Trainee Manual
Start Here: From Zero to Scanning
A high-yield pathway for the complete beginner. Goal: safely run supervised routine scans as fast as possible, then deepen understanding on the job.
The core idea: You do not need to master physics before you scan. You need safety habits, pattern recognition, and a repeatable console workflow. Physics depth comes later, driven by the problems you actually hit.
The 6-Week Fast Track
| Week | Focus | You can now… |
|---|---|---|
| 1 | Safety (Section 2) + shadowing. Complete Level 1 screening training, observe a full list, practise the screening interview on colleagues. | Enter Zone IV correctly; screen a patient under supervision. |
| 2 | Console basics (Section 4) + coils (Section 5). Register phantom “patients”, load protocols, run localizers, position volunteers in head and knee coils. | Drive the console for a localizer end-to-end. |
| 3 | First real scans, fully supervised: routine brain (Section 6). Learn slice planning on the 3-plane localizer. Recognise T1 vs T2 vs FLAIR vs DWI at a glance (Section 3). | Run a routine brain with the supervisor watching. |
| 4 | Add lumbar spine and knee (Section 6). Start troubleshooting: repeat a motion-degraded sequence, add a saturation band. | Run 3 routine exam types; fix simple problems. |
| 5 | Artifacts week (Section 7). Deliberately review every artifact you produced; name it, state the fix. Learn parameter trade-offs (TR/TE/NEX/matrix vs time and SNR). | Identify the 8 common artifacts and the first-line fix for each. |
| 6 | Independence drills: full list under distant supervision, contrast studies observed, incident/quench drill walkthrough, implant lookup practice. | Run a routine list with a supervisor available but hands-off. |
Non-negotiable: “Layperson scanning quickly” never means alone. Local law and policy govern who may operate an MRI scanner and inject contrast. This manual accelerates competence — a qualified supervisor signs off every stage, and formal credentialing (e.g. registration as a radiographer/technologist where required) is not replaced by it.
Competency Sign-Off Checklist
- ☐ Safety: zones, screening interview, projectile awareness, quench procedure, emergency codes
- ☐ Screens a patient and checks an implant against its conditions with supervisor verification
- ☐ Registers patient, selects protocol, positions + landmarks, runs localizer unaided
- ☐ Plans slices correctly for brain, lumbar spine, knee
- ☐ Identifies weighting (T1/T2/PD/FLAIR/DWI) on any image within 5 seconds
- ☐ Names artifact + first-line fix for the 8 common artifacts
- ☐ Completes a routine list within booked slot times
Study tip: Pair this manual with the site’s Glossary, Protocol Explorer, Calculators and Safety Guidelines pages — they are the reference layer; this page is the pathway.
Safety First — The Gate Before Everything
You may not touch a patient or the console until this section is second nature. The magnet is always on.
The one rule: Nothing and no one enters Zone IV (the magnet room) unscreened. Not once, not briefly, not “just a pen”. Fatal projectile and implant accidents have happened exactly this way.
The Four Zones (ACR model)
| Zone | What it is | Access |
|---|---|---|
| I | Public areas (waiting room) | Unrestricted |
| II | Interface: reception, screening, changing | Patients under supervision |
| III | Control room and corridors near the magnet; fringe field may exceed 0.5 mT (5 G) | Screened persons + MR personnel only; physically restricted |
| IV | The magnet room itself | Screened persons accompanied/authorised by Level 2 MR personnel |
The Screening Interview — Every Patient, Every Time
1
Written form first, then verbal confirmation. Read the completed form back; people tick boxes without reading.
2
The red-flag list: cardiac devices (pacemaker/ICD), neurostimulators, cochlear implants, aneurysm clips, programmable shunts, drug pumps, metal in the eye (ever worked with grinding/metal?), shrapnel, recent stents/surgery (<6 weeks), pregnancy, welding history without orbit imaging where indicated by local policy.
3
Identify every implant precisely (make/model where possible) and check its MR conditions from the manufacturer’s labeling before scanning. Verdicts: MR SafeMR ConditionalMR Unsafe. “Conditional” means specific field strength, spatial gradient, SAR and positioning limits — check each one against your scanner.
