Magnetic Resonance Curriculum



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Pelvis

  1. Female reproductive organs (uterus, ovaries, vagina and associated structures)

    1. Neoplastic disorders

      1. Leiomyoma

      2. Endometrial polyps

      3. Endometrial carcinoma

      4. Cervical carcinoma

      5. Adenocarcinoma

      6. Vaginal carcinoma

      7. Ovarian carcinoma

      8. Dermoid/teratoma

      9. Fibroma

    2. Inflammatory disorders

      1. Pelvic inflammatory disease

      2. Salpingitis and oophoritis

    3. Endometriosis

    4. Ovarian cysts

    5. Other

      1. Congenital anomalies and hereditary disorders

      2. Traumatic disorders




    1. Male reproductive organs (prostate, seminal vesicles and associated structures)

      1. Neoplastic disorders

        1. Benign prostatic hyperplasia

        2. Prostatic carcinoma

      2. Inflammatory disorders

        1. Prostatitis

        2. Orchitis and epididymitis

      3. Other

        1. Congenital anomalies and hereditary disorders

        2. Traumatic disorders




    1. Bladder

      1. Neoplastic disorders

      2. Inflammatory disorders

      3. Other

        1. Congenital anomalies and hereditary disorders

        2. Traumatic disorders




  1. Musculoskeletal

    1. Skeletal system

      1. Traumatic injury

      2. Bone fracture union

      3. Bone neoplasms and tumor like lesions

        1. Cartilage lesions

        2. Fibrous lesions

        3. Osteoid osteoma

        4. Tumor-like lesions

        5. Malignant tumors

        6. Metastases

      4. Inflammatory disorders

        1. Osteomyelitis

        2. Periprosthetic infections

      5. Other

        1. Congenital abnormalities

        2. Osteonecrosis and bone infarcts

        3. Avascular necrosis

        4. Contusion




    1. Soft tissues

      1. Neoplastic disorders

        1. Lipomatous tumors

        2. Vascular lesions

        3. Synovial lesions and sarcoma

        4. Fibrous tumors

        5. Peripheral nerve sheath tumors

        6. Benign vs. malignant lesions

      2. Inflammatory disorders

        1. Infections and abscesses

        2. Myositis

        3. Bursitis

        4. Tenosynovitis

        5. Osteomyelitis




    1. Joints

      1. Fibrocartilage disorders

        1. Articular cartilage injuries

        2. Cartilage status

        3. Degenerative joint disease

      2. Ligament and tendon tears

        1. Rotator cuff tear

        2. Anterior/posterior cruciate tear

        3. Patellar tendon tear

        4. Collateral ligament

        5. Achilles tendon

        6. Labral tears

      3. Inflammatory disorders

        1. Infections and abscesses

        2. Myositis

        3. Bursitis

        4. Tenosynovitis

        5. Osteomyelitis

        6. Overuse synovitis

        7. Ganglion and bursal cysts

        8. Rheumatoid and seronegative arthritides

      4. Meniscal Disorders

        1. Meniscal tears

          1. Bucket handle

          2. Anterior horn

          3. Posterior horn

        2. Meniscal cysts

        3. Discoid lateral meniscus

      5. Other

        1. Trauma

        2. Congenital anomalies and hereditary disorders

        3. Bone marrow abnormalities




  1. General Vascular Disorders

    1. Atherosclerosis




    1. Post radiation injury




    1. Dissections




    1. Aneurysms




    1. Graft patency




    1. Venous mapping




    1. Vena caval tumor invasion

MR Instrumentation and Imaging

Description

This unit provides a comprehensive overview of the instrumentation associated with MR imaging. The subjects are formatted in individual outlines and can be sequenced according to level of knowledge desired. Topics include: magnetism, properties of magnetism, MR system components, MR magnets (permanent, resistive, superconducting, hybrid), radiofrequency (RF) systems, gradient systems, shim systems and system shielding.


