ACR MRI Accreditation: Medical Physicist Role in the Application Process
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1 ACR MRI Accreditation: Medical Physicist Role in the Application Process Donna M. Reeve, MS, DABR, DABMP Department of Imaging Physics University of Texas M.D. Anderson Cancer Center Educational Objectives Present an overview of the new modular ACR MRI Accreditation program as it applies to phantom image acquisition for accreditation application. Discuss the role of the medical physicist in the application process. Discuss phantom image quality failures, possible causes and potential remedies. Provide advice for avoiding common pitfalls in the phantom image submission process. ACR MRI Accreditation Program Modular program launched October 20, modules (head, spine, body, MSK, MRA, cardiac) Allows accreditation of whole body, dedicated and certain specialty MRI systems Added a second, small phantom for use in small bore orthopedic MRI systems Previous programs Whole body Cardiac New Modular Program *Breast MR: to be included with Breast Imaging Accreditation programs (Mammography, Stereotactic Breast Biopsy, Breast Ultrasound) Head Spine Musculoskeletal (MSK) Body Magnetic Resonance Angiography (MRA) Cardiac ACR MRI Accreditation Program Unit based facility accreditation program: For every unit must apply for all modules routinely performed on that unit for a facility to be accredited. Allowances made for loaner units and emergency use of magnets <10 exams in 30 day period, or <50 exams in any 12 month period MRI scanners dedicated to Interventional MRI and Radiation Therapy treatment planning are exempt. ACR MRI Accreditation Program Additional guidance documents Guidance documents available Online application process Longer time period to acquire phantom and clinical images (+/- 1 month from phantom exam) 1
2 Guidance documents Clinical images guidance documents Describes criteria ACR uses to evaluate clinical images submitted for each of the six modules: Head Spine MSK Body MRA Cardiac ACR Technical Standards 2004 ACR MRI Quality Control Manual Radiologist s section Technologist s section Medical Physicist s section In the process of being revised. Medical Physicist/MR Scientist Medical Physicist: Board Certification in radiological physics or diagnostic radiological ogical physics (recommended) Ref: ACR Accreditation Program Requirements, 2009 Board Certification in appropriate subfield(s) ) by the American Board of Radiology (ABR), the Canadian College of Physics in Medicine, or for MRI, by the American Board of Medical Physics (ABMP) in magnetic resonance imaging physics. Ref: ACR Technical Standard for Diagnostic Medical Physics Performance Monitoring of MRI Equipment, 2006 Medical Physicist/MR Scientist MR Scientist: A qualified MR Scientist is an individual who has obtained a graduate degree in a physical science involving nuclear MR or MRI. Should have 3 years documented experience in a clinical MRI environment. Refs: ACR Accreditation Program Requirements, 2009; ACR Technical Standard for Diagnostic Medical Physics Performance Monitoring of MRI Equipment, 2006 Medical Physicist / MR Scientist role Member of team: supervising physician, MRI technologist; involved in the accreditation process. Acquires or assists in acquisition of phantom images Performs phantom image evaluation to assess image quality and determine if images will pass ACR. Evaluates spatial and temporal resolution of submitted clinical images 2
3 Medical Physicist / MR Scientist role Scanner purchase specifications and MRI system siting Acceptance testing and scanner testing after installation and after major upgrade or repair* Annual medical physicist performance evaluation* Establishment and oversight of equipment QC & performance monitoring* Protocol development and optimization *topics covered by next two speakers ACR MR Accreditation Phantoms Manufacturer: J.M Specialty Parts San Diego, CA $1050 large phantom $780 small phantom Guidance for Phantom tests Guidance for Phantom tests ACR (large) Phantom Analysis #1 #5 #7 #8 #9 #10 #11 #1) Slice thickness and position, geometric accuracy, high contrast resolution #5) Geometric accuracy #7) Percent image uniformity, ghosting #8-11) Low contrast object detectability, and slice position (in #11) ACR (small) Phantom Analysis Sag localizer) Geometric accuracy #1) Slice thickness and position, geometric accuracy, high contrast resolution #3) Geometric accuracy #5) PIU, ghosting #6-7) LCD 1 sag 20 mm slice 7 axial 5mm slices w/ 3mm gap FOV 12 cm 192 x 152 matrix Slide courtesy of E.F. Jackson, PhD From Phantom Test Guidance for Small MRI Phantom for the ACR MRI Accreditation Program 3
4 ACR Accreditation: Preparation Service engineer check system prior to acquiring phantom & clinical images. Physicist acquire and evaluate phantom images in advance of starting accreditation process. Identify and correct scanner and coil problems. Re-acquire phantom images and evaluate to ensure images meet ACR limits. Common pitfalls phantom images Phantom image quality problems Causes Potential remedies available to the Medical Physicist Phantom position Scan 3-plane 3 localizer prior to acquiring sagittal series to optimize phantom position Axial rotation Sagittal tilt Coronal alignment Poor phantom positioning (off isocenter) Geometric accuracy (gradient non-linearity, B 0 inhomogeneity) Low contrast detectability (LCD), high contrast resolution Phantom not centered in coil: PIU (non-uniform RF) Large phantom - Slice Position Slice 1 Slice 11 Criteria: <5mm Small phantom - Slice Position Phantom position Criteria: <5mm Slice 1 Isocenter Off isocenter 100 mm inferior 4
