Magnetic Resonance Curriculum



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Post-processing

  1. Measurements

    1. ROI – region of interest

    2. Distance




    1. Reconstruction/reformatting

      1. Multiplanar reconstruction (MPR)

      2. 3-D reformats

      3. Volume reconstruction (VR)




    1. MRA reformats/reconstructions

      1. Maximum intensity pixel (MIP)

      2. Shaded surface display (SSD)


MR Safety

Description

This content introduces the basic principles of MR safety and covers the basic concepts of patient management. Educating patients and ancillary staff on magnet safety also is presented. Patient and magnet-related emergencies represent a unique situation to an MR technologist; recommended procedures and responsibilities of the technologist will be discussed for these situations. This content also covers MR contrast agents.


Rationale

This introduction provides basic knowledge of MR safety, patient preparation and monitoring of patients in the MR suite. This information enables the student to better communicate with the health care team to ensure the patients’ safety.


Prerequisites

Methods of patient care – equipment, psychology, communication and rationale of patient care techniques.


Objectives

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



  1. Discuss the elements of safety management that ensure an MR facility operates safely.

  2. Demonstrate proper screening and preparation of patients for MR.

  3. Monitor patients during procedures.

  4. Describe when and how to quench the magnet and handle other emergencies in the MR environment.

  5. Demonstrate an understanding of MR contrast agents.


Content

  1. Introduction

    1. Magnetic fields in MR

      1. Main static field aligns spins

      2. Radio frequency field flips spins

      3. Gradient field is used for spatial encoding of the image




    1. MR safety concerns

      1. Force and torque on magnetic materials from the static magnetic field

      2. Heating caused by the RF magnetic field used to flip spins

      3. Nerve stimulation caused by gradient magnetic fields used for spatial encoding

      4. Implanted medical devices affected by the static magnetic field, RF magnetic field and gradient magnetic fields




    1. MR safety organizations

      1. International Electrotechnical Commission (IEC)

      2. U.S. Food and Drug Administration (FDA)

      3. National Electrical Manufacturers Association (NEMA)

      4. American Society for Testing and Materials (ASTM)

      5. American College of Radiology (ACR)

      6. International Society for Magnetic Resonance in Medicine (ISMRM) Safety Group

      7. Institute for Magnetic Resonance Safety Education and Research (IMRSER)




  1. Static Magnetic Field

    1. Force and torque on magnetic materials caused by the static magnetic field can cause projectile hazards

      1. Potential dangers in a hospital setting with examples of projectiles

      2. Force vs. distance from magnet: The force increases very rapidly as distance to magnet decreases




    1. Magnetic shielding: active and passive




    1. Designing MR guidelines for safety

      1. Provide written safety policies and procedures

      2. Enforce vigilance in controlling access to the MR suite to trained MR personnel

      3. ACR guidelines regarding MR suite safety zones I through IV

      4. Lock MR suite door when trained MR personnel are absent

      5. Provide safety education to all staff that could potentially work near the magnet, including the local fire department

