These supplements cover a variety of applications in CT and MR imaging and provide practical guidance to Radiologic Technologists and related healthcare professionals. To review a course, select the appropriate profession. To complete the post test and earn CE credits you must be registered and signed-in to appliedradiology.org.

MRI Contrast Selection: Greater Stability or Higher Relaxivity?

Howard Rowley, MD, FACR; Lorna P. Browne, MD; Kevin J. Chang, MD, FACR; Christopher Comstock, MD, FACR; J. Paul Finn, MD; Scott Reeder, MD, PhD;
Max Wintermark, MD

Estimated time for completion: 1.0 hour   •   Date of Release: July 1, 2022  •   Expiration Date: June 30, 2024

Currently, 6 general-use gadolinium-based contrast agents (GBCA) are available and approved for a variety of MRI indications, including brain, body, and breast imaging, in adults and children. Gadolinium-based contrast agents comprise a gadolinium (Gd) ion bound to an organic ligand to form a chelate. Whether the chelate is linear or macrocyclic and ionic or nonionic impacts the size and stability of the Gd-chelate complex, as well as its distribution and elimination. In addition, the chelate structure also impacts the relaxivity, or r value, of the GBCA, which dictates the ability to provide contrast enhancement relative to background. Understanding the different safety and efficacy profiles of GBCAs can be valuable when selecting a GBCA. Here, we present discussions from a recent Expert Panel Forum focused on the safety and efficacy of GBCAs, as well as specific considerations related to their selection for neuroimaging, pediatric imaging, body imaging, and breast imaging applications.

Learning Objectives

At the conclusion of this activity, participants should be able to:

Accreditation

This course is approved by the The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

This program has been supported through an educational grant from Bracco Diagnostics, Inc.

To view and complete the Post-Exam and claim credits select Profession below.

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Clinical Utility of Barium Sulfate Products: Formulation Determines Appropriate Use

Steven Sireci, MD

Estimated time for completion: .75 hour   •   Date of Release: June 14, 2021  •   Expiration Date: June 30, 2023

Barium-containing contrast media contain barium sulfate (BaSO⁴), as well as a number of additives. The BaSO⁴ provides radiodensity (ie, radio-opacity) and physical density (g/mL) to the suspension. Depending on the intended use of the contrast, the specific combination of additives provide other useful properties, including: BaSO⁴ particle suspension; mucosal coating; viscosity and texture; sweetness; filling and laxative effects; preservation; foaming prevention; and flavoring. Here we describe the purpose of each ingredient and additive found in BaSO4 contrast media products currently available for fluoroscopic and radiographic examinations. In addition, we review the role of these products in anatomic radiographic evaluation of the gastrointestinal (GI) tract and in evaluation of the physiology of swallowing. Finally, we review barium preparations used in computed tomography (CT) applications.

Learning Objectives

At the conclusion of this activity, participants should be able to:

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 0.75 "Category A" ARRT continuing education credit.

Commercial Support

This program has been supported through an educational grant from Bracco Diagnostics, Inc.

To view and complete the Post-Exam and claim credits select Profession below.

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Diagnosis and Management of Swallowing Physiology:

Standardized Contrast, the MBSImP™ & the IDDSI Framework

Catriona M. Steele, PhD, Bonnie Martin-Harris, PhD, Memorie Gosa, PhD, Stephanie Edwards Allen, BSRT, MBA

Estimated time for completion: 1 hour   •   Date of release and review: May 1, 2021   •   Expiration Date: April 30, 2023

The MBSS, also known as a video fluoroscopic swallow study (VFSS), is a barium-sulfate–enhanced fluoroscopic motion study used to evaluate anatomy and swallowing physiology si¬multaneously in real time. Varibar, an FDA-approved barium sulfate product for evaluation of dysphagia, together with The Modified Barium Swallow Impairment Profile (MBSImP), are used to ensure standardization and reproducibility in the MBSS. This monograph explains the relationship between Varibar, the MBSImP, and the International Dysphagia Diet Standardisation (IDDSI) framework in evaluation of swallowing in clinical practice.

