Magnetic Resonance Curriculum



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Part placement




    1. Earplugs or earphones




    1. Coil selection




    1. Localization




    1. Special considerations

      1. Atypical conditions

      2. Anesthesia considerations

      3. Ancillary staff considerations

      4. Special needs patients

      5. Trauma




  1. Positioning and Procedural Considerations for Specific Studies

    1. MR/MRA of the central nervous system

      1. Clinical indications

        1. Vascular disease

        2. Trauma

        3. Neoplasia

        4. Inflammation

        5. Anomalies

      2. Anatomic locations

        1. Brain

        2. Spine and spinal cord




    1. MR of the musculoskeletal system

      1. Clinical indications

        1. Degenerative disease

        2. Infection/inflammation

        3. Vascular

        4. Trauma

        5. Neoplasia

      2. Anatomic locations

        1. Hip

        2. Femur

        3. Knee

        4. Lower leg

        5. Ankle and foot

        6. Shoulder

        7. Elbow

        8. Wrist and hand

        9. Temporomandibular joint dysfunction (TMJ)




    1. MR/MRA of the abdomen and pelvis

      1. Clinical indications

        1. Infection/inflammation

        2. Vascular

        3. Trauma

        4. Neoplasia

      2. Anatomic locations

        1. Abdomen

        2. Retroperitoneum

        3. Pelvis, male and female




    1. MR/MRA of the thorax

      1. Clinical indications

        1. Infection/inflammation

        2. Vascular disease

        3. Trauma

        4. Neoplasia

        5. Anomalies

      2. Anatomic locations

        1. Mediastinum

        2. Chest

        3. Brachial plexus

        4. Neck

        5. Breast

      3. Pediatric MRI/MRA

        1. Clinical Indications

      4. Tumor/infections

      5. Developmental anomalies, congenital malformations

      6. Myelination patterns

      7. Age related

      8. General anesthesia




  1. Procedural_Considerations_for_Contrast_Studies'>Procedural Considerations for Contrast Studies

    1. Equipment and materials needed




    1. Contrast media

      1. Purpose

      2. Types




  1. Procedural Considerations for Special Studies




  1. Patient Education

    1. Communication

      1. Types

      2. Barriers

        1. Methods for overcoming barriers

      3. Clinical situations

      4. Common MR safety issues and concerns

MR Parameters, Imaging Options, and Quality Assurance

Description

This course provides the student with knowledge of the parameters and imaging options used to create MR images. In addition, the content introduces quality assurance measures used in maintaining image quality.


Rationale

This course is necessary to educate the student on how to create high-quality diagnostic images that will be reviewed by the interpreting physician. A thorough knowledge base in the application of parameters, imaging options and quality assurance allows technologists to obtain the highest quality images possible, ensuring accurate diagnosis of the patient’s condition.


