MRI – Radiology Learning London

MRI Course Information
Syllabus Map

This course covers the main topics required for the FRCR Part 1 examination.

The course has been provided by the London School of Radiology and has been put together by the following lecturers:

Prof Martin Graves, Cambridge University Hospitals
Prof Gareth Barker, King’s College London
Dr Jessica Winfield, The Royal Marsden NHS Foundation Trust
Dr Geoff Charles-Edwards, Guy’s & St Thomas’ Hospitals

The MRI module forms 1 of 7 components of the physics exam for the FRCR Part 1 (Matter and Radiation, Radiography and Fluoroscopy, Radiation Safety, Computed Tomography, Radionuclide Imaging, Magnetic Resonance Imaging, and Ultrasound)

The conversion to this format of online courses is new for 2021; the content is under continual review, and may modified, added to or removed based on peer review and user feedback.

The London School of Radiology has been granted permission by the above lecturers to use the videos and materials provided by them within this course. These lecturers retain the copyright and intellectual property rights of this content. Unless permission has otherwise been obtained, redistribution or unauthorised access to this material is strictly prohibited.

Please leave any feedback using the comments boxes on the individual lesson/topic pages, or use the contact form to get in contact directly. Comments/feedback will not be published and will be used to improve our courses

Content	Examples of expected knowledge
Creation, detection and spatial localisation of the MR signal	Nuclear magnetic resonance –> Principle of NMR Precession about magnetic fields (B0 and B1) –> Magnetism and Principles of NMR Equilibrium magnetisation (M0) –> Principle of NMR (4:08). Longitudinal (Mz) & transverse magnetisation (Mxy) –> MR Signal –> Transverse and Longitudinal Relaxation Magnitude and phase of transverse magnetisation –> MR Signal T2* Relaxation Dependence of MR signal on the strength of the static magnetic field, B0 –> Signal Detection Overview of MR hardware –> The Hardware: Magnets and Coils Slice selection –> Slices and Spatial Localisation Axial Slice Selection Basic understanding of k-space · Relationship between k-space and MR image –> K-Space · Frequency-encoding –> Frequency Encoding · Phase-encoding –> Phase Encoding · Awareness of different k-space trajectories and their advantages/disadvantages 2D versus 3D sequences –> 2D TOF 3D TOF
Basic contrast mechanisms	T1. Understand the concept of MR signal saturation T2 T2* –> Relaxation T1 and T2 Relaxation Mechanisms –> T1, T2 and PD Weighted Imaging –> T2 vs T2* T2* Relaxation Understand the impact of relaxivity of gadolinium-based contrast agents on T1-weighted and T2-weighted MR images. –> Contrast Agents Understand the difference between a contrast-weighted MR image and a quantitative image (map) Understand the extension of T2-weighted MRI to susceptibility-weighted imaging (SWI)
Basic MRI sequences & common variants	Spoiled gradient echo, spin echo –>Gradient Echo Spin Echo Gradient Echo vs Spin Echo –> Fast Gradient Echo –> Three Types of Gradient Echo –> Spoiled T1 vs bSSFP T2/T1 Multiple echo variants (TSE/FSE, EPI) –> RARE/FSE/TSE Single Shot FSE/TSE or HASTE –> Gradient Echo Planar Imaging –> TSE Single shot versus multi shot –> Single Shot FSE/TSE or HASTE Pulse sequence diagram –> Slices and Spatial Localisation Basics of steady-state sequences
Frequency-dependent techniques	Understanding of chemical shift: fat & water –> Fat Chemical Shift –> Chemical Shift Artefact (of the First Kind) and Echo Planar Imaging Chemical Shift (of the second kind) and DIxon Methods Fat saturation –> Fat Suppression In-phase & out-of-phase TEs, Dixon –> In and Out of Phase Awareness of MR spectroscopy (MRS) and appropriate TEs for particular clinical questions –> Principles of Magnetic Resonance Spectroscopy (MRS) In-vivo MRS MRS Signal – Single Voxel and Spectroscopic Imaging Clinical Applications
