Kanal's MR Medical Director/MR Safety Officer Training Course January 25 - 26, 2023 Dallas, TX UT Southwestern Accreditation Verification Form Step 1 of 12 8% Please Note: This program will be designated for CME credit, Category A CE Technologist credit, and MPCEC (Medical Physics Continuing Education Credit) credit. Program Description / Statement of Need: In an effort to provide Physicians, Technologists, Medical Physicist and other course attendees with current information and data to make informed decisions in their clinical settings, this symposium covers several objectives. These include: A) Teaching and reviewing the basic principles underlying the potential areas of safety concern involved in the MR imaging process and magnetic resonance environment; B) Defining the thought process algorithms for assessing whether a patient/ device/implant/ foreign object can safely undergo MR imaging; and C) Familiarizing the attendee with medico-legal considerations associated with MR safety. Target Audience: The content of this CME Symposium is intended for healthcare professionals including Radiologists and other Physicians, Technologists, Physicists, Radiologic and Imaging Nurses, Radiology Administrators, Facility Managers, Researchers, Risk Managers, and others. Accreditation and CME Credit Statements: This CME activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). Northwest Imaging Forums, Inc., is accredited to provide continuing medical education for physicians. Northwest Imaging Forums, Inc. designates this live activity for a maximum of 16.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Nurses may claim credit for activities approved for AMA PRA Category 1 Credits™ in most states, for up to 50% of the nursing requirement for recertification. This activity is designated for up to 16.0 AMA PRA Category 1 Credits™. This MRI program has been submitted for approval of 16 hours of category A CE technologist credit as designated by The International Society for MR Radiographers & Technologists (ISMRT) RCEEM. ARRT regulations state that an individual may not repeat a live activity for credit if it was reported in the same or any subsequent biennium. To receive the maximum amount of credit hours, you must attend all sessions. Verification of attendance policies will be in place for each lecture. This meeting has applied to CAMPEP for approval of 16 MPCEC (Medical Physics Continuing Education Credit) hours. Faculty and Planner Disclosures: As an accredited provider of continuing medical education, it is the policy of Northwest Imaging Forums Inc., to ensure balance, independence, objectivity, and scientific rigor in all of its live activities. In accordance with this policy, faculty and planners must disclose any financial relationships with commercial interests germane to program content. The planner has nothing to disclose. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of Northwest Imaging Forums Inc., to ensure that the COI is resolved in order to ensure the integrity of the CME activity. Please choose the applicable accreditation(Required) Technologist Category A CE Credit Physician CME Physicist MPCEC Credit Select an Event(Required)Select an EventKanal’s MR Medical Director/MR Safety Officer Training Course - January 25 - 26, 2023Full Name ( As you want is displayed on your Certificate)(Required) First Last ATTENDANCE SHEET: Please fill in your name and email address as recognized in the CAMPEP database.CredentialsMDMD, PhDDOPASpecialty(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)Email(Required) I certify that I attended the above referenced conference claiming XX Hours of credit (maximum for this activity is 16.0 credit).(Required)1.02.03.04.05.06.07.08.09.010.011.012.013.014.015.016.0I certify that I have completed this CME activity as designedSignature(Required) Reset signature Signature locked. Reset to sign again Date(Required) MM slash DD slash YYYY Evaluation:Please evaluate the effectiveness of this CME activity on a scale of 1 to 5, with 1 being the LOWEST, and 5 being the HIGHEST by selecting your choice.1. Overall quality of this CME/CE activity 1 Lowest 2 3 4 5 Highest 2. Content 1 Lowest 2 3 4 5 Highest 3. Format 1 Lowest 2 3 4 5 Highest 4. Speaker EvaluationEmanuel Kanal, MD, FACR, FISMRM, MRMD/SE, AANG(Required) 1 Lowest 2 3 4 5 Highest 5. Achievement of Educational ObjectivesA. Discuss static magnetic fields(Required) 1 Lowest 2 3 4 5 Highest B. Review RF magnetic fields(Required) 1 Lowest 2 3 4 5 Highest C. Explore gradient magnetic fields(Required) 1 Lowest 2 3 4 5 Highest D. Discover cryogen safety considerations(Required) 1 Lowest 2 3 4 5 Highest E. Learn how to apply implant safety; clinical