Magnetic Resonance Curriculum



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Magnetic Resonance Curriculum


A Multiorganizational Curriculum Project Group produced this MR Curriculum.
©Copyright 2008, by the American Society of Radiologic Technologists (ASRT), Association of Educators in Imaging and Radiologic Sciences (AEIRS) and the Section for Magnetic Resonance Technologists (SMRT) of the International Society for Magnetic Resonance in Medicine (ISMRM). All rights reserved. Request to reprint all or part of this document is prohibited without advance written permission of the ASRT, AEIRS or ISMRM/SMRT.

Acknowledgements
Just as the modality and applications of Magnetic Resonance are complex and dynamic (and sometimes long), so too was the development of this multiorganizational MR curriculum. In 2006, the American Society of Radiologic Technologists (ASRT), the Association of Educators in Imaging and Radiologic Sciences (AEIRS) and the Section for Magnetic Resonance Technologists of the International Society for Magnetic Resonance in Medicine (SMRT) came together at a Summit with a unified mission:
To develop a nationally recognized entry-level MRI Curriculum that includes didactic and clinical competencies.
Also at the Summit were the American Registry of Radiologic Technologists (ARRT) and the Joint Review Committee on Education in Radiologic Technology (JRCERT), both in support of this multiorganizational approach.
While many people have provided input to this project on various levels, the core group of authors, editors and reviewers deserve extraordinary recognition and appreciation.


Carolyn Bonaceto

Karen Bove Bettis

Cindy Comeau

Denise Davis

Rosemary Fisher

Retta Ford

Jacqueline Kralik

Mark Haacke

Cindy Hipps

Julie Lowe

Vera Miller

Bart Pierce

Sonya Robb-Belville

Carolyn Kaut Roth

Mark Spooner

Charles Stanley


`This guideline has also been reviewed by members of the ASRT Magnetic Resonance Chapter, the AEIRS Ad-Hoc MRI Curriculum Committee and the SMRT Education Standards Ad Hoc Committee.


A special Thank You to: Cindy Hipps, 2006 SMRT President - for making the Summit happen and now a dream realized; and to Kevin Powers, ASRT Education Director – for multiple revisions, multiple phone calls, multiple emails, and for being a man of patience.
As MR continues to evolve, so too will this MR curriculum guideline. Please forward any comments to the ASRT, AEIRS or SMRT. All three organizations will continue to work collaboratively to support this effort.
My personal thanks to EVERYONE for the opportunity to facilitate this project.
Luann J. Culbreth

Magnetic Resonance Curriculum
Introduction

This curriculum identifies the cognitive base of entry-level education in the practice of magnetic resonance (MR) technology. This document represents a collaborative effort involving representatives from the American Society of Radiologic Technologists (ASRT), Association of Educators in Imaging and Radiologic Sciences (AEIRS) and the Section for Magnetic Resonance Technologists (SMRT) of the International Society for Magnetic Resonance in Medicine (ISMRM).


This curriculum document establishes national, standardized educational guidelines for MR, including clinical and didactic components. The curriculum is suitable for all programs in this discipline, including limited fellowships, certificate programs, as well as collegiate-based education programs. The curriculum recognizes that the educational components are not static, but represent current practice and trends in the field. Educators are responsible for incorporating new concepts and trends in the curriculum as they occur.
This document contains education appropriate to body areas defined through examinations of the ARRT. The content is designed to assure quality patient care and production of quality diagnostic images.
This curriculum is divided into specific content areas that represent the essential components of an MR program. The content and objectives should be adapted to meet the mission, goals and needs of each MR program. Faculty members are encouraged to expand and broaden these fundamental objectives as they incorporate them into their curricula. The curriculum committee intentionally omitted specific instructional methods to encourage programmatic prerogative and creativity in instructional delivery.
Advances in diagnostic imaging and employer expectations demand independent judgment by MR technologists. Consequently, the educational process must foster, develop and assess critical-thinking skills. Critical thinking is incorporated in multiple content areas and faculty is expected to develop and implement critical thinking throughout the curriculum. In summary, the MR curriculum is based on data relevant to today’s health care environment. The curriculum offers a foundation for lifelong learning that will serve MR technologists throughout their careers. It offers faculty the flexibility to develop curriculum designed to meet the needs of individuals performing diagnostic magnetic resonance procedures.