Rationale

This course is required in order to understand the system components necessary for MR image acquisition. The course provides information on the fundamentals of MR instrumentation/hardware. This information enables the student to maximize MR image quality by understanding MRI components.


Prerequisites

  1. Medical Terminology – a course in terminology used in the medical profession.

  2. Patient Care – methods, equipment, psychology, communication and a rationale of patient care techniques.

  3. An overview of imaging parameters and terminology, safety and patient care procedures.

  4. A course in the fundamentals of digital imaging systems.


Objectives

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



  1. Understand magnetism and magnetic properties.

  2. Define gauss (g), Tesla (T) and the electromagnetic spectrum.

  3. Describe the three basic types of magnets and give the advantages and disadvantages of each.

  4. Discuss the differences in low-, mid-, high- and ultra-high field systems.

  5. Describe field strength in relation to image quality (image contrast, SNR and artifacts).

  6. Explain the functionality of the radiofrequency system in MR imaging.

  7. Explain the functionality of the gradient system in MR imaging.

  8. Explain the functionality of the shim system in MR imaging.

  9. Explain the functionality of the ancillary equipment in MR imaging.

  10. Compare MR instrumentation to other imaging modalities.


Content

  1. Magnetism

    1. Magnetic properties

      1. Diamagnetism

        1. Principles

          1. Electron configurations

          2. Effects of externally applied magnetic fields

        2. Materials

          1. Examples of materials (wood, glass, gold, etc.)

          2. Nonmagnetic

      2. Paramagnetism

        1. Principles: slightly magnetic

          1. Electron configurations

          2. Effects of externally applied magnetic fields

        2. Materials

          1. Contrast agents

            1. Gadolinium

            2. Manganese

            3. Others

      3. Superparamagnetism

        1. Principles: slightly higher than paramagnetic

        2. Materials

          1. T2* contrast agents

            1. Iron oxide

              1. Oral agents (liver)

              2. Others

      4. Ferromagnetism

        1. Principles: highly magnetic

        2. Materials

          1. Iron

          2. Steel

        3. Permanent magnets/bipolar




    1. Magnetic field strength (units of measure)

      1. Gauss (g)

      2. Tesla (T)




  1. Magnets

    1. Types of magnets/magnet configurations

      1. Permanent

        1. Characteristics

          1. Field strength (low field)

          2. Configuration

        2. Temperature dependence

          1. 70° +/- 2° F

          2. Maintain homogeneity

        3. Ferromagnetic materials

          1. Iron

          2. Other materials

      2. Resistive

        1. Characteristics

          1. Field strength (low field)

          2. Configuration

        2. Temperature dependence

          1. Water cooled

      3. Superconductive

        1. Characteristics

          1. Field strength (high field)

          2. Configuration

        2. Temperature dependence

          1. Cryogens

            1. Liquid helium

            2. Liquid nitrogen

            3. 4 Kelvin

          2. Quench

            1. Reduce magnetic field

            2. Safety considerations

              1. Frostbite/hypothermia

              2. Asphyxia/hypoxia

      4. Hybrid

        1. Characteristics

          1. Field strength

          2. Configuration




    1. Field direction

      1. Horizontal field

      2. Vertical field




    1. Field configuration

      1. B0

      2. Static field

      3. Safety considerations for static magnetic fields




    1. Field strengths and imaging systems

      1. Ultra-low field (for example: 0.01T)

      2. Low field (for example: 0.3 T)

      3. Mid field (for example: 0.5 T)

      4. High field (for example: 1.0 T to 2.0 T)

      5. Ultra-high field (for example: 3.0 T and greater)




    1. Field strengths and imaging considerations

      1. SNR and field strength

      2. Image contrast and field strength

        1. T1 relaxation and field strength

          1. TR and field strength

          2. Flip angle and field strength

          3. T1 and field strength

        2. T2 relaxation and field strength

          1. TE and field strength

          2. TE artifacts and field strength

        3. T2* and field strength

          1. TE and field strength

          2. TE artifacts and field strength

      3. Artifacts and field strength

        1. Susceptibility

        2. Chemical shift

        3. Dielectric effect

        4. Other artifacts and field strength




    1. Field strengths and safety considerations

      1. FDA regulations

      2. Forces

        1. Translational force

          1. Projectiles

          2. Missile effect

        2. Rotational force

          1. Torque

        3. Bioeffects

          1. Magnet – hemo-dynamic effect

          2. Magnet – hydro-dynamic effect

          3. Elevated T-wave

        4. Implanted devices

          1. Cardiac pacemaker

          2. Intracranial vascular clips

          3. Intraocular ferrous foreign bodies

        5. Ancillary equipment

          1. MR safe

          2. MR conditional

          3. MR unsafe

        6. Safety screening

          1. Patients

          2. Others

        7. Other safety considerations




    1. Magnetic field shielding

      1. Regulations

        1. 5 gauss

        2. Shielding

      2. Mechanisms for magnetic field shielding

        1. Passive shielding

        2. Active shielding

      3. “Zoning” (ACR white paper)

        1. Zone 1 (accessible to all)

        2. Zone 2 (connects Zone 1 to Zone 3 – examples: reception area)

        3. Zone 3 (near Zone 4 – restricted access)

        4. Zone 4 (magnet room)

      4. “Levels of training” (ACR white paper)