Objectives

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



  1. Describe the imaging parameters that determine image contrast.

  2. Describe the imaging parameters that determine spatial resolution on MR images.

  3. Describe the imaging parameters involved in MR image formation.

  4. Apply MR imaging parameters in the clinical setting.

  5. Describe many typical imaging options used to optimize image quality.

  6. Understand parameters and imaging options to obtain diagnostic MR images with minimal image artifacts.

  7. Maintain high-quality MR images via routine quality assurance practices


Content

  1. MR Imaging Parameter and Sequence Selections

    1. Pulse sequence selections

      1. Spin echo

        1. Types

          1. Single echo

          2. Multiecho

          3. Rapid acquisition recalled echo (RARE)

            1. Fast Spin Echo (FSE) / Turbo Spin Echo (TSE)

          4. Single Shot – Fast Spin Echo (SS-FSE)/Half Acquisition Single Shot Turbo Echo (HASTE)

        2. Image contrast

          1. T1

          2. T2

          3. Proton Density (PD)

      2. Inversion recovery

        1. Types

          1. Spin-echo inversion recovery (SE IR)

          2. Fast spin-echo inversion recovery (FSE-IR)

          3. Gradient-echo inversion recovery (GRE-IR)

        2. Image contrast

          1. Short tau inversion recovery (STIR)

            1. Spectrally selected inversion recovery (SPIR)

            2. Spectral selected attenuation inversion recovery (SPAIR)

          2. Fluid-attenuated inversion recovery (FLAIR)

          3. T1 FLAIR

      3. Gradient echo

        1. Types

          1. GrE

          2. EPI

        2. Image Contrast

          1. T1

          2. T2*

          3. PD




    1. Image contrast parameters

      1. Extrinsic contrast parameters (user selectable parameters)

        1. TR – repetition time

          1. Image influenes

            1. T1 contrast

            2. Scan time

            3. Signal-to-noise ratio (SNR)

            4. Number of slice locations

        2. TE – echo time

          1. Image influenes

            1. T2 contrast

            2. Number of slices

            3. SNR

            4. Susceptibility artifact

          2. TE settings for FSE

            1. Effective TE

            2. Target TE

        3. TI – Inversion time

          1. STIR

            1. Short TI (varies with field strength)

            2. Suppresses fat

            3. Suppresses gadolinium

          2. FLAIR

            1. Long TI (varies with field strength)

            2. Suppresses water

          3. T1 FLAIR

        4. Flip angle

          1. T1 contrast

          2. Ernst angle

        5. “B” value

          1. Diffusion weighting

          2. Gradient amplitude and duration

        6. Velocity encoding (VENC)

          1. Gradient amplitude and duration

      2. Intrinsic contrast parameters (determined by tissue characteristics)

        1. T1 recovery time

        2. T2 decay time

        3. Proton/spin density

        4. Physiologic motion

          1. Periodic motion

            1. Pulsatile flow

            2. Respiration

            3. Flow velocity/direction

          2. Aperiodic motion

            1. Peristalsis

            2. Molecular diffusion

      3. Extrinsic contrast influences (contrast media)

        1. T1 agents

          1. Gadolinium

            1. IV agent

              1. Dynamic imaging

              2. Delayed imaging

            2. Dose

              1. Single dose (0.1 mmol/kg)

              2. Double dose

              3. Triple dose

            3. Affects on images

              1. Relaxivity

              2. Shortens T1 relaxation time

              3. Bright on T1WI

          2. Manganese

            1. IV agent

              1. Delayed imaging

              2. Liver imaging

            2. Dose

            3. Effects on images

              1. Shortens T1 relaxation time

              2. Bright on T1WI

        2. T2 agents

          1. Gadolinium

            1. IV agent

              1. Delayed liver imaging

              2. Affects on images

                1. Shortens T2 relaxation time

                2. Dark on T2*WI

            2. Oral agent

