Back Module: S-IN-S2

MRI

Module information

Module details

Title
MRI
Type
Specialist
Module code
S-IN-S2
Credits
20
Phase
3
Requirement
Compulsory

Aim of this module

The module aims to provide the trainee with an in-depth knowledge of MRI physics, its clinical applications and safe use in practice.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 3 Training activities

Investigate MR safety conditions associated with different active and passive devices, including a pacemaker and a neuro-stimulator, and make recommendations on the scanning of patients with these devices

 Type ETA Action View
# 2 Learning outcome 3,5 Training activities

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

 Type ETA Action View
# 3 Learning outcome 3 Training activities

Review the proposed plans for a new MRI unit and make appropriate recommendations

 Type DTA Action View
# 4 Learning outcome 3 Training activities

Carry out a risk assessment for scanning  a device which is MR unlabelled or a device whose MR conditions cannot be met

 Type DTA Action View
# 5 Learning outcome 2 Training activities

Model the signal and perform simulations for pulse sequence acquisitions including the different varieties of gradient-echo and CPMG, to optimise image contrast and/or quality

 Type DTA Action View
# 6 Learning outcome 2,5 Training activities

Investigate the use of methods to accelerate static and dynamic pulse sequences

 Type DTA Action View
# 7 Learning outcome 5 Training activities

Develop, test in vivo and optimise two clinical MRI protocols for different body regions, taking into account radiologist requirements for a specific clinical indication

 Type DTA Action View
# 8 Learning outcome 1,7,8 Training activities

Perform, or contribute to, acceptance testing of an MR scanner

 Type DTA Action View
# 9 Learning outcome 3 Training activities

Review the department’s MR risk assessments and safety policies and recommend improvements where appropriate

 Type ETA Action View
# 10 Learning outcome 9 Training activities

Carry out a market comparison of scanners available from the main manufacturers. Review the advantages and disadvantages of the available systems in relation to departmental requirements

 Type DTA Action View
# 11 Learning outcome 4,6,7 Training activities

Identify the clinical context that necessitates imaging, the optimal pulse sequences and acquisition parameters to meet this clinical need, and process and analyse data for clinical use for each of the cardiovascular imaging methods listed:

  • Flow
  • Cardiac function
  • Perfusion
  • Delayed enhancement
 Type DTA Action View
# 12 Learning outcome 4,6,7 Training activities

Identify the clinical context that necessitates imaging, the optimal pulse sequences and acquisition parameters to meet this clinical need, and process and analyse data for clinical use, for each of the neuroimaging methods listed:

  • Spectroscopy
  • Diffusion tensor imaging
  • Perfusion, including DSC, DCE and ASL
  • fMRI
  • MRA
  • SWI
 Type DTA Action View
# 13 Learning outcome 4,6,7 Training activities

Identify the clinical context that necessitates imaging, the optimal pulse sequences and acquisition parameters to meet this clinical need, and process and analyse data for clinical use, for each of the body imaging methods listed:

  • DCE
  • DWI
  • MRA
  • Dixon imaging
  • Fat/iron quantification
 Type DTA Action View
# 14 Learning outcome 1,2,5 Training activities

Set up and optimise methods for T1, T2 and T2* mapping in a specified clinical context, comparing the suitability of different possible methods

 Type DTA Action View
# 15 Learning outcome 1,5 Training activities

Evaluate and optimise different pulse sequences and protocols for radiotherapy planning

 Type DTA Action View
# 16 Learning outcome 2 Training activities

Using raw k-space data acquired from human subjects, reconstruct magnitude and phase images; investigate the impacts of simple manipulations of the k-space data to correctly align the images and resolve image quality issues

 Type DTA Action View
# 17 Learning outcome 2 Training activities

Perform a simple pulse-sequence development task using the manufacturer-supplied or an open-source development environment. Evaluate the results using either simulations or tests on an MRI scanner

 Type DTA Action View
# 18 Learning outcome 10 Training activities

Critically appraise a hybrid MRI modality with particular emphasis on its use in the patient pathway and the role of the MRI physicist

 Type DTA Action View
# 19 Learning outcome 10 Training activities

Investigate and critically evaluate a new or emerging MR technique or hardware development, considering its potential role in patient care

 Type DTA Action View
# 20 Learning outcome 8 Training activities

Investigate, report and provide recommendations to rectify poor or faulty equipment performance

 Type ETA Action View

Assessments

Complete 4 Case-Based Discussions

Complete 4 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Perform a targeted QA test to test the accuracy of an advanced (or quantitative) technique.
  • Measure acoustic noise levels for MRI sequences using a sound meter.
  • Use magnetometer to plot 3mT and 0.5mT contours.
  • Perform MRI safety screening of a human volunteer undergoing MRI scanning.
  • Set up and scan a human volunteer using an advanced (quantitative) technique.

Observed Clinical Event Titles

  • Advise a Radiographer how to manage an MR conditional implant to comply with SAR and safety conditions.
  • Deliver training in MR safety to a group of staff.
  • Explain sequence or technique principles to another healthcare professional.
  • Discuss the results of a service review with a service engineer.
  • Demonstrate how to perform a post processing task to another healthcare professional and/or train another healthcare professional in the task.

