Patient Care
Not publishedof exam
Safety
Not publishedof exam
Image Production
Not publishedof exam
Procedures
Not publishedof exam
Quick Facts
- Exam
- ARRT MRI
- Pathways
- Primary + postprimary
- Scored
- 200 items
- Pilot
- 30 unscored items
- Total
- 230 items
- Test Time
- 230 minutes
- Appointment
- 250 minutes
- Pass
- Scaled score 75
- Score Scale
- 1–99
- Effective
- February 1, 2025
- Delivery
- Pearson computer-based
- Pilot Display
- Random and indistinguishable
- Official Weights
- Question counts
Scored vs Pilot
Scored
- 200 items
- Counts toward result
- Blueprint allocated
Pilot
- 30 items
- Does not count
- Indistinguishable onscreen
Answer every item seriously
Patient Care Blueprint
- Scored allocation
- 16 of 2008% derived
- Only subcategory
- Patient Interactions and Management
- Subcategory allocation
- 16 scored questions
- 2025 additions
- Time-out; critical-findings communication
Patient Interaction + Care
- Patient verification
- Two identifiers + matching order
- Informed consent
- Explain procedure, risks, benefits
- Confidentiality
- Protect patient information
- Communication barrier
- Adapt mode and language
- Patient education
- Purpose, length, pre/post instructions
- Physical assistance
- Transfer safely; protect lines
- Routine monitoring
- Vitals, symptoms, comfort, privacy
- Sedation
- Monitor per approved protocol
- Time-out
- Verify patient and procedure
Contrast + Emergencies
- Renal screening
- Review BUN, creatinine, eGFR
- Contrast selection
- Condition, age, weight, labs
- Gadolinium types
- Linear versus macrocyclic
- Dose calculation
- Use weight and concentration
- Power injector
- Confirm route and timing
- Extravasation
- Stop; assess; document
- Contrast reaction
- Classify severity; follow protocol
- Cardiorespiratory arrest
- Remove safely; begin response
- Critical findings
- Notify health care team
- Infection control
- Standard and transmission precautions
Field Hazards
B0 pulls | RF heats | Gradients stimulate
B0: projectile + torqueRF: SAR + burnsGradients: PNS + noise
MR Safe vs Conditional
MR Safe
- No known hazards
- All MR environments
- No conditions required
MR Conditional
- Defined conditions only
- Verify device details
- Match every condition
Universal vs conditional safety
Safety Decision Picker
- Unknown implanted device→Stop and identify(Never assume)
- MR Conditional label→Match every condition(Field, coil, SAR)
- Ferrous object suspected→Screen and localize(Before Zone IV)
- Conductive loop risk→Separate and pad(Prevent RF burn)
- Patient reports heating→Stop scan immediately(Assess contact points)
- Contrast risk concern→Review history and labs(Follow facility policy)
- Emergency inside Zone IV→Remove patient safely(Use designated response area)
- Cryogen release suspected→Evacuate magnet room(Follow emergency plan)
- Unscreened person approaches→Restrict access(Screen before entry)
Safety Blueprint
- Scored allocation
- 21 of 20010.5% derived
- Only subcategory
- MRI Screening and Safety
- Subcategory allocation
- 21 scored questions
- Primary hazards
- Static, RF, gradient fields
RF vs Gradient
RF
- Tissue heating
- SAR
- Burn risk
Gradient
- Peripheral nerve stimulation
- Acoustic noise
- Magnetophosphenes
Heat vs stimulation
Screening + Labels
- Device identity
- Document year, make, model
- MR Safe
- No known MR hazards
- MR Conditional
- Safe under listed conditions
- MR Unsafe
- Unacceptable MR risk
- Foreign body
- Screen and localize first
- Medical conditions
- Include pregnancy screening
- Applied items
- Patches, tattoos, jewelry, monitors
- MR personnel
- Know Level 1 versus 2
Fields + Environment
- Static field
- Projectile force and torque
