. ETL or Turbo Factor
ii. Effective TE or TE
iii. Echo spacing
2. FSE types
i. Conventional FSE
ii. FSE-IR
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iii. Single shot FSE
iv. HASTE
f.
Gradient echo
1. Steady state – coherent gradient echo
2. Spoiled – incoherent gradient echo
3. Echo Planar Imaging (EPI)
V. Image Contrast Characteristics
K. T1-weighted image
a. For spin echo
1. Parameter selection (short TR/TE)
2. Image contrast characteristics (fat bright/water dark)
3. Generally acquired for anatomy
b. For gradient echo
1. Parameter selection (short TR/TE)
2. Image contrast characteristics (fat bright/water dark)
3. Generally acquired for rapid/dynamic imaging
4. In/out-of-phase imaging
c. Gradient echo (spoiled sequences for flow)
1. TOF-MRA
2. Dynamic contrast-enhanced MRA
L. T2-weighted image
a. For spin echo
1. Parameter selection (long TR/TE)
2. Image contrast characteristics (fat dark/water bright)
3. Generally acquired for pathology
b. For gradient echo
1. Parameter selection (short TR/TE)
2. Image contrast characteristics (fat bright/water dark)
3. Generally acquired for T2*
c. Gradient echo (steady state sequences for flow)
1. PC MRA – flow velocity and flow direction
2. Cine PC – dynamic cardiac and vascular imaging
d. Gradient echo (EPI sequences)
1. Diffusion – for stroke
2. Perfusion – for stroke and for tumors
3. BOLD – for brain function
M. PD-weighted image
a. For spin echo
1. Parameter selection (long TR/short TE)
2. Image contrast characteristics (fat bright/water bright)
3. Generally acquired for anatomy and pathology
b. For gradient echo
1. Parameter selection (short TR/TE)
2. Image contrast characteristics (fat bright/water bright)
VI. MR Image Formation
A. Gradients
a. Z
b. Y
c. X
B. Spatial localization
a. Slice selection
1. Sagittal
2. Axial
3. Coronal
4. Oblique
b. Slice thickness
1. Gradient amplitude (strength)
42
2. Transmit bandwidth
Phase encoding
1. FOV (gradient amplitude)
2. Matrix (phase encoding steps)
i. Sampling
ii. K-space filling
3. Scan time (phase matrix)
4. Resolution (pixel size)
d. Frequency encoding
1. FOV
2. Matrix
3. Readout gradient
i. Sampling
ii. Receiver bandwidth
4. Nyquist theorem
C. Gradient refocusing
a. Gradient echoes
b. Gradient moment nulling
c.
VII. Post-processing
A. Measurements
a. ROI
b. Distance
B. Reconstruction/reformatting
a. Multiplanar reconstruction (MPR)
b. 3-D reformats
c. Volume reconstruction (VR)
C. MRA reformats/reconstructions
a. Maximum intensity pixel (MIP)
b. Shaded surface display (SSD)
VIII. MR Imaging Parameter
A. Image contrast parameters
a. Extrinsic contrast parameters (user selectable parameters)
1. TR – repetition time
2. TE – echo time
3. TI – Inversion time
4. Flip angle
5. B value
6. Velocity encoding (VENC)
b. Intrinsic contrast parameters (determined by tissue characteristics)
1. T1 recovery time
2. T2 decay time
3. Proton/spin density
4. Physiologic motion
c. Extrinsic contrast influences (contrast media)
1. T1 agents
2. Gadolinium
3. Dose
4. Affects on images
5. Manganese
6. Dose
d. T2 agents
1. Gadolinium
2. Oral agent
B. Resolution parameters
a. Voxel size
1. FOV
2. Thickness
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3. Matrix
Affect on quality
1. SNR
2. Affect on resolution
3. Affect on scan time
c. Sampling parameters
1. Number of signals averaged (NSA)
2. Number of excitations (NEX)
3. Number of acquisition (NAQ)
d. Receiver bandwidth
1. Sampling time
2. FOV
3. TE
e. Number phase encodings (matrix)
1. Resolution
2. Scan time
f. Echo Train Length (―ETL‖)/turbo factor
1. Echo spacing
2. Effective TE
3. Number of shots
g. Slices in a 3-D (volume) acquisition
1. SNR
2. Scan time
h. Effect on quality
1. SNR
2. Effect on resolution
3. Effect on scan time
i. Dimensionality
1. 2-D
2. 3-D
3. Thickness / gap
4. Slice order
C. Scan Time
a. Spin Echo Scan time formula
1. TR
2. Phase Encoding Steps
3. Number of signals averaged (NSA), Number of excitations (NEX), Number of acquisition
(NAQ)
b. Fast Spin Echo/Turbo Spin Echo
1. TR
2. Phase Encoding Steps
3. Number of signals averaged (NSA), Number of excitations (NEX), Number of acquisition
(NAQ)
4. ETL or Turbo Factor
c. Volumetric Acquisition
1. TR
2. Phase Encoding Steps
3. Number of signals averaged (NSA), Number of excitations (NEX), Number of acquisition
(NAQ)
4. Number of Slices
b.