4
Remove everything removable: hearing aids, dentures with metal, piercings, wigs with clips, drug patches (some have foil — burn risk), glucose monitors/insulin pumps per labeling, all items in pockets. Gown per local policy.
Use the site’s Implant Safety Checker to look up device conditions with source links — then have your Level 2 supervisor confirm the decision. The trainee never clears an implant alone.
The Three Hazards to Internalise
| Hazard | Cause | Your defence |
|---|---|---|
| Projectile | Static field B₀ pulls ferromagnetic objects with force rising steeply near the bore | Screen everything entering Zone IV; ferromagnetic detection where installed; MR-conditional equipment only |
| Burns (RF heating) | Transmit RF induces current in loops and conductors: skin-to-skin contact, cables, leads, some tattoos | Pad between skin surfaces and against the bore wall; no cable loops; cables off bare skin; use provided pads — the single most common MRI injury is preventable padding failure |
| Peripheral nerve stimulation / noise | Fast gradient switching (dB/dt); acoustic noise up to ~110+ dB | Hearing protection for everyone in the room during scanning, always; warn patients about twitching sensations at high slew rates |
Emergencies — Know Before You Need
| Event | Action |
|---|---|
| Cardiac arrest in Zone IV | Remove the patient from the magnet room to a safe resuscitation area — the crash team and their equipment must never enter Zone IV. Start CPR outside. |
| Projectile pinning a person | If life-threatening and the object cannot be removed: controlled quench (Level 2 decision). Otherwise never quench for convenience. |
| Quench (helium release) | Evacuate the room, keep the door open if pressure allows per local procedure, no one re-enters; asphyxiation risk if venting fails into the room. |
| Fire | Only MR-conditional extinguishers enter Zone IV. Fire service does not enter until the field is controlled/quenched per policy. |
| Table stop / emergency buttons | Learn the difference on day one: table stop (halts table), magnet stop/quench button (dumps the field — irreversible, costly, for life danger only), electrical emergency off. |
High yield: Superconducting magnets are at field 24/7 — power cuts, fire alarms and “the scanner is off” change nothing. Treat the room as live, always.
See the full Safety Guidelines comparison page (ACR 2024 · MHRA 2021 · IEC 60601-2-33 · ISMRM).
Physics Essentials — Just Enough to Scan
The 20% of physics that explains 80% of what you do at the console. Deeper theory can wait.
The Machine in Three Parts
| Component | Job | What you notice |
|---|---|---|
| Main magnet (B₀) | Aligns hydrogen protons; 1.5 T or 3 T typically | Always on; the projectile hazard |
| Gradient coils | Vary the field across the patient → spatial encoding (where the signal comes from) | The loud knocking; PNS tingling |
| RF system | Transmit coil excites protons; receive coils detect the returning signal | Coil selection; SAR limits; heating risk |
Image Contrast in One Table
Protons “relax” after excitation at tissue-specific rates: T1 (regrowth of longitudinal magnetisation) and T2 (decay of transverse signal). You choose which difference dominates via TR (repetition time) and TE (echo time).
| Weighting | TR / TE | Instant recognition | Main use |
|---|---|---|---|
| T1 | Short TR, short TE | Fat bright, fluid (CSF) dark, white matter brighter than grey | Anatomy; post-gadolinium enhancement |
| T2 | Long TR, long TE | Fluid bright — pathology (oedema) lights up | Pathology detection |
| PD | Long TR, short TE | Intermediate everything; fluid mildly bright | MSK — menisci, cartilage |
| FLAIR | T2 + inversion pulse nulling CSF | Fluid bright except CSF dark | Periventricular lesions (MS, small vessel) |
| STIR | Inversion pulse nulling fat | Fat dark, fluid/oedema very bright | Robust fat suppression, marrow oedema |
| DWI + ADC | Diffusion gradients | Restricted diffusion = bright on DWI + dark on ADC | Acute stroke, abscess, cellularity |
| GRE / SWI | Gradient echo, no 180° refocus | Blooming black dots | Blood products, calcium, iron |
High yield: Find the CSF (or any free fluid). Dark → T1. Bright → T2. Bright everywhere but dark CSF → FLAIR. Always read DWI with the ADC map — T2 shine-through fools everyone once.