              1. MRCP or bowel imaging

              2. Affects on images

                1. Shortens T2 relaxation time

                2. Dark on T2WI and T2*WI




    1. Resolution parameters

      1. Voxel size

        1. Voxel size parameters

          1. FOV

          2. Thickness

          3. Matrix

        2. Affect on Quality

          1. SNR

          2. Affect on resolution

          3. Affect on scan time

      2. Sampling parameters

        1. Sampling parameters

          1. Number of signals averaged (NSA)

            1. Number of excitations (NEX)

            2. Number of acquisition (NAQ)

          2. Receiver bandwidth

            1. Sampling time

            2. FOV

            3. TE

          3. Number phase encodings (matrix)

            1. Resolution

            2. Scan time

          4. Echo Train Length (“ETL”)/turbo factor

            1. Echo spacing

            2. Effective TE

            3. Number of shots

          5. Slices in a 3-D (volume) acquisition

            1. SNR

            2. Scan time

        2. Effect on quality

          1. SNR

          2. Effect on resolution

          3. Effect on scan time

      3. Dimensionality

        1. 2-D

        2. 3-D

        3. Thickness / gap

        4. Slice order




  1. Imaging Options

    1. Saturation pulses

      1. Spatial preset

      2. Spectral saturation, chemical saturation (fat saturation)




    1. Gradient moment nulling (flow comp)




    1. Physiologic gating and triggering

      1. Respiratory gating

      2. Cardiac gating




    1. Magnetization transfer




    1. Phase/frequency orientation




    1. Bandwidth (receive)

      1. Narrow

      2. Wide




    1. Signal suppression techniques

      1. Fat suppression

        1. Fat saturation (chemical sat)

          1. SPIR

          2. SPAIR

          3. SPECIAL

        2. STIR

      2. Water suppression

      3. Silicone suppression




    1. In/out of phase




    1. Antialiasing




  1. Quality Assurance

    1. Artifacts, cause, appearance and compensation

      1. Physics artifacts

        1. Chemical shift

          1. Types

            1. First kind (frequency direction on SE images)

            2. Second kind (out of phase imaging)

          2. Cause

          3. Compensation

        2. Susceptibility

          1. Metal

          2. Tissues with dissimilar chemical compensation

      2. Sampling artifacts

        1. Aliasing

        2. Cross-talk

      3. Motion artifacts

      4. Technical errors

        1. Improper centering

        2. Coil selection

      5. Hardware artifacts

        1. Corduroy

        2. RF leak

          1. Zipper

          2. Buzz




    1. Cause and appearance




    1. Compensation




    1. Operator-adjustable parameters




    1. Quality assurance

      1. Electronic measurements

      2. NMR measurement

      3. Archival QA

      4. QA of display and multiformat cameras

      5. Record keeping

MR Pathology



Description

This course familiarizes the student with the common pathologies found in magnetic resonance imaging and the appearance of these pathologies in various imaging protocols. The course content is inclusive of all commonly-imaged body systems and areas.


Rationale

The technologist should recognize the need for additional sequences and changes in protocols based upon recognizing pathological changes. In addition, a technologist must be aware of indications that show a contrast agent is required. The knowledge of disease processes and their signal characteristics on various imaging sequences is essential to ensure the best practices in patient care and quality imaging.


Prerequisites

Some course work may take place simultaneously.



  1. Introduction to MR imaging.

  2. MR physics and instrumentation.

  3. Sectional anatomy.

  4. Imaging procedures


Objectives

Upon completing the course, the student will be able to:



  1. State pathologies that commonly require an MR study.

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

  3. Recognize changes in anatomical sizes and shapes of structures that can 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 effect of contrast agents on visualizing pathology.