IX. Imaging Options
A. Saturation pulses
a. Spatial preset
b. Spectral saturation, chemical saturation (fat saturation)
B. Gradient moment nulling (flow comp)
C. Physiologic gating and triggering
a. Respiratory gating
b. Cardiac gating
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D. Magnetization transfer
E. Phase/frequency orientation
F. Bandwidth (receive)
a. Narrow
b. Wide
G. Signal suppression techniques
a. Fat suppression
1. Fat saturation (chemical sat)
2. SPIR
3. SPAIR
4. SPECIAL
5. STIR
b. Water suppression
c. Silicone suppression
H. In/out of phase
I. Antialiasing
X. Artifacts
A. Artifacts, cause, appearance and compensation
a. Physics artifacts
1. Chemical shift
2. Types
3. Cause
4. Compensation
b. Susceptibility
1. Metal
2. Tissues with dissimilar chemical compensation
c. Sampling artifacts
1. Aliasing
2. Cross-talk
d. Motion artifacts
1. Voluntary
2. Involuntary
e. Technical errors
1. Improper centering
2. Coil selection
f. Hardware artifacts
1. Corduroy
2. RF leak
XI. Functional MRI
A. Diffusion
a. Physiology of diffusion
1. Normal diffusion
2. Restricted diffusion
b. Pulse sequence
1. SS SE EPI
c. b-value
d. DWI Trace
e. ADC map
f. T2 shine through
g. Diffusion tensor
h. Clinical applications
B. Perfusion
a. Physiology of perfusion
1. normal perfusion
2. Hypoperfusion
3. Hyperperfusion
b. Pulse sequence
45
c.
d.
e.
f.
C. fMRI
a.
b.
c.
d.
e.
1. SS GE EPI
Perfusion techniques
1. T1 PWI
2. T2/T2* PWI
Intensity curve
1. Blood volumes
2. Transient time
3. Perfusion measurement
4. CBV map
Perfusion arterial spin tagging
Clinical applications
Concept
Magnetic properties of hemoglobin molecule
Blood Oxygenation Level Dependent (BOLD) technique
Pulse sequence
1. EPI
2. Fast GRE
Clinical applications
XII. Spectroscopy
A. Chemical shift
B. Metabolites
a. N-acetil aspartate (NAA)
b. Lactate (Lac)
c. Choline (Cho)
d. Creatinine (Cr)
e. Lipids (Lip)
f. Myo-insitol (Ins)
g. Glutamine (Glx)
C. Metabolites effect
D. Metabolites resonance
E. Hunter angle
F. MR spectroscopy physical principles
G. Clinical applications
XIII. Interventional MR
A. Advantages of interventional procedures under MRI
B. Interventional MRI units designs
C. Safety aspects
D. Clinical applications
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Sectional Anatomy
Course Description
This will coursework emphasize in studying the human anatomy as seen in multiple imaging planes. Structures from the
head, neck, spine, thorax, abdomen, pelvis, and musculoskeletal, will be covered.
Objectives
Upon completing the course, the student will be able to:
1.
2.
3.
4.
5.
6.
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Identify anatomical structures of the head as seen in multiple orthogonal planes on MR images.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of the head anatomy.
Distinguish normal anatomy from abnormal anatomy of the head.
Identify anatomical structures of the spine as seen in multiple orthogonal planes on MR images.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of the spine anatomy.
Distinguish normal anatomy from abnormal anatomy of the spine.
Identify anatomical structures of the face and neck as seen in multiple orthogonal planes on MR images.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of the face and neck anatomy.
Distinguish normal anatomy from abnormal anatomy of the face and neck.
Identify anatomical structures of the thorax as seen in multiple orthogonal planes on MR images.
Describe gross anatomic relationships of the thoracic structures.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the thorax.
Distinguish normal anatomy from abnormal anatomy of the thorax.
