11/07/2021 Quality Control: MRI/Breast MRI (Revised 10-21-2020) : Accreditation Support

Quality Control: MRI/Breast MRI (Revised 10-21-2020)

Modified on: Wed, 21 Oct, 2020 at 3:47 PM

Revision History

The MR equipment specifications and performance shall meet all state and federal requirements. The requirements
include, but are not limited to, specifications of:

Maximum static magnetic field strength

Maximum rate of change of magnetic field strength (dB/dt)

Maximum radiofrequency power deposition (specific absorption rate)

Maximum auditory noise levels

The ongoing QC program assesses relative changes in system performance as determined by the technologist,
service engineer, qualified medical physicist/MR scientist, or supervising physician. A qualified medical physicist/MR
scientist must have the responsibility for overseeing the equipment quality control program and for monitoring
performance upon installation and routinely thereafter. All ACR MR accredited facilities and those applying for
accreditation must maintain a documented quality control (QC) program and must comply with the minimum
frequencies of testing outlined in the 2015 ACR MR Quality Control Manual. The ACR will send a QC manual to the
modality’s supervising physicians of facilities not previously accredited in MRI. There are no QC tests specific to
breast MR accreditation, as distinct from those required for general MRI accreditation.

As part of the accreditation application, facilities must demonstrate compliance with ACR requirements for QC by
providing:

The most recent annual MR system equipment performance evaluation summary form signed by a qualified
medical physicist - for Breast MR, this must include an indication that the performance of the site’s bilateral
breast coil(s) has been checked and was acceptable

Documentation of corrective action (if the annual MR system performance evaluation summary identifies
performance problems)

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Breast MR: If your facility has already submitted your medical physicist’s MRI Equipment Evaluation Summary Form and MR Safety
Checklist for a given unit when accrediting in the general MRI accreditation program, your medical physicist/MR scientist does not need
to repeat the MRI Equipment Evaluation survey specifically for breast MRI as long as the breast coils were checked during the survey.
However, you must submit the MRI Equipment Evaluation Summary Form and MR Safety Checklist for Breast MRI Accreditation, even if
it was submitted previously for general MRI accreditation. The ACR will check to ensure that the unit has been surveyed within the past
year.

Although many of the procedures and action criteria outlined in the 2015 ACR Magnetic Resonance Imaging (MRI) Quality Control
Manual were written specifically for the ACR MRI Accreditation Phantom, the ACR understands that the use of this phantom may not be
possible for all QC in breast imaging. Some facilities use the ACR Small MRI Phantom
(https://www.acraccreditation.org/~/media/ACRAccreditation/Documents/MRI/SmallPhantomGuidance.pdf?la=en) for this purpose. The ACR leaves
the choice of the QC phantom and the resultant action criteria to the facility. This decision must be made by the qualified medical
physicist/MR scientist in cooperation with the system vendor. An order form
(https://www.acraccreditation.org/~/media/ACRAccreditation/Documents/MRI/SmallPhantomOrderForm.pdf?la=en) and more information about the
ACR small phantom (https://www.acraccreditation.org/-/media/ACRAccreditation/Documents/MRI/SmallPhantomGuidance.pdf?la=en) are available
through the ACR.

Acceptance Testing 
Acceptance testing is intended to measure quantifiable system parameters, which may then be compared to the
manufacturer’s specifications and used to develop baseline performance. A complete evaluation of system
performance should be conducted by a qualified medical physicist (QMP)/MR scientist after completion of installation
and prior to patient imaging. This testing should be more comprehensive than periodic performance testing and
should be consistent with current acceptance testing practices. It should include all of the technologist’s QC tests as
well as the annual tests in the 2015 ACR Magnetic Resonance Imaging (MRI) Quality Control Manual and an
evaluation of all coils, including all breast imaging and biopsy coils. Useful guidance is also available in a report from
the MR Subcommittee Task Group of the AAPM (https://www.aapm.org/pubs/reports/RPT_100.pdf).
(https://www.aapm.org/pubs/reports/RPT_100.pdf)