        1. Level 1

        2. Level 2

        3. Non-MR personnel




    1. Magnetic field function

      1. Align nuclei in a magnetic field

        1. Magnetic moments

        2. Vectors

          1. Magnitude

          2. Direction

        3. Alignment

          1. Low energy state (aligned with the magnetic field)

          2. High energy state (aligned opposed to the magnetic field)

          3. Net magnetization




    1. Magnetic field production

      1. Power supply (for resistive)

      2. No power for superconducting

        1. Power to ramp up

      3. No power for permanent magnets




  1. Shim Systems

    1. Types of shim systems

      1. Passive shimming

        1. Shim plates

        2. Metal

      2. Active shimming

        1. Shim coils

        2. Shim power supply




    1. Shim function

      1. Maintain homogeneity

        1. Units of measure

        2. Parts per million (PPM)

      2. Performed by

        1. Technologists

        2. Service engineers




    1. Shim field production

      1. Power supply




  1. Radiofrequency Systems

    1. Types of RF coils/RF configurations

      1. Transmit coils

        1. Linear

        2. Quadrature

          1. Birdcage coil

          2. Saddle coil

          3. Other configurations

        3. Multichannel

      2. Receive-only coils

        1. Linear

          1. Single coil

            1. 3” to 5” round coil

            2. Saddle coils

          2. Helmholtz pair

          3. Maxwell pair

        2. Quadrature

          1. Birdcage coil

          2. Saddle coil

        3. Multichannel

          1. 8-channel coil

          2. 32-channel coil

          3. Other configurations

        4. Phased array

          1. Linear array (example: spinal coil)

          2. Volume array (example: torso coil)

      3. Transmit/receive

        1. Linear

        2. Quadrature

        3. Multichannel




    1. RF field configuration

      1. B1

      2. Oscillating field

      3. Safety considerations for RF fields




    1. RF field production

      1. Power supply

      2. Amplifiers and preamplifiers

      3. Receivers




    1. Resonance and RF frequencies

      1. Precession

        1. Spin alignment (angled to the magnetic field)

        2. Precessional frequency

      2. Larmor equation

        1. Frequency in megahertz

        2. Frequency in radians

      3. Larmor frequency

        1. Related to field strength (B0)

        2. Related to chemicals

          1. Gyro-magnetic ratio (magneto-gyric ratio)

            1. Hydrogen (1H)

            2. Phosphorus (31P)

            3. Other chemicals

          2. Spin angular momentum

          3. Magnetic moment

      4. Units of measure

        1. MHz (megahertz)

        2. Hz (hertz)

      5. Energy Level (radiation)

        1. Electromagnetic spectrum

        2. Nonionizing radiation vs. ionizing radiation

        3. Low energy

      6. RF excitation pulses

        1. 90° RF pulse

        2. 180° RF pulse

        3. Flip angle




    1. Signal induction

      1. Faraday’s law of induction

        1. The equations

          1. dB/dT = dV

          2. V

        2. MR signal induction

          1. Free induction decay (FID)

          2. Echo

      2. Safety considerations (related to gradient coils but due to Faraday’s law)

        1. Peripheral nerve stimulation

          1. Magneto-phosphenes (“stars in your eyes”)