Identify anatomical structures of the heart as seen in multiple orthogonal planes on MR images.
Describe gross anatomic relationships of the heart.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the heart.
Distinguish normal anatomy from abnormal anatomy of the heart.
Identify anatomical structures of the abdomen as seen in multiple orthogonal planes on MR images.
Describe gross anatomic relationships of the abdominal structures.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the abdomen.
Distinguish normal anatomy from abnormal anatomy of the abdomen.
Identify anatomical structures of the male and female pelvis as seen in multiple orthogonal planes on MR images
Describe gross anatomic relationships of the pelvic structures.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the pelvis.
Distinguish normal anatomy from abnormal anatomy of the pelvis.
Identify anatomical structures of the skeletal system as seen in multiple orthogonal planes on MR images.
Describe gross anatomic relationships of the skeletal system.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the skeletal system.
Distinguish normal anatomy from abnormal anatomy of the skeletal system.
Identify anatomical structures of the muscular system as seen in multiple orthogonal planes on MR images.
Describe gross anatomic relationships of the muscles.
Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the muscular system.
Distinguish normal anatomy from abnormal anatomy of the muscular system.
Identify anatomical structures of the joints of the musculoskeletal system as seen in multiple orthogonal planes on MR
images.
35. Describe gross anatomic relationships of the joints of the musculoskeletal system.
36. Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy of the joints of the musculoskeletal
system.
37. Distinguish normal anatomy from abnormal anatomy of the joints of the musculoskeletal system.
Content
I. Head
A. Bones of the skull and cranium
a. Cranial cavity
b. Facial skeleton
c. Paranasal sinuses
d. Foramina of the skull
B. The brain
a. Nervous tissue and organization
47
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
1. White matter structures
2. Gray matter structures
Regions of the brain
1. Cerebrum to include hemispheres, lobes, fissures, sulci, etc.
2. Diencephalon to include epithalamus, thalamus, hypothalamus, etc.
3. Brainstem
Cranial nerves (I through XII)
Cerebellum to include hemispheres and peduncles
The ventricular system
1. Cerebrospinal fluid
2. Choroid plexus
3. Lateral ventricles
4. Third ventricle
5. Fourth ventricle
Meninges
1. Dura mater and major extensions
2. Arachnoid
3. Subarachnoid cisterns
4. Pia mater
Arterial blood supply
1. Anterior supply
2. Posterior supply
3. Circle of Willis
Venous drainage
1. Superficial drainage system
2. Dural sinuses
3. Internal jugular vein
The orbital cavity
1. Skeletal formation of the orbital cavity
2. Eyeball
3. Orbital muscles
4. Vascular supply
5. Optic nerve
Auditory canal
1. Temporal bone and bony structures
2. Vestibulocochlear nerve and course
Endocrine system –
1. Pituitary gland (Hypophysis)
2. Infundibulum
Pineal gland
II. Spine
A. Vertebral column
a. Sections
b. Curvatures
B. Typical vertebrae components
a. Cervical vertebrae components
b. Thoracic vertebrae components
c. Lumbar vertebrae components
C. Sacrum
D. Coccyx
E. Intervertebral discs
a. Nucleus pulposus
b. Annulus fibrosus
F. Spinal cord
a. White matter
b. Gray matter
G. Spinal plexus
a. Cervical
48
b.
c.
d.
Brachial
Lumbar
Sacral
III. Soft Tissue Neck
A. Tissue organization
a. Suprahyoid
b. Infrahyoid
B. Pharynx
a. Nasopharynx
b. Oropharynx
c. Palatine tonsils
d. Hypopharynx
C. Larynx (distinguishing between true and false cords)
D. Esophagus
E. Trachea
F. Thyroid gland
G. Salivary glands
H. Vascular supply
I. Musculature of the neck
a. Muscles of mastication
b. Anterior triangle
c. Posterior triangle
IV. Thorax
A. Skeletal anatomy of the thorax
a. Sternum
b. Thoracic vertebrae
c. Ribs
B. Thoracic cavity
a. Lungs
b. Mediastinum
C. Heart
a. Superficial features of the heart
b. Chambers and valves
c. Vascular supply and drainage
1. Coronary arteries
2. Cardiac veins
D. The great vessels of the heart
a. Aorta
1. Ascending aorta
2. Arch
3. Descending aorta
b. Pulmonary trunk
c. Superior vena cava
d. Inferior vena cava
E. Associated thoracic structures
a. Thymus
b. Trachea and bronchi
c. Esophagus
d. Azygos veins
F. Breast
a. General structure
b. Hormonal participation
G. Lymphatic system
V. Abdomen
A. Abdominal regions
B. Diaphragm
49
C.