Learning outcomes

# Learning outcome
1

Use MRI equipment safely to obtain images.
2

Model signals and perform image reconstruction.
3

Appraise and advise on the safe application of MRI in the clinical environment.
4

Explain the principles of major pulse sequences in clinical use.
5

Optimise sequence parameters for specific clinical needs.
6

Appraise the key issues for advanced/specialist MR examinations and optimise clinical protocols.
7

Apply image analysis software to extract quantitative information from MR data.
8

Assess and evaluate equipment performance through routine quality assurance and fault investigation.
9

Identify equipment for a specified clinical service need.
10

Appraise the key issues of an emerging technique/technology and a hybrid modality.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  1. Observe the use of advanced MRI techniques for cardiac imaging, neuroimaging and body imaging.
  2. Observe the reporting process for an advanced MRI technique for example cardiac imaging, neuroimaging and body imaging.
  3. Attend clinical multidisciplinary team meetings where MRI is discussed in the context of patient clinical management to appreciate the patient pathway.
  4. Attend meetings where translational research projects are discussed to appreciate the pathway for embedding research in practice.
  5. Observe clinical scanning with an MRI hybrid system to appreciate the benefits, challenges, risks and workflow differences in using combined modalities.
  6. Attend a planning meeting for a new MRI installation or a new element of service delivery to appreciate the requirements for developing a new service.
  7. Attend a meeting hosted by an external scientific/professional body to appreciate the application of developments in specialty.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

On successful completion of this module the trainee will be able to:

  1. Discuss the principles of MR functional and metabolic investigation techniques.
  2. Critically evaluate MR quantification and optimisation techniques.
  3. Identify appropriate MR techniques for a range of clinical conditions, identifying associated risks and limitations.
  4. Demonstrate a critical awareness of key factors in the specification, tendering, commissioning and room design for MR equipment.
  5. Discuss safety issues and regulatory requirements relevant to MR techniques.
  6. Summarise key issues associated with MR hybrid modalities.

Indicative content

Physiological MR methods to quantify pathology Diffusion imaging: physics of diffusion and restriction, acquisition sequences, DWI vs diffusion mapping, diffusion coefficient and ADC, diffusion directions, DTI (ADC/FA/L1-3/E1-3), qSpace, limitations to our understanding of diffusion in vivo

Diffusion imaging reconstruction: tensor calculation, tractography (deterministic and probabilistic)

Perfusion imaging (dynamic contrast methods): indicator dilution theory, multi-compartment modelling and exchange, quantitation and metrics (CBF/CBF/MTT/TTP)

Perfusion imaging (arterial spin labelling methods): PASL, CASL, PCASL, bolus truncation, inflow time, quantitation

MR angiography: TOF vs phase contrast; flow and gradient interactions on signal, parameter selection for MRA.

quantitative analysis techniques: ROI analysis, pixelwise analysis
Functional and metabolic MR methods Functional MRI (basics): The BOLD mechanism, Sequences for fMRI, Paradigm design

fMRI Processing: Corrections (motion, distortion, timing), General linear modelling, Data overlays

MRS (basics) and signal localisation techniques: recap chemical shift, introduction to interesting biomolecules (proton MRS – NAA/Cre/Cho/mI/Citrate), physics of localisation sequences (PRESS/STEAM)

Spectroscoping imaging (voxel localised or OVS)

Nuclei other than protons: Interesting biomolecules (non-proton MRS) – ATP, PCr, Pi, carbon-13 enrichment. Fluorine-19, Sodium-23, Sequences for non-proton MRS (Pulse-acquire, SI, ISIS)

Reconstructing function and metabolism: commonly used tools to extract the functional or metabolic response (FSL, SPM, jMRUI)
Clinical and research examples of MR methods Clinical and research examples, to specifically include:

Functional MRI of the heart: Image formation in the presence of motion, cardiac triggering and gating techniques (prospective and retrospective), respiratory gating and navigator methods, cardiac perfusion methods

Neuroimaging: susceptibility weighted imaging of the brain
Specifying and commissioning an MRI system System specification: component performance, requirements vs applications (e.g. radiotherapy and distortion), cost implications, tender criteria, acceptance testing

Site planning: what is in the environment (thinking in 3D)?, what will affect the scanner? what will the scanner affect? power requirements, quench pipes
Safety in detail Physics of safety, regulations, specific restrictions (by patient group), SAR, monitoring of RF, electric and magnetic fields, contrast agents, nephrogenic systemic fibrosis (NSF), quenches
Image display Hard and soft copy display systems, QA of imaging display systems
Hybrid imaging PET-MR, MR-CT, MR-Ultrasound

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPE1-2-22 Specialty title Imaging with Non-Ionising Radiation [2022] Action View
Specialty code SPE1-2-23 Specialty title Imaging with Non-Ionising Radiation [2023] Action View
Specialty code SPE1-2-24 Specialty title Imaging with Non-Ionising Radiation [2024] Action View
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