T1-dependent techniques	Inversion recovery (IR) –> Inversion Recovery Principles Suppression: STIR & FLAIR. The role(s) of TR (and T1) in determining null point –> STIR Fat Sat vs STIR –> FLAIR 3D T2 FLAIR Enhanced T1W, e.g. MPRAGE Phase-sensitive IR –> Inversion Recovery Principles
Diffusion MRI	Diffusion weighting, relationship with underlying cellularity –> Principles of Diffusion Imaging b-values, ADCs and calculated b-values –> Principles of Diffusion Imaging Potential perfusion contribution to ADC Awareness of diffusion anisotropy –> Principles of Diffusion Imaging Processing, Display and Applications
Acceleration techniques	Awareness of acceleration techniques (no need to understand how they work in detail) and their impact on image quality & potential artefacts · Zero-filling (interpolation) · Half-Fourier –> Scan Parameters and Scan Time · Parallel imaging –> Parallel Imaging Methods · Simultaneous multislice (multiband) · Compressed sensing –> Compressed Sensing · Temporal sharing (TWIST/TRICKS) –> Temporal Interpolation and K-space Sharing
Flow-related MR techniques	Dynamic contrast-enhanced (DCE) Perfusion MRI · Dynamic susceptibility contrast (DSC) · Awareness of Arterial spin labelling (ASL) · Dynamic contrast-enhanced (DCE) for myocardial perfusion, oncology MR angiography (MRA) techniques, · Time of flight –> Time of Flight MR · Contrast-enhanced –> Contrast Enhanced MRA · Phase contrast –> Phase Contrast MRA · Awareness of other non-contrast enhanced MRA options –> Non-contrast MRA
MR artefacts and artefact reduction techniques	An understanding of the causes and potential olutions for a wide range of artefacts found in MRI Motion artefact, respiratory gating, navigated sequences, saturation bands, radial-type k-space acquisitions –> Motion B0 inhomogeneities, various sources –> B0 Inhomogeneity o Metal –> Metal Artefact and Artefact Reduction Sequences o Air/tissue interfaces B1 inhomogeneities, especially at 3T –> B1 Inhomogeneity RF interference –> RF Interferences o Instantaneous (RF spikes) o Continuous RF interference Phase wrap –> Phase Wrap Truncation artefact (Gibb’s ringing) –> Gibbs Ringing Chemical shift, receiver bandwidth –> Chemical Shift Artefact (of the First Kind) and Echo Planar Imaging Chemical Shift (of the second kind) and DIxon Methods Suppression of signal from cross talk, use of interleaved slice ordering –> Slice Cross Talk Fat-water swaps in Dixon MRI –> Dixon Fat-water Swaps Poor geometry-factor with high acceleration factors in parallel imaging –> Artefact Associated with Parallel Imaging
MR safety	Awareness of MHRA guidelines as the primary MR safety reference for UK Understanding of MR safety framework, definitions, roles & responsibilities –> Guidelines · MR Responsible Person –> Classification of People in MRI · MR Safety Expert –> Classification of People in MRI · MR Authorised Persons –> Classification of People in MRI · MR Environment –> Classification of People in MRI · MR Controlled Access Area –> Classification of People in MRI · MR Safe/ MR Conditional/ MR Unsafe/ MR Unlabelled –> Regulations and Standards for MR Safety Labelling Awareness of safety issues, particularly with regards implanted devices and emergency situations · Attraction, torque –> Static Magnetic Field · RF heating: SAR, B1+rms, SED –> Time Varying Magnetic Fields · Contrast agents (see generic contrast agent section) –> Contrast Agents · Magnet quench –> Cryogens Awareness of recommendations for scanning patients with implanted devices without the device manufacturer’s approval, e.g. “off-label” –> Regulations and Standards for MR Safety Labelling Understand the safety issues associated with gadolinium-based contrast agents –> Contrast Agents · Linear versus Macrocyclic-based agents · NSF · Gadolinium deposition/retention
Quality assurance	Awareness of the importance of QA in MR to identify failing elements in phased array coils. Awareness of the need for QA to help establish reproducibility of quantitative MR techniques.

Course Content

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