      6. Post warning signs citing examples of potentially dangerous projectiles




    1. Field strength relevance to safety




    1. Status of high-field MR safety studies




  1. Radio Frequency (RF) Magnetic Field

    1. Theory of RF heating in MR

      1. Faraday's Law

      2. Factors that affect the amount of heat produced

      3. Most heat is deposited on perimeter of body where it can be more easily dissipated




    1. Regions with high resistance can cause focal heating




    1. RF heating in clinical MR

      1. Use SAR to estimate temperature increase

      2. SAR = absorbed power/mass (e.g., watts/kg)

      3. Concerns are for core (whole body) and localized heating




    1. Responsibilities of technologist concerning patient safety in avoiding RF heating

      1. Position patients properly

      2. Position monitoring equipment properly

      3. Screen patients for electronically conducting jewelry, tattoos, cosmetics, medication patches, etc.

      4. Monitor patients with physiological conditions that are unable to dissipate heat

      5. Monitor patients who are unable to respond due to sedation or mental status

      6. Limit pregnant individuals from being present in the RF field




    1. How a scanner estimates SAR

      1. Scanner calibration routine

      2. Determines energy needed to get a 90° flip and 180° flip

      3. Adds energy of all RF pulses in a sequence and divides by pulse repetition time (TR) to calculate power

      4. Divides by patient weight to calculate whole body SAR




    1. IEC/FDA limits for whole-body heating

      1. Normal mode limit (suitable for all patients)

      2. First level controlled mode (medical supervision)




  1. Gradient Magnetic Fields

    1. Gradient coils and current waveforms

      1. Linear magnetic fields for spatial encoding

      2. Echo planar imaging pulse train




    1. Effects on patients

      1. Nerve stimulation

        1. Orientation of field gradient with respect to the body

        2. Location in the body

        3. Duration of the gradient pulse




    1. Hearing damage caused by dangerously loud sound pressure levels




    1. Hyperbolic relationship between pulse duration and stimulation threshold

      1. Nerve stimulation

      2. Variations in patient response to nerve stimulation




  1. Patient and Personnel Safety Screening in MR (Technologist Responsibilities)

    1. Obtain documentation and consent in the form of an MR safety screening questionnaire completed by the patient or guardian




    1. Obtain any necessary special consent documentation for non-FDA approved MR scanning for the following instances:

      1. Pregnancy

      2. Injection of contrast to a pregnant patient

      3. Implanted device

      4. Cardiac stress agent




    1. Patient and personnel safety — contraindications for entering the MR suite

      1. Implanted electronic devices

      2. Implanted metallic objects at risk of deflection

      3. Indications for plain film radiography for safety screening include intra-ocular foreign bodies, shrapnel and bullets in the body

        1. The physician in charge should be consulted in each instance and approve of the patient entering the MR environment




  1. Equipment Safety Screening in MR Environment (Technologist Responsibilities)

    1. Screen all equipment before allowing entrance to the MR suite




    1. Properly label MR-safe equipment




    1. Keep all MR conditional and MR unsafe equipment clear of the MR suite and anteroom




    1. Recognize table stop and emergency shut-down switches that control electricity to the scanner, and quench or magnet run-down switch




    1. Monitor, record and report cryogen levels




    1. Monitor the cryogen exhaust vent line for blockages




    1. Monitor the cryogen fill line for ice blockages




    1. Maintain awareness and marking of gauss lines in MR area




    1. Display warning signs prominently

      1. Strong magnetic field

      2. This magnet is always on

      3. Radio frequency field

      4. Hearing protection necessary

      5. Hazardous material including phantom liquids and helium dewars

      6. Laser light in use




    1. Display signage that prohibits items and implants

      1. Implants susceptible to electromagnetic fields

      2. Open flame

      3. Electronic media

      4. Ferrous objects

      5. Credit cards




  1. Monitoring of Ancillary Equipment

    1. Perform quality measurement of the RF coils




    1. Perform quality measurement of software




    1. Perform and report cryogen levels




    1. Perform checks on pulse receptor, ECG cables and disposable electrodes




    1. Measures to take if phantom fluid spills

      1. First aid in case of contact with phantom fluid

      2. Mandatory reporting to local fire department of phantom fluid contents in case of fire

      3. Disposal as special waste

      4. Gauss lines and their relationship to electronic equipment




  1. Emergencies in the MR Environment Requiring Technologist Action

    1. Code blue: Remove patient from the MR suite




    1. Fire emergency

      1. Evacuate patients and others

      2. Suspend all electricity to the MR scanner

      3. Follow institution's fire emergency procedure

      4. Employ MR safe fire equipment

      5. Local fire department should be trained by MR personnel

      6. Follow procedures when the fire cannot be contained




    1. Metallic items pinned to the magnet

      1. If a person is in immediate danger

      2. If equipment only is pinned to the magnet




    1. Quench

      1. Causes

      2. Procedure for evacuation

      3. Remove patient and staff from MR suite

      4. Establish a procedure for gaining entry to the MR suite in case positive pressure is pinning the door to the MR suite (if the door opens inward)

