STANFORD UNIVERSITY MEDICAL CENTER



Rotation:Body MRIRotation Duration:4 wksMonth(s):2Institution:StanfordCall Responsibility:Triage Night(s):covered by fellowResponsible Faculty Member(s):Shreyas Vasanawala MD, PhD, section chiefRobert Herfkens, M.D.Bruce Daniel, M.D.Frandics Chan, M.D., Ph. D.Brooke Jeffrey, M.D.Graham Sommer, M.D.Aya Kamaya, M.D.Terry Desser, M.D.Juergen Wilmann, M.D.Lewis Shin, M.D.Location:SUH, Blake WilburPhone Numbers:Hospital Reading Room:332-4MRITechnicians Telephone Numbers:Hospital: 723-7315 or 723-6335Blake Wilbur scanner: 736-2061BWMR1: 725-8645BWMR2: 736-2060Sherman Ave: 721-3373Technologists/Technical Staff:Claudia Cooper, MRT Technical CoordinatorTeresa Nelson, MRI Technical SupervisorTraining Level:Second and 3rd or 4th yearsGoals & ObjectivesThe 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 KnowledgeBy 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 imagingRecognize the most common artifacts in body MRIRecognize normal abdominal and pelvic MRI anatomy and contrast.Patient care Knowledge Based ObjectivesDistinguish MR compatible devices and equipment from incompatible devicesUnderstand the clinical goal of each exam and select the correct imaging protocolUnderstand the rationale behind the protocol designBe able to premedicate and counsel claustrophobic patientsKnow gadolinium indications and contraindications SkillsProtocol cases according to the clinical question and the indication for the studyIdentify relevant comparison studies in the PACS system and use them during readoutTriage cases by level of urgencyPreview all cases before the readout session begins. Behavior and Attitude ObjectivesBe 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 ProfessionalismSkillsDictate a clear, concise report that explicitly addresses the clinical question to be answered.Prepare and present five interesting MR cases during the monthCommunicate results to referring physicians in a timely fashionAttitudesBe punctual for readoutsDivide work appropriately and proportionally among the residents and fellows on the serviceBe available to consult with clinicians on interesting cases, and provide insight on how MRI might answer clinical questions for patients.Behave courteously to clinicians, technologists and patients at all timesPractice-based learning: Routinely search PubMed, standard texts, and other online sources for material relevant to interesting cases reviewed during read-outPrepare five interesting cases for presentation at conference. For each case, associate an evidence-based publication and a teaching point.Between readouts, observe the MRI technologists as patients are scanned to obtain greater familiarity with scan parameters and protocols. Systems-based practice:Be familiar with the ACR appropriateness criteria with regard to ordering of MRI studiesRotation 2:Medical Knowledge:By the end of this rotation, the resident will be able to:Describe and interpret diffusion-weighted and flow-sensitive MRI sequencesUnderstand the pharmacokinetics and indications for the different gadolinium-based contrast mediaUnderstand and describe Dixon-type sequences for imaging fat and waterProtocol 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 ObjectivesDistinguish MR compatible devices and equipment from incompatible devicesUnderstand the clinical question to be answered and select the correct imaging protocolUnderstand the rationale behind the protocol designUnderstand the purpose and utility of each pulse sequence included in the study protocolBe able to premedicate and counsel claustrophobic patientsKnow the indications for and contraindications to administration of gadolinium contrast mediaSkillsProtocol cases according to the clinical question and the indication for the studyIdentify relevant comparison studies in the PACS system and use them during readoutTriage cases by level of urgencyPreview all cases before the readout session begins. Behavior and Attitude ObjectivesBe 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: SkillsDictate a clear and concise report that makes explicit reference to the clinical question to be answered.Prepare and present one conference of interesting MR cases during the monthCommunicate all results to referring physicians in a timely fashionAttitudesBe punctual for readoutsDivide work appropriately and proportionally among the residents and fellows on the serviceBe available to consult with clinicians on interesting cases, and provide insight on how MRI might answer clinical questions for patients.Behave courteously to clinicians, technologists and patients at all timesPractice-based learningComplete review of body MRI recommended readingBe able to search PubMed, standard texts, and other online sources for material relevant to interesting cases reviewed during read-outPrepare five interesting cases for presentation at conference. For each case, associate an evidence-based publication and a teaching point.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 2Be familiar with the ACR appropriateness criteria with regard to ordering of MRI studiesConference Schedule/FormatTitleDayTimeLocationMRI case conferenceTuesday, monthly12 noonLucas Method of Assessment of Performance:Written evaluation of resident by responsible faculty member monthlyVerbal feedback to resident by faculty ACR In-Training Service Exam annuallyRecommended ReadingOnline resources:Body MRI section website: MRI website wiki: for MRI technologists: : Mitchell and Cohen, MRI Principles, Second edition. On reserve at Lane.Siegelman, Evan S. Body MRI. On reserve at LanePractical Guide to Abdominal and Pelvic MRIby John R., Md. Leyendecker, Jeffrey J., Md. Brown. On reserve at LaneMRI curriculumI. Physics and instrumentationBasic principles of MRIOverview of MR imaging processFactors that affect the MR signalRelaxation times T1 and T2II. Spatial localization of the MR signalTypes of pulse sequences: spin echo and gradient echoContrast and signal to noise on imagesIII. MR contrast agents: mechanism of action of paramagnetic materials and other materials that affect the MRI signal intensityHemorrhageOther factors affecting MR image: flow, chemical shiftIV. Practical patient care informationPatient care; monitoring the patient, MR compatible devices, treating claustrophobia, precautions, MR in pregnancyChoosing pulse sequences and timing parametersTrade-offs in MRIArtifacts in MRIV. Clinical MRIMR angiography: flow sensitive sequences and contrast enhanced sequencesGeneral abdomen and pelvis MRIOptimizing spatial and contrast resolutionIn and out of phase imagingMotion artifact reduction techniquesGU MRI: Adrenal and kidney: characterizing adrenal masses on mri; renal masses, renal ca stagingHepatic MRI: Normal liver anatomy and appearance on different pulse sequences, benign and malignant liver masses, inflammatory diseases, diffuse liver disease, vascular diseases, transplant evaluationBiliary MRI: biliary neoplasms and strictures, transplant complications, autoimmune diseasePancreas: pancreatic masses, secretin stimulated MRI, ductal variants, chronic pancreatitisspleen: splenic masses, infiltrative disordersBowel: inflammatory bowel disease, rectal neoplasms. transplant evaluationPelvic MRI: Congenital anomaliesPelvic masses: adnexal masses, uterine anomalies, fibroids, adenomyosis, ovarian and uterine cancerProstate MRI: staging prostate cancer with MRI ................
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