Association of Educators in Imaging and Radiologic Sciences, Inc. - Resources

Magnetic Resonance Imaging Curriculum Guide

THE SECTION FOR MAGNETIC RESONANCE TECHNOLOGISTS OF

THE SOCIETY OF MAGNETIC RESONANCE

AND

THE ASSOCIATION OF EDUCATORS IN RADIOLOGICAL SCIENCES

JOINT CURRICULUM COMMITTEE

1998

This document is available on the following web sites:

Hard copy may also be purchased

Section for Magnetic Resonance Technologists (SMRT)

Robert Goldstein, Education Coordinator

2118 Milvia Street

Suite 201

Berkeley, California 94704

phone 1-510-841-2340

Association of Educators in Radiological Sciences (AERS)

820 Jorie Boulevard

Sudbury, Illinois 60523

phone 1-708-571-9183

fax 1-708-571-7837

email aers@att.net

FORWARD

The following sample MRI curriculum is the product of a joint committee of the Association of Educators in Radiological Sciences (AERS) and the Section for Magnetic Resonance Technologists (SMRT). This curriculum is intended as a guideline for the education of MRI technologists. This document is intended to provide a framework for the body of knowledge with which a technologist, working in the field of MRI, should be familiar. The curriculum is thought to encompass all topics pertinent to a thorough understanding of the modality. It is understood, however, that individual educational programs will differ somewhat in the exact depth and breadth to which each topic area is presented. The committee welcomes input from all areas of the technical community. We encourage comment on the suggested curriculum; please send your suggestions to the committee at the following address:

Joan Quets, M.S., R.T.(R), (CT) (MR)

Program in Radiologic Technology

University of Iowa Hospitals and Clinics

200 Hawkins Drive - C 725 GH

Iowa City, IA 52242-1077

1-319-356-4334

e-mail joan-quets@uiowa.edu

AERS/SMRT Committee Members Kelly Baron Alliance Imaging Inc, Anaheim CA

Heidi Berns University of Iowa Hospitals and Clinics, Iowa City, IA

Luann Culbreth Baylor University Medical Center, Dallas,TX

Carolyn Roth University of Pennsylvania Medical Center, Philadelphia, PA

Joan Quets University of Iowa Hospitals and Clinics, Iowa City, IA

Loren Sachs Daniel Freeman Hospitals, Inglewood, CA

Table of Contents

Forward

Introduction to Magnetic Resonance Imaging

Physical Principles of Magnetic Resonance Imaging

Imaging Procedures

Magnetic Resonance Imaging Pathology

Sectional Anatomy

Clinical Education

Clinical Performance Objectives
Example Entry Level & Level 1

Level 2

Level 3

Level 4

Clinical Competency Testing Reference Guide

INTRODUCTION TO MAGNETIC RESONANCE IMAGING

Course Description

This unit will provide the student with an overview of magnetic resonance imaging. Program policies and student responsibilities will be outlined. The fundamental principles of MRI, equipment and terminology will be introduced. The role of the technologist in maintaining patient safety and comfort will be discussed as well as personal safety and safety of coworkers. MR contrast agents and venipuncture will be studied. A brief introduction about imaging parameters and the clinical application of MRI is included.

Course Rationale

This introduction will provide basic knowledge of terminology, imaging parameters, safety, patient preparation and monitoring of the patient in MRI. This information will enable the student to better communicate with the MR imaging staff and to ensure the safety of the patient and coworkers during the observation in the clinical setting.

Prerequisites

1. Medical Terminology - course in terminology used in the medical profession.

2. Patient Care - elements of methods, equipment, psychology, communication and rationale of patient care techniques.

3. Darkroom Procedures - familiarity with the processing of film used in MRI. This may include the use of laser imagers and automatic processors.

Course Objectives

Upon completion of the course, the students will be able to:

