1
Rotation: Body MRI Rotation Duration: 4 wks Month(s): 2
Institution: Stanford Call Responsibility: Triage Night(s): covered by fellow
Responsible Faculty Member(s): Location: SUH, Blake Wilbur
Shreyas Vasanawala MD, PhD, section chief
Robert Herfkens, M.D.
Bruce Daniel, M.D. Phone Numbers:
Frandics Chan, M.D., Ph. D. Hospital Reading Room:
Brooke Jeffrey, M.D. 332-4MRI
Graham Sommer, M.D. Technicians Telephone Numbers:
Aya Kamaya, M.D. Hospital: 723-7315 or 723-6335
Terry Desser, M.D. Blake Wilbur scanner: 736-2061
Juergen Wilmann, M.D. BWMR1: 725-8645
Lewis Shin, M.D. BWMR2: 736-2060
Sherman Ave: 721-3373
Technologists/Technical Staff: Training Level:
Claudia Cooper, MRT Technical Coordinator Second and 3rd or 4th years
Teresa Nelson, MRI Technical Supervisor
Goals & Objectives
The goal of the Body MRI rotation is to give the resident experience in selecting MRI protocols,
supervising performance of MRI exams, and interpreting MRI studies of the chest, abdomen, and
pelvis.
Rotation 1:
Medical Knowledge
By the end of this rotation, the resident will be able to:
Determine the type of contrast weighting present in MR images.
Understand the mechanisms that generate T1, T2, and contrast-enhanced images.
Understand the principles of fat saturation and chemical-shift based imaging
Recognize the most common artifacts in body MRI
Recognize normal abdominal and pelvic MRI anatomy and contrast.
Patient care
Knowledge Based Objectives
o Distinguish MR compatible devices and equipment from incompatible devices
o Understand the clinical goal of each exam and select the correct imaging protocol
o Understand the rationale behind the protocol design
o Be able to premedicate and counsel claustrophobic patients
o Know gadolinium indications and contraindications
12/15/2011
2
Skills
o Protocol cases according to the clinical question and the indication for the study
o Identify relevant comparison studies in the PACS system and use them during readout
o Triage cases by level of urgency
o Preview all cases before the readout session begins.
Behavior and Attitude Objectives
o Be available by pager at all times for consultations with clinicians, for questions
about cases or appropriate imaging work-up of clinical problems.
Interpersonal and communication skills, and Professionalism
Skills
o Dictate a clear, concise report that explicitly addresses the clinical question to be
answered.
o Prepare and present five interesting MR cases during the month
o Communicate results to referring physicians in a timely fashion
Attitudes
o Be punctual for readouts
o Divide work appropriately and proportionally among the residents and fellows on the
service
o Be available to consult with clinicians on interesting cases, and provide insight on
how MRI might answer clinical questions for patients.
o Behave courteously to clinicians, technologists and patients at all times
Practice-based learning:
o Routinely search PubMed, standard texts, and other online sources for material
relevant to interesting cases reviewed during read-out
o Prepare five interesting cases for presentation at conference. For each case, associate
an evidence-based publication and a teaching point.
o Between readouts, observe the MRI technologists as patients are scanned to obtain
greater familiarity with scan parameters and protocols.
Systems-based practice:
o Be familiar with the ACR appropriateness criteria with regard to ordering of MRI
studies
Rotation 2:
Medical Knowledge:
By the end of this rotation, the resident will be able to:
Describe and interpret diffusion-weighted and flow-sensitive MRI sequences
12/15/2011
3
Understand the pharmacokinetics and indications for the different gadolinium-based
contrast media
Understand and describe Dixon-type sequences for imaging fat and water
Protocol and interpret MRI imaging studies of the liver, biliary tree, pancreas, bowel,
and pelvis, as well as general abdominal MRI imaging studies.
Demonstrate mastery of all sections of the MRI curriculum (see below)
Patient care objectives:
Knowledge Based Objectives
o Distinguish MR compatible devices and equipment from incompatible devices
o Understand the clinical question to be answered and select the correct imaging
protocol
o Understand the rationale behind the protocol design
o Understand the purpose and utility of each pulse sequence included in the study
protocol
o Be able to premedicate and counsel claustrophobic patients
o Know the indications for and contraindications to administration of gadolinium
contrast media
o
Skills
o Protocol cases according to the clinical question and the indication for the study
o Identify relevant comparison studies in the PACS system and use them during readout
o Triage cases by level of urgency
o Preview all cases before the readout session begins.
