The following information is required for sites applying to participate in ACRIN trials involving MRI imaging anddo not have ACR MRI accreditation.

Technologist Qualifications

  • Number of full-timetechnologists performing MRI scans:
  • Number of above technologists who are registered:
  • Number of above registered technologists with MRI certification:

Radiologist Qualifications

  • Number of board certified radiologists who interpret MRI scans:
  • Number of above radiologists who have at least 150 hours of CME over a three-year period:
  • Type ofMRI related certifications or fellowships held by facility radiologists
  • Hours an MRI supervising radiologist is available in the MRI department daily:
  • Number of MRI body and musculoskeletal cases interpreted for the most recent calendar year:
  • Does the facility or department have dedicated readers for body and musculoskeletal cases? Yes No
  • If yes, how many?
  • Number of MRI neuro cases interpreted for the most recent calendar year:
  • Does the facility or department have a dedicated neuro reader? Yes No
  • If yes, how many?
  • Please list any other MRI sub-specialties for which the department has dedicated readers:

Medical Physicist

  • Identify medical physicist who oversees the quality control program and attach CV:
  • Is medical physicist certified by the American Board of Radiology in the following sub-fields?

Diagnostic Radiological Physics Yes No

Radiological Physics Yes No

Quality Assurance Program

  • Does your institution have a Quality Assurance program in place that outlines policies and procedures related to quality, patient education, infection control, and safety?

Yes (attach copy if applicable) No

  • Does your facility maintain documentation on site of any results of an appropriateness/outcomes analysis and actions taken to correct any deficiencies?

Yes No

MR Equipment Quality Control

Does all equipment meet state and federal requirements? Yes No

Does facility have regularly scheduled preventive maintenance checks performed and documented by a qualified service engineer on a regular basis? Yes No

Does facility site maintain documentation of services performed to correct any system deficiencies? Yes No

Please complete the following regarding MR equipment performance checks:

Checked Annually by Medical Physicist?
Yes / No
(If no, provide frequency of inspection)
Magnetic Field Homogeneity
Slice Position Accuracy
Slice Thickness Accuracy
Radiofrequency Coil Checks
Inter-Slice Radiofrequency Interference
Soft-Copy Displays (Monitors)
Checked Weekly by Technologist?
Yes / No
(If no, provide frequency of inspection)
Center frequency
Table Positioning
Setup and Scanning
Geometric Accuracy
High-Contrast Resolution
Low-Contrast Resolution
Artifact Analysis
Film Quality Control
Visual Checklist

Publications

  • Attach a list of recent MRI related publications, if any, authored by radiologistswho interpret MRI cases.

Name and title of individual completing this questionnaire:

Signature:Date:

Version Date: 5.15.07 Page 1 of 2 MR QA Program Questionnaire