1. Use MRI terminology correctly.

2. Demonstrate maintenance of a safe work environment.

3. Demonstrate proper screening and preparation of patients for MRI.

4. Monitor patients during procedures.

5. Briefly explain how an image is produced.

Content Outline

I. Basic terminology related to image formation

A. Components of the MR system

B. Magnetic fields

C. Precession

D. Resonance

E. Repetition time

F. Echo time

G. Gradient coils, radiofrequency coils

H. Signal averages

II. Basic patient and personnel safety A. Magnetic fields 1. Bioeffects

2. FDA regulations

3. SMR safety committee regulations

4. Time varying

5. Gradient

6. Static

7. Fringe

B. Specific absorption rate (SAR) 1. Factors that affect amount of heat produced

2. SAR limits

3. Biological considerations

C. Induction of electrical currents

D. Maximum permissible field strengths

1. Time varying

2. Static

3. Gradient

E. Contraindications to patient scanning

F. Electronic instruments

1. Specific objects of concern a. Pacemakers

b. Pumps

c. Monitors and other electronic equipment

G. In vivo items of concern for deflection 1. Aneurysm and hemostatic clips

2. Cochlear implants

3. Vascular access ports

4. Shrapnel

5. Intraocular ferrous foreign bodies

6. Miscellaneous items

H. Indications for plain film radiography 1. Intraocular foreign bodies

2. Shrapnel

3. Miscellaneous items

I. Projectiles

1. Relationship of distance to speed of projectile

2. Specific objects of danger

a. Oxygen tanks, carts, wheelchairs

b. Scissors, hemostats

c. Writing pens

d. Others

3. Responsibilities of technologists J. Emergencies in the scanning area 1. Code Blue

2. Fire Emergency

3. Cryogen Emergency

4. Metallic items pinned to the magnet

5. Quench

K. Guidelines for safety 1. Non-imaging personnel

2. Technologists and other personnel

a. Pregnancy 3. Patients a. Surface coils and electrical cables

b. Pregnancy

III. Patient preparation and monitoring A. Gaining patient's confidence and assuring safety 1. Acoustic damage

2. Earplugs/headphones

B. Techniques to reduce anxiety 1. Claustrophobia techniques C. Information included in explanation

D. Patient history

1. Occupational

2. Medical

E. Contraindications to scanning

F. Monitoring of patients

1. Routine

2. Sedated or compromised patients

G. Use of monitoring and life sustaining equipment 1. Pulse oximeter

2. Suction

H. Venipuncture 1. Common veins for administration

2. Equipment and pharmaceuticals used in department

a. Gd-based contrast

b. Sedations

(1) Adult

(2) Pediatric

3. Allergy history a. Reactions and their treatment 4. Selection and preparation of site

5. Insertion of needle

6. Injection

a. Power injectors 7. Extravasation a. Treatment I. Contrast Enhancement 1. Gd-based contrast a. Side effects and precautions

b. Dose

c. Effects

(1) Relaxation times and relaxivity

(2) Anatomy most susceptible

(3) Peak opacification time

(4) Magnetic susceptibility and signal intensity

2. Other agents a. Perfluorocarbon

b. Barium

IV. Brief overview of imaging parameters A. Imaging planes

B. T1-weighted

C. T2-weighted

D. Proton density-weighted

E. Motion reduction

F. Rapid imaging

V. Brief overview of clinical applications of MRI A. Information gained on sequences stated above

B. Basic positioning guidelines

PHYSICAL PRINCIPLES OF MAGNETIC RESONANCE IMAGING

Course Description

This unit is designed to provide the student with a comprehensive overview of MR imaging. The subjects are formatted in individual outlines and can be sequenced according to level of knowledge desired. Topics include Instrumentation, Magnetism, NMR Signal Production, Tissue Characteristics, Spatial Localization, Pulse Sequencing, Imaging Parameters/Options, Special Applications, Safety, and Quality Assurance.

Course Rationale

This course is required to develop an understanding of MR image acquisition and the hardware used in the acquisition of images. The course provides information in the use and manipulation of the hardware and technical parameters used in the generation of images. Included are a review of safety and special applications such as advanced imaging techniques. This information is useful to enable the student to maximize MR image quality by understanding the fundamentals of MR imaging.

Prerequisites

1. Medical Terminology - course in terminology used in the medical profession.

2. Patient Care - elements of methods, equipment, psychology, communication and rationale of patient care techniques.

3. Introduction to MRI - overview of imaging parameters and terminology, safety, and patient care procedures.

4. Digital Image Acquisition and Processing - course in the fundamentals of digital imaging systems.

Course Objectives

Upon completion of the course, the students will be able to:

1. Describe the components of the MR system hardware.

2. Discuss magnetism with reasonable comfort and ability to use the subject material.

3. Explain the mechanism by which MR signal is produced and detected.

4. Explain MR tissues characteristics such as spin density, T1 and T2 relaxation.

5. Conceptualize and explain spatial localization and MR image formation.

6. Apply the principle of pulse sequences for appropriate clinical application.

7. Describe and apply the imaging parameters & options available to the user for optimal MR imaging.

8. Discuss and apply special applications of MR such as contrast agents, magnetic resonance angiography (MRA), magnetization transfer imaging (MTI), spectroscopy, maximum intensity projection (MIP), Cine, and perfusion /diffusion imaging.

9. Distinguish between absolute contraindications, severe adversities, mild reactions and relative contraindications for MR imaging.

10. Maintain high quality MR images via routine quality control practices.

Content Outline

I. Instrumentation

A. Magnet hardware 1. Permanent magnets

2. Resistive magnets

3. Superconducting magnets

a. Cryogens

b. Quench

4. Shim systems a. Passive systems

b. Active systems

c. Field homogeneity (ppm)

B. Magnetic field strength 1. Tesla

2. Gauss

3. Magnetic field shielding (passive/active)

C. Radiofrequency hardware 1. Transmit & receive coils

2. Coil configuration

3. Transmit and receive bandwidth

4. Coil tuning

5. Pulse profile

6. RF shielding

D. Gradient hardware 1. Coil configuration

2. Amplitude

a. Gradient strength (MT/M or g/cm) 3. Rise time a. Slew rate/duty cycle E. Computer components 1. Storage capacity