The Trade-Off Triangle
Every parameter change trades between SNR (signal-to-noise), resolution, and scan time. You can improve two at the expense of the third.
| You change | Effect | Cost |
|---|---|---|
| ↑ NEX/averages | ↑ SNR (√NEX) | Time doubles per doubling |
| ↑ Matrix (finer pixels) | ↑ resolution | ↓ SNR, ↑ time (phase steps) |
| ↑ Slice thickness | ↑ SNR | ↓ resolution, partial volume |
| ↑ Receiver bandwidth | ↓ chemical shift, ↓ distortion | ↓ SNR |
| Parallel imaging (GRAPPA/SENSE) | ↓ time, ↓ distortion (EPI) | ↓ SNR, possible unfolding artifacts |
Trainee habit: before editing any protocol parameter, predict what happens to SNR, resolution and time — then check the console’s predicted values. This single habit teaches more physics than any textbook chapter.
Sequence Families at a Glance
- Spin echo / TSE (FSE): workhorse; 180° refocusing → robust to field inhomogeneity.
- Gradient echo (GRE): fast, thin slices, 3D volumes; sensitive to susceptibility (feature for SWI, bug near metal).
- Inversion recovery: STIR (null fat), FLAIR (null CSF) — a prep pulse bolted onto TSE.
- EPI: whole image per shot — DWI, fMRI; fast but distortion-prone.
Deeper dives: site Glossary and Calculators (Ernst angle, TI-to-null, SNR).
The Console — Siemens syngo Workflow
One repeatable loop covers ~90% of routine scanning. Learn it as muscle memory. (Vendor-neutral terms in Section 8.)
The Universal Exam Loop
1
Register the patient. Select from the RIS worklist (never free-type if a worklist entry exists — mismatched IDs break PACS). Confirm name, DOB, weight (drives SAR calculation — be accurate), and patient position/orientation (e.g. Head First Supine).
2
Choose the protocol. From the Exam Explorer tree, pick the site protocol matching the clinical question (e.g. Neuro → Brain → Routine). Site protocols exist for a reason — don’t improvise as a trainee.
3
Position, coil, landmark. Patient on table, correct coil connected (watch it appear on the coil display), pads + hearing protection, emergency squeeze-ball in hand. Centre the laser on the landmark (Section 5), press the Isocentre / table position button to drive to isocentre. Laser off before it crosses eyes.
4
Run the localizer (scout). Three-plane fast acquisition. Everything else is planned on these images.
5
Plan slices. Drag/rotate the slice group graphically on all three localizer planes. Check: coverage of the anatomy, correct angulation, saturation bands where the protocol uses them, phase-encode direction sensible (Section 7). Copy the geometry to subsequent sequences (Copy references) so all sequences match.
6
Run, watch, adapt. Queue sequences; watch each as it reconstructs. Motion? Stop and repeat now, not after the patient leaves. Talk to the patient between sequences — informed patients hold still.
7
Check completeness, then close. All sequences diagnostic? Radiologist requirements met? Send to PACS, verify arrival, end the exam, clean the coil and table.
Siemens-Specific Landmarks
| Concept | Where / what |
|---|---|
| Exam Explorer | Protocol tree (region → exam → program of sequences) |
| Dot engine | Guided workflows (Brain Dot, Knee Dot…): auto-align, decision points, guidance view — excellent for trainees; understand what it automates so you can work without it |
| Program / queue | Sequence list at left; running = green, queued = waiting; drag to reorder, right-click to append/duplicate |
| Routine / Contrast / Resolution / Geometry / System cards | Parameter tabs when a sequence is open — TR/TE on Contrast, matrix/FOV on Resolution, slices on Geometry |
| Copy references | Propagates slice geometry from one sequence to others |
| Phoenix | Drag a prior image into the exam to reload its exact protocol — gold for follow-ups |
| Auto Align (neuro) | Automatic AC-PC-aligned slice prescription from a scout — check it, don’t trust it blindly |
| Inline display | Images appear as reconstructed; review here before the patient moves |
Which syngo Are You On? (VE vs XA)
Siemens ships two current interface generations. The exam loop is identical; the buttons and layout differ. Check the bottom of the screen or Help → About for your version.