Magnetic Resonance Curriculum

Table of Contents


Clinical Practice and Patient Management 1

Computers in Imaging and Medical Informatics 11

Ethics and Law in the Imaging Sciences 19

Fundamentals of Imaging Science and Health Care 21

General Education 27

MR Imaging Procedures 29

MR Parameters, Imaging Options, and Quality Assurance 35

MR Pathology 41

MR Instrumentation and Imaging 49

MR Pulse Sequences, Image Formation and Image Contrast 61

MR Safety 69

Pharmacology and Drug Administration 75

Physical Principles of Magnetic Resonance Imaging 79

Sectional Anatomy 86

References 94





Clinical Practice and Patient Management

Description

Content is presented as a progression in competency levels through clinical performance objectives and competency exams. Students can access the facilities, personnel, examinations and educational materials necessary to competently achieve content objectives. Activities include demonstration and observation, after which the student assists in performing the activity. When a satisfactory degree of proficiency is apparent, the student can perform the activity under direct supervision. When both the student and instructor are satisfied with the student’s proficiency, the student performs studies under indirect supervision to gain experience and expertise in MR imaging.


Rationale

Technologists performing magnetic resonance imaging must competently apply basic protocols, recognize when and how to appropriately alter the standard protocol and recognize equipment and patient considerations that affect image quality. The technologist is responsible for maintaining a safe MRI environment. This course provides the necessary supervised clinical education to become proficient in these skills.


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 proceeds or is offered in conjunction with the clinical education.


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 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.

