The Division of Body MRI is responsible for approval of patient studies, working up of in-patient and out-patient studies prior to examination, determining the appropriate protocol for examination, and interpreting and dictating examinations for all MRI applications other than head, neck and spine. During the residency, residents spend a total of three months during each of their first three years on the MRI service. Additionally, several elect to spend additional months on the MRI service during their fourth year. During this time, the residents are expected to show continued progress in the following areas:
1. Provide optimal MRI examinations and interpretations
2. Improve clinical communications so that appropriate information is obtained and provides without delay.
1. Learn the basic principles of MRI and how these are applied toward constructing examination protocols.
2. Modifying protocols to suit individual patients
3. Recognize abnormal findings on MR images
4. Characterize tissue abnormalities based on their MRI appearance, and relate this to previous medical knowledge to evaluate complex and coexisting diseases.
1. Obtain additional clinical information from referring clinicians when necessary
2. Communicate with referring clinicians to determine the clinical information needed
3. Provide prompt and satisfactory information and service, to best help referring physicians manage their patients.
4. Discuss clinical and protocol issues with technologists, and learn scanning technique from them.
1. Improve understanding of MRI pulse sequences by critical examination of clinical cases, asking appropriate questions
2. Read current literature and review sources intensively
3. Use web-based resources to obtain additional information
4. Learn hands-on scanning technique from MRI technologists at outpatient sites, to facilitate protocol decision and communication with technologists.
1. Recognize the importance of establishing satisfactory 2-way communication for all cases.
2. Understand the needs of patients, as well as those of referring physicians and other health professionals.
1. Use hospital and radiology information systems appropriately to obtain all needed clinical information and results of prior examinations, and relate this to current clinical requests and patient status.
2. Know and follow all standard policy, with adaptation to unique clinical and individual needs.
The resident and fellow clinical responsibilities include understanding the importance of clinical history and applying this towards selecting the appropriate protocol, monitoring patient examinations and making changes were necessary, administering contrast agent injections, responding to any adverse events, and interpreting and dictating cases in consultation with the MRI attendings.
By the end of the first year, the resident should:
Patient Care –
• Screen and supervise routine body MRI studies.
• Screen and supervise patients for contrast administration.
• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.
• Gather essential and accurate information about patients that is relevant to prioritizing prescribing and interpreting the body MRI examination.
• Use information technology to support patient care decisions.
Medical Knowledge –
• Demonstrate basic knowledge of normal anatomy of the chest, abdomen and pelvis.
• Discuss the basic principles of MRI physics, including: T1 and T2 relaxation time, T1 and T2-weighting, principles of flow related enhancement, contrast agents, relationship between signal-to-noise, spatial resolution and acquisition time.
• Identify the most important pulse sequences necessary for examining all body parts.
• Recognize the appearance on MR images of common benign and malignant masses.
• Know and apply basic and clinically supportive sciences appropriate to the discipline.
Practice-Based Learning and Improvements –
• Use information technology to manage information, access on-line medical information, and support their own education.
Interpersonal and Communication Skills –
• Interact with primary care attending physicians and residents in consultation regarding the use of MRI to facilitate patient care.
• Use effective listening and writing skills.
• Dictate accurate and concise radiologic reports for basic body MRI studies.
Professionalism –
• Demonstrate respect, compassion, and integrity to patients and other physicians.
• Demonstrate sensitivity and responsiveness to patient's culture, age, gender and disabilities.
Systems-Based Practice –
1. Understand how their patient care affects other healthcare professionals.
By the end of the second year, the resident should:
Patient Care –
• Screen and supervise more complex Body MRI studies, including inpatient and outpatient studies.
• Assist technologists in deciding on alternate pulse sequences if patient factors interfere with image quality.
• Provide preliminary impressions about diagnostic findings for all body MRI applications, including benign and malignant disease in the chest, abdomen, pelvis, vascular stenoses and occlusions as well as musculoskeletal pathology.
• Understand the importance of clinical information and clinical decision making towards clinical interpretation and communication.
• Learn hands-on scanning technique from the MRI technologists during a week assigned to coverage of the Clinial Office Building outpatient practice, and complete at least one examination supervised by the technologists.
Medical Knowledge –
• Demonstrate a basic knowledge of anatomy throughout the body and musculoskeletal system.
• Provide preliminary impressions about diagnostic findings for all body MRI applications, including benign and malignant disease in the chest, abdomen, pelvis, vascular stenoses and occlusions as well as musculoskeletal pathology.
• Demonstrate an analytic thinking approach to the performance of MRI studies for diverse clinical situations.
Practice-Based Learning and Improvements –
• Locate, appraise and assimilate evidence from scientific studies related to their patient's problems.
Interpersonal and Communication Skills –
• Work effectively with clinicians as a member of the healthcare team.
• Dictate accurate and concise radiologic reports for more complex MRI studies.
Professionalism –
• Demonstrate a commitment to the ethical principles pertaining to confidentiality of patient information.
• Demonstrate responsiveness to the needs of patients that supercede self-interest.
Systems-Based Practice –
• Know how types of clinical practice and delivery systems differ from one another.
• Effectively prioritize patients requiring MRI studies.
By the end of the third year, the resident should:
Patient Care –
• Screen and supervise, with an increasing level of responsibility, most MRI studies.
• Understand the importance of clinical information and clinical decision making towards clinical interpretation and communication.
• Use basic image workstation post-processing techniques to improve interpretation of 3D vascular MRI exams.
Medical Knowledge –
• Demonstrate an increasing ability to recognize abnormalities on MRI studies and discuss a differential diagnosis.
• Be able to learn new pulse sequences as they arise and relate them to older pulse sequences.
• Relate MRI principles of relaxation and protocol components to clinical applications.
• Improve hands-on scanning technique from the MRI technologists during a week assigned to coverage of the Clinial Office Building outpatient practice, and complete at least one examination supervised by the technologists.
Practice-Based Learning and Improvements –
• Facilitate the teaching of medical students and other health care professionals.
• Teach first year residents regarding the basic MRI principles and principles of MRI decision making.
• Teach junior residents who may also be on the clinical rotation.
Interpersonal and Communication Skills –
• Dictate accurate and concise reports for complex MRI studies.
Professionalism –
• Demonstrate a commitment to excellence and on-going professional development.
Systems-Based Practice –
• Practice cost-effective evaluation of patients requiring MRI studies that does not compromise the quality of care.