application and decision-making(Required) 1 Lowest 2 3 4 5 Highest 6 This CME activity provided a balanced, scientifically rigorous presentation of therapeutic options related to the topic, without commercial bias. 1 Lowest 2 3 4 5 Highest Comments 7. Please describe how this CME activity will change your practice and/or the strategies you plan to implement in your practice.8. Please comment on the impact (if any) that this CME activity might have on the clinical care you administer.9. Additional comments and/or suggested topics for future CME activities? Wednesday (8.0 Hours)Static Magnetic Fields Part I Static Magnetic Fields Part II Static Magnetic Fields Part III Static Magnetic Fields Part IV Static Magnetic Fields Part V RF Magnetic Fields Part I RF Magnetic Fields Part II RF Magnetic Fields Part III Thursday (8.0 Hours)RF Magnetic Fields Part IV RF Magnetic Fields Part V KGradient Magnetic Fields Cryogen Safety Considerations Implant Safety: Clinical Application and Decision-Making Part I Implant Safety: Kanal's MR Safety Implant Risk Assessment app: Decision tree review and utilization Implant Safety: Clinical Application and Decision Making Part II Course Review and Case Study MEDICAL PHYSICS CONTINUING EDUCATION PROGRAM EVALUATIONDates(Required) MM slash DD slash YYYY Location(Required)Dallas, TXMember: AAPM ACMP ACR COMP Certified: ABR ABMP CCPM Evaluation -Program Content 1 Lowest 2 3 4 5 Highest Learning Objectives Clearly Presented 1 Lowest 2 3 4 5 Highest Faculty Knowledge 1 Lowest 2 3 4 5 Highest Quality and Level of Presentations 1 Lowest 2 3 4 5 Highest Handouts 1 Lowest 2 3 4 5 Highest Meeting Room and Facilities 1 Lowest 2 3 4 5 Highest Audiovisuals 1 Lowest 2 3 4 5 Highest Followed Schedule 1 Lowest 2 3 4 5 Highest Comments: Section BreakSPEAKER EVALUATION - Emanuel Kanal, MD, FACR, FISMRM, MRMD/SE, AANGLearning Objectives Appropriate(Required) 1 Lowest 2 3 4 5 Highest Usefulness of Information(Required) 1 Lowest 2 3 4 5 Highest Quality and Level of Presentation(Required) 1 Lowest 2 3 4 5 Highest Handout/Lecture Notes(Required) 1 Lowest 2 3 4 5 Highest Worthiness for Repeating(Required) 1 Poor 2 3 4 5 Excellent Comments: Day 1 - SESSION ATTENDANCE REPORT - Emanuel Kanal, MD, FACR, FISMRM, MRMD/SE, AANGTopic #1Select a SessionStatic Magnetic Fields Part I#1check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #2Select a SessionStatic Magnetic Fields Part II#2check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #3Select a SessionStatic Magnetic Fields Part III#3check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #4Select a SessionStatic Magnetic Fields Part IV#4check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #5Select a SessionStatic Magnetic Fields Part V#5check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #6Select a SessionRF Magnetic Fields Part I#6check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #7Select a SessionRF Magnetic Fields Part II#7check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #8Select a SessionRF Magnetic Fields Part III#8check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for" Day 2 - SESSION ATTENDANCE REPORT - Emanuel Kanal, MD, FACR, FISMRM, MRMD/SE, AANGTopic #9Select a SessionRF Magnetic Fields Part IV#9check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #10Select a SessionRF Magnetic Fields Part V#10check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #11Select a SessionGradient Magnetic Fields#11check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #12Select a SessionCryogen Safety Considerations#12check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #13Select a SessionImplant Safety: Clinical Application and Decision Making Part I#13check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #14Select a SessionImplant Safety: Kanal's MR Safety Implant Risk Assessment app: Decision tree review and utilization#14check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #15Select a SessionImplant Safety: Clinical Application and Decision Making Part IIImplant Safety: The Kanal MethodImplant Safety: Decision Tree Review and utilization#15check I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendance(Required)Please enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"Topic #16Select a SessionCourse Review and Case Study#16check(Required) I attended this entire session and request full credit I did not attend this session I attended only part of this session and request credit for ______ minutes of attendancePlease enter a number from 0 to 120.Please fill this in if you checked "I attended only part of this session and request credit for"EmailThis field is for validation purposes and should be left unchanged.