  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

  1. Clinical Practice

    1. Code of ethics/professional behavior

      1. Scope of practice

      2. Incident reporting mechanisms

      3. Standards for supervision

        1. Direct

        2. Indirect




    1. Professional communication

      1. Patient

      2. Patient’s family and friends

      3. Health care team




    1. Role of health care team members

      1. Technical

      2. Professional

      3. Patient’s Bill of Rights




    1. Scheduling and sequencing exams




  1. Procedural Performance

    1. Order/requisition evaluation and measures




    1. Facilities setup




    1. Patient assessment, education and care

      1. Patient monitoring – emergent and non-emergent

        1. Vital signs – ranges and values

      2. Temperature

        1. Fahrenheit

        2. 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




    1. Acquiring and recording vital signs

      1. Procedures

      2. Demonstration




    1. Review of laboratory data

      1. Normal ranges for:

        1. Blood urea nitrogen (BUN)

        2. Creatinine

        3. Hemoglobin

        4. Red blood cells (RBCs)

        5. Platelets

        6. Oxygen (O2) saturation

        7. Prothrombin

        8. Part thromboplastin time

        9. Glomerular filtration rate calculation (GFR)




    1. Patient chart

      1. Aspects of patient chart

      2. Retrieving specific information

      3. Proper documentation in the chart




  1. Infection Control

    1. Terminology

      1. Nosocomial

      2. Communicable

      3. Infectious pathogens

      4. Human immunodeficiency virus (HIV)

      5. Hepatitis

        1. Hepatitis A Virus (HAV)

        2. Hepatitis B Virus (HBV)

        3. Hepatitis C Virus (HCV)

        4. Hepatitis D Virus (HDV)

        5. Hepatitis E Virus (HEV)

        6. Others




    1. Centers for Disease Control and Prevention (CDC)

      1. Purpose

      2. Publications and bulletins




    1. Cycle of infection

      1. Infectious pathogens – blood-borne and airborne

      2. Reservoir of infection

        1. Direct

        2. Indirect




    1. Preventing disease transmission

      1. Transmission-based precautions

      2. Health care worker

        1. Immunization

        2. Booster

        3. Post-exposure protocols




    1. Asepsis

      1. Medical

        1. Definition

        2. Procedures

          1. Hand washing

          2. Chemical disinfectants

      2. Surgical

        1. Definition

        2. Growth conditions for microorganisms

        3. Methods used to control microorganisms

          1. Moist heat

            1. Boiling

            2. Steam under pressure

          2. Dry heat

            1. Incineration

            2. Dry heat sterilized

          3. Gas

          4. Chemicals

        4. Procedures – demonstrate

          1. Opening packs

          2. Gowning/gloving

          3. Skin preparation

          4. Draping

          5. Dressing changes

        5. Packing

        6. Storage

        7. Rules for surgical asepsis




    1. Environmental asepsis

      1. Handling linens

      2. Wound care

        1. Cleansing

        2. Dressing

      3. Techniques

        1. Dress

        2. Hair

        3. Handwashing

        4. Gloves

        5. Eye protection

        6. Cleaning and proper disposal of contaminated waste

      4. Practice




    1. Isolation techniques and communicable diseases

      1. Category-specific

      2. Disease-specific

      3. Standard precautions

      4. Examples

        1. HIV virus (AIDS)

        2. Hepatitis

          1. Type A

          2. Type B

          3. Type C (non-A or -B)

          4. Type D

          5. Type E

        3. Tuberculosis (TB)

        4. Respiratory syncytial virus (RSV)

        5. Other




    1. Isolation patient in the imaging department

      1. Procedure

        1. Gowning

        2. Gloving

        3. Masking

      2. Patient transfer

      3. Cleaning and proper disposal of contaminated waste

      4. Cleaning of imaging equipment




    1. Precautions for compromised patient (reverse isolation)

      1. Purpose

      2. Procedure




    1. Psychological considerations




  1. Medical Emergencies

    1. Terminology




    1. Emergency equipment




    1. Latex reactions




    1. Shock

      1. Signs and symptoms

      2. Types

        1. Hypovolemic

          1. Hemorrhage

          2. Plasma loss

          3. Drugs

        2. Disruptive

          1. Anaphylactic

          2. Neurogenic

          3. Septic

      3. Medical intervention




    1. Diabetic emergencies – signs, symptoms and interventions

      1. Hypoglycemia

      2. Ketoacidosis

      3. Hyperosmolar coma




    1. Respiratory and cardiac failure – signs, symptoms and interventions

      1. Adult vs. pediatric

      2. Equipment




    1. Airway obstruction – signs, symptoms and interventions




    1. Cerebral vascular accident (stroke) – signs, symptoms and interventions




    1. Fainting and convulsive seizures, signs, symptoms and interventions

      1. Types

        1. Nonconvulsive (petit mal)

        2. Convulsive (grand mal)

      2. Reasons for fainting




    1. Other medical conditions

      1. Epistaxis

      2. Nausea

      3. Postural hypotension

      4. Vertigo

      5. Asthma

      6. Psychiatric




    1. Unique Situations and Trauma

      1. Head injuries

      2. Four levels of consciousness

      3. Symptoms

      4. Medical intervention

      5. Adult vs. pediatric




    1. Spinal injuries

      1. Assessment

      2. Symptoms

      3. Medical intervention

      4. Transportation




    1. Extremity fractures

      1. Types

      2. Symptoms

      3. Splints

      4. Casts

      5. Positioning

      6. Adult vs. pediatric




    1. Wounds

      1. Symptoms

      2. Medical intervention




    1. Burns

      1. Burn classifications

      2. Medical intervention




    1. 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




  1. Contrast Studies

    1. Patient education

      1. Technologist’s responsibility

      2. Standard procedure




    1. Preparation for examination

      1. Diet

      2. Bowel preparation

        1. Laxatives

        2. Enemas

      3. Care during the procedure

      4. Follow-up care




    1. Procedure

      1. Monitoring and care during invasive procedures

        1. Preparation for MR-compatible cardiac monitoring

        2. Electrocardiogram (ECG) rhythms

          1. Normal

          2. Abnormal

        3. Patient care considerations

          1. Adverse reactions

            1. Reactions to contrast media

          2. Other medical conditions

            1. Nephrogenic systemic fibrosis (NSF)




  1. Tubes, Catheters, Lines and Collection Devices

    1. Terminology




    1. Function of devices




    1. Nasogastric/nasointestinal




    1. IVs, butterflies, angiocatheters and power injectors




    1. Suction

      1. Adult vs. pediatric

      2. Special precautions




    1. Tracheostomy

      1. Suction techniques

      2. CPR with tracheostomy




    1. Chest (thoracostomy) tube

      1. Purpose

      2. Location




    1. Central venous lines

      1. Purpose

      2. Types




    1. Tissue drains




    1. Oxygen administration using MR-conditional equipment

      1. Values

      2. Oxygen therapy

      3. Oxygen delivery systems

        1. Low-flow systems

        2. High-flow systems

      4. Documentation

      5. Special precautions




    1. Urinary collection

      1. Procedure

        1. Male

        2. Female

      2. Alternative methods of urinary drainage

      3. Documentation




    1. Other

      1. Ileostomy

      2. Ureteroileostomy



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