D.
E.
F.
G.
H.
a. Structure
b. Openings
Abdominal musculature
a. Anterolateral muscles
b. Posterior muscles
Abdominal peritoneum
a. Mesentery
b. Peritoneal elements
Abdominal vasculature
a. Abdominal aorta
b. Branches
Venous drainage of the abdomen
a. Inferior vena cava
b. Major veins connecting to inferior vena cava (IVC)
Hepatic portal system
a. Portal vein
b. Veins connecting to portal system
Abdominal viscera
a. Liver
1. Lobes
2. Vasculature
b. Gallbladder
c. Esophagus
d. Stomach
1. Vasculature
2. Divisions
e. Small intestine
f. Large intestine
g. Spleen
h. Pancreas
1. Vascular landmarks
2. Divisions
3. Blood supply
i. Kidneys
1. Blood supply
2. Structure
j. Suprarenal gland
1. Blood supply
2. Composition
VI. Pelvis
A. Pelvic cavity
B. Bony pelvis
a. Sacrum
b. Coccyx
c. Os Coxae
d. Pubis
e. Ischium
f. Ilium
g. Acetabulum
C. Pelvic musculature
a. Wall of the false pelvis
b. Pelvic floor
c. Wall of the true pelvis
D. Vasculature
a. Common iliac arteries
b. Common iliac veins
E. Innervation
F. Pelvic viscera
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a. Gastrointestinal organs
b. Urinary organs
G. Viscera of female pelvis
a. Peritoneal folds
b. Ligaments
c. Ovaries
d. Uterus
1. Body
2. Fundus
3. Uterine wall
4. Perimetrium
5. Ligamentous attachments
e. Uterine tubes
f. Cervix
g. Vagina
h. Maternal and fetal
H. Viscera of the male pelvis
a. Scrotum
b. Ductus deferens
c. Spermatic cord
d. Cremaster muscle
e. Seminal vesicles
f. Prostate
g. Penis
VII. Musculoskeletal
A. Shoulder joint
a. Bony components
b. Ligaments
c. Musculature
d. Bursae
B. Upper arm (brachium)
a. Bony components
b. Muscular components
c. Vasculature
d. Innervation
C. Elbow joint
a. Bony components
b. Articulations
c. Ligaments
d. Musculature
e. Vasculature
f. Innervation
D. Forearm
a. Bony components
b. Muscular components
c. Vasculature
d. Innervation
E. Wrist
a. Bony compartments
b. Ligamentous components
c. Tendinous components
d. Vasculature
e. Innervation
F. Hand
a. Bony components
b. Muscular components
c. Vasculature
d. Innervation
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G. Hip joint
a. Bony components
b. Ligamentous components
c. Muscular components
d. Vascular components
e. Innervation
H. The thigh
a. Bony components
b. Muscular components
c. Vasculature
d. Innervation
I. The knee
a. Bony components
b. Ligamentous components
c. Menisci
d. Muscular components
e. Neurovascular components
J. The leg
a. Bony components
b. Muscular components
c. Anterior compartment
d. Posterior compartment
e. Superficial
f. Deep
g. Lateral compartment
h. Vasculature
i. Innervation
K. The ankle
a. Bony components
b. Ligamentous components
c. Musculotendinous components
d. Neurovascular components
L. The foot
a. Bony components
b. Muscular components
c. Dorsal
d. Plantar
e. Innervation
f. Vasculature
MR Procedures
Course Description
This course familiarizes the student with the common pathologies of the head, neck, spine, thorax, abdomen, pelvis, and
musculoskeletal found in magnetic resonance imaging and the appearance of these pathologies in various MR imaging
protocols. The course content is inclusive of all commonly-imaged body systems and areas.
This course content provides the student with imaging techniques related to the head, neck, spine, thorax, abdomen,
pelvis, and musculoskeletal. The content covers specific clinical application, coils and protocol selection based on
procedure indications, and positioning criteria. Anatomical structures and the plane that best demonstrates anatomy are
discussed as well as signal characteristics of normal and abnormal structures.
Objectives
Upon completing the clinical education, students will be able to:
1.
2.
3.
4.
State pathologies that commonly require an MR study.
Display understanding of the signal characteristics displayed by abnormal tissues during various pulse sequences
and imaging modes in illustrating pathological processes.