| Task | syngo MR VE line (e.g. VE11) | syngo MR XA line (e.g. XA31/XA51/XA61) |
|---|---|---|
| Overall look | Classic dark 3-column layout; Exam Explorer top-left | Modern flat UI, larger touch targets, redesigned dark theme |
| Start / register patient | Patient Browser → Examination | Patient view → Register; worklist front-and-centre |
| Parameter editing | Card tabs: Routine / Contrast / Resolution / Geometry / System / Physio | Same cards, reorganised panel; more inline validation & predicted-time feedback |
| Guided workflow | Dot Cockpit / Dot engine | Dot successor + myExam Cockpit & Assist; deeper automation |
| Auto slice alignment | Auto Align (neuro), AutoCoverage | AutoAlign + Deep Resolve / AI-assisted positioning where licensed |
| Reload prior protocol | Phoenix (drag image in) | Phoenix retained |
| Acceleration on offer | GRAPPA, SMS (Simultaneous Multi-Slice) | GRAPPA, SMS, Deep Resolve Boost/Sharp denoise-reconstruction |
Trainee note: If your site runs XA, lean on myExam Assist for guided decision points early, then practise the same exam without it so you can scan when automation is off or unavailable. If on VE, the Dot Cockpit is the equivalent trainer.
SAR & stop conditions: If the scanner blocks a sequence for SAR, the fix is longer TR, fewer slices, lower flip/turbo factor, or First Level mode only per local policy and patient condition — never bypass by editing the patient’s weight.
High yield: The localizer is your one chance to be lazy later. Thirty extra seconds of careful slice planning saves whole repeated sequences.
Positioning & Coils
Good positioning is half of image quality. Signal falls off fast with distance from the receive coil — anatomy must be in the coil and at isocentre.
Rules That Never Change
- Anatomy at isocentre — the magnet’s sweet spot for field homogeneity and fat suppression. Off-centre knees are why fat-sat fails.
- Coil as close as possible to the anatomy; smallest coil that covers the region wins on SNR.
- Pad every skin-to-skin and skin-to-bore contact. Hands clasped on chest = RF loop = burn risk; separate them.
- Comfort = compliance. Knee bolster, blanket, clear time estimates (“this one is 4 minutes”). An uncomfortable patient moves at minute 3 of every sequence.
- Hearing protection for every scan, earplugs and/or headphones; squeeze-ball in hand, tested, every patient.
Region Quick Reference
| Exam | Coil | Position | Landmark (laser) | Pearls |
|---|---|---|---|---|
| Brain | Head/neck array | HFS, head snug with pads | Nasion / glabella | Chin neutral; mirror set so patient can see out; warn about DWI knocking |
| C-spine | Head/neck + spine array | HFS | Thyroid cartilage (~C4) | Ask patient not to swallow during scans; no talking mid-sequence |
| L-spine | Posterior spine array (built into table) | HFS, knees flexed over bolster | Iliac crest (~L3/4) | Bolster flattens lordosis onto coil; check coverage T12–S1 on scout |
| Knee | Dedicated knee coil | Usually FFS; knee ~10–15° flexion, slight external rotation | Patella apex / joint line | Off-centre anatomy → shift table so the knee sits at isocentre; sandbag the foot |
| Shoulder | Shoulder array | HFS, arm at side, thumb up (neutral/slight external rotation) | Humeral head | Far off-centre: shim/fat-sat is hardest here — consider STIR/Dixon over spectral fat-sat |
| Abdomen/pelvis | Anterior body array + spine array | HFS, arms up or on pillow (not on abdomen if avoidable) | Xiphoid–umbilicus midpoint (abd) / ASIS (pelvis) | Coach breath-holds before starting: “breathe in, breathe out, stop breathing” |
High yield: When image quality is inexplicably poor, check in order: correct coil elements selected → anatomy at isocentre → coil plugged/seated → patient moved. This finds it 9 times in 10.
Claustrophobia toolkit: feet-first when possible, eye mask or mirror (patient preference), airflow up, constant voice contact between sequences, a relative in the room (screened!), and never minimise — acknowledge and pace.
Your First Scans — Three Walkthroughs
The three exams that make up most routine lists. Master these before anything exotic. Sequences shown are typical — your site protocol wins.