Content

  1. Central Nervous System

    1. Brain

      1. Neoplastic disorders

        1. Intra-axial

          1. Astrocytoma

          2. Glioblastoma

          3. Ependymoma

          4. Ganglioma

          5. Neuroblastoma

          6. Metastases

          7. Lymphoma

          8. Medulloblastoma

          9. Hemangioblastoma

        2. Extra-axial

          1. Meningioma

          2. Epidermoid

          3. Dermoid

          4. Lipoma

          5. Pituitary adenoma

          6. Pineal gland tumors

      2. Infections and inflammatory disorders

        1. Meningitis

        2. Cerebral abscess

        3. Encephalitis

        4. HIV and associated infections

        5. Sarcoidosis

        6. Multiple sclerosis

      3. Vascular disorders

        1. Stroke

          1. Acute

          2. Subacute

          3. Brain hypoxia

        2. Venous sinus occlusion

        3. Arterial origin

          1. Aneurysm

          2. Vascular malformation

          3. Nontraumatic hemorrhage

      4. Congenital and hereditary disorders

        1. Aquaductal stenosis

        2. Chiari malformations

        3. Dandy-Walker

      5. White matter disorders

      6. Trauma

        1. Skull fracture

        2. Hematomas

        3. Shearing injury

        4. Contusion

        5. Hemorrhage

        6. Child abuse

        7. Arterial dissection

      7. Other (i.e., aging, metabolic, idiopathic, iatrogenic, phakomatoses, etc.)




    1. Spine and spinal cord

      1. Tumor and tumor-like disorders

        1. Metastases (vertebral body and spinal cord)

        2. Spinal cord astrocytoma

        3. Spinal cord ependymoma

        4. Spinal meningioma

        5. Hemangioma

        6. Bone and/or spinal cord cyst

        7. Chordoma

        8. Paget disease

      2. Inflammatory disorders

        1. Spondylitis

        2. Discitis

        3. Abscesses

      3. Vascular disorders

        1. Arteriovenous malformation

        2. Cavernous angioma

        3. Infarctions

      4. Trauma

        1. Fractures

        2. Hematomas

      5. Degenerative spine

        1. Herniated disc

        2. Free herniated disc fragment

        3. Postsurgical fibrosis and arachnoiditis

        4. Spondylolysis and spondylolisthesis

        5. Ossified ligaments

      6. Other (e.g., congenital anomalies, demyelinating disorders, etc.)




  1. Head and Neck

    1. Eye and orbital contents

      1. Persistent hyperplastic primary vitreous

      2. Retinopathy

      3. Retinoblastoma

      4. Hemangioma

      5. Melanoma

      6. Tumors

      7. Optic neuritis

      8. Grave ophthalmopathy

      9. Sarcoidosis

      10. Abscess

      11. Orbital trauma




    1. Sinuses, pharynx (nasal and oral), and larynx

      1. Ostiomeatal unit obstruction

      2. Cysts and polyps

      3. Sinusitis

      4. Malignancy

      5. Mucocele

      6. Papilloma




    1. Temporal bone and TMJ

      1. Tumor and tumor-like disorders

        1. Schwannoma

        2. Cholesteatoma

        3. Cholesterol granuloma

      2. Bell palsy

      3. Vascular middle ear anomalies

      4. Fractures

      5. Dislocated TMJ




    1. Neck

      1. Masses

        1. Nasopharyngeal space

        2. Parapharyngeal space

        3. Parotid space

        4. Retropharyngeal space

        5. Oropharyngeal space

        6. Masticator space

        7. Buccinator space

        8. Carotid space

        9. Laryngeal

        10. Angiofibroma

        11. Hemangioma

        12. Hygroma

        13. Thyroid

        14. Glomus jugulare

      2. Metastases

      3. Cysts

      4. Sialolithiasis




    1. Brachial Plexus

      1. Masses

      2. Malignancy

      3. Response to therapy

      4. Trauma




  1. Thorax

    1. Mediastinum

      1. Thyroid masses

      2. Thymoma

      3. Duplication cysts

      4. Lymph node enlargement

      5. Lymphoma

      6. Teratoma

      7. Neurogenic

      8. Pancoast tumors

      9. Aneurysms

      10. Esophageal tumors




    1. Chest wall

      1. Malignant processes

      2. Inflammatory lesions




    1. Respiratory system




    1. 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

        1. Ventricular septal defect (VSD)

        2. Atrial septal defect (ASD)

        3. Tetralogy of Fallot (TOF)




    1. Breast

      1. Dysplasia

      2. Cysts

      3. Benign tumors

      4. Inflammatory conditions

      5. Carcinomas

      6. Post surgery or radiation

      7. Implant rupture




  1. Abdomen

    1. Liver

      1. Hemangioma

      2. Cysts

      3. Abscesses

      4. Hepatocellular carcinoma

      5. Hepatic metastases

      6. Venous thrombosis

      7. Hemochromatosis

      8. Transplant

      9. Gall bladder and ductal anomalies




    1. Pancreas

      1. Pseudocyst

      2. Cystic fibrosis

      3. Pancreatitis

      4. Transplants

      5. Adenocarcinoma

      6. Islet cell tumors

      7. Lymphoma

      8. Metastases

      9. Ductal anomalies




    1. 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




    1. Adrenals

      1. Adenoma

      2. Metastasis

      3. Pheochromocytoma

      4. Neuroblastoma

      5. Hemorrhage




    1. Spleen and lymphatics

      1. Infections

      2. Benign focal lesions

      3. Hodgkin and non-Hodgkin lymphoma




    1. Gastrointestinal (GI) tract

      1. Colon polyps

      2. Tumors

      3. Congenital anomalies




    1. Vascular disorders

      1. Renal artery stenosis





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