2. Speed

3. Operators console

F. Site planning 1. ACR Guidelines for site accreditation

2. Shielding

3. Mobile

II. Magnetism A. Fundamentals 1. Magnetic susceptibility

2. Magnetic properties of matter

a. diamagnetic

b. paramagnetic

c. ferromagnetic

B. Electromagnetism 1. Faraday's Law

2. Solenoid

3. Right hand thumb rule

C. Nuclear Magnetism 1. Quantum description

2. Classical description

3. Nuclei in a magnetic field

a. MR active nuclei

b. magnetic moment

c. reference frames

(1) laboratory frame

(2) rotating frame

d. energy states III. NMR Signal Production A. Net magnetization 1. Vectors

2. Longitudinal magnetization

3. Transverse magnetization

B. Larmor frequency 1. Precession

2. Gyromagnetic ratio

3. Resonance

4. Flip angle

A. Free induction decay 1. Fourier transformation IV. Tissue Characteristics A. Longitudinal regrowth 1. T1 Relaxation

2. Spin-lattice interaction

B. Transverse Decay 1. T2 relaxation

2. Spin-spin interaction

3. T2*

C. Spin density

D. Flow and motion

E. Diffusion

F. Magnetization transfer

V. Spatial Localization A. Gradient functions for image formation

B. Slice selective excitation

C. Phase encoding

D. Frequency encoding/readout

E. K-space

VI. Pulse Sequencing A. Spin echo 1. TR

2. TE

B. Inversion recovery 1. TI

2. TR

3. TE

C. Gradient recalled echo 1. Flip angle

2. TR

3. TE

D. Rapid acquisition recalled echo or fast spin echo 1. Echo train length (ETL)

2. Effective TE

E. Echo planar 1. Number of shots

2. Echo spacing

VII. Imaging Parameters/Options

A. TR/TE/TI

B. FOV

1. Regular

2. Irregular

C. Matrix

D. Number of signal averages (NSA)

E. Phase/Frequency orientation

F. Bandwidth

G. Slice thickness/order/gap

H. Dimensionality (2D vs. 3D)

I. Saturation pulses

1. spatial presaturation

2. chemical saturation

J. Gradient moment nulling

K. Fat suppression techniques

1. chemical saturation

2. Short Tau Inversion Recovery (STIR)

L. Physiologic gating & triggering 1. respiratory gating

2. cardiac gating

M. Cine N. Half-Fourier

VIII. Special Applications

A. Contrast agents 1. Types

2. Dosing

3. Mechanism

4. Effects on image

B. Magnetic resonance angiography (MRA) 1. Flow characteristics

2. Time of flight

3. Phase contrast

4. Maximum Intensity projection C. Magnetization transfer imaging

D. Spectroscopy

E. Diffusion

F. BOLD

G. Perfusion

IX. MR Safety A. Screening 1. Patients

2. Personnel

3. Equipment

B. Precautions 1. Environmental considerations

2. Placement of electrical conductors

3. Emergency procedures

C. Biological considerations 1. RF

2. Static

3. Gradient

X. Quality Assurance A. Artifacts 1. Cause & appearance

2. Compensation

B. Quality Control 1. Operator-adjustable parameters

2. Electronic measurements

3. NMR measurement

4. Archival QA

5. QA of display and multiformat cameras

6. Record keeping

7. PM

IMAGING PROCEDURES

Course Description

This course will provide the student with imaging techniques related to the CNS, neck, thorax, musculoskeletal system and abdominopelvic regions. Specific clinical application, coils that are available and their use, considerations in the scan sequences, specific choices in the protocols (ie: slice thickness, phase direction, flow compensation), and positioning criteria will be covered in this course. Anatomical structures and the plane that best demonstrates anatomy will be discussed as well as signal characteristics of normal and abnormal structures.

Course Rationale

This course outlines the critical criteria relevant to the acquisition of high quality images of various anatomical regions. Due to different considerations for the various regions in the body, imaging protocols vary. This course allows the student to study the variations in the imaging parameters for specific body regions and the resultant effect on the signal characteristics and the anatomy represented. Evaluation criteria for determining the quality of images allows technologists a better understanding of what constitutes a high quality image. In a competency-based educational system, this course is completed prior to competency examinations to allow a better understanding of what is necessary for achieving high quality images.

Prerequisites

1. Introduction to MRI - Overview of imaging parameters and terminology, safety, and patient care procedures.

2. Sectional Anatomy - Human anatomy in axial, sagittal, and coronal planes. Other planes are discussed as appropriate to particular anatomy. Correlation of the anatomy to MR images. (May be taking place simultaneously with Imaging Procedures.)

3. Magnetic Resonance Physics - Physical principles of magnetic resonance, relaxation characteristics, signal production, pulse sequences, signal-to-noise and parameter influences, fluid flow compensation and demonstration, and image formation. (May be taking place simultaneously with Imaging Procedures)

4. Magnetic Resonance Instrumentation - Equipment used in production of the MR signal and image, specific coil designs, quality assurance measures, and equipment safety. (May be taking place simultaneously with Imaging Procedures.)

Course Objectives

Upon completion of the course, the student should be able to:

1. State the advantage or disadvantage of MRI over traditional methods of diagnosing pathology.

2. State the coils available for MRI and their specific application.

3. Describe considerations in designing an imaging protocol and state the application of protocols in specific situations.

4. State positioning criteria for different areas of the body.

5. State advantages and disadvantages of axial, sagittal, coronal and oblique images (i.e. what structures are best demonstrated).