1 · Routine Brain
Sag T1Ax T2Ax FLAIRAx DWI+ADCAx SWI/GRE
1
Plan axials on the sagittal localizer: angle parallel to the AC–PC line (anterior–posterior commissure; in practice, often the genu–splenium line per local convention). Cover foramen magnum to vertex.
2
Check on coronal and axial planes too — no head tilt (symmetrical orbits/IACs), FOV centred midline.
3
Copy geometry to all axial sequences so T2, FLAIR, DWI, SWI match slice-for-slice — the radiologist scrolls them side by side.
4
Review DWI immediately with ADC. Suspected acute stroke findings get escalated now, not at the end of the exam.
2 · Lumbar Spine
Sag T1Sag T2Sag STIRAx T2 (stacked or angled)
1
Sagittals on the coronal localizer: parallel to the spinous process line; cover both foramina left to right. On the sagittal view: T12 through S1 minimum, include conus.
2
Count levels correctly. Use the sagittal to confirm — transitional anatomy (lumbosacral variants) is common; note it for the report rather than guessing.
3
Axials per local style: either angled blocks parallel to each disc (L3/4, L4/5, L5/S1) or a straight stack covering the same range. Angle along the disc, not the endplate.
4
Saturation band anterior to the spine kills breathing/bowel and CSF-flow ghosting over the canal (most site protocols include it — check it sits over the abdomen, not the spine).
3 · Knee
Sag PD FSCor PD FSCor T1Ax PD FS
1
Sagittals: on the axial localizer, angle parallel to the lateral border of the femoral condyle (≈ along the ACL); cover condyle to condyle.
2
Coronals: parallel to the posterior condylar line on the axial; cover patella to posterior capsule.
3
Axials: perpendicular to the trochlea, patella superior border through tibial tuberosity.
4
Check fat suppression on the first FS sequence. Patchy fat-sat off-centre? Confirm knee at isocentre, re-shim, or switch to STIR/Dixon per protocol options.
High yield: All slice planning is the same skill: find the reference line for the region, angle to it, cover the anatomy with margin, verify on the other two planes. Full parameter sets for 60+ protocols live in the Protocol Explorer.
Contrast studies: gadolinium administration involves screening (renal function/eGFR, prior reactions, pregnancy), agent selection and dose — a supervised, credentialed activity. Observe in weeks 1–5; local policy governs when and whether you ever inject. Agent classes and NSF risk groups: see the gadolinium calculator.
Artifacts & Fixes — The Big Eight
Name it, know the mechanism in one line, apply the first-line fix. This is the highest-yield troubleshooting skill on the scanner floor.
| Artifact | Looks like | Mechanism | First-line fix |
|---|---|---|---|
| Motion / ghosting | Repeated ghost copies along the phase direction | Patient/physiologic movement between phase steps | Coach + immobilise; repeat now; swap phase direction to move ghosts off the anatomy; sat bands; faster sequence; triggering for cardiac/flow |
| Wrap (aliasing) | Anatomy outside FOV folded onto the far side, phase direction | FOV smaller than the body part | Enlarge FOV or enable phase oversampling (“No phase wrap”); swap phase direction |
| Susceptibility / metal | Signal void + geometric warping, worst on GRE/EPI | Local field distortion from metal/air | Use TSE not GRE, ↑ bandwidth, thinner slices, STIR not spectral fat-sat, dedicated metal-artifact (MARS/advanced) protocols |
| Chemical shift | Bright/dark band at fat–water interfaces (frequency direction); India-ink outlines on opposed-phase GRE | Fat and water precess at different frequencies (~3.5 ppm) | ↑ receiver bandwidth; fat suppression; know type 2 (in/opposed phase) is your friend for adrenal imaging |
| Poor fat suppression | Patchy bright fat on FS images, often one side | Field inhomogeneity — off-centre anatomy, poor shim, metal | Centre anatomy at isocentre; re-shim; use STIR or Dixon instead of spectral fat-sat |
| Flow artifact | Vessel-aligned ghosts across the image (phase direction) | Pulsatile blood/CSF mis-mapped | Saturation band over the inflowing vessel; gradient moment nulling (“flow comp”); swap phase direction |
| Zipper / RF interference | Line(s) of noise dots across the image | External RF leaking in — door open, faulty device, light bulb | Close the door properly; remove/repair the offending device; call service if persistent |
| Gibbs / truncation | Fine parallel lines at sharp edges (e.g. fake syrinx in cord) | Finite sampling of a sharp signal boundary | ↑ matrix in phase direction; recognise it so you don’t repeat needlessly |
High yield: Half of artifact management is one question — “which way is phase-encoding?” Motion, wrap, and flow all propagate along phase; your two cheapest tools are swapping the phase direction and dropping a saturation band.