      5. Maintain the room

      6. Notify in-house maintenance personnel

      7. Notify vendor service of quench

      8. Risks of cryogen boil-off during quench

        1. Asphyxiation from displacement of oxygen

        2. Frostbite

        3. Fire due to condensation of oxygen




  1. Safety in MR Contrast Administration

    1. Patient history

      1. Sickle cell (in crisis)

      2. Severe asthma

      3. Drug allergy

      4. Adverse reaction to contrast media

      5. Kidney function




    1. Preparation

      1. Proper dose

      2. Check for expiration date on contrast vial before administering

      3. Keep the vial until patient has been released

      4. Use sterile technique in preparing lines, tubing and needles

      5. Obtain venous access




    1. Contrast administration

      1. Administration by hand

        1. Check for integrity of venous access

        2. Visualize access site during administration, watch for extravasation

      2. Administration by power injector

        1. Check for integrity of venous access site

        2. Understand the relationship between the gauge of the angiocatheter vs. the rate of contrast media flow and follow the guidelines of angiocatheter manufacturer

        3. Follow guidelines for contrast administration through alternative sites such as venous access ports, central lines, etc.




    1. Adverse reactions

      1. Local events

        1. Stop contrast administration

      2. Treatment/follow-up guidelines

        1. Compress (hot or cold)

        2. Written instructions for patient to follow after discharge

        3. Notify the physician in charge that the patient needs to be examined

        4. Document/report the extravasation

      3. Systemic events

        1. Stop contrast administration immediately if dose is not complete

        2. Remove patient from MR suite if treatment is required

        3. Assess patient for breathing difficulty

        4. Notify the physician in charge to examine the patient before he/she is released

        5. Treatment/follow-up guidelines:

          1. Appropriate health care provider to administer medications if necessary

          2. Give patient written instructions to follow after discharge

          3. Document/report the contrast reaction

        6. Keep epinephrine and asthma-related drugs in MR suite for emergencies

        7. Have the respiratory therapy immediate response number available

        8. Have code blue button available in the MR area




    1. Gadolinium-based MR contrast and NSF

      1. ACR guidelines regarding renal function and dialysis.

Pharmacology and Drug Administration

Description

Content__Drug_Nomenclature'>Content provides basic concepts of pharmacology. This section covers the theory and practice of basic techniques of venipuncture and administering diagnostic contrast agents and/or intravenous medications. The appropriate delivery of patient care during these procedures is emphasized.


Considerations

Prior to introducing this educational content, students should have successfully completed patient care objectives (including CPR/BLS certification), as well as objectives related to anatomy and physiology of the circulatory and excretory systems.


Although regulations regarding administration of contrast media and intravenous medications vary in different states and institutions, the skill should be included in the didactic and clinical curriculum with demonstrated competencies of all appropriate disciplines regardless of the state or institution where the curriculum is taught.
In states or institutions where students are permitted to perform intravenous injections, the program has specific ethical and legal responsibilities to the patient and the student. The student shall be assured that:


  • Legal statutes allow student MR technologists to perform this procedure.

  • Professional liability coverage is adequate.

  • Adequate supervision is provided.

  • Appropriate, structured, laboratory objectives are identified.

  • Competency is demonstrated and evaluated before the student performs this task unsupervised.


