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Running the fMRI

What this page tells you

Day-of protocol for the HUP6 clinical fMRI: door codes (in the password manager), consent forms, training the patient on each language task, laptop and push-box setup (logins in the lab password manager), telling the tech protocol v5 and the Flywheel handle, sending mid-scan screenshots to Joel, and CAMRIS check-in.

Credential removed

A password or key that appeared in the original text has been removed. Get it from the lab password manager, never from a wiki page.

📄 fMRI Training -Spanish.pdf

📄 fMRI Training - English.pdf

📄 fMRI Training Powerpoint.pptx

Pre-scan procedure:

  • If the patient is participating in a 3T research scan, consent them prior to the fMRI with the following forms: All Consent Forms (All Consent Forms (Box links))
    • UPenn 3T C-2 Human Subject Voucher
    • W-9 form
    • Two copies of the 3T consent form (Davis 3T)
    • demographic form

Meeting the Patient

  • CODE TO WAITING ROOM: in the lab password manager
  • Note: If the patient is accompanied by a family member or friend, they can either wait in the radiology waiting room or in the waiting room outside of the scanner.
    • Parking is in Perelman Center so a lot of times the patient will be there instead of the HUP Lobby--call them if you are having trouble finding them.
  • The patient should be waiting in Radiology check in room, where they will be checked in (Gabby instructs them in their email to meet you here).
  • On the walk to the 3T scanner, ask the patient if they have ever had an MRI scan before
    • If so, explain that this one will be slightly different, and that they will have a screen above their head on which words, symbols, and pictures will appear
    • Explain that the fMRI will be one hour, followed by a 50-minute research scan where they can lay in the scanner and do nothing.
  • Ask the patient if they wear corrective vision
    • Ask the patient if they know their corrective prescription (will need to provide them with MR compatible glasses)
    • If they do not, that is okay. The MRI tech will help pick glasses that they can see in. 

Training the Patient on the Tasks

  • Ask about their seizures: how often they get them, if they know a seizure is coming, their auras, their triggers, what their seizures look like, if they have rescue medication (tech will most likely also ask this)
  • In the waiting room, go through the powerpoint with the patient and consent them to 3T
    • Remind them they will not need to memorize any of the words or rules of the tasks
    • We will communicate with them over an intercom, briefly reviewing the tasks as they are presented
    • Everything they see in the scanner will be demonstrated during the training
    • When they perform the tasks in the scanner, they should not say answers out loud; only think them in their head
    • Explain that moving (even speaking) while the scanner is capturing images of their brain will degrade the quality of their scan

Tasks to explain:

  • Order of the tasks: Sentence completion, Word generation, Rhyme/Patterns, Object, X vs T and meaningfulness.
    • Depending on the cognitive ability of the patient, give them more time or rounds of the task to practice out loud for you to make sure they are proficient at the task and will remember the task when they are in the scanner
    • Be very explicit and persistent about reminding the patient that they are not going to be performing the task out loud when they are actually in the scanner
  • Task 1: Sentence
    • Will be shown a line of jumbled letters, but will not be able to read it, since there are no vowels. Focus on the line of jumbled letters–this is the “rest period”
    • When you are shown a sentence, it will have a blank space for a word. Read the full sentence in your head, filling in the blank with a word that makes sense
  • Task 2: Word
    • When you are shown a random symbol, focus on it and clear your mind (rest period)
    • When you are shown a letter on the screen, think of as many words starting with that letter as you can before the screen changes (will have ~6 seconds)
  • Task 3: Rhyme
    • Will be shown 2 sets of lines: If the line pattern on the top row matches the pattern on the bottom row, think “same”. If they are different, think “different”
      • It is important that the patient thinks “same” or “different” rather than yes or no. Practice this out loud together
    • Will be shown 2 words
      • Read the words, and say if they “Rhyme”, or “Don’t rhyme”.
      • Again, it is important for the patient to respond “Rhyme”, or “Don’t rhyme” (“same” or “different” is also fine), rather than with “yes” and “no”, etc.
  • Task 4: Object
    • When you see the fixation target (+), clear your head and focus on the (+) (rest)
    • When you see an image, name what you see in the image using a complete sentence.
      • E.g., “This is a tree.”
  • Task 5:
    • You will be shown a fuzzy screen with a hidden letter (X or T) in it. Using a push-box, press the right button if the hidden letter is an “X”, and press the left button if the letter is a “T”
    • You will be shown an image of a scene. If the image is meaningful to you, press the right button. If it is not meaningful to you, press the left button
      • meaningful=evokes an emotional response, positive or negative
    • Demonstrate both of these tasks to the patient, and remind them that the two different games will alternate throughout the task 