6. Describe common pulse sequences used in evaluation of the different areas of the body.

7. State tissue signal characteristics of anatomical structures with and without contrast.

8. Describe the use of contrast media in evaluation of pathology.

9. Describe common artifacts that occur during imaging.

10. Describe differences between adult and pediatric pulse sequences in MRI.

11. Describe differences in tissue signal characteristics between adult and pediatric examinations.

12. Describe criteria for imaging windows for different areas of the body (i.e. when wide vs. narrow windows are useful).

Content Outline

I. 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

H. windowing

II. Imaging planes A. positioning criteria

B. sagittal, coronal, axial

C. anatomy best demonstrated

D. slice thickness

III. Signal characteristics A. proton density vs. T1-weighted vs. T2-weighted of normal anatomy

B. spin-echo vs. gradient-echo

C. without and with contrast agents

IV. 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

V. MRI of Musculoskeletal System A. Clinical indications 1. degenerative disease

2. infection / inflammation

3. vascular

4. trauma

5. neoplasia

B. Anatomic Locations 1. Hip

2. Knee

3. Ankle and foot

4. Shoulder

5. Elbow

6. Wrist and hand

VI. MRI of the Abdomen and Pelvis A. Clinical indications 1. infection/inflammation

2. vascular

3. trauma

4. neoplasia

B. Anatomic Locations 1. Abdomen

2. Retroperitoneum

3. Pelvis, male and female

V. MRI of the Thorax A. Clinical indications 1. infection/inflammation

2. vascular

3. trauma

4. neoplasia

5. anomalies

B. Anatomic Locations 1. mediastinum

2. chest

3. brachial plexus

4. neck

5. breast

VI. Pediatric MRI

A. Clinical Indications

1. tumor/infections

2. developmental anomalies, congenital malformations

3. myelination patterns

B. Sedation 1. age related

2. general anesthesia

MRI PATHOLOGY

Course Description

This course will familiarize the student with the common pathologies found in magnetic resonance imaging and their appearance with various imaging protocols. The course content will be inclusive of all commonly imaged body systems and areas. Case studies and images of the pathologies will be used to reinforce the lectures.

Course Rationale

Technologists doing magnetic resonance imaging must be able to recognize the general appearance of pathology in patients' studies so that proper filming is accomplished to maximize the appearance of the area in question. Many technologists also work in settings that require them to recognize the need for additional sequences, changes in protocols, and the need for contrast studies based upon the recognition of pathological changes. The knowledge of disease processes and their signal characteristics on different imaging sequences therefore is vital to the professional technologist working with magnetic resonance imaging.

Prerequisites(some coursework may be taking place simultaneously)

1. Introduction to MRI - MRI terminology and imaging parameters, patient care, and safety issues.

2. Magnetic Resonance Physics - Physical principles of magnetic resonance, relaxation characteristics, signal production, pulse sequences, signal-to-noise and parameter influences, fluid flow (compensation and demonstration), and image formation.

3. Magnetic Resonance Instrumentation - Equipment used in production of the MR signal and image, quality assurance measures, and equipment safety.

4. Sectional Anatomy - Human anatomy in axial, sagittal, and coronal planes. Other planes are discussed as appropriate to particular anatomy (i.e., cardiac). Correlation of the anatomy to MR images.

5. Imaging Procedures - Basic protocol parameters, coil selection, patient positioning, sequence selection, planes appropriate to particular anatomy, evaluation criteria and clinical applications of MR.

Course Objectives

Upon completion of this course, the student should be able to:

1. State pathologies that commonly require MR investigation.

2. Display understanding of the signal characteristics displayed by abnormal tissues during various pulse sequences and imaging modes in demonstrating pathological processes.

3. Recognize changes in anatomical sizes and shapes of structures which would indicate pathology.

4. Describe basic pathological processes demonstrated by MR.

5. Identify the nature and courses of the pathologies listed in the course outline.

6. Describe the impact of contrast agents on visualization of the pathology.

Content Outline

I. Central Nervous System

A. Brain to suggest, but need not be limited to 1. Neoplastic disorders a. Intraaxial

1. Astrocytoma

2. Glioblastoma

3. Ependymoma

4. Gangliooma

5. Neuroblastoma

6. Metastases

7. Lymphoma

8. Medulloblastoma

9. Hemangioblastoma

b. Extraxial

1. Meningioma

2. Epidermoid

3. Dermoid

4. Lipoma

5. Pituitary adenoma

6. Pineal gland tumors

2. Infections and inflammatory disorders a. Meningitis

b. Cerebral abscess

c. Encephalitis

d. HIV and associated infections

e. Sarcoidosis

f. Multiple sclerosis

3. Vascular disorders a. Stroke(acute, subacute)

1. Brain hypoxia

2. Venous sinus occlusion

3. Arterial origin

b. Aneurysm

c. Vascular malformation

D. Non-traumatic hemorrhage

4. Congenital and hereditary disorders a. Aquaductal stenosis

b. Chiari malformations

c. Dandy-Walker

5. White matter disorders 6. Trauma

a. Skull fracture

b. Hematomas

c. Shearing injury

d. Contusion

e. Hemorrhage

f. Child abuse

g. Arterial dissection

7. Other (i.e., aging, metabolic, idiopathic, iatrogenic, phakomatoses, etc.) B. Spine and spinal cord to suggest, but need not be limited to 1. Tumor and tumor-like disorders a. Metastases(verttebral body and spinal cord)