5 Phantom position Phantom position: small bore orthopedic systems Important to position phantom at center of bore Off-isocenter isocenter: : potential for distortion due to gradient non- linearity and field inhomogeneity Isocenter Off isocenter 100 mm superior Common pitfalls clinical images Poor image quality on Site T1 and Site T2 series due to incorrect slice positions. Solution: Scan 3-plane 3 localizer to optimize phantom position Slices must intersect correct areas of the phantom. Large phantom: 5mm thick / 5mm gap image spacing 10mm Small phantom: 5mm thick / 3mm gap image spacing 8mm Low contrast detectability Factors that impact LCD score: Field strength Slice position accuracy Phantom position off isocenter Coil, coil connection, whether coil is working properly (passes QC test) Reference: Site Scanning Instructions for use of the MR Phantom for the MRI Accreditation Program, Large phantom Low Contrast Detectability (LCD) Small phantom Low Contrast Detectability (LCD) Slice 8: 1.4% Slice 9: 2.5% Slice 10: 3.6% Slice 11: 5.1% Criteria: 1.5T - at least 9 spokes (total) 3T - at least 37 spokes (total) Slice 7 Slice 6: 3.6% Slice 7: 5.1% Criteria: at least 9 spokes (total) 5
6 Low field systems SNR vs. Field strength Lower SNR Challenge: to pass low contrast detection test Clinical protocols modified to increase SNR Increase number of averages (impacts scan time) Narrow bandwidth (impacts chemical shift, geometric distortion) Use of higher SNR pulse sequences Phantom alignment and slice position in LCD sections is important 1.5T 0.2T Slice 11 Low Contrast Detection section of large ACR MRI phantom (ACR T1 series) LCD score sensitive to slice position SNR vs. Field strength Geometric accuracy Factors that impact geometric accuracy: Phantom position off isocenter Gradient non-linearity, B 0 field inhomogeneity Gradient non-linearity correction Gradient correction application is a user choice on some, but not all scanners Receive bandwidth 3.0T 1.5T Slice 8 Low Contrast Detection section of large ACR MRI phantom (8 channel array, ACR T1 series, SCIC) Large phantom - Geometric Accuracy Small phantom - Geometric Accuracy Slice 1 Slice 5 Criteria: 190 ± 2 mm Sag Loc Criteria: 148 ± 2 mm Slice 1 Slice 3 Sag Loc Criteria: 100 ± 2 mm 6
7 Gradient nonlinearity correction Correction ON Correction OFF Receive bandwidth: geometric accuracy +/- 4 khz = Hz/pixel +/- 16 khz = Hz/pixel 190 mm 196 mm Isocenter Isocenter ACR T1 series, Slice 5 large ACR MRI phantom frequency ACR Sag T1 large ACR MRI phantom Receive bandwidth: geometric accuracy Receive bandwidth: chemical shift +/- 4 khz = Hz/pixel +/- 16 khz = Hz/pixel +/- 4 khz +/- 16 khz frequency ACR Axial T1 large ACR MRI phantom ACR Axial T1 large ACR MRI phantom Uniformity Factors that impact PIU score: Dielectric effect at 3T Use of 8 channel phased array coils Phantom position inside coil Gradient non-linearity, B 0 field inhomogeneity; geometric distortion correction Both phantoms - Percent Image Uniformity PIU=[1-(max-min)/(max+min)] T: Criteria: PIU 87.5% 3.0T: Criteria: PIU 82 % 7
8 3 Tesla systems Dielectric effect Decreased uniformity: Reduced RF penetration with increasing frequency Phased array coils Small coil elements improve SNR Multiple elements for anatomical coverage Independent receivers enables parallel imaging Apply Surface Coil Intensity Correction Composite image 1.5T 3T Impacts Uniformity measurement MRI Devices 8 channel HR Brain array: Images acquired from individual channels 8 channel head coils Uniformity vs. Coil If your facility uses an eight channel head coil, it is necessary to perform all phantom scans using the surface coil intensity correction option. 1.5T Quad head coil 1.5T 8 channel array 1.5T 8 channel array SCIC applied Reference: ACR MRI Accreditation Program Testing Instructions, rev , ACR T1 series, Slice 7 Uniform section of large ACR MRI phantom High contrast resolution Factors that impact resolution score: Excessive phantom rotation Excessive ghosting due to motion or vibration Ensure that coil is stable Immobilize phantom in coil Excessive low pass filtration Filter application and degree of filtration is a user choice on some, but not all scanners Large phantom High Contrast Spatial Resolution Must be able to resolve 1.0 mm holes vertically and horizontally. 25 cm FOV, 256 x 256 matrix Pixels: 0.98 mm x 0.98 mm 1.1mm 1.0mm 0.9 mm 8
9 Small phantom High Contrast Spatial Resolution 0.9 mm 0.8 mm 0.7 mm Must be able to resolve 0.8 mm holes vertically and horizontally. FILTER ON Low pass filter FILTER OFF 12 cm FOV, 192 x 152 matrix Pixels: 0.63 mm x 0.79 mm Reduces truncation artifacts May impact high contrast resolution score Prominent truncation artifacts ACR T1 series, Slice 5 large ACR MRI phantom Common pitfalls phantom images ACR Sagittal T1 image localizer not included on CD CD not readable by the reviewer Not uncompressed DICOM format Embedded viewer ACR reviewer unable to evaluate DICOM images Solution: Review images on PC(s) ) separate from PACS and MRI systems using (Osiris( and/or K-PACS) K before submitting to ACR. Verify correct series and scan parameters - view DICOM header information. Summary Presented a brief overview of the new modular ACR MRI Accreditation program. Medical physicist involvement in the application process is important as part of the accreditation team. Discussed phantom image quality problems, possible causes and potential remedies, with focus on solutions available to the physicist. Provided advice for avoiding common pitfalls in the phantom image submission process. 9
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