Content

  1. Drug Nomenclature

    1. Chemical name




    1. Generic name




    1. Trade name




  1. Methods of Drug Classification

    1. Chemical group




    1. Mechanism/site of action




    1. Primary effect




  1. General Pharmacologic Principles

    1. Pharmacokinetics




    1. Pharmacodynamics




  1. Five Rights of Drug Safety

    1. The right medication




    1. The right dose




    1. The right patient




    1. The right time




    1. The right location




  1. Drug Categories of Relevance to MRI (Side Effects, Uses and Impacts on Medical Imaging)

    1. Analgesics




    1. Antiemetic drugs




    1. Antianxiety drugs




    1. Antidepressants




    1. Anti-inflammatory drugs




    1. Antiarrhythmic drugs




    1. Vasodilators and vasoconstrictors




    1. Diuretics




    1. Antihypertensive drugs




    1. Anticoagulant and coagulant drugs




    1. Antiallergic and antihistamine drugs




    1. Bronchodilators




    1. Antibacterial drugs




    1. Antiseptic and disinfectant agents




    1. Sedative and hypotonic drugs




    1. Anesthetic agents




    1. Cathartic and antidiarrheal drugs




    1. Diagnostic contrast agents




  1. Classification of Contrast Agents

    1. Types of compound

      1. Metallic salts

      2. Organic iodides

        1. Ionic contrast agents

        2. Nonionic contrast agents

      3. Iodized oils

      4. Gaseous




    1. Pharmacologic profile of contrast agents

      1. Chemical composition

      2. Absorption characteristics

      3. Distribution characteristics

      4. Metabolic characteristics

      5. Elimination characteristics

      6. Indications, actions and effects

      7. Interactions and contraindications

      8. Patient reactions




    1. Dosage




    1. Preparation




  1. Routes of Drug Administration

    1. Systemic

      1. Oral

      2. Rectal

      3. Tube/catheter

      4. Inhalation




    1. Parenteral

      1. Intravenous

      2. Intra-arterial

      3. Intrathecal




  1. Intravenous Drug Therapy

    1. Purpose




    1. Advantages




    1. Methods

      1. Continuous infusion

      2. Intermittent infusion

      3. Direct injection




    1. Sites of administration

      1. Peripheral

      2. Central




    1. Complications

      1. Infiltration

      2. Extravasation

      3. Phlebitis

      4. Air embolism

      5. Drug incompatibility

      6. Low fluid level in container




    1. Initiation of intravenous therapy

      1. Intravenous infusion/venipuncture equipment

      2. Patient identification, assessment and instructions

      3. Dosage, dose calculations and dose-response

        1. Adults

        2. Pediatrics

      4. Patient preparation

      5. Application of standard precautions

      6. Procedure for intravenous infusion/direct puncture

      7. Site observation

      8. Emergency medical treatment procedure

        1. Appropriate codes

        2. Emergency cart (crash cart)

        3. Emergency medications

        4. Accessory equipment

          1. Oxygen

          2. Suction

        5. Emergency medical treatment follow-up tasks

      9. Discontinuation of intravenous therapy

        1. Equipment/supplies for withdrawal

        2. Patient preparation

        3. Application of standard precautions

        4. Withdrawal procedure

        5. Site observation

        6. Patient observation

        7. Post-procedural tasks

      10. Documenting administration

      11. Documenting a complication/reaction




  1. Current Practice Status

    1. Professional standards

      1. Scope of Practice

      2. Practice Standards

      3. Professional liability and negligence




    1. State statutes




    1. Employer prerogative




  1. Informed Consent

Physical Principles of Magnetic Resonance Imaging

Description

This unit provides the student with a comprehensive overview of MR imaging principles. The subjects are formatted in individual outlines and can be sequenced according to the level of knowledge desired. Topics include the history of MR, nuclear MR signal production, tissue characteristics, pulse sequencing, imaging parameters/options and image formation.


Rationale

This course is required in order to understand the basic principles of MR image acquisition. The course provides information on the fundamentals of MR image acquisition. This information is useful to enable the student to maximize MR image quality by understanding the fundamentals of MR imaging.


Prerequisites

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

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

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

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


Objectives

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



  1. Know the researchers who provided the means for MR imaging.

  2. Describe various nuclei in a magnetic field.

  3. Explain how an image is acquired in MR (nuclei in a magnetic field, excitation, relaxation).

  4. Explain how an MR signal is produced and detected.

  5. Explain MR tissue characteristics, such as spin density and T1 and T2 relaxation.

  6. Understand the behavior of various nuclei in the magnetic field and/or during the application of the radiofrequency pulse.