b. Spinal cord astrocytoma

c. Spinal cord ependymoma

d. Spinal meningioma

e. Hemangioma

f. Boneand/or spinal cord cyst

g. Chordoma

h. Paget=s disease

2. Inflammatory disorders a. Spondylitis

b. Discitis

c. Abscesses

3. Vascular disorders a. Arteriovenous malformation

b. Cavernous angioma

c. Infarctions

4. Trauma a. Fractures

b. Hematomas

5. Degenerative spine a. Herniated disc

b. Free herniated disc fragment

c. Postsurgical fibrosis and arachnoiditis

d. Spondylolysis ans spondylidthesis

e. Ossified ligaments

6. Other (i.e., congenital anomolies, demyelinating disorders, etc.) II. Head and Neck to suggest, but need not be limited to A. Eye and orbital contents 1. Peristent hyperplastic primary vitreous

2. Retinopathy

3. Retinoblastoma

4. Hemangioma

5. Melanoma

6. Tumors

7. Optic neuritis

8. Graves opthalmopathy

9. Sarcoidosis

10. Abscess

11. Orbital truama

B. Sinuses, pharynx (nasal & oral), and larynx 1. Obstiomeatal unit obstruction

2. Cysts and polyps

3. Sinusitis

4. Malignancy

5. Mucocele

6. Papilloma

C. Temporal bone and TMJ 1. Tumor and tumor-like disorders a. Schwannoma

b. Cholesteatoma

c. Cholesterol granuloma

2. Bell=s Palsy

3. Vascular middle ear anomolies

4. Fractures

5. Dislocated TMJ

D. Neck 1. Masses a. Nasopharyngeal space

b. Parapharyngeal space

c. Parotid space

d. Retropharyngeal space

e. Oropharyngeal space

f. Masticator space g. Buccinator space

h. Carotid space

I. Laryngeal

j. Angiofibroma

k. Hemangioma

l. Hygroma

m. Thyroid

N. Glomus jugulare

2. Metastases

3. Cysts

4. Sialolithiasis

E. Brachial Plexus

1. Masses

2. Malignancy

3. Response to therapy

4. Trauma

III. Thorax to suggest, but need not be limited to

A. Mediastinum 1. Thyroid masses

2. Thymoma

3. Duplication cysts

4. Lymph node enlagement

5. Lymphoma

6. Teratoma

7. Neurogenic

8. Pancoast tumors

9. Aneurysms

10. Esophageal tumors

B. Chest wall 1. Malignant processes

2. Inflammatory lesions

C. Respiratory system 1. MR not extensively used for lung parenchyma D. Cardiac and aorta 1. Aneurysm

2. Dissection

3. Coarctation

4. Thrombus

5. Infarction

6. Hypertrophic cardiomyopathy

7. Pericardial disease

8. Intracardiac masses

9. Valvular heart disease

10. Congenital heart conditions

a. VSD

b. ASD

c. TOF

E. Breast 1. Dysplasia

2. Cysts

3. Benign tumors

4. Inflammatory conditions

5. Carcinomas

6. Post surgery or radiation

7. Breast implants

IV. Abdomen to suggest, but need not be limited to

A. Liver 1. Hemangioma

2. Cysts

3. Abscesses

4. Hepatocellular carcinoma

5. Hepatic metastases

6. Venous thrombosis

B. Pancreas 1. Pseudocyst

2. Cystic fibrosis

3. Pancreatitis

4. Transplants

5. Adenocarcinoma

6. Islet cell tumors

7. Lymphoma

8. Metastases

C. Kidneys 1. Polycystic kidney disease

2. Renal cell carcinoma

3. Transitional cell carcinoma

4. Metastatic disease

5. Wilm=s tumor

6. Nephroblastoma

7. Infarction

8. Infection

9. Transplant

D. Adrenals 1. Adenoma

2. Metastasis

3. Pheochromocytoma

4. Neuroblastoma

5. Hemorrhage

E. Spleen and lymphatics 1. Infections

2. Benign focal lesions

3. Hodgkins and non-Hodgkins lymphoma

F. GI track

1. MR emerging for a number of abnormalities

J. Other

1. Congenital anomalies and hereditary disorders 2. Traumatic disorders 3. Vascular disorders

a. Renal artery stenosis

V. Pelvis to suggest, but need not be limited to

A. Female sexual organs (uterus, ovaries, vagina and associated structures) 1. Neoplastic disorders

a. Leiomyoma

b. Endometrial polyps

c. Endometrial carcinoma

d. Cervical carcinoma

e. Adenocarcinoma

f. Vaginal carcinoma (squamous cell)

g. Ovarian carcinoma h. Dermoid/teratoma

i. Fibroma

2. Inflammatory disorders

a. Pelvic inflammatory disease 3. Endometriosis

4. Ovarian cysts

5. Other

1. Congenital anomalies and hereditary disorders

2. Traumatic disorders B. Male sexual organs (prostate, seminal vesicles, and associated structures) 1. Neoplastic disorders

a. Benign prostatic hyperplasia

b. Prostatic carcinoma

2. Inflammatory disorders

a. Prostatitis

3. Other

a. Congenital anomalies and hereditary disorders b. Traumatic disorders C. Bladder 1. Neoplastic disorders