Preparing the Patient and the Scanner

  • Encourage the patient to use the restroom before scanning
    • code: in the lab password manager
  • After the consent form and other patient information has been collected, go next door to the scanner control room and see if the technician is ready
    • Door code: in the lab password manager
      • If the scanner is still in use, return to the briefing room with the patient until it is available
      • Be mindful of the patient’s appointments for the rest of the afternoon.
        • If the person before you is running into your scan time and your patient has an appointment that they need to make after the scan, then please ask the MRI tech to end their scan so that you can start yours.
  • Before they enter the scan: ask the patient if they have any metal inside their body, jewelry, safety pins, medical patches, etc
    • The tech will also check
  • If the patient indicated that they wear corrective vision, use the eyesight chart in the scanner control room to test their sight ability, in order to make sure that they will be able to read the monitor
    • In the case labeled “MR SAFE” you will find an assortment of corrective lenses and a pair of glasses. Have the patient hold up each pair of lenses, progressively getting stronger, and try to read the vision chart that is posted on the corkboard on the wall
    • Remind the technician that the patient will need a 2 button push-box (does not matter how it is oriented)
    • Let the technician know that the protocol is for Dr. Davis and that we are on v5 (819126_NEW_7.21.25) of the protocol. Let them know that the first scan is a clinical scan and the second is research. BOTH scans should be uploaded to flywheel
      • sub-RIDXXXX@davis:presurgicalEpilepsy
    • We use the 64-channel head coil for 3T

COMPUTER SETUP

    • Login to Computer: in the lab password manager
    • connect the laptop to a power source to preserve the battery
    • Make sure the white box is set to: HID_KEY_BYGRT
      • has to be done FIRST
    • Using the white converter stored with the laptop (this belongs to our lab), connect the fully WHITE A/V dongle to the HDMI port on the laptop
    • Connect the USB cable from the push-box receiver to the laptop USB port directly next to the white USB dongle
    • The small USB dongle on the left side of the laptop stays plugged in at all times -- this contains the program that runs the tasks

  • DO NOT RUN THE TASK UNTIL YOU ARE READY TO START IT (e-run➝run➝press enter until you see "waiting for scanner to begin")

  • WAIT TO PLUG THE CORDS IN UNTIL RIGHT BEFORE THE SCAN STARTS
  • Ask the patient if they can see the screen okay, also open door and check screen is projecting

Preparing Patient and the Scanner - Clinical Scan

  • Check in to scan on CAMRIS; keep screen open until scan is finished so that you can press "finish session"
  • When ready to begin the scan, communicate with the patient over the intercom
    • You will communicate the tasks with the patient over the intercom using the same instructions you gave them earlier
    • Emphasize to the patient that they will be responding in their own head and will not be completing the task out loud
  • At about half-way to 3/4 through the scan, take a picture of the scan to send to Joel.
    • Before sending: crop out the patient's name and date/time of the scan in the image
    • Also indicate to Joel the patient’s handedness (Right or Left), and how easy or difficult they were to train
      • Can find handedness information in the patient’s chart
  • Prior to each task, say to the patient, “Hi name, how are you doing in there?”
    • Joel may recommend that the task be repeated. If so, relay this information to the technician and inform the patient that we will try the task again
    • If the data collected during the task is acceptable, communicate to the patient that we will be moving on to the next task
  • When the clinical scan is complete, disconnect the laptop, as well as the white HDMI converter. Store both, along with the laptop power cord, in the file cabinet located in the storage closet

**sign out of CAMRIS when the scan is done