  7. Understand the concept of resonance and excitation in MR.

  8. Understand the concept of relaxation in MR.

  9. Apply the principle of pulse sequences and image formation to appropriate clinical applications.

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


Content

  1. History of MR

    1. Scientific discovery of the principles of nuclear magnetic resonance (NMR)

      1. Felix Bloch (Bloch equations)

      2. Edward Purcell

      3. Sir Peter Mansfield




    1. Scientists associated with MR

      1. Nikola Tesla

      2. Jean Baptiste Fourier (Fourier transformation)

      3. Richard R. Ernst (Ernst angle)

      4. Joseph Larmor (Larmor equation)

      5. Michael Faraday (Faraday’s Law of Induction)

      6. Charles Dumoulin (MRA)




    1. Early MR images

      1. Raymond Damadian

      2. Paul Lauterbur



  1. Matter

    1. Periodic table of elements

      1. MR active nuclei

        1. Hydrogen (1H)

          1. Water( H20)

          2. Fat (CH3)

          3. Soft tissue structures of the body

        2. Phosphorous (31P)

        3. Other MR active chemicals (uneven mass number)

      2. Chemicals that are not MR active (even mass number)




    1. Atom

      1. Nucleus

        1. Proton

        2. Neutron

      2. Electron




  1. Nuclear Magnetism

    1. Definitions

      1. Approach/methodology

        1. Quantum

        2. Classical

      2. Frames of reference

        1. Laboratory frame of reference

        2. Rotating frame of reference




    1. Nuclei in a magnetic field

      1. Nuclear alignment

        1. Magnetic moment

        2. Vectors

          1. Magnitude

          2. Direction

      2. Energy states

        1. Low energy state

          1. Spin up

          2. Parallel

        2. High energy state

          1. Spin down

          2. Antiparallel




  1. MR Signal Production

    1. Thermal equilibrium

      1. Magnetization

        1. Longitudinal magnetization (“z” axis)

        2. Transverse magnetization (“x” “y” plane)

        3. Net magnetization

      2. Spin excess




    1. Precession

      1. Precessional frequency

      2. Larmor frequency (o)

        1. Hertz (Hz)

        2. Megahertz (MHz)

      3. Larmor equation (o = Bo 

        1. Field strength (Bo)

        2. Gyro-magnetic ratio ( ) – (spin angular momentum and the magnetic moment)

          1. ( ) for 1H = 42.6 MHz/T

          2. ( ) for 31P = 17.2 MHz/T

          3. ( ) for other MR active chemicals




    1. Resonance

      1. Excitation

        1. RF pulse (B1)

          1. 90° RF pulse – when the RF pulse tips the magnetization into the transverse plane it is known as a “90° RF pulse”

          2. 180° RF pulse – when the RF pulse tips the magnetization into the 180° it is known as a “180° RF pulse”