2. Inflammatory disorders

3. Congenital anomalies and hereditary disorders

4. Traumatic disorders

5. Other

VI. Musculoskeletal to suggest, but need not be limited to A. Skeletal system 1. Traumatic injury

2. Bone fracture union

3. Bone neoplasms and tumor like lesions

a. Cartilage lesions

b. Fibrous lesions

c. Osteoid osteoma

d. Tumorlike lesions

e. Malignant tumors

f. Metastases

4. Inflammatory disorders

a. Osteomyelitis

b. Periprosthetic infections

5. Other

a. Congenital abnormalities

b. Osteonecrosis and bone infarcts

c. Avascular necrosis

d. Bone bruise

B. Soft tissues 1. Neoplastic disorders a. Lipomatous tumors

b. Vascular lesions

c. Synovial lesions and sarcoma

d. Fibrous tumors

e. Peripheral nerve sheath tumors

f. Benign versus malignant lesions

2. Inflammatory disorders a. Infections and abscesses

b. Myositis

c. Bursitis

d. Tenosynovitis

e. Osteomyelitis

C. Joints 1. Fibrocartilage disorders a. Articular cartilage injuries

b. Cartilage status

c. Degenerative joint disease

d. Ligament and tendon tears

1. Rotaotor cuff tear

2. Anterior/posterior crutiate tear

3. Patellar tendon tear

4. Collateral ligament

5. Achilles tendon

2. Inflammatory disorders a. Infections and abscesses

b. Myositis

c. Bursitis

d. Tenosynovitis

e. Osteomyelitis

f. Overuse synovitis

g. Ganglion and bursal cysts

h. Rheumatoid and seronegative arthrotides

3. Meniscal Disorders

a. Meniscal tear

1. Bucket handle tear

b. Meniscal cysts

c. Discoid lateral meniscus

D. Other 1. Trauma 2. Congenital anomalies and hereditary disorders 3. Bone marrow abnormalities VII. General Vascular Disorders A. Run-off

1. Atherosclerosis

2. Post radiation injury

B. Renal artery stenosis

C. Graft patency

D. Venous mapping

E. Vena cava tumor invasion

F. Subtraction techniques.

SECTIONAL ANATOMY

Course Description

This is a study of human anatomy as seen in axial, sagittal, and coronal planes. Other imaging planes are studied when relevant for demonstration of anatomy in specific regions. Correlation to MR images is practiced in this course. Bony, muscular, vascular, organs and soft tissues of the following anatomical regions are studied: central nervous system (brain and spine), other structures in the head, soft tissue neck, musculoskeletal, cardiovascular, thorax, abdomen, and pelvis.

Course Rationale

The student should be able to recognize normal anatomy to ensure that the region of interest has been adequately imaged. A study of normal anatomy and normal variations and its appearance in planes enables the student to better recognize abnormal conditions and thus make the associated changes in imaging requirements to adequately demonstrate the patient's anatomy and pathology.

Note to Instructors

The content outline which follows in organized by body regions, this organization allows the student to grasp the three dimensional relationship to structures. Studying anatomy in this manor enhances the students understanding of how one structure in related to another, instead of the student simply memorizing anatomical structures. The depth and amount of anatomy taught is greatly related to the length of time given to this subject. Often this course is part of a general curriculum in programs teaching multiple specialties. In this case it is advantageous to include CT, ultrasound and angiographic images.

Prerequisites

1. Human Anatomy and Physiology - anatomy of all body regions.

Course Objectives

Upon completion of the course, the student should be able to:

1. Identify anatomical structures listed as seen in axial, sagittal, coronal, and oblique (as required) planes.

2. Describe gross anatomic relationships in the body.

3. Describe anterior-posterior, superior-inferior, and lateral-medial relationships of anatomy.

4. Describe MR appearance of tissues.

5. Explain how the MR appearance differs due to anatomic structural differences.

6. Identify anatomical structures on MR images.

7. Distinguish normal anatomy from abnormal anatomy on MR images.

Content Outline

I. The Head

A. Bones of the skull and cranium 1. Skull and cranium

2. Cranial cavity

3. Facial skeleton

4. Paranasal sinuses

5. Foramina of the skull

B. The Brain 1. Nervous tissue and organization a. White matter structures

b. Gray matter structures

2. Regions of the brain a. Cerebrum to include hemispheres, lobes, fissures, sulci, etc.

b. Diencephalon to include epithalamus, thalamus, hypothalamus, etc.

c. Brainstem

(1) Midbrain

(2) Pons

(3) Medulla oblongata

(4) Cranial nerves

d. Cerebellum to include hemispheres and peduncles (1) Neural tissue organization (a) Gray matter structures

(b) White matter structures

C. The Ventricle System 1. Cerebrospinal fluid

2. Choroid plexus

3. Lateral ventricles

4. Third ventricle

5. Fourth ventricle

D. Meninges 1. Dura Mater and major extensions

2. Arachnoid

a. Subarachnoid cisterns 3. Pia Mater E. Arterial Blood Supply 1. Anterior supply (major branches)

