Applied Radiology
LOGIN TO YOUR MYAR CE ACCOUNT
Forgot Your Password? Register Submit
Applications In Contrast Imaging
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:
  • Describe the distinguishing properties of the available gadolinium-based contrast agents (GBCAs) currently used for magnetic resonance imaging (MRI);
  • Review how the structure of the gadolinium (Gd)-chelate complex determines the stability of a GBCA, and how stability relates to both Gd retention and nephrogenic systemic fibrosis (NSF);
  • Explain what a “high-relaxivity” GBCA is and summarize results of crossover studies comparing standard- and high-relaxivity GBCAs for MRI;
  • State the key considerations when selecting a GBCA for neuro MRI, pediatric MRI, body MRI, and breast MRI.
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.
(Site Registration/Login Required)
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:
  • Explain the role that BaSO4 plays in barium-containing contrast media;
  • Review the purpose of each ingredient/additive found in BaSO4 contrast media products available for fluoroscopic and radiographic examinations;
  • Describe the formulation of barium products that are appropriate for single- and double-contrast anatomic radiographic evaluation of the gastrointestinal (GI) tract;
  • Summarize qualities of the barium-containing contrast media used in evaluation of swallowing that make them most appropriate for that application; and,
  • State the properties of barium-containing contrast media used in computed tomography (CT) applications.
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.
(Site Registration/Login Required)
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: May 31, 2026
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:
  • Explain how a standardized set of barium sulfate products is used during a modified barium swallow study (MBSS) to identify pathology related to swallowing physiology
  • Describe how the Modified Barium Swallow Impairment Profile (MBSImP) is used to ensure objective scoring and communication of the results of an MBSS
  • Review what the global International Dysphagia Diet Standardisation (IDDSI) framework is and how it is used to classify foods and liquids according to their physical properties (ie, consistency, stickiness, etc.)
  • Describe any pediatric-specific considerations related to use of the MBSS, MBSImP, and the IDDSI framework to assess and manage dysphagia in infants and children
  • Summarize best practices for assessing swallowing physiology using the MBSS in the clinical setting
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.