Recognize changes in anatomical sizes and shapes of structures that can indicate pathology.
Describe basic pathological processes demonstrated by MR.
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5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Identify the nature and courses of the pathologies listed in the course outline.
Describe the effect of contrast agents on visualizing pathology.
State the coils available for MR and their specific application.
Describe considerations in designing an imaging protocol and state the application of protocols in specific
situations.
Demonstrate proper patient screening.
Demonstrate knowledge of scanning menus, archival procedures and display functions.
Demonstrate proper windowing levels and widths.
Demonstrate proper use of MR-safe monitoring devices.
Demonstrate how to prepare contrast materials and use MR injectors.
State positioning criteria for different areas of the body.
State advantages and disadvantages of axial, sagittal, coronal and oblique images (i.e., what structures are best
demonstrated).
Describe common pulse sequences used to evaluate the different areas of the body.
State tissue signal characteristics of anatomical structures with and without contrast.
Explain the use of contrast media in evaluating pathology.
Describe common artifacts that occur during imaging.
Describe the differences between adult and pediatric pulse sequences in MR.
Describe the differences in tissue signal characteristics between adult and pediatric examinations.
Describe the criteria for imaging windows for different areas of the body.
Describe the MR characteristics of blood as seen on arterial and venous magnetic resonance angiography (MRA).
Identify how field strength affects the ability to visualize select pathology.
Describe the MR tissue characteristics of select pathological processes.
Discuss saturation pulses, which help to identify arteries and veins.
Evaluate images for appropriate positioning, anatomy, pulse sequences and overall quality.
Identify the common indications and common pathology for the central nervous system, soft tissue structures of the
head and face, orbit, nasopharynx, oropharynx, neck, and spine, the abdomen, the musculoskeletal system, the soft
tissue pelvis that includes the male and female reproductive systems, the chest, the heart, mediastinum, the brachial
plexus and breast exams.
Demonstrate effective communication skills with patients, their family members and staff.
Demonstrate MR safety and protective practices associated with MR examinations.
Prerequisites
1. MR Sectional Anatomy
Content
I. Brain
A. Neoplastic disorders
B. Infections and inflammatory disorders
C. Vascular disorders
D. Congenital and hereditary disorders
E. White matter disorders
F. Trauma
II. Spine and spinal cord
A. Tumor disorders
C. Inflammatory disorders
D. Vascular disorders
D. Trauma
E. Degenerative spine
III. Head and Neck
A. Eye and orbital contents
B. Sinuses, pharynx (nasal and oral), and larynx
C. Temporal bone and TMJ
D. Neck
E. Brachial Plexus
53
IV. Thorax
A. Mediastinum
B. Chest wall
C. Respiratory system
D. Cardiac and aorta
E. Breast
V. Abdomen
A. Liver
B. Pancreas
C. Kidneys
D. Adrenals
E. Spleen and lymphatics
F. Gastrointestinal (GI) tract
G. Vascular disorders
VI. Pelvis
A. Female reproductive organs (uterus, ovaries, vagina and associated structures)
a. Neoplastic disorders
b. Inflammatory disorders
c. Endometriosis
d. Ovarian cysts
e. Other
B. Male reproductive organs (prostate, seminal vesicles and associated structures)
a. Neoplastic disorders
b. Inflammatory disorders
c. Other
C. Bladder
a. Neoplastic disorders
b. Inflammatory disorders
VII. Musculoskeletal
A. Skeletal system
a. Traumatic injury
b. Bone fracture union
c. Bone neoplasms and tumor-like lesions
d. Inflammatory disorders
B. Soft tissues
a. Neoplastic disorders
b. Inflammatory disorders
C. Joints
a. Fibrocartilage disorders
b. Ligament and tendon tears
c. Inflammatory disorders
d. Meniscal disorders
VII. Imaging Considerations
A. Coil types
B. Pulse sequences
C. Parameters (phase/frequency direction)
D. Flow and motion effects
E. Motion reduction techniques
F. Contrast agents
G. Artifacts
VIII. Imaging Planes
A. Positioning criteria
B. Axial, sagittal, coronal
a. Movement and direction
54
1. Inferior – superior
2. Left – right
3. Posterior – anterior
4. Oblique
C. Anatomy best demonstrated
D. Slice thickness
IX. Signal Characteristics