2. Posterior supply (major branches)

3. Circle of Willis

F. Venous drainage 1. Superficial drainage system

2. Dural sinuses

3. Internal jugular vein G. Cranial nerves H. The Orbital Cavity 1. Skeletal formation of the orbital cavity

2. Bulbus oculi (eyeball)

a. Fibrous tunic

b. Vascular tunic

3. Orbital muscles

4. Vascular supply

5. Optic Nerve

I. Auditory Canal 1. Temporal bone and bony structures

2. Vestibulocochlear nerve and course

J. Endocrine System - Pituitary Gland 1. Sphenoid bone

2. Infundibulum

3. Hypophysis (pituitary gland)

II. The Spine A. Typical vertebrae components

B. Cervical vertebrae components

C. Thoracic vertebrae components

D. Lumbar vertebrae components

E. Sacrum

F. Coccyx

G. Intervertebral discs

1. Nucleus pulposus

2. Annulus fibrosus

H. Vertebral column 1. Sections

2. Curvatures

I. Spinal cord 1. Composition a. White matter

b. Gray matter

2. Components J. Spinal plexus 1. Cervical

2. Brachial

3. Lumbar

4. Sacral

III. The Soft Tissue Neck (Skeletal Components -- see Spine) A. Tissue organization 1. Suprahyoid

2. Infrahyoid

B. Viscera of the neck 1. Pharynx a. components, recesses, tonsils, etc. 2. Rectopharyngeal space

3. Larynx (distinguishing between true and false cords)

4. Esophagus

5. Trachea

6. Thyroid gland

7. Salivary glands

C. Vascular supply (major branches)

D. Musculature of the neck

1. Muscles of mastication

2. Anterior triangle

3. Posterior triangle

IV. The Thorax A. Skeletal anatomy of the thorax 1. Sternum

2. Thoracic vertebrae

3. Ribs

B. Thoracic cavity 1. Lungs

2. Mediastinum

C. Superficial features of the heart

D. Chambers and valves

E. Vascular supply and drainage

1. Coronary arteries

2. Cardiac veins

F. The great vessels of the heart 1. Aorta a. Ascending aorta 2. Pulmonary trunk

3. Superior vena cava

4. Inferior vena cava

G. Associated thoracic structures 1. Thymus

2. Trachea and bronchi

3. Esophagus

4. Azygos veins

H. Breast 1. General structure

2. Hormonal participation

I. Lymphatic system 1. Major lymph node chains V. The Abdomen A. Abdominal regions

B. Diaphragm

1. Structure

2. Openings

C. Abdominal musculature 1. Anterolateral muscles

2. Posterior muscles

D. Abdominal peritoneum 1. Mesentery

2. Peritoneal elements

E. Peritoneal Cul-De-Sacs

F. Abdominal vasculature

1. Abdominal aorta

2. Branches

G. Venous drainage of the abdomen 1. Inferior vena cava and major branches H. Hepatic portal system 1. Possible configurations of portal blood supply I. Abdominal viscera 1. Liver a. Lobes

b. Vasculature

2. Gallbladder

3. Esophagus

4. Stomach

a. Vasculature

b. Divisions

5. Small intestine a. Divisions 6. Large intestine a. Divisions 7. Spleen a. Vasculature 8. Pancreas a. Vascular landmarks

b. Divisions

c. Blood Supply

9. Kidneys a. Blood supply

b. Structure

10. Suprarenal gland a. Blood supply VI. The Pelvis A. Pelvic cavity

B. Bony pelvis

1. Sacrum

2. Coccyx

3. Os Coxae

4. Pubis

5. Ischium

6. Acetabulum

C. Pelvic musculature 1. Wall of the false pelvis

2. Pelvic floor

3. Wall of the true pelvis

D. Vasculature 1. Common iliac arteries E. Innervation

F. Pelvic viscera

1. Gastrointestinal organs

2. Urinary organs

G. Viscera of female pelvis 1. Peritoneal folds

2. Ligaments

3. Ovaries

4. Uterus

a. Body

b. Fundus

c. Uterine wall

d. Perimetrium

e. Ligamentous attachments

5. Uterine tubes

6. Cervix

7. Vagina

H. External genitalia and related perineum 1. Regions

2. Female external genitalia

3. Male external genitalia

I. Musculature J. Reproductive organs of the male pelvis 1. Scrotum

2. Ductus deferens

3. Spermatic cord

4. Cremaster muscle

5. Seminal vesicles

6. Prostate

7. Bulbourethral glands

8. Penis

VII. The Upper Extremity A. Shoulder joint 1. Bony components

2. Ligaments

3. Musculature

a. Rotator cuff muscles 4. Bursae B. Upper arm (brachium) 1. Bony components

2. Muscular components (Anterior and posterior)

3. Vasculature

4. Innervation

C. Elbow joint 1. Bony components

2. Articulations

3. Ligaments

4. Musculature

5. Vasculature

6. Innervation

D. Cubital Fossa 1. Musculature

2. Fascia

3. Contents (identify nerves, arteries, veins and tendons emphasizing a medical to lateral relationship.) E. Forearm 1. Bony components