          3. Flip angle – the degree that the magnetization is “tipped” is known as the flip angle

        2. Bioeffects for RF pulses

          1. Heating tissues

          2. Measured by SAR

          3. Limited by the FDA

        3. NMR Signals

          1. FID

          2. Echoes

            1. Spin echo signal

            2. GRE

      2. Relaxation characteristics that relate to MR image contrast

        1. T1 relaxation

          1. Longitudinal recovery

          2. Spin-lattice

          3. T1 recovery (exponential relaxation/recovery)

            1. In one T1 time, 63% of longitudinal magnetization recovers

            2. In one T1 time, 37% of longitudinal magnetization remains

        2. T2 relaxation

          1. Transverse decay

          2. Spin-spin

          3. T2 decay (exponential relaxation/decay)

            1. In one T2 time, 63% of transverse magnetization decays

            2. In one T2 time, 37% of transverse magnetization remains

        3. Relaxation and contrast media in MR

          1. Enhanced T1 relaxation with contrast agents

            1. Gadolinium

            2. Manganese

          2. Enhanced T2* relaxation with contrast agents

            1. Gadolinium

            2. Iron oxide

      3. Tissue characteristics that relate to MR image contrast

        1. Proton density

          1. Number of mobile water protons

          2. Varies with tissue type

        2. Relative proton density

          1. Number of mobile water protons in the spin excess

          2. Varies with tissue type and field strength




  1. MR Signal Induction/Sampling/Conversion

    1. MR signal induction

      1. FID

        1. Free of the RF pulse

        2. Induced in the receiver coil

        3. Decays over time

      2. Echo/readout

        1. Sampled at the TE time

        2. Sampling points related to the frequency matrix

        3. Sampling points stored as lines in k-space

      3. Nyquist theorem

        1. Must be sampled at discrete time intervals

        2. Sampled twice at its highest frequency




    1. MR signal conversion

      1. Fourier transformation

        1. Frequency domain (spectrum)

        2. Time domain (FID)

      2. Array processor

        1. Performs multiple Fourier transformation equations




    1. Spectroscopy

      1. Spectrum (1H)

        1. Chemical shift

          1. Spectral resolution

          2. Parts per million (PPM)

        2. Field strength

      2. Spectrum of other MR active chemicals




  1. MR Image Contrast Characteristics

    1. Weighting in MR imaging

      1. T1 weighted images

        1. Parameter values

          1. Short TR

          2. Short TE

        2. Image contrast characteristics

          1. Tissues with short T1 times bright

          2. Tissues with long T1 times dark

      2. T2 weighted images

        1. Parameter values

          1. Long TR

          2. Long TE

        2. Image contrast characteristics

          1. Tissues with short T2 times dark

          2. Tissues with long T1 times bright

      3. T2* weighted images (GRE sequences)

        1. Parameter values

          1. Short TR

          2. Short TE

          3. Short flip angle

        2. Image contrast characteristics

          1. Tissues with short T2 times dark

          2. Tissues with long T1 times bright

        3. Susceptibility artifacts are increased with gradient echo sequences

      4. Proton density (PD) weighted images

        1. Parameter values

          1. Long TR

          2. Short TE

        2. Image contrast characteristics

          1. Tissues with high proton density times bright

          2. Tissues with high proton density times bright

      5. Image contrast characteristics/comparison

        1. T1-weighted image

        2. T2-weighted image

        3. T2*-weighted image

        4. PD-weighted image

        5. Flow imaging

        6. Diffusion imaging

        7. Magnetization transfer

      6. Introduction to pulse sequences and image contrast

        1. Partial saturation

        2. Spin echo

          1. Conventional spin echo

          2. FSE (turbo spin echo, rapid acquisition recalled echo)

        3. GRE

          1. Steady state (T2)

            1. PC MRA

            2. Steady-state dynamic cine

          2. Spoiled (T1)

            1. Dynamic imaging

            2. In/out of phase imaging

            3. MRA

              1. TOF MRA

              2. Enhanced dynamic MRA

          3. Echo planar imaging

            1. Rapid imaging

            2. Perfusion

            3. Diffusion

            4. Functional (BOLD) imaging

        4. Inversion recovery

          1. Standard IR

            1. STIR

            2. FLAIR

          2. FSE – IR

            1. STIR (FSE)

            2. FLAIR (FSE)




    1. Image quality comparison of spin echo vs. gradient echo

      1. T1 weighted images

        1. T1 spin echo – generally higher quality and lower susceptibility artifacts

          1. 90° and 180° RF pulses

          2. Short TR/short TE

        2. T1 gradient echo – generally lower quality and higher susceptibility artifacts

          1. Flip angle RF pulses with gradient echo

          2. Short TR/short TE with smaller flip angle and RF and/or spoiling

      2. T2 weighted images

        1. T2 spin echo – generally higher quality and lower susceptibility artifacts

          1. 90° and 180° RF pulses

          2. Short TR/short TE

        2. T2 gradient echo – generally lower quality and a higher number of susceptibility artifacts

          1. Flip angle RF pulses with gradient echo

          2. Short TR/short TE with smaller flip angle and RF and/or spoiling




  1. Introduction to MR Image Formation

    1. Magnetic field 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 – timing diagram)

        2. “Y” (phase encoding – timing diagram)

        3. “X” (frequency encoding – timing diagram)




    1. Gradient functions

      1. Image formation

        1. Slice selection

          1. Gradient amplitude

          2. Transmitter bandwidth

        2. Phase encoding

          1. Imaging matrix

          2. FOV

          3. Scan time

        3. Frequency encoding

          1. Imaging matrix

          2. FOV

          3. Receiver bandwidth

          4. TE

      2. Gradient signal refocusing

        1. Gradient echo

        2. Gradient moment nulling

        3. “b” value

        4. “VENC” settings




  1. Imaging Planes

    1. Sagittal




    1. Axial




    1. Coronal




    1. Oblique




  1. K-Space and Image Formation

    1. Normal filling




    1. Centric filling




    1. Zero fill




    1. Rectangular FOV




    1. Parallel imaging

Sectional Anatomy

Description

This is a study of human anatomy as seen in multiple orthogonal planes. Bone, muscle, vascular structures, 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.


Rationale

The student should be able to recognize normal anatomy to ensure that the region of interest is adequately imaged. A study of normal anatomy and normal variations, as well as its appearance in multiple planes, enables the student to better recognize abnormal conditions and make the associated imaging changes required to adequately demonstrate the patient's anatomy and pathology.


Prerequisites

Human Anatomy and Physiology I and II – anatomy of all body regions.