Annual Medical Physicist/MR Scientist Survey

All facilities applying for accreditation or renewal must demonstrate compliance with the ACR requirements for QC
by including a copy of the facility’s most recent Annual MRI System Performance Evaluation Summary (must be
performed and signed by a medical physicist/MR scientist and must include evaluation of the weekly technologist QC
and MR Safety Program Assessment). A technologist may perform the ACR phantom portion of the accreditation
submission, although the ACR strongly recommends the services of a medical physicist or MR scientist for this
also. The medical physicist/MR scientist must provide a written report of findings of acceptance testing and
performance evaluations to the responsible physician(s) and to the professional(s) responsible for service of the MRI
equipment. If appropriate, the medical physicist/MR scientist should inform the site supervisor of the required
service. Written reports must be provided in a timely manner consistent with the importance of any adverse findings.
If use of the equipment poses imminent danger to patients or staff, the medical physicist/MR scientist must take
immediate action to preclude use of the equipment. Compliance with this requirement will be checked during the
unannounced site visits that will be conducted by the ACR and/or the CMS.

The ACR realizes that surveys cannot usually be scheduled exactly on the anniversary date of the previous survey;
therefore, a period of up to 14 months between surveys is acceptable. If the facility has been conducting QC for less
than one quarter, the facility will submit whatever they have on these forms.

Additionally, if the Annual MRI System Performance Evaluation and/or QC files show performance deficits (e.g.
problems with the system and/or data outside of the action limits), the facility must state what steps it has taken to
correct the problems.

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All QC testing must be carried out in accordance with the written procedures and methods outlined in the ACR 2015
MRI Quality Control Manual. The evaluation must include, but is not limited to, the following:

Annual Medical Physicist's/MR Scientist's MR System Performance Evaluation

QC Test Description

Checks the uniformity of the main magnetic field strength (B0) over a designated volume.
Magnetic Field Homogeneity Inhomogeneities can contribute to geometrical distortion of images, adversely influence image
quality, and compromise the signal-to-noise ratio (SNR) in some fast imaging sequences.

Checks the accuracy with which axial slices are positioned at specific locations utilizing a sagittal
Slice Position Accuracy localizing image. The test determines whether the actual locations of acquired slices differ from
their prescribed locations by substantially more than is normal for a well-functioning scanner.

Checks the prescribed slice thickness against that of the measured slice thickness. Poor slice
Slice Thickness Accuracy thickness accuracy may not only suggest that slices are too thick or thin, but can extend to factors
such as incorrect image contrast or SNR.

Checks the trade-off between maximizing image uniformity and enhancing SNR that is inherent to
various types of radiofrequency coils. Tests should be performed on all coils used clinically
(including breast coils) and include:
Radiofrequency Coil Checks
frequency and gain/attenuator verification (pre-scan values)
image SNR
intensity uniformity for volume coils
phase stability and image artifact assessment

Checks that display devices meet manufacturer’s published specifications for

maximum and minimum luminance

Soft-Copy Displays (Monitors)
luminance uniformity
resolution
spatial accuracy

Provides an external assessment of QC, checks that appropriate actions are taken to correct
Evaluation of QC Program problems, identifies areas where quality and QC testing may be improved and enables a
comparison of QC practices with those of other MRI sites.