Week-5 drill: keep a personal artifact logbook. Every degraded image: screenshot, name, mechanism, what you changed, result. Ten entries in, you will troubleshoot faster than most people with years of unreflective experience.
Vendor Translator & References
Same physics, four dialects. The Siemens workflow in Section 4 maps directly onto other consoles.
Terminology Map
| Concept | Siemens | GE | Philips | Canon |
|---|---|---|---|---|
| Turbo/fast spin echo | TSE | FSE | TSE | FSE |
| Turbo factor | Turbo factor | ETL | TSE factor | ETL |
| Spoiled GRE | FLASH | SPGR | T1-FFE | FastFE |
| Balanced SSFP | TrueFISP | FIESTA | bFFE / Balanced FFE | True SSFP |
| 3D T1 brain volume | MPRAGE | BRAVO | 3D TFE | 3D FFE |
| Volumetric body 3D T1 | VIBE | LAVA | THRIVE | QuickFE 3D |
| Averages | Averages | NEX | NSA | NAQ |
| Parallel imaging | GRAPPA/CAIPIRINHA | ASSET/ARC | SENSE | SPEEDER |
| Phase oversampling | Phase oversampling | No Phase Wrap | Foldover suppression | Phase wrap suppression |
| Flow compensation | GMR / Flow comp | Flow Comp | Flow compensation / FLAG | FC |
| Motion-robust radial/PROPELLER | BLADE | PROPELLER | MultiVane | JET |
| Dixon fat–water | Dixon | IDEAL / FLEX | mDIXON | WFS (Dixon) |
| Guided workflow | Dot engine | —/AIRx assists | SmartExam | — |
| Reload prior protocol from image | Phoenix | — | ExamCards reuse | — |
A fuller switcher is built into the Protocol Explorer (Generic/Siemens/GE/Philips/Canon toggle).
Key References & Further Study
- ACR Committee on MR Safety. ACR Manual on MR Safety, 2024. acr.org
- MHRA. Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use, 2021. gov.uk
- IEC 60601-2-33. Particular requirements for the basic safety and essential performance of MR equipment.
- Westbrook C, Talbot J. MRI in Practice, 6th ed. Wiley, 2024 — the standard trainee text.
- Elster AD. Questions and Answers in MRI. mriquestions.com — free, superb physics explanations.
- McRobbie DW et al. MRI from Picture to Proton, 3rd ed. Cambridge University Press, 2017.
- Shellock FG. Reference Manual for Magnetic Resonance Safety, Implants and Devices (annual editions) — implant conditions always verified against manufacturer labeling.
- ISMRM Safety Committee resources. ismrm.org
- Siemens Healthineers, syngo MR operator documentation (site-specific version) — the authoritative source for your console’s buttons and Dot workflows.
Disclaimer: Educational reference for supervised trainees. It does not confer authorisation to operate MRI equipment, screen patients independently, or administer contrast. Local policy, national regulation, and manufacturer labeling take precedence in all cases.
Where next?
Finished the manual? Keep going:
Career guide
How to get into MRI in 10+ countries — routes, costs, salaries. Registration exam prep
ARRT, HCPC, ASMIRT, CAMRT, MRTB & CORU practice questions. MRSO certification guide
The MR safety officer career path — exams, fees, requirements. MRI jobs board
Vacancies across NZ, AU, UK, IE, US and Canada.
How to get into MRI in 10+ countries — routes, costs, salaries. Registration exam prep
ARRT, HCPC, ASMIRT, CAMRT, MRTB & CORU practice questions. MRSO certification guide
The MR safety officer career path — exams, fees, requirements. MRI jobs board
Vacancies across NZ, AU, UK, IE, US and Canada.