    1. RF and field strengths

      1. Ultra-low field (for example: 0.01 T)

        1. Ultra-low frequency

        2. Coil configurations

      2. Low field (for example: 0.2 T)

        1. Low frequency

        2. Coil configurations (for vertical fields vs. horizontal)

      3. Mid field (for example: 0.5 T)

        1. Medium frequency

        2. Coil configurations (for vertical fields vs. horizontal)

      4. High field (for example: 1.0 T to 2.0 T)

        1. High frequency

        2. Coil configurations (for vertical fields vs. horizontal)

      5. Ultra-high field (3.0 T and greater)

        1. Ultra-high frequency

        2. Coil configurations (for vertical fields vs. horizontal)




    1. RF fields and safety considerations

      1. FDA guidelines

        1. SAR

        2. Over time

      2. SAR

        1. Watts/kg

        2. Patient weight

      3. Bioeffects

        1. Nonionizing radiation

        2. Heating tissues

      4. Other safety considerations

        1. RF heat deposition

        2. Burns




    1. RF field shielding

      1. Regulations and recommendations

      2. Mechanisms for RF field shielding

        1. Copper

          1. In walls

          2. Around door

          3. In window

        2. Faraday cage




    1. RF coil function

      1. Transmit coils

        1. Excite proton spins

        2. Resonance

        3. Larmor frequency

        4. Transmit gain

      2. Receive coils

        1. Receive MR signal

        2. Faraday’s Law of Induction

        3. Tuning

        4. Receiver gain (attenuation)

      3. Transmit/receive coils

        1. Decoupling

  1. Gradient Systems

    1. Types of gradients/gradient configurations

      1. Wire configurations determine gradient slope

        1. Characteristics

        2. Gradient slope (amplitude or strength)

        3. Polarity (direction)




    1. Gradient characteristics

      1. Strength/amplitude

        1. Millitesla/meter (mT/m)

        2. Gauss/meter (g/cm)

        3. Inter-relationship (10 (mT/m) = 1 g/cm)

      2. Rise time

        1. Microseconds

      3. Amplitude and rise time

        1. Slew rate

        2. T/m/sec (Tesla per meter per second)

      4. Duty cycle

        1. Percent of time that the gradient can work

        2. Gradient heating




    1. Gradient fields and safety considerations

      1. FDA guidelines

        1. Faraday’s Law (V)

        2. Until a patient feels discomfort

      2. Bioeffects

        1. Peripheral nerve stimulation

        2. Acoustic noise

      3. Other safety considerations

        1. No skin-to-skin contact

        2. Burns




    1. Gradient function

      1. Spatial encoding

        1. Slice selection

        2. Phase encoding

        3. Frequency encoding

      2. Gradient refocusing

        1. Gradient echoes

        2. Gradient moment nulling




    1. Gradients

      1. Physical gradients

        1. Z (superior to inferior)

        2. Y (anterior to posterior)

        3. X ( right to left)

      2. Logical gradients

        1. Z (slice selection)

        2. Y (phase encoding)

        3. X (frequency encoding or readout)

          1. Signal detection

          2. Nyquist Theorem

          3. K-space filling

            1. Normal k-space filling

            2. centric

            3. Partial Fourier





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