Continuous Quality Control

A continuous QC program must be implemented for all MRI units and should be established with the assistance of a
qualified medical physicist/MR scientist. The technologist must perform the QC tests listed below at a weekly
minimum frequency. The medical physicist/MR scientist should identify the person responsible for performing the
tests and may choose to increase the frequency of testing based on the facility and MRI usage. If any QC parameter
being monitored falls outside of the control limits, corrective action should be taken. A medical physicist/MR
scientist should be available to assist in prescribing corrective actions for unresolved problems. The technologist
weekly QC program must include, but not be limited to, the following:

Annual Medical Physicist's/MR Scientist's MR System Performance Evaluation

QC Test Description

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Table Positioning To determine that the MRI scanner is functioning properly with regard to performing patient set up

To determine that the MRI scanner is functioning properly with regard to performing data entry and
Setup and Scanning
prescan tasks

To determine that the MRI system is set on-resonance; the effects of off-resonance relate primarily
Center (Central) Frequency
to system sensitivity and appear as a reduction in image SNR

Transmitter Gain or Attenuation To determine whether there are problems with the radiofrequency chain (coil RF calibration)

Geometric Accuracy To determine whether the geometric relationships of the MR image are in error (gradient calibration)

High Contrast (Spatial) Resolution To assess the scanner’s ability to resolve small objects

To assess the extent to which objects of low-contrast are discernible in the images
Low Contrast Resolution
(Detectability)
NOTE: SNR is an acceptable alternative to LCD scoring for daily/weekly phantom QC. However, LCD
scores must be included in the Annual System Performance Evaluation. 

To assess the presence of artifacts that may be early indicators of declining MRI system
Artifact Analysis
performance

To ensure artifact-free laser films are produced with consistent gray levels that match the image
Film (Hardcopy Image) QC
appearance on the filming console

To ensure the MRI system patient bed transport, alignment and system indicator lights, RF room
Visual Checklist integrity, emergency cart, safety lights, signage and monitors are present and working properly and
are electrically and mechanically stable

If your facility does not have laser printer capability for Breast MRI, there is no need to perform QC for a laser printer.
Just indicate that you do not use a laser printer when you complete the application.

MRI Safety 
Safety guidelines, practices, and policies must be written, enforced, reviewed and documented at least annually by
the MR supervising physician. For guidance, see the ACR’s Manual on MR Safety (https://www.acr.org/Clinical-
Resources/Radiology-Safety/MR-Safety) and the ACR Manual on Contrast Media (https://www.acr.org/Clinical-
Resources/Contrast-Manual). The annual medical physicist/MR scientist performance summary must also include an
assessment of the MRI safety program (signage, access control, screening procedures and cryogen safety) as well
as an inspection of the physical and mechanical integrity of the system. 

Note: The use of remote MR system operation does not, in any way, diminish the obligations of the site to provide
safe MR patient care. 

Preventive Maintenance 
Preventive maintenance must be scheduled, performed and documented by a qualified service engineer on a regular
basis. Service performed to correct system deficiencies must also be documented and service records maintained by
the MR site.

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Revision History for this Article

Date Section Description of Revision(s)

12-12-19 All Article created; FAQs incorporated; No criteria changes

4-24-2020 MRI Safety Updated link to ACR Manual on MR Safety

Added NOTE to the Annual Medical Physicist's/MR Scientist's MR System Performance
9-24-2020 Low Contrast Detectability
Evaluation
10-21-2020 MR Safety Added remote scanning statement

Previous: Next:

MRI Accreditation Testing Overview

(https://accreditationsupport.acr.org/support/solutions/articles/11000061018-
(https://accreditationsupport.acr.org/support/solutions/articles/11000055863-
mri-medical-physicist-mr-scientist)MRI/Breast MRI Medical Physicist/MR
mri-accreditation-testing-overview)
Scientist
(https://accreditationsupport.acr.org/support/solutions/articles/11000061018-
(https://accreditationsupport.acr.org/support/solutions/articles/11000055863-
mri-accreditation-testing-overview)
mri-medical-physicist-mr-scientist)
Equipment: Breast MRI
(https://accreditationsupport.acr.org/support/solutions/articles/11000045909-

equipment-breast-mri)
(https://accreditationsupport.acr.org/support/solutions/articles/11000045909-
equipment-breast-mri)

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