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					Centers for Quantitative Imaging Excellence
LEARNING MODULE




                                          CQIE MRI
                                        PROCEDURES

                                    American College of Radiology
                                      Clinical Research Center




  Imaging Core Laboratory                                       v.2
Centers for Quantitative Imaging Excellence
LEARNING MODULE


    This module is intended to provide a
    general overview of the CQIE MRI
    procedures. All participants are urged
    to review the CQIE Manual of
    Procedures (MOP) for further details.

     CQIE MOP and program information:
        www.acrin.org/NCI-CQIE.aspx
 After you‟ve reviewed this module please let us know by submitting the learning
          module attestation. The link is provided at the end of this module.

CQIE MRI Procedures                                                                v.2
Centers for Quantitative Imaging Excellence
LEARNING MODULE


    CQIE Site Qualification Process
    Site Initiation – MRI Team
    Learning Modules
    Clinical Test Cases
    Phantom Tests
       ACR MRI & CQIE Body DCE-MRI Phantoms
  Data Submission / Analysis
  Standardized Quality Control

CQIE MRI Procedures                            v.2
CQIE Site Qualification

 Qualify NCI cancer centers to participate in
  future NCI clinical trials in which there is a
  quantitative imaging component.

 Qualify NCI cancer centers in the following
  quantitative imaging methodologies:
       Volumetric CT (body), Volumetric MRI (brain)
       DCE-MRI (body and brain)
       Static and dynamic PET, PET/CT (body and brain)

 Provide imaging team with introduction to
  multicenter imaging trials

CQIE MRI Procedures                                       v.2
CQIE Site Qualification

 The CQIE qualification requirements
  are designed to…
       qualify scanners
       qualify site imaging capabilities
       promote imaging standardization
        (harmonization) within multicenter
        clinical trials



CQIE MRI Procedures                          v.2
CQIE Site Qualification

Why standardize?
 Standardization of imaging is essential for trials
 in which imaging plays a central role in the
 research aim / endpoint. Standardization helps
 control / limit the inter- and intra-variability
 inherent in multicenter imaging trials due to…
         multiple radiologists / image interpretation
         multiple technologists / image performance
         varying make/models of imaging equipment
         varying image quality / QC
         varying image acquisition protocols

CQIE MRI Procedures                                      v.2
CQIE Site Qualification

Why standardize?
   Good Science - For results to be of benefit to
    researchers and patients, the results must be
    accurate and reproducible (across patients, time-
    points, imaging equipment, institutions).
       Standardize imaging equipment (when possible)
       Standardize image/data acquisition
       Standardize image/data processing
       Standardize readers



CQIE MRI Procedures                                     v.2
CQIE Site Qualification

Standardization of Quantitative MRI, DCE-MRI
   Patient preparation & positioning
   Contrast administration (dose, rate, timing)
   Data acquisition / imaging parameters
   Data reconstruction
   Quality control
   Input function (normalized versus measured)
   Kinetic modeling & analysis

Challenges to Quantitative Imaging:
 Vendor-related variability - measurement results, imaging
  protocols
 Site-related variability - measurement results, protocol
  compliance


CQIE MRI Procedures                                           v.2
CQIE Qualification

 CQIE MRI Qualification Process
  Site Initiation
  Learning Modules
  Annual Qualification Imaging *
       Clinical Test Cases (MR brain diffusion)
       ACR MRI Phantom
      CQIE Body DCE-MRI Phantom
  Standardized QC Testing *

 * For each scanner to be qualified
CQIE MRI Procedures                                v.2
                 SITE INITIATION
                    MRI TEAM




CQIE MRI Procedures                v.2
Site Initiation

 Purpose:
  To familiarize the MRI team with CQIE
   qualification requirements – phantom
   scans and standardized QC testing.