A. Proton density vs. T1-weighted vs. T2-weighted of normal anatomy
B. Spin-echo vs. gradient-echo
C. With and without contrast agents
X. General Considerations
A. Evaluation of MR orders
a. Patient identification
b. Verification of procedure(s) ordered
c. Establishes patient repport
1. Explains procedure
2. Proper screening of patient
3. Patient preparation
4. Room preparation
5. Patient assistance
6. Patient monitoring
7. Exam evaluation
8. Patient dismissal
XI. Considerations for Routine MR Procedures
A. Patient instructions
B. Patient positioning
C. Part placement
D. Earplugs or earphones
E. Coil selection
F. Localization
G. Special considerations
a. Atypical conditions
b. Anesthesia considerations
c. Ancillary staff considerations
d. Special needs patients
e. Trauma
XII. Positioning and Procedural Considerations for Specific Studies
A. MR/MRA of the central nervous system
a. Clinical indications
1. Vascular disease
2. Trauma
3. Neoplasia
4. Inflammation
5. Anomalies
b. Anatomic locations
1. Brain
2. Spine and spinal cord
XIII. Procedural Considerations for Contrast Studies
A. Equipment and materials needed
B. Contrast media
C. Purpose
D. Types
XIV. Procedural Considerations for Special Studies
55
XV. Patient Education
A. Communication
B. Types
C. Barriers
a. Methods for overcoming barriers
D. Clinical situations
E. Common MR safety issues and concerns
Clinical Education
Description
This class goal is to train the students to become problem solvers and technically capable of handling and resolving
situations of suitable patient care, environmental and department safety, effective communication, and professional and
ethical behavior. Content is presented as a progression in competency levels through clinical performance objectives
and competency exams. Students will be trained in, patient position, coil selection, image plane selection, slice position,
motion suppression techniques, and contrast administration. In the curse of this class the students will be under direct
supervision of an MRI registered technologist at all times.
Prerequisites
1. MR Fundamentals
2. Current CPR/BLS certification.
Objectives
Upon completion of the clinical education, the student will:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Maintain a safe work environment for patients, visitors and health care workers.
Properly schedule and prescreen patients.
Communicate professionally with patients and staff members.
Use standard protocols to perform routine MR examinations.
Use Digital Imaging and Communications in Medicine (DICOM).
Identify when to modify a protocol and successfully perform the modification.
Identify the probable cause of image quality problems and recommend an appropriate solution.
Perform and monitor quality assurance tests.
Power up and shut down the system.
Correlate the requested exam with clinical history and reported physical exam.
Ensure patient safety by correlating surgical, accident and occupational history.
Properly screen patients for contraindications to MR.
Monitor the patient to ensure proper attire and that no unauthorized metals enter the exam room.
Maintain a clean, comfortable and safe environment.
Employ proper precautions to prevent disease transmission.
Monitor linens and supplies and restock when necessary.
Demonstrate how to properly prepare a patient for the requested exam.
Demonstrate the actions required if a patient requires sedation.
Demonstrate the actions required if a patient requires contrast media.
Demonstrate the actions required for allergic reactions.
Demonstrate the actions required if a patient is claustrophobic.
Demonstrate how to use earplugs or headphones to protect patient.
Ensure proper setup of MR coils, equipment, table accessories and cushioning.
Demonstrate an understanding of a patient’s cultural, ethnic or value system differences.
Speak with patients in a professional and empathetic manner to alleviate any concerns they express.
Demonstrate professional ethics by preserving the patient's modesty.
Demonstrate how to give proper instructions to optimize patient comfort and cooperation.
Respond appropriately in emergency situations.
Recognize patient adverse reactions during MR procedures to contrast administration and act appropriately.
Identify and report equipment problems.
56
31. Adhere to national, organizational and departmental standards, protocols, policies and procedures regarding
MR exams and patient care.
