Magnetic Resonance Imaging (MRI)



Magnetic Field Strength of Scanner Used: FORMCHECKBOX 1.5 T FORMCHECKBOX 3.0 T FORMCHECKBOX 4.0 T FORMCHECKBOX 7.0 T FORMCHECKBOX Other: TName of the scanner manufacturer: FORMCHECKBOX GE FORMCHECKBOX Siemens FORMCHECKBOX Philips FORMCHECKBOX Toshiba FORMCHECKBOX Other:Name of the scanner software and its version number:Name: Version Number: Body part scanned: FORMCHECKBOX Brain FORMCHECKBOX Cervical spine FORMCHECKBOX Thoracic spine FORMCHECKBOX Lumbar spine FORMCHECKBOX Calf FORMCHECKBOX Thigh FORMCHECKBOX Other, specify:RF coil(s):RF Coil(s) TableCoilName of CoilType of coilSurfaceType of coilVolumeTransmit (Tx)Receive (Rx)Tx/Rx# of ChannelsData to be entered by site FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Data to be entered by siteData to be entered by site FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Data to be entered by siteData to be entered by site FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Data to be entered by siteData to be entered by site FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Data to be entered by siteGeneral sequence parameters (copy the following sections if multiple sequences are used)Slice orientation: FORMCHECKBOX Axial FORMCHECKBOX Coronal FORMCHECKBOX Sagittal FORMCHECKBOX ObliqueScan dimension: FORMCHECKBOX 2D FORMCHECKBOX 3DField of view: x (x) mm2In-plane resolution: x (x ) mm2Slice thickness: mmGap between slices: mm or % (for 2D acquisition)Number of slices:Repetition time (TR): msEcho time (TE): msFlip angle (FA): ?Base resolution: pointsBand width: Hz/PixelSlice over sampling: %Phase-encode direction:Flow compensation used: FORMCHECKBOX Yes FORMCHECKBOX NoFat signal suppressed: FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, method used: FORMCHECKBOX SPAIR FORMCHECKBOX SPIR FORMCHECKBOX OtherIf SPIR, please specify Inversion time (TI): msParallel acquisition used: FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, method used: FORMCHECKBOX GRAPPA FORMCHECKBOX SENSE FORMCHECKBOX OtherAdditional Details:Fast imaging: FORMCHECKBOX Yes FORMCHECKBOX NoPartial Fourier FORMCHECKBOX Yes, specify: FORMCHECKBOX NoPhase resolution: %Echo spacing: ms; Echo train length:Total acquisition time: minutesSequence specific parametersFLAIR sequence: FORMCHECKBOX Yes FORMCHECKBOX NoInversion time (TI): msT2 measurement: FORMCHECKBOX Yes FORMCHECKBOX NoEcho spacing: ms;Echo train length;Contrast agent: FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, name of the contrast: dosage:Time of injection:General InstructionsThis CRF includes data typically recorded when performing Magnetic Resonance Imaging. This technique is used to visualize detailed internal structures in the body and brain. Specific InstructionsPlease see the Data Dictionary for definitions for each of the data elements included in this CRF Module.Imaging scanner strength – Choose one.Field of view - Answer should be recorded as a dimension (AAxAA) and in millimeters squared (mm2).Plane resolution - Answer should be recorded as a dimension (AAxAA) and in millimeters squared (mm2)Slice thickness - Answer should be recorded in millimeters squared (mm)Gap between slices - Answer should be recorded in millimeters squared (mm) or % (for 2D acquisition)Repetition time – Answer should be recorded in milliseconds (ms)Echo time – Answer should be recorded in milliseconds (ms)Flip angle – Answer should be recorded in degreesBase resolution – Answer should be recorded in pointsBandwidth – Answer should be recorded in Hx/PixelFat signal suppressor used – Only answered if Yes is answered for “Fat signal suppressed”Inversion time - Only answered if SPIR is answered for “Method Used.” Answer should be recorded in milliseconds (ms)Echo spacing - Answer should be recorded in milliseconds (ms). Must be answered with Echo Train Length, if Yes is answered for Fast Imaging.Acquisition time – Answer should be recorded in minutes. ................
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