2. Muscular components (anterior and posterior)

3. Vasculature

4. Innervation

F. Wrist 1. Bony compartments

2. Ligamentous components

3. Tendinous components

4. Vasculature

5. Innervation

G. Hand 1. Bony components

2. Muscular components

3. Vasculature

4. Innervation

VIII. Lower Extremity A. Hip joint 1. Bony components

2. Ligamentous components

3. Muscular components (Anterior, posterior, and medical groups)

4. Vascular components

5. Innervation

B. The Thigh 1. Bony components

2. Muscular components (Anterior, medical and posterior compartments)

3. Vasculature

4. Innervation

C. The Knee 1. Bony components

2. Ligamentous components

a. Menisci

b. Extracapsular ligaments

3. Intracapsular ligaments

4. Muscular components

5. Neurovascular components

D. The Leg 1. Bony components 2. Muscular components a. Anterior compartment

b. Posterior compartment

(1) Superficial

(2) Deep

c. Lateral compartment 3. Vasculature 4. Innervation E. The Ankle 1. Bony components

2. Ligamentous components

3. Musculotendinous components (Medial, lateral, anterior, and posterior groups)

4. Neurovascular components

F. The Foot 1. Bony components

2. Muscular components

a. Dorsal

b. Plantar

3. Innervation a. Dorsal

b. Plantar

4. Vasculature

CLINICAL EDUCATION

Course Description

This course will allow the student the opportunity to practice skills necessary to obtain high quality MR images, to objectively alter protocols based on patient pathology or physical condition, and to identify image quality problems and make appropriate corrections. Clinical education is conducted at a clinical facility after or in conjunction with didactic instruction. Activities include demonstration and observation, after which the student assists in performing the activity. When a satisfactory degree of proficiency is apparent, the student will be allowed to perform the activity under direct supervision. When both the student and instructor are satisfied with the students proficiency, the student will proceed with performing studies under indirect supervision to gain experience and expertise in MR imaging. This course is presented with a progression in competency levels in the form of clinical performance objectives and competency exams. The student will have access to the facilities, personnel, examinations and educational materials to competently achieve the course objectives.

Course Rationale

Technologists performing magnetic resonance imaging must be able to competently perform basic protocols, recognize the need for altering the standard protocol, be able to appropriately alter a protocol, and recognize equipment and patient considerations affecting image quality. The technologist is responsible for maintaining a safe environment in and around the MRI suite. This course allows the student the necessary supervised clinical education to become proficient in these skills.

Instructors Note: Beginning in January of 2000, the ARRT will impose new eligibility requirements for the ARRT Advanced Certification Exam in MR. A candidate must show proof of clinical experience gained during the year proceeding the application. This experience may be gained through a formal education program, or on-the-job training. The ARRT has specific forms for the documentation of this experience. It is recommended that instructors providing clinical training contact the ARRT for these materials.

Prerequisites

1. Introduction to MRI - coursework that provides the basic terminology of imaging parameters, patient screening, and safety for the patient and personnel within the MRI department.

2. Didactic coursework will proceed or be in conjunction with the clinical education.

Course Objectives

Upon completion of the clinical education, the student will be able to:

1. Maintain a safe work environment for patients, visitors, and health care workers

2. Properly schedule and pre-screen patient.

3. Communicate professionally with the patient and with members of the staff.

4. Perform daily routine examinations based on normal protocols.

5. Perform archiving procedure and filming.

6. Identify need to modify protocol and successfully perform modification.

7. Identify image quality problems and identify probable cause and recommend appropriate solution.

8. Identify indications for MR imaging procedures.

9. Perform and monitor quality assurance tests.

10. Perform system start-up and shutdown.

Content Outline

I. Preliminary Patient Assessment

A. Clinical History 1. Correlate clinical history to the requested exam.

2. Correlate reported physical exam findings to the requested exam.

3. Correlate surgical, accidental and occupation history to ensure proper

safety precautions.

4. Properly screen patients for contraindications to MRI.

a. SMR safety committee screening form or departmental forms 5. Monitor the patient to ensure proper attire and that no unnecessary metals enter the exam room. II. Preliminary Preparation A. Requisition evaluation 1. Identify procedure to be followed for requested exam.

2. Identify the reason for the requested exam.

3. Identify any conditions that exist to change routine of the procedure.

B. Patient identification 1. Enter patient name and hospital number and other pertinent information. C. Room readiness 1. Prepare clean, comfortable and safe environment.

2. Demonstrate proper precautions in the prevention of disease

transmission.

3. Have the necessary accessory equipment available.

4. Monitor the linen and supplies, and restock when necessary.

5. Have the machine ready for the patient, to include:

a. QA performed

b. Correct protocol for the required exam
c. Selection of appropriate coil

D. Patient Preparation 1. Demonstrate knowledge of proper patient preparation required for

requested exam.

2. Demonstrate knowledge of action required if the patient requires sedation.

3. Demonstrate knowledge of action required if the patient requires contrast

media.

4. Demonstrate knowledge of action required for allergic reactions.

5. Demonstrate knowledge of action required if patient is claustrophobic.

6. Demonstrate proper use of earplugs or headphones to reduce the possibility of

acoustic damage.

III. Patient Care and Handl