  To provide assistance with technical
   issues associated with standardizing
   imaging acquisition protocols across
   multiple models, platforms, and software
   versions.
CQIE MRI Procedures                           v.2
Site Initiation

 Site initiation options:
       On-site initiation visit
       Teleconference with ACRIN-CQIE team
 Site initiation includes:
       Review of qualification requirements and timeline
       Review of MRI phantom scanning procedures
        and acquisition protocols
       Review of standardized QC testing
       Demonstration of phantom scans (on-site visits)


CQIE MRI Procedures                                         v.2
          LEARNING MODULES




CQIE MRI Procedures          v.2
Learning Modules


Modules for MRI Team:
 Complete as part of the site initiation process
  CQIE Overview
  CQIE MR Procedures

 Complete prior to T1
  Introduction to Multicenter Imaging Trials
  Quantitative Imaging for Multicenter Trials (MR)

 Additional modules will be developed for T2-T3


CQIE MRI Procedures                                v.2
      QUALIFICATION IMAGING




CQIE MRI Procedures           v.2
Qualification Imaging

MR Imaging Requirements:
For each scanner to be CQIE-qualified


 MR Brain Diffusion (test case)
 Phantom Tests
      ACR MRI Phantom – ACRIN will provide, on loan, if
       you do not own one.
      CQIE Body DCE-MRI Phantom – ACRIN to provide.

 Images and data forms submitted to ACRIN for
  review / analysis

CQIE MRI Procedures                                        v.2
Qualification Imaging

Clinical Test Case: MR Brain Diffusion
 Diffusion-weighted MR series from a live
  subject or volunteer (with or without findings)
 Preferably, acquired within past month
 Submit imaging data set to ACRIN, include…
     post-processed reconstruction of ADC maps
     eADC or FA maps, if part of your routine
      imaging protocol


CQIE MRI Procedures                               v.2
               PHANTOM TESTS




CQIE MRI Procedures            v.2
ACR MRI Phantom Tests




CQIE MRI Procedures     v.2
ACR MRI Phantom Tests

Phantom Scans: Brain Imaging
 CQIE-ACR Series
      Sagittal Locator
      Axial T1
      Axial T2 Double-Echo
 CQIE Sagittal 3D Volumetric Protocol
 CQIE Brain DCE-MRI Protocol
      T1 Mapping (5 T1 scans)
      Axial Dynamic series (DCE)

CQIE MRI Procedures                      v.2
ACR MRI Phantom Tests

Purpose of the ACR MRI Phantom Tests:
 Provide means of evaluating scanner
  geometric accuracy, high‐contrast spatial
  resolution, slice thickness accuracy, slice
  position accuracy, image intensity
  uniformity, percent‐signal ghosting, and
  low‐contrast object detectability.
 Evaluate compliance with advanced MRI
  acquisition protocols.

CQIE MRI Procedures                             v.2
ACR MRI Phantom Tests




          Refer to Appendix C1 of the
       CQIE Manual of Procedures (MOP)
         for detailed scan instructions




CQIE MRI Procedures                       v.2
CQIE Body DCE-MRI Phantom Tests




CQIE MRI Procedures               v.2
CQIE Body DCE-MRI Phantom Tests


Phantom Scans: Body DCE-MRI
   3 Plane Localizer
   Body Coil Map – 15° (tuned, with pre-scan)
   Array Coil Map – 15° (not tuned, no pre-scan)
   T1 Map – 30° (tuned, with pre-scan)
   T1 Map – 15° (not tuned, no pre-scan)
   T1 Map – 5° (not tuned, no pre-scan)
   Dynamic Scan – 30° (not tuned, no pre-scan)



CQIE MRI Procedures                                 v.2
CQIE Body DCE-MRI Phantom Tests


Purpose of the DCE-MRI Phantom Tests:
 Provide means for qualitative and
  quantitative evaluation, including T1 map
  error estimation, temporal resolution and
  image quality.
 Evaluate compliance with image acquisition
  protocols.



CQIE MRI Procedures                            v.2
CQIE Body DCE-MRI Phantom Tests




          Refer to Appendix C2 of the
       CQIE Manual of Procedures (MOP)
         for detailed scan instructions




CQIE MRI Procedures                       v.2
             DATA SUBMISSION
               & ANALYSIS




CQIE MRI Procedures            v.2
Data Submission

 All image data should be transmitted to
  ACRIN via sFTP:
   Secure File Transfer Protocol (sFTP) is the protocol for
    exchanging files over the Internet. FTP works in the same
    way as HTTP for transferring web pages from a server to a
    user's browser and SMTP for transferring electronic mail
    across the Internet in that, like these technologies, FTP
    uses the Internet's TCP/IP protocols to enable data
    transfer.
 Refer to Appendix A-2 of the CQIE MOP for
  detailed instructions.
CQIE MRI Procedures                                        v.2
Data Submission



Submit Image/Data Sets
 MR Brain Diffusion Test Case
 ACR-MRI Phantom Tests
 CQIE Body DCE-MRI Phantom Tests
For all MR scanners to be CQIE qualified




CQIE MRI Procedures                        v.2
Data Analysis

   Upon receipt of the image data, the ACRIN
    Imaging Core Laboratory will perform a
    “submission-level” QC review to determine
    whether each modality-specific data set is
    complete and ready for evaluation.
   If a discrepancy is found, ACRIN will contact the
    site for resolution of the discrepancy.
   Once the modality-specific data set has passed
    the submission-level QC, the image data will be
    queued for analysis.