32. Ensure that professional performance and competence is reflected throughout an exam.
33. Critique images for appropriate clinical information, image quality and patient information.
34. Demonstrate the appropriate corrective actions to improve inadequate image information.
35. Consistently maintain patient confidentiality standards.
36. Perform safe, ethical and legal practices.
Content
I. Clinical Practice
A. Code of ethics/professional behavior
a. Scope of practice
b. Incident reporting mechanisms
c. Standards for supervision
B. Professional communication
a. Patient
b. Patient’s family and friends
c. Health care team
C. Role of health care team members
a. Technical
b. Professional
c. Patient’s Bill of Rights
D. Scheduling and sequencing exams
II. Procedural Performance
A. Order/requisition evaluation and measures
B. Facilities setup
C. Patient assessment, education and care
a. Patient monitoring – emergent and nonemergent
b. Temperature
c. Pulse
d. Respiration
e. Blood pressure
f. Normal values
g. Interfering factors
h. Terminology
i. Adult vs. pediatric
j. Documentation
k. Pain assessment
l. Body type
D. Acquiring and recording vital signs
a. Procedures
b. Demonstration
E. Review of laboratory data
a. Blood urea nitrogen (BUN)
b. Creatinine
c. Hemoglobin
d. Red blood cells (RBCs)
e. Platelets
f. Oxygen (O2) saturation
g. Prothrombin
h. Part thromboplastin time
i. Glomerular filtration rate calculation (GFR)
F. Patient chart
a. Aspects of patient chart
b. Retrieving specific information
c. Proper documentation in the chart
III. Infection Control
57
A. Terminology
a. Nosocomial
b. Communicable
c. Infectious pathogens
d. Human immunodeficiency virus (HIV)
e. Hepatitis
B. Centers for Disease Control and Prevention (CDC)
a. Purpose
b. Publications and bulletins
C. Cycle of infection
a. Infectious pathogens – blood-borne and airborne
b. Reservoir of infection
D. Preventing disease transmission
a. Transmission-based precautions
b. Health care worker
E. Asepsis
a. Medical
b. Surgical
F. Environmental asepsis
a. Handling linens
b. Wound care
c. Techniques (Dress, Hair, Hand washing, Gloves, Eye protection, Cleaning and proper disposal of
contaminated waste)
d. Practice
G. Isolation techniques and communicable diseases
a. Category-specific
b. Disease-specific
c. Standard precautions
d. Examples
H. Isolation patient in the imaging department
a. Procedure
b. Patient transfer
c. Cleaning and proper disposal of contaminated waste
d. Cleaning of imaging equipment
I. Precautions for compromised patient (reverse isolation)
a. Purpose
b. Procedure
J. Psychological considerations
IV. Medical Emergencies
A. Terminology
B. Emergency equipment
C. Latex reactions
D. Shock
a. Signs and symptoms
b. Types
c. Medical intervention
E. Diabetic emergencies – signs, symptoms and interventions
a. Hypoglycemia
b. Ketoacidosis
c. Hyperosmolar coma
F. Respiratory and cardiac failure – signs, symptoms and interventions
a. Adult vs. pediatric
b. Equipment
G. Airway obstruction – signs, symptoms and interventions
H. Cerebral vascular accident (stroke) – signs, symptoms and interventions
I. Fainting and convulsive seizures, signs, symptoms and interventions
a. Nonconvulsive (petit mal)
58
J.
K.
L.
M.
N.
O.
P.
b. Convulsive (grand mal)
c. Reasons for fainting
Other medical conditions
a. Epistaxis
b. Nausea
c. Postural hypotension
d. Vertigo
e. Asthma
f. Psychiatric
Unique situations and trauma
a. Head injuries
b. Four levels of consciousness
c. Symptoms
d. Medical intervention
e. Adult vs. pediatric
Spinal injuries
a. Assessment
b. Symptoms
c. Medical intervention
d. Transportation
Extremity fractures
a. Types
b. Symptoms
c. Splints
d. Casts
e. Positioning
f. Adult vs. pediatric
Wounds
a. Symptoms
b. Medical intervention
Burns
a. Burn classifications
b. Medical intervention
Reactions to contrast agents
a. Signs and symptoms of mild, moderate and severe contrast reactions
b. Medical interventions for each type of reaction
c. Vasovagal reactions
V. Contrast Studies
A. Patient education
a. Technologist’s responsibility
b. Standard procedure
B. Preparation for examination
a. Diet
b. Bowel preparation
c. Care during the procedure
d. Follow-up care
C. Monitoring and care during invasive procedures
a. Preparation for MR-conditional cardiac monitoring
b. Electrocardiogram (ECG) rhythms
c. Patient care considerations
VI. Tubes, Catheters, Lines and Collection Devices
A. Terminology
B. Function of devices
C. Nasogastric/nasointestinal
D. IVs, butterflies, angiography catheters and power injectors
E. Suction
a. Adult vs. pediatric
59
F.
G.
H.
I.
J.
K.