Behavior and Attitude Objectives
o Be available by pager at all times for consultations with clinicians, for questions about
protocols from technologists, and for answering questions from medical students and visitors.
Interpersonal and communication skills, and Professionalism:
Skills
o Dictate a clear and concise report that makes explicit reference to the clinical question
to be answered.
o Prepare and present one conference of interesting MR cases during the month
o Communicate all results to referring physicians in a timely fashion
Attitudes
o Be punctual for readouts
o Divide work appropriately and proportionally among the residents and fellows on the
service
o Be available to consult with clinicians on interesting cases, and provide insight on
how MRI might answer clinical questions for patients.
o Behave courteously to clinicians, technologists and patients at all times
12/15/2011
4
Practice-based learning
o Complete review of body MRI recommended reading
o Be able to search PubMed, standard texts, and other online sources for material
relevant to interesting cases reviewed during read-out
o Prepare five interesting cases for presentation at conference. For each case, associate
an evidence-based publication and a teaching point.
o Between readouts, observe the MRI technologists as patients are scanned to obtain
greater familiarity with scan parameters and protocols.
Systems-based practice: Rotations 1 and 2
o Be familiar with the ACR appropriateness criteria with regard to ordering of MRI
studies
Conference Schedule/Format
Title Day Time Location
MRI case conference Tuesday, monthly 12 noon Lucas
Method of Assessment of Performance:
Written evaluation of resident by responsible faculty member monthly
Verbal feedback to resident by faculty
ACR In-Training Service Exam annually
Recommended Reading
Online resources:
Body MRI section website: http://radiology.stanford.edu/sections/body_mri/
Body MRI website wiki:
https://medwiki.stanford.edu/display/radiologybodymr/Body+MR+Wiki+-+Moderated#
http://www.mrisafety.com/
Curriculum for MRI technologists: http://www.ismrm.org/smrt/mri.htm
Books:
Mitchell and Cohen, MRI Principles, Second edition. On reserve at Lane.
Siegelman, Evan S. Body MRI. On reserve at Lane
Practical Guide to Abdominal and Pelvic MRI
by John R., Md. Leyendecker, Jeffrey J., Md. Brown. On reserve at Lane
12/15/2011
5
MRI curriculum
I. Physics and instrumentation
Basic principles of MRI
Overview of MR imaging process
Factors that affect the MR signal
Relaxation times T1 and T2
II. Spatial localization of the MR signal
Types of pulse sequences: spin echo and gradient echo
Contrast and signal to noise on images
III. MR contrast agents: mechanism of action of paramagnetic materials and other materials that
affect the MRI signal intensity
Hemorrhage
Other factors affecting MR image: flow, chemical shift
IV. Practical patient care information
Patient care; monitoring the patient, MR compatible devices, treating claustrophobia,
precautions, MR in pregnancy
Choosing pulse sequences and timing parameters
Trade-offs in MRI
Artifacts in MRI
V. Clinical MRI
MR angiography: flow sensitive sequences and contrast enhanced sequences
General abdomen and pelvis MRI
Optimizing spatial and contrast resolution
In and out of phase imaging
Motion artifact reduction techniques
GU MRI: Adrenal and kidney: characterizing adrenal masses on mri; renal masses, renal ca
staging
Hepatic MRI: Normal liver anatomy and appearance on different pulse sequences, benign
and malignant liver masses, inflammatory diseases, diffuse liver disease, vascular diseases,
transplant evaluation
Biliary MRI: biliary neoplasms and strictures, transplant complications, autoimmune disease
Pancreas: pancreatic masses, secretin stimulated MRI, ductal variants, chronic pancreatitis
spleen: splenic masses, infiltrative disorders
Bowel: inflammatory bowel disease, rectal neoplasms. transplant evaluation
Pelvic MRI: Congenital anomalies
Pelvic masses: adnexal masses, uterine anomalies, fibroids, adenomyosis, ovarian and uterine
cancer
Prostate MRI: staging prostate cancer with MRI
12/15/2011