Body MRI Service (3-Gibbon) Responsibilities
MRI Reading Room
Inpatient Service (3 Gibbon and Methodist Hospital MRI systems)
Outpatient Service (COB/ JCCI and other
JOI sites / Langhorne / Doylestown, etc)
Breast (MOB)
MRI Contraindications and Policies
Each day (usually throughout a given week), one housestaff
(resident or fellow) is assigned primary responsibility for MRI
inpatients and ED patients, one housestaff is assigned primary
responsibility for outpatient protocoling, and the other MRI housestaff
spend their time in the 3-Gibbon reading room reading MRI and some CT
cases. Note that finishing the day's work on both CT and MRI services
is a shared responsibility of the entire 3-Gibbon Body team.
The specific responsibilities for each MRI housestaff are
described below:
1. Expected reading room arrival time is 8:00 AM (or immediately after conference) in the morning, and 1:20 PM or earlier in the afternoon. Upon arrival, the housestaff assigned to inpatient service will review pending inpatient and ED MRI exams for TJUH, JHN and MHD, provide protocols for newly requested exams, and consider the relative order in which cases should be done. Even if an inpatient case was previously protocoled by a different housestaff, the housestaff covering the inpatient MRI service is expected to be familiar with all pending inpatient exams.
Determine the urgency and priority of all pending cases. Also keep track of whether there is a backlog of urgent cases for the neuro and msk services, so that this can be considered when estimating when body cases can be done. Keep in touch with technologists regarding when a case might be scanned. Be present or available during all examinations. Help localize pertinent anatomy.
2. At 9 AM, this resident or fellow goes to the 3-Gibbon MRI technologist control room for a brief "huddle" with the technologists, and possibly representatives from the Neuro and MSK services, to improve understanding regarding which body patients are likely to be completed during the day.
3. Protocol inpatient cases for TJUH, JHN and Methodist
MOST IMPORTANT: Obtain clinical information and review pertinent
examinations, and determine the indication and clinical questions, as
soon as the request has been received. Use protocol manager to communicate
issues not only of appropriate protocol for technologists to use, but
clinical information needed. View old
cases, and their reports! Discuss any questions with the
attending. Understanding
the clinical context of the case is most important; protocol changes
cannot even be considered unless the clinical issues of the case are
understood. If the requesting housestaff does not know the answer to
important questions, have them call back when they have a better
understanding of what they need to know.
4. This resident/fellow is responsible for maintaining communication with clinical housestaff, technologists and attending MRI radiologists about all cases. Make sure that we understand the clinical question that the MRI is expected to answer, and that the clinical service has realistic expectations about when a case can get done. Inform the clinical service if the exam will be delayed.
Consult with Body MRI Fellow or the Attending as to which MRI protocol is most appropriate to answer the clinical questions. When necessary, speak to the patient prior to examination. Conversation with the patient should be accomplished promptly, and should not delay the start of the exam.
5. Monitor inpatient cases whenever possible. This involves checking series to determine that sufficient anatomy is covered, with sufficient spatial resolution, to match the clinical question. Eliminate unnecessary pulse sequences, if possible. If critical pulse sequences are inadequate, determine if they should be repeated or if there is an alternative technique to obtain the information. Consult with the Body MRI Fellow or Attending whenever needed. The Inpatient resident/fellow (not the technologist), in consultation with the attending, has primary responsibility for making sure that the entire examination is appropriate and of sufficient quality to address the clinical concerns of the patient and referring physician.
6. The resident or fellow on the inpatient service should read the inpatient exams whenever possible, unless this would delay the dictation.
PRIORITY LIST FOR INPATIENT HOUSESTAFF
1. Make sure all inpatient and ED MRI cases have been
protocoled.
2. Discuss clinical issues with housestaff, including if a case will be
delayed more than 24 hours, or longer than initially expected.
3. Review inpatient MRI exams, predictate, readout with faculty, and
dictate.
4. If there are more than 2 unclaimed CT inpatient exams, review one
and readout with either of the 3-Gibbon faculty.
5. Read outpatient or consult MRI exams if the above is taken care of.
6. Read outpatient or consult CT exams if the above is taken care of.
Physical coverage at COB is indicated on the schedule posted on
RadLink. Otherwise, arrival time is 8 AM or immediately after
conference. On days assigned to COB coverage, report to COB
(Clinical Office Building; 909 Walnut St)
before 7 AM. Make sure there is another Radiologist in the COB or JHN
before
leaving. If necessary, stay or return to monitor cases. Neuro staff is
expected to arrive at the COB or JNH by 8:00 AM, except for Tuesday
when they arrive by 9:15 AM Tuesday. Please make sure Neuro staff is
present at their expected location before you
leave, and that the technologists know where they are and that you are
leaving.
The resident or fellow assigned to the outpatient service is responsible for reviewing the indications and protocols for all outpatient exams, from all of our centers that perform outpatient MRI, scheduled for that day and at least the next 2 days. Make sure you are aware of the results of prior imaging exams, and consult JeffChart, EMR, or call requesting MD when necessary. Use protocol manager to communicate issues not only of appropriate contrast agent and protocol for technologists to use, but clinical information needed. The requested exam should generally not be changed, since this may impact the precertification for the exam. The focus is determination of the appropriate contrast agent, and whether it is necessary to modify the standard protocol for that body part. Consult with the Body MRI Fellow or Attending whenever needed.
PRIORITY LIST FOR OUPATIENT HOUSESTAFF
1. Make sure all outpatient MRI cases have been protocoled
for the current day, and the next day.
2. If there are more than 2 unclaimed CT or MRI inpatient exams, review
one and readout with either of the 3-Gibbon
faculty.
3. Protocol all pending cases for next 3 days. On Friday, protocol
through the end of Tuesday.
4. Read outpatient or consult MRI exams if the above is taken
care of.
5. Read outpatient or consult CT exams if the above is taken care of.
All residents and fellows on the Body MRI service are expected to be in the reading room when not assigned to other physical locations. Expected reading room arrival time is 8:00 AM, unless you attend morning conference, in which case 8:20 arrival is acceptable. There must be at least one body radiologist in the room during lunch/conference time, and others are expected to return by 1:20 PM or earlier.
Cases should be set up as they become available. If practical, it is preferred if MRI inpatient studies can be read by the housestaff covering the MRI inpatient service. Understanding the background and clinical questions, and viewing the images, is more important than the details of how the case is formatted; actually setting up the case should be less than 5 minutes.
Review cases prior to readout. Read cases with the attending and staff, dictate the cases, and inform the referring clinicians of the results if requested or if findings might impact on management that day. Include in the dictation a brief description of what was done. Always include the anatomic regions covered, dose and name of contrast agents given, MRA, MRCP, and/or other post-processing, etc.
PRIORITY LIST FOR BODY MRI READING ROOM (NOT IN- OR OUT- PATIENT HOUSESTAFF
1. If there are more than 2 unclaimed CT or MRI inpatient
exams, review one and readout with either of the 3-Gibbon
faculty.
2. Read outpatient or consult MRI exams if there is
not a backlog of CT or MRI inpatient exams.
3. Read outpatient or consult CT exams if all MRI cases are read.
Contact the Breast Imaging attending in the morning to determine what is needed for preparing and reading Breast MRI at the Breast Imaging Center in the MOB (Medical Office Building), 11th & Walnut).