- Spatial gradient
- Force changes by location
- RF field
- Heating and burn risk
- SAR
- RF energy deposition
- Conductive loops
- Separate skin, cables, coils
- Gradient field
- PNS and acoustic noise
- Safety zones
- Control progressively restricted access
- Gauss lines
- Map static-field boundaries
- Quench
- Rapid cryogen boil-off
- Emergency planning
- Fire, quench, evacuation procedures
Weighting Pairs
T1: short-short | T2: long-long | PD: long-short
T1: short TR + short TET2: long TR + long TEPD: long TR + short TE
T1 vs T2
T1
- Short TR
- Short TE
- Fat relatively bright
T2
- Long TR
- Long TE
- Fluid relatively bright
Short-short vs long-long
Image Quality Picker
- Need more SNR→Increase NEX(Time increases)
- Need finer resolution→Increase matrix(SNR decreases)
- Need shorter scan→Reduce NEX(SNR decreases)
- Wraparound appears→Increase phase FOV(Or oversample)
- Chemical shift appears→Increase receive bandwidth(SNR decreases)
- Motion ghosts appear→Immobilize or gate(Address source)
- Susceptibility dominates→Prefer spin echo(Shorten TE)
- Need fat suppression→Choose STIR or spectral(Match contrast needs)
- Need CSF suppression→Choose FLAIR(Long TI)
- Need flow velocity→Choose phase contrast(Set VENC)
Image Blueprint
- Image Production
- 106 of 20053% derived
- Physical Principles
- 40 of 20020% derived
- Parameters + Options
- 36 of 20018% derived
- Acquisition + Processing
- 30 of 20015% derived
- Largest domain
- More than half scored
K-Space Map
Center = contrast | Periphery = detail
Center: gross signalPeriphery: fine edges
T2 vs T2*
T2
- Spin-spin decay
- Refocused by 180°
- Less inhomogeneity influence
T2*
- Includes field inhomogeneity
- GRE sensitive
- Faster signal loss
True decay vs added dephasing
MR Physics
- Larmor frequency
- Proportional to field strength
- Precession
- Spins rotate around B0
- Resonance
- RF matches Larmor frequency
- FID
- Signal after RF excitation
- T1 recovery
- Longitudinal magnetization returns
- T2 decay
- Transverse coherence decreases
- T2* decay
- T2 plus field inhomogeneity
- Proton density
- Hydrogen concentration
- Gradients
- Enable spatial localization
- K-space
- Raw spatial-frequency data
Artifact Shortcuts
Wrap FOV | Shift bandwidth | Gibbs matrix
Wrap: phase FOVShift: bandwidthGibbs: matrix
STIR vs FLAIR
STIR
- Suppresses fat
- Short TI
- Broad fat nulling
FLAIR
- Suppresses CSF
- Long TI
- Neurological emphasis
Fat null vs CSF null
Parameter Tradeoffs
- TR ↓
- Time↓; T1 weighting↑
- TE ↑
- T2 weighting↑; SNR↓
- TI
- Nulls selected tissue
- NEX ↑
- SNR↑; time↑
- FOV ↓
- Resolution↑; wrap risk↑
- Matrix ↑
- Resolution↑; SNR↓
- Slice thickness ↓
- Z-resolution↑; SNR↓
- Bandwidth ↑
- Chemical shift↓; SNR↓
- ETL ↑
- Time↓; blurring↑
- Flip angle
- Changes contrast and SAR
TOF vs Phase Contrast
TOF
- Inflow enhancement
- No VENC
- Vessel morphology
Phase Contrast
- Velocity encoding
- Requires VENC
- Quantifies flow
Inflow vs velocity
Sequences + Suppression
- Spin echo
- Robust refocusing
- Fast spin echo
- Multiple echoes per TR
- Gradient echo
- Fast; susceptibility sensitive
- Inversion recovery
- TI selects tissue null
- STIR
- Fat suppression by TI
- FLAIR
- CSF suppression by TI
- DWI
- Diffusion-sensitive signal
- ADC
- Maps apparent diffusion magnitude
- SWI
- Susceptibility-sensitive imaging
- EPI
- Very fast; distortion prone
- TOF MRA
- Inflow-based angiography
- Phase contrast
- Velocity-encoded flow
SNR vs Resolution
Higher SNR
- Larger voxels
- More NEX
- Longer scans possible
Higher Resolution
- Smaller voxels
- Larger matrix
- Lower SNR likely
Signal usually trades for detail
Artifacts + Fixes
- Aliasing
- Increase phase FOV; oversample
- Gibbs