CQIE MRI Procedures                                     v.2
Data Analysis
   Analyses will include qualitative and quantitative
    assessments performed at the ACRIN imaging
    core lab.
   Each submission will receive a Pass/Fail score
    based on modality-specific criteria.
  • ACRIN will work with each site to identify and
    remedy deficiencies resulting in one or more
    „Fail‟ scores.
   Sites must pass at least one scanner for each of
    the imaging methods (CT, MR, PET) to become
    CQIE qualified.

CQIE MRI Procedures                                      v.2
         STANDARDIZED
      QUALITY CONTROL (QC)




CQIE MRI Procedures          v.2
Standardized QC

 QC is an important function of image quality and
  patient safety. Benefits of routine QC include…
     verification of operational integrity of imaging systems
     early identification of technical issues
     consistent, high image quality
     consistent quantitative accuracy
 Quantitative imaging increases importance of QC.
 Multicenter trials increases the importance of QC.



CQIE MRI Procedures                                              v.2
Standardized QC

 Standardized QC helps to ensure the
  quantitative data generated within a clinical
  trial is comparable within an institution and
  across institutions.
 Sites are expected to incorporate the CQIE
  standardized QC measures into their existing
  QC activities.
 Sites are required to adhere to the CQIE
  standardized QC measures to maintain
  qualification status.

CQIE MRI Procedures                               v.2
Standardized QC

  Quality Control - MRI
   MR system stability
   To reduce system-level variance in longitudinal
    measurements, a robust quality control program
    is needed.
   Research is ongoing to develop standard,
    validated phantoms and processes for
    quantitative MR (QIBA, AAPM, ISMRM, NIST)



CQIE MRI Procedures                                   v.2
Standardized QC – MRI

     Test                         Minimum Frequency
     Center Frequency                  Weekly
     Table Positioning                 Weekly
     Signal to Noise                   Weekly
     Artifact Analysis                 Weekly
     Geometric Accuracy                Weekly
     High-Contrast Resolution          Weekly
     Low-Contrast Resolution           Weekly
     Magnetic Field Homogeneity       Quarterly
     Slice Position Accuracy          Quarterly
     Slice Thickness Accuracy         Quarterly
     Radiofrequency Coil Checks        Annually


CQIE MRI Procedures                                   v.2
References

 American College of Radiology. MRI Quality Control Manual,
  2004
 American College of Radiology. ACR Technical Standard for
  Diagnostic Medical Physics Performance Monitoring of
  Magnetic Resonance Imaging Equipment, 2009.
 American College of Radiology. ACR Practice Guideline for
  Performing and Interpreting Magnetic Resonance Imaging,
  2006.
 Quantitative Imaging Biomarkers Alliance (QIBA), Radiological
  Society of North America (RSNA).
 AAPM Working Group for Standards for Quantitative MR
  Measures.
 Imaging Working Group (IWG), Clinical Translational Science
  Awards (CTSA).

CQIE MRI Procedures                                               v.2
Qualification Checklist


 CQIE MR Qualification Requirements   T0 T1 T2 T3
 □ Learning Modules (2 per year)
        - CQIE Overview (T0)          X   X   X   X
        - CQIE MRI Procedures (T0)
 □ ACR MRI Phantom Tests              X   X   X   X
 □ CQIE Body DCE-MRI Phantom Tests    X   X   X   X
 □ Quality Control Questionnaire          X   X   X




CQIE MRI Procedures                                   v.2
ACRIN-CQIE

           Please follow the link below to report your
                      review of this module
          http://www.surveymonkey.com/s/RG6RHLS


                      Questions should be directed to:
                        CQIE-MR-CT@acr.org

                         American College of Radiology
                            Clinical Research Center
                         1818 Market Street, Suite 1600
                            Philadelphia, PA 19103



                              Thank you!
CQIE MRI Procedures                                       v.2

				
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