L.
b. Special precautions
Tracheostomy
a. Suction techniques
b. CPR with tracheostomy
Chest (thoracostomy) tube
a. Purpose
b. Location
Central venous lines
a. Purpose
b. Types
Tissue drains
Oxygen administration using MR-conditional equipment
a. Values
b. Oxygen therapy
c. Oxygen delivery systems
d. Documentation
e. Special precautions
Urinary collection
a. Procedure
b. Alternative methods of urinary drainage
c. Documentation
Other
a. Ileostomy
b. Ureteroileostomy
VII. Imaging
A. Positioning
a. Body mechanics
b. Exam coils
c. Positioning accessories
B. Technical considerations
a. Protocols
b. Variations
C. Image processing
a. Display functions
b. Archival
D. Image analysis
a. Window levels and widths
b. Formats
c. Parameters
d. Artifacts
e. Region of interest
E. Patient/personnel protection (Screening)
a. Metallic objects
b. Implants/pacemakers
c. Sickle cell disease
d. Renal disease
e. Asthma
f. Pregnancy
g. Breast feeding
h. Dialysis
i. Claustrophobia
F. Equipment/accessories (Screening)
a. Coils
b. Call button
c. Earplugs/ headphones
d. MR-conditional
e. ECG leads
f. Oxygen/tanks
60
g. IV pumps
h. Anesthesia equipment
i. Pulse oximeters
j. Blood pressure cuffs
k. Suction
l. Monitors
G. Medical/artifact error reduction
a. Gauss lines
b. Radio frequency (RF) shielding/magnetic shielding
c. Warning alarms/signs
d. Biological considerations
H. Specific absorption rate (SAR)
I. Biological effects
J. FDA guidelines
K. Static and gradient fields
VIII. Competency (Mandatory, Elective)
A. Head and neck
a. Brain
b. IAC
c. Pituitary
d. Pineal
e. Brain attack
f. Stroke
g. Head MRA
h. Obits, Face, and Neck
i. Neck MRA
B. Spine and Plexuses
a. Cervical
b. Thoracic
c. Lumbar
d. Sacrum/coccyx
e. Cervical Plexus
f. Brachial Plexus
g. Lumbar Plexus
h. Sacral Plexus
i. Spine MRA
C. Thorax
a. Lungs
b. Mediastinum
c. Heart
d. Great Blood Vessels
e. Breast
D. Abdomen
a. Liver
b. Spleen
c. Pancreas
d. Gall Bladder
e. Supra Renal
f. Kidneys
g. MRCP
h. Abdominal MRA
E. Pelvis
a. Bladder
b. Rectum
c. Ovary
d. Uterus
e. Vagina
f. Próstata
61
g. Testes
h. Angiography (iliac and run-off)
F. Musculoskeletal
a. TMJ
b. Shoulder
c. Elbow
d. Wrist
e. Hand
f. Hip
g. Knee
h. Ankle
i. Foot
j. Arthrography
k. Long Bones
l. Soft Tissue
G. Special imaging procedures
a. Interventional MRI
b. Perfusion
c. Diffusion
d. Spectroscopy
e. Functional Brain MRI
H. Quality control
a. Signal to Noise
b. Center Frequency
c. Spatial Resolution
d. Contrast Resolution
e. Transmit Gain
f. Geometric Accuracy
g. Equipment Inspection (e.g., coils, cables, and door seals)
MR Registry Review
Description
This course content is target to prepare students to pass the MRI boards. The course provides the student with a deep
review of all topics cover during the program. Mock exams will be performed. The mock exams also provide
immediate feedback, explanations and references as to why a selected answer was correct or incorrect. Mock exam
questions are in a variety of formats to enhance the learning experience and to avoid the memorization of
questions/answers. In addition, the students will present to the class and instructor real MRI cases. Students must
critique and evaluate the MRI cases based on techniques, patient positioning, parameter and protocol selection, artifacts
and their compensation, anatomy and pathology.
Prerequisites
1. MR Fundamentals
2. MR Image Formation
3. MR Sectional Anatomy
4. MR Pathology & Procedures
5. MR Clinical Education
Objectives
Upon completing the clinical education, students will be able to:
1. List the central components of an MRI imager.
2. Define key concepts such as nuclear magnetism, Larmor equation, precession, gyromagnetic ratio, etc
3. Examine various MRI pulse sequences
4. Apply MRI protocols and imaging techniques for different body parts.
5. Summarize the main safety concerns pertaining to MRI.
6. Integrate technical and practical considerations for patient care, assessment, monitoring and management.
7. Review sectional anatomy of the human body
8. Summarize the most common pathologies seen under MRI procedures
9. Develop student critical thinking
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