Learning Objectives

At the conclusion of this activity, participants should be able to:

Disclosures

Catriona M. Steele: Financial disclosures for Dr. Steele include: Salary from University Health Network, Toronto; R01 Grant funding from National Institute of Deafness and Other Communication Disorders; Consulting relationship (speaker honoraria and advisory panel) with Nestle Health Science; Consulting relationship (advisor) with Benitec Biopharma; Royalties on webinars from Northern Speech Services and Medbridge; Previous educational grant from Bracco Canada. and honorarium received for participating in this monograph. Non-financial disclosures include: Board Member, International Dysphagia Diet Standardisation Initiative; Councilor, Dysphagia Research Society; Associate Editor, Dysphagia journal. Editorial board member, Journal of Texture Studies; Consulting relationship (speaker honoraria and advisory panel) with Nestle Health Science; Consulting relationship (advisor) with Benitec Biopharma. Royalties on webinars from Northern Speech Services and Medbridge; Previous educational grant from Bracco Canada.

Bonnie Martin-Harris: Financial disclosures for Dr. Martin-Harris include: Principal Investigator, NIH/NIDCD K23DC005764, Standardized assessment of swallowing impairment, 2003-2010; Principal Investigator, NIH/NIDCD 2K24DC012801-0, Data Science Applications in Communication and Swallowing Disorders, 2013-2024; Clinical Impact of Respiratory-Swallow Training on Refractory Dysphagia in OP HNC, VA Merit Review Award 5101RX002352 2018-2022; Machine Vision Fellowship, Bracco Diagnostics 2020-2021; MBSImP Royalty recipient from the Medical University of South Carolina, owner, and honorarium received from participation in this monograph. Non-financial disclosure includes license guarantor to Northern Speech Services (NSS).

Memorie Gosa:Financial disclosures for Dr. Gosa include: Salary from The University of Alabama, Druid City Hospital, and Le Bonheur Children’s Hospital; honorarium received for participation in this monograph. Non-financial disclosures include: Board Member, Council on Academic Accreditation, American Journal of Speech-Language Pathology.

Stephanie Edwards Allen: Financial disclosure for Ms. Allen includes received an honorarium for her participation in this monograph. She has no non-financial relationships to disclose.

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

This program has been supported through an educational grant from Bracco Diagnostics, Inc.

To view and complete the Post-Exam and claim credits select Profession below.

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The Modified Barium Swallow Study: When, How, and Why?

Margaret M. Fynes, MD; Christine Smith, MS; and Martin B. Brodsky, PhD, ScM

Estimated time for completion: 1 hour   •   Date of Orignal Release: September 01, 2019  •   Updated Release: September 17, 2021  •   Expiration Date: September 30, 2023

Dysphagia is a common clinical challenge, particularly in the elderly. The modified barium swallow study (MBSS), initially developed by radiologists and speech-language pathologists (SLPs) at The Johns Hopkins Hospital, is critically important for evaluation and treatment of dysphagia. In this article, the authors, radiologist Margaret M. Fynes, MD, and two SLPs, Christine Smith, MS, and Martin B. Brodsky, PhD, ScM, review the technical and patient considerations for optimal performance of the MBSS according to The Johns Hopkins protocol. Because both perspectives, radiologist and SLP, are included, the article is able to highlight the importance of the role of each, as well as how they work together. Elements of the MBSS that have become more standardized over time, specifically the barium sulfate contrast agent products used, and the scoring and reporting of the examination with the Modified Barium Swallowing Impairment Profile (MBSImP), are described, and the contribution of this standardization to the overall accuracy and reliability of the MBSS is discussed.

Learning Objectives

At the conclusion of this activity, participants should be able to:

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

This program has been supported through an educational grant from Bracco Diagnostics, Inc.

To view and complete the Post-Exam and claim credits select Profession below.

(Site Registration/Login Required)