MRI —
Training activity: 2

Details

Optimise a clinical protocol for low SAR scanning, to meet the SAR requirements for a device

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• SAR models
• Effect of scanning parameters on SAR
• Trade-offs between image quality/scanning times and SAR
• B1+RMS

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• Identify what is expected of you in relation to optimising a clinical protocol for low Specific Absorption Rate (SAR) scanning to meet device requirements. This involves understanding the interplay between pulse sequences, acquisition parameters, and SAR.
• Discuss with your training officer to gain clarity on the acceptable methods for SAR reduction, the specific SAR limits for a given device, and the expected outcomes of your protocol optimisation. How will you demonstrate that the protocol is genuinely low SAR and meets the requirements?
• Think about what you already know about SAR, its determinants e.g., flip angle, repetition time, pulse sequence type, and how it relates to device safety.
• Have you had prior exposure to MRI protocol optimisation or observed SAR monitoring in clinical practice?
• Consider possible challenges you might face during the activity, such as maintaining image quality while reducing SAR, understanding complex scanner controls for SAR management, or balancing SAR reduction with clinical diagnostic needs. How might you handle these challenges?
• When optimising protocols for SAR, when would you need to seek advice or help, and from whom e.g., a senior physicist, applications specialist, or radiologist?
• Do you feel prepared to manipulate complex sequence parameters, or are you concerned about unintended consequences?
• Consider the specific skills you want to develop, drawing upon previous experiences of protocol adjustments or safety considerations. Do you aim to improve your practical skills in manipulating MRI sequence parameters, your understanding of SAR calculation and real-time monitoring, or your ability to troubleshoot SAR-related issues?
• Identify the specific insights you hope to gain from engaging with this activity. For example, do you want to understand the trade-offs involved in SAR reduction, or gain a deeper appreciation for the practical implementation of MRI safety guidelines?
• Consult any actions identified following previous experiences related to MRI safety or protocol optimisation. Did you previously note a need to research specific pulse sequences for their SAR characteristics?
• Identify important information you need to consider before embarking on the activity. This could include reviewing the scanner’s user manuals regarding SAR management, understanding the specific device’s MR conditional limits, and researching recommended low-SAR strategies for different clinical applications.

In action

• During the optimisation process, is anything unexpected occurring in meeting the low SAR requirements for a specific device, or in the performance of the protocol?
• Is any parameter adjustment or the resulting SAR calculation feeling surprising or different from what is anticipated when optimising for low SAR?
• How is this experience comparing with previous experiences of optimising protocols or dealing with SAR requirements?
• How are you reacting to any unexpected developments whilst optimising the low SAR protocol?
• How is this impacting on the actions taken, for example, is your response to an unexpected SAR challenge appropriate? Are you adapting or changing your approach to protocol optimisation? Is it affecting your ability to independently optimise the protocol for the device’s SAR requirements?
• Is it difficult to adapt the protocol in real-time? Is it affecting your confidence in achieving the SAR target?
• What is the conclusion or outcome of the actions you are taking during the optimisation of the low SAR clinical protocol?
• How are you working within your scope of practice when adjusting protocol parameters to meet SAR limits for a device?
• What are you learning as a result of any unexpected development you are encountering during this protocol optimisation?

On action

• Begin by summarising the key points of your experience in optimising a clinical protocol for low Specific Absorption Rate (SAR) to meet device requirements.
  • Consider specific events, actions, or interactions that felt important, such as the challenges you faced in reducing SAR while maintaining diagnostic image quality, the specific sequence parameters you adjusted e.g., TR, flip angle, number of slices, parallel imaging, or the software tools you used for SAR estimation.
  • Include any ‘reflect-in-action’ moments where you adapted your optimisation strategy as you encountered unexpected SAR values or image quality degradation. For example, did you initially try one approach to SAR reduction that proved ineffective, prompting you to pivot to another?
  • Did you feel confident in manipulating pulse sequence parameters for SAR control, or did you feel a sense of technical challenge in balancing safety and image utility?
• Identify what learning you can take from this experience regarding SAR optimisation. What strengths did you demonstrate, for instance, in understanding the interplay of sequence parameters and SAR, or in problem-solving to meet safety constraints? What skill or knowledge gaps were evident, such as understanding the impact of different coil types or advanced SAR modelling?
  • Compare this experience against previous engagement with similar activities e.g., general protocol optimisation or other safety considerations. Were any previous identified actions for development related to protocol optimisation or MR safety achieved? Has your practice in creating safe and effective MRI protocols improved?
  • Identify any challenges you experienced during the optimisation process, such as reaching the SAR limit too quickly or compromising image quality significantly, and how you reacted to these. Did these challenges affect your ability to deal with the situation, and were you able to overcome them?
  • Did you need to seek advice or clarification from a radiologist regarding the clinical necessity of certain sequence parameters, or from a senior physicist on advanced SAR reduction techniques?
  • Do you feel more proficient in optimising protocols for SAR compliance?
• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt from SAR optimisation.
  • What will you do differently next time you need to optimise a protocol for low SAR, perhaps a more systematic approach to parameter adjustment?
  • Has anything changed in terms of what you would do if you were faced with a similar situation again, such as your initial approach to protocol design or your consideration of specific hardware limitations?
  • Do you need to practise any aspect of this activity further, such as using different SAR estimation tools or exploring alternative pulse sequences for low SAR imaging?

Beyond action

• Have you revisited the experiences of optimising clinical protocols for low SAR scanning?
• Review your actions from your previous reflections for this activity. What actions did you identify to improve your understanding of SAR requirements, the impact of different sequence parameters on SAR, or your ability to effectively optimise protocols for specific devices? For instance, did you aim to research specific pulse sequences or consult with radiographers on their practical needs? Have you completed these actions?
• Are you ready to demonstrate this new learning into practice when faced with future SAR optimisation challenges for various devices or clinical situations?
• Has discussing different approaches or challenges related to low SAR scanning changed your perspective or deepened your strategy for achieving compliance?
• How have these experiences impacted upon your current practice in MRI protocol optimisation and safety?
• Consider how this learning will support you in preparing for observed ‘in-person’ assessments such as advising a Radiographer on managing an MR conditional implant to comply with SAR conditions, or setting up and scanning a human volunteer using an advanced technique that might have SAR implications.
• Consider how your practice in optimising MRI protocols, particularly for SAR compliance, has developed and evolved over time. Do you now have a more intuitive understanding of how to balance image quality with safety requirements, and can you more readily identify when a particular SAR challenge might be beyond your immediate scope of practice?

Relevant learning outcomes

#	Outcome
# 3	Outcome Appraise and advise on the safe application of MRI in the clinical environment.
# 5	Outcome Optimise sequence parameters for specific clinical needs.