Objectives

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



  1. Identify anatomical structures as seen in multiple orthogonal planes on MR images.

  2. Describe gross anatomic relationships in the body.

  3. Describe anterior-posterior, proximal-distal and lateral-medial relationships of anatomy.

  4. Distinguish normal anatomy from abnormal anatomy.


Content

  1. The Head

    1. Bones of the skull and cranium

      1. Cranial cavity

      2. Facial skeleton

      3. Paranasal sinuses

      4. Foramina of the skull




    1. The Brain

      1. Nervous tissue and organization

        1. White matter structures

        2. Gray matter structures

      2. Regions of the brain

        1. Cerebrum to include hemispheres, lobes, fissures, sulci, etc.

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

        3. Brainstem

          1. Midbrain

          2. Pons

          3. Medulla oblongata

          4. Cranial nerves

        4. Cerebellum to include hemispheres and peduncles

      3. The Ventricular System

        1. Cerebrospinal fluid

        2. Choroid plexus

        3. Lateral ventricles

        4. Third ventricle

        5. Fourth ventricle

      4. Meninges

        1. Dura mater and major extensions

        2. Arachnoid

          1. Subarachnoid cisterns

        3. Pia mater

      5. Arterial blood supply

        1. Anterior supply (major branches)

        2. Posterior supply (major branches)

        3. Circle of Willis

      6. Venous drainage

        1. Superficial drainage system

        2. Dural sinuses

        3. Internal jugular vein

      7. Cranial nerves

      8. The orbital cavity

        1. Skeletal formation of the orbital cavity

        2. Bulbus oculi (eyeball)

          1. Fibrous tunic

          2. Vascular tunic

        3. Orbital muscles

        4. Vascular supply

        5. Optic nerve

      9. Auditory canal

        1. Temporal bone and bony structures

        2. Vestibulocochlear nerve and course

      10. Endocrine system - pituitary gland

        1. Sphenoid bone

        2. Infundibulum

        3. Hypophysis (pituitary gland)




  1. The Spine

    1. Vertebral column

      1. Sections

      2. Curvatures




    1. Typical vertebrae components

      1. Cervical vertebrae components

      2. Thoracic vertebrae components

      3. Lumbar vertebrae components




    1. Sacrum




    1. Coccyx




    1. Intervertebral discs

      1. Nucleus pulposus

      2. Annulus fibrosus




    1. Spinal cord

      1. Composition

        1. White matter

        2. Gray matter

      2. Components




    1. Spinal plexus

      1. Cervical

      2. Brachial

      3. Lumbar

      4. Sacral




  1. The Soft Tissue Neck (Skeletal Components – see Spine)

    1. Tissue organization

      1. Suprahyoid

      2. Infrahyoid




    1. Viscera of the neck

      1. Pharynx

        1. Nasopharynx

        2. Oropharynx

        3. Palatine tonsils

        4. Hypopharynx

      2. Rectopharyngeal space

      3. Larynx (distinguishing between true and false cords)

      4. Esophagus

      5. Trachea

      6. Thyroid gland

      7. Salivary glands




    1. Vascular supply (major branches)




    1. Musculature of the neck

      1. Muscles of mastication

      2. Anterior triangle

      3. Posterior triangle




  1. The Thorax

    1. Skeletal anatomy of the thorax

      1. Sternum

      2. Thoracic vertebrae

      3. Ribs




    1. Thoracic cavity

      1. Lungs

      2. Mediastinum




    1. Heart

      1. Superficial features of the heart

      2. Chambers and valves

      3. Vascular supply and drainage

        1. Coronary arteries

        2. Cardiac veins

      4. The great vessels of the heart

        1. Aorta

          1. Ascending aorta

          2. Arch

          3. Descending aorta

        2. Pulmonary trunk

        3. Superior vena cava

        4. Inferior vena cava




    1. Associated thoracic structures

      1. Thymus

      2. Trachea and bronchi

      3. Esophagus

      4. Azygos veins




    1. Breast

      1. General structure

      2. Hormonal participation




    1. Lymphatic system




  1. The Abdomen

    1. Abdominal regions




    1. Diaphragm

      1. Structure

      2. Openings




    1. Abdominal musculature

      1. Anterolateral muscles

      2. Posterior muscles




    1. Abdominal peritoneum

      1. Mesentery

      2. Peritoneal elements




    1. Peritoneal cul-de-sacs




    1. Abdominal vasculature

      1. Abdominal aorta

      2. Branches