- Increase matrix or resolution
- Chemical shift
- Increase bandwidth; suppress fat
- Susceptibility
- Use SE; shorten TE
- Zipper
- Find RF leakage
- Motion ghosting
- Immobilize, gate, or trigger
- Flow ghosting
- Saturate or gate
- Partial volume
- Use thinner slices
- Cross-talk
- Add gap or interleave
- Dielectric shading
- Reposition; use dielectric pads
Data + QC
- Nyquist
- Sample twice highest frequency
- FFT
- K-space to image
- K-space center
- Contrast and gross signal
- K-space periphery
- Edges and fine detail
- MIP
- Projects brightest voxels
- MPR
- Reformats alternate planes
- Subtraction
- Removes shared background
- ADC mapping
- Displays diffusion values
- DICOM
- Medical image data standard
- QC targets
- SNR, geometry, slice accuracy
Procedure APPS
Anatomy -> Pathology -> Protocol -> Setup
Anatomy: planesPathology: contrastProtocol: sequencesSetup: coil + landmark
Protocol Decision Picker
- Acute diffusion question→DWI + ADC(Correlate both)
- Demyelination question→T2 + FLAIR(CSF suppressed)
- IAC or pituitary→Thin focused sections(Small FOV)
- Noncontrast angiography→Choose TOF(Inflow effect)
- Flow quantification→Choose phase contrast(Set VENC)
- Biliary tree→Choose MRCP(Heavily T2)
- Fat characterization→Compare in/out-of-phase(Look for signal loss)
- Small joint→Dedicated coil(Small FOV)
- Moving anatomy→Gate or trigger(Match physiology)
Procedures Blueprint
- Procedures
- 57 of 20028.5% derived
- Neurological
- 25 of 20012.5% derived
- Body
- 15 of 2007.5% derived
- Musculoskeletal
- 17 of 2008.5% derived
Procedure Planning
- Anatomy
- Know structures and physiology
- Imaging planes
- Match anatomy and pathology
- Pathology
- Choose sensitive contrast
- Protocol
- Select sequences and parameters
- Patient factors
- Age, size, trauma, tolerance
- Coil selection
- Match anatomy and coverage
- Landmarking
- Center planned anatomy
- Gating
- Synchronize physiologic motion
- Contrast
- Predict image effects
- Additional procedures
- CINE or surgical planning
Anatomic Coverage
- Head + neck
- Brain through vascular neck
- Spine
- Cervical through total spine
- Thorax
- Chest, breast, vascular thorax
- Abdomen
- Solid organs, bowel, MRCP
- Pelvis
- Soft tissue and vascular
- Upper extremity
- Shoulder through fingers
- Lower extremity
- Hip through foot
- Arthrogram
- Joint contrast procedure
- Vascular studies
- MRA and MRV
- Soft tissue
- Tumor and infection
Common Traps
Scaled score vs percent
75 is scaled ≠ 75% is not required
Total vs scored items
230 appear onscreen ≠ Only 200 are scored
Pilot vs optional
Pilots are indistinguishable ≠ Answer all 230
Conditional vs universally safe
Conditions are mandatory ≠ Device name alone insufficient
T2 vs T2*
T2 refocuses inhomogeneity ≠ T2* includes it
STIR vs FLAIR
STIR nulls fat ≠ FLAIR nulls CSF
Resolution vs free improvement
Smaller voxels cost SNR ≠ More NEX costs time
Artifact vs pathology
Trace encoding direction ≠ Test corrective change
Pathway vs blueprint
Eligibility routes differ ≠ MRI content stays shared
Last Minute
- 1.Effective February 1, 2025
- 2.230 total = 200 scored + 30 pilot
- 3.Test time 230; appointment 250 minutes
- 4.Pass = scaled 75, not 75%
- 5.Patient Care: 16 scored; 8% derived
- 6.Safety: 21 scored; 10.5% derived
- 7.Image Production: 106 scored; 53% derived
- 8.Procedures: 57 scored; 28.5% derived
- 9.Image subcounts: 40 / 36 / 30
- 10.Procedure subcounts: 25 / 15 / 17
- 11.Verify every implant condition
- 12.B0 pulls; RF heats; gradients stimulate
- 13.SNR, resolution, time trade off
- 14.Procedure questions test planning factors
- 15.Answer every item; flag uncertainty
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