The application of fMRI for measuring sensory, motor and cognitive brain function has considerable importance not only for neuroscience in humans but has the potential to aid in medical management of many forms of neuropathology. Several issues must be addressed in the medical setting that are not present in a research environment. As the results of a given patient are to be applied to that patient's care, reliability and error assessment are of crucial importance and must be available as a part of the functional data. Not only must the studies of patients use selective and brief paradigms but must often be performed on a clinical service by the MR technologist and nurse. To be clinically useful, the results need to be available immediately for interpretation. These challenges can be met by appropriate fMRI technology. This equipment must be maintained with appropriate quality assurance. Head motion is an important source of technical failure and methods to prevent its occurrence in acquisition or to provide correction in post processing are essential. The use of blood oxygenation level dependent (BOLD) contrast for fMRI of patients differs from normal cooperative volunteers in that not only are the patients ill and more anxious but also are often on medications and have neuropathology that may disrupt the neuronal hemodynamic response on which such fMRI is dependent. These issues require that the underlying physiology and metabolism of the brain be characterized for each patient and incorporated into the interpretation. The clinical uses of fMRI in patients will be discussed in terms of importance to medical management and on the ways that the above challenges can be met through a team approach that crosses disciplines including imaging, cognitive science, computer science, electrical engineering and, most importantly, statistics.

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