    1. Venous drainage of the abdomen

      1. Inferior vena cava

      2. Major veins connecting to inferior vena cava (IVC)




    1. Hepatic portal system

      1. Portal vein

      2. Veins connecting to portal system




    1. Abdominal viscera

      1. Liver

        1. Lobes

        2. Vasculature

      2. Gallbladder

      3. Esophagus

      4. Stomach

        1. Vasculature

        2. Divisions

      5. Small intestine

      6. Large intestine

      7. Spleen

      8. Pancreas

        1. Vascular landmarks

        2. Divisions

        3. Blood supply

      9. Kidneys

        1. Blood supply

        2. Structure

      10. Suprarenal gland

        1. Blood supply

        2. Composition




  1. The Pelvis

    1. Pelvic cavity




    1. Bony pelvis

      1. Sacrum

      2. Coccyx

      3. Os Coxae

      4. Pubis

      5. Ischium

      6. Ilium

      7. Acetabulum




    1. Pelvic musculature

      1. Wall of the false pelvis

      2. Pelvic floor

      3. Wall of the true pelvis




    1. Vasculature

      1. Common iliac arteries

      2. Common iliac veins




    1. Innervation




    1. Pelvic viscera

      1. Gastrointestinal organs

      2. Urinary organs




    1. Viscera of female pelvis

      1. Peritoneal folds

      2. Ligaments

      3. Ovaries

      4. Uterus

        1. Body

        2. Fundus

        3. Uterine wall

        4. Perimetrium

        5. Ligamentous attachments

      5. Uterine tubes

      6. Cervix

      7. Vagina

      8. Maternal and fetal




    1. Viscera 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




    1. External genitalia and related perineum

      1. Regions

      2. Female external genitalia

      3. Male external genitalia




  1. The Upper Extremity

    1. Shoulder joint

      1. Bony components

      2. Ligaments

      3. Musculature

      4. Bursae




    1. Upper arm (brachium)

      1. Bony components

      2. Muscular components (anterior and posterior)

      3. Vasculature

      4. Innervation




    1. Elbow joint

      1. Bony components

      2. Articulations

      3. Ligaments

      4. Musculature

      5. Vasculature

      6. Innervation




    1. Cubital fossa

      1. Musculature

      2. Fascia

      3. Contents (identify nerves, arteries, veins and tendons that emphasize a medial to lateral [ulnar to radial] relationship)




    1. Forearm

      1. Bony components

      2. Muscular components (anterior and posterior)

      3. Vasculature

      4. Innervation




    1. Wrist

      1. Bony compartments

      2. Ligamentous components

      3. Tendinous components

      4. Vasculature

      5. Innervation




    1. Hand

      1. Bony components

      2. Muscular components

      3. Vasculature

      4. Innervation




  1. Lower Extremity

    1. Hip joint

      1. Bony components

      2. Ligamentous components

      3. Muscular components (anterior, posterior and medial groups)

      4. Vascular components

      5. Innervation




    1. The thigh

      1. Bony components

      2. Muscular components (anterior, medial and posterior compartments)

      3. Vasculature

      4. Innervation




    1. The knee

      1. Bony components

      2. Ligamentous components

        1. Menisci

        2. Extracapsular ligaments

        3. Intracapsular ligaments

      3. Muscular components

      4. Neurovascular components




    1. The leg

      1. Bony components

      2. Muscular components

        1. Anterior compartment

        2. Posterior compartment

          1. Superficial

          2. Deep

        3. Lateral compartment

      3. Vasculature

      4. Innervation




    1. The ankle

      1. Bony components

      2. Ligamentous components

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

      4. Neurovascular components




    1. The foot

      1. Bony components

      2. Muscular components

        1. Dorsal

        2. Plantar

      3. Innervation

        1. Dorsal

        2. Plantar

      4. Vasculature

References

This list of magnetic resonance resources can assist educators in sampling the pool of references and study materials that pertain to medical imaging. The resources list should be viewed as a snapshot of available materials. Omission of any title is not intentional. Because the creation of literature and media related to the field is dynamic, educators are encouraged to search additional sources for recent updates, revisions and additions to this title collection.



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