MRI Quality Assurance Program Questionnaire
The following information is required for sites applying to participate in ACRIN trials
involving MRI imaging and do not have ACR MRI accreditation.
Technologist Qualifications

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Number of full-time technologists performing MRI scans:
Number of above technologists who are registered:
Number of above registered technologists with MRI certification:
Radiologist Qualifications
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Number of board certified radiologists who interpret MRI scans:
o Number of above radiologists who have at least 150 hours of CME over a
three-year period:
Type of MRI 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:
o Does the facility or department have dedicated readers for body and
musculoskeletal cases?
Yes
No
o If yes, how many?

Number of MRI neuro cases interpreted for the most recent calendar year:
o Does the facility or department have a dedicated neuro reader?
Yes
No
o 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
Version Date: 5.15.07
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MR QA Program Questionnaire
MRI Quality Assurance Program Questionnaire
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?
No
(If no, provide frequency of inspection)
Yes
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
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Attach a list of recent MRI related publications, if any, authored by radiologists who
interpret MRI cases.
Name and title of individual completing this questionnaire:
Signature:
Version Date: 5.15.07
Date:
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MR QA Program Questionnaire