Scan performed by: ................................... Position ............................... MRI Report Completed by: ....................... Position......................... MRI scanner make/model ................../................ MRI scan date: MRI scan start time: : MRI scan end time: : Part A Sequences performed T1 T2 T1-FS Performed? Slice Inter FOV Performed? Slice Inter FOV Performed? Slice Inter FOV Contrast thickness thickness Plane Subjective assessment slice Subjective assessment thickness slice Subjective assessment slice (mm) (mm) of quality gap of quality (mm) gap of quality gap (%) (%) (%) Axial No Yes No Yes No Yes No Good Good Good Satisfactory Satisfactory Satisfactory Yes Inadequate Inadequate Inadequate Poor Poor Poor Sagittal No Yes No Yes No Yes No Good Good Good Satisfactory Satisfactory Satisfactory Yes Inadequate Inadequate Inadequate Poor Poor Poor Coronal No Yes No Yes No Yes No Good Good Good Satisfactory Satisfactory Satisfactory Yes Inadequate Inadequate Inadequate Poor Poor Poor Additional No Yes No Yes No Yes sequences No Good Good Good Satisfactory Satisfactory Satisfactory Yes Inadequate Inadequate Inadequate Poor Poor Poor These reading can be collected from scan legend at a later stage.
Scan performed by: ................................... Position ............................... MRI Report Completed by: ....................... Position......................... MRI scanner make/model ................../................ MRI scan date: MRI scan start time: : MRI scan end time: : Part A Sequences performed T1 T2 T1-FS Plane Performed? Subjective assessment of quality Slice thickness (mm) Inter slice gap (%) FOV Performed? Subjective assessment of quality Slice thickness (mm) Inter slice gap (%) FOV Performed? Subjective assessment of quality Slice thickness (mm) Inter slice gap (%) FOV Contrast Axial No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Sagittal No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Coronal No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Additional sequences No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes Good Satisfactory Inadequate Poor No Yes These reading can be collected from scan legend at a later stage.
Form-07(a)(b)---Medal-study-MRI-Report-v1-7-04-03-2013.docx