Sample Documents (MRI)
The IAC is pleased to include sample documents to assist facilities in providing quality care to their patients. These documents meet or exceed the requirements of the Standards, and they may be used to develop facility policies and reporting forms, whether your facility is seeking accreditation or simply working to standardize or improve current practices.
Please Note: The following documents are SAMPLES only. Protocols submitted with the application must be customized to reflect current practices of the facility.
- IAC MRI Accreditation Checklist (751KB) (Updated 10-10-2018)
- MRI Multiple Site Checklist (65KB)
- MRI Safety & QC Checklist (88KB)
- MRI Scan Parameter Form (61KB)
- Contrast Policy (41KB)
- Employee Training Policy (43KB)
- Incident/Adverse Events Policy (41KB)
- Infection Control Policy (43KB)
- Medical Emergencies Policy (42KB)
- MRI Reporting Policy(45KB)
- Patient Complaint Policy (27KB)
- Patient Confidentiality Policy (61KB)
- Patient Identification Policy (43KB)
- Primary Source Verification Policy (37KB)
- Patient Pregnancy Screening Policy (57KB)
- Preliminary Report Policy (43KB)
- Safety Policy (49KB)
- Medical Director Attestation for Consultant Use [SAMPLE] (58KB)
*Facilities are required to attach a letter from the facility's Medical Director (on the facility's letterhead) providing the consultants permission to complete the application for accreditation on the facility's behalf.
- IAC Quality Improvement (QI) Self-Assessment Tool
Created to help your facility employ and document continuous process improvement, this free tool provides a mechanism for facilities to meet the quality measures required by the Standards.
- Sample QI Policy
- Sample QI Evaluation Forms (Use of these evaluation forms will meet all the required IAC MRI Quality Improvement Standards)
Site Visit Documents
- Site Visitor Agenda (15KB)
- American College of Radiology - ACR Appropriateness Criteria
- NEW! Magnetic Resonance Imaging (MRI) Systems with Magnet Rundown Unit by GE Healthcare: Class I Recall - Potential Disabling of the Magnet Rundown Unit
GE Healthcare sent an urgent medical device correction letter (GEHC Ref# 60876) on January 6, 2015 to affected customers with instructions for confirming that the MRU is connected to the magnet. Read»
- ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging
A report of the American College of Cardiology Foundation Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions and Society of Interventional Radiology.
- ACR Guidance Document for Safe MR Practices (2007)
The MR safe practice guidelines document is intended to be used as a template for MR facilities to follow in the development of an MR safety program. These guidelines were developed to help guide MR practitioners regarding these issues and to provide a basis for them to develop and implement their own MR policies and practices. It is intended that these MR safe practice guidelines (and the policies and procedures to which they give rise) be reviewed and updated on a regular basis as the field of MR safety continues to evolve. American Journal of Roentgenology
- CDRH Draft Document: A Primer on Medical Device Interactions With Magnetic Resonance Imaging Systems
This guidance was written prior to the February 27, 1997 implementation of FDA's Good Guidance Practices, GGP's. It does not create or confer rights for or on any person and does not operate to bind FDA or the public. An alternative approach may be used if such approach satisfies the requirements of the applicable statute, regulations, or both.
- CDRH Draft Document: Guidance for Testing MR Interaction With Aneurysm Clips
This guidance was written prior to the February 27, 1997 implementation of FDA’s Good Guidance Practices, GGP’s. It does not create or confer rights for or on any person and does not operate to bind FDA or the public. An alternative approach may be used if such approach satisfies the requirements of the applicable statute, regulations, or both.
Sources and Hazards of MRI Electromagnetic Interference
- FDA Advisory for Contrast Use in MR (Related to NSF)