MRI Quality Assurance Program Summary - DOC

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					                               MRI Quality Assurance Program Questionnaire

The following information is required for sites applying to participate in ACRIN trials
involving MRI imaging and do not have ACR MRI accreditation.

Technologist Qualifications

       Number of full-time technologists performing MRI scans:
       Number of above technologists who are registered:
       Number of above registered technologists with MRI certification:

Radiologist Qualifications

       Number of board certified radiologists who interpret MRI scans:
           o Number of above radiologists who have at least 150 hours of CME over a
               three-year period:
       Type of MRI related certifications or fellowships held by facility radiologists
       Hours an MRI supervising radiologist is available in the MRI department daily:

       Number of MRI body and musculoskeletal cases interpreted for the most recent
        calendar year:
        o Does the facility or department have dedicated readers for body and
            musculoskeletal cases?    Yes   No
        o If yes, how many?

       Number of MRI neuro cases interpreted for the most recent calendar year:
        o Does the facility or department have a dedicated neuro reader?       Yes    No
        o If yes, how many?
       Please list any other MRI sub-specialties for which the department has dedicated
        readers:

Medical Physicist

       Identify medical physicist who oversees the quality control program and attach CV:


       Is medical physicist certified by the American Board of Radiology in the following
        sub-fields?
                Diagnostic Radiological Physics    Yes   No
                Radiological Physics    Yes     No

Quality Assurance Program

       Does your institution have a Quality Assurance program in place that outlines policies
        and procedures related to quality, patient education, infection control, and safety?
           Yes (attach copy if applicable)     No

       Does your facility maintain documentation on site of any results of an
        appropriateness/outcomes analysis and actions taken to correct any deficiencies?
           Yes    No




Version Date: 5.15.07                     Page 1 of 2                MR QA Program Questionnaire
                               MRI Quality Assurance Program Questionnaire


MR Equipment Quality Control

Does all equipment meet state and federal requirements?                   Yes     No

Does facility have regularly scheduled preventive maintenance checks performed and
documented by a qualified service engineer on a regular basis?   Yes     No

Does facility site maintain documentation of services performed to correct any system
deficiencies?     Yes     No

Please complete the following regarding MR equipment performance checks:


                                                Checked Annually by Medical Physicist?
                                                                             No
                                               Yes
                                                         (If no, provide frequency of inspection)
 Magnetic Field Homogeneity
 Slice Position Accuracy
 Slice Thickness Accuracy
 Radiofrequency Coil Checks
 Inter-Slice Radiofrequency Interference
 Soft-Copy Displays (Monitors)
                                                     Checked Weekly by Technologist?
                                                                             No
                                               Yes
                                                         (If no, provide frequency of inspection)
 Center frequency
 Table Positioning
 Setup and Scanning
 Geometric Accuracy
 High-Contrast Resolution
 Low-Contrast Resolution
 Artifact Analysis
 Film Quality Control
 Visual Checklist


Publications

       Attach a list of recent MRI related publications, if any, authored by radiologists who
        interpret MRI cases.


Name and title of individual completing this questionnaire:


Signature:                           Date:




Version Date: 5.15.07                      Page 2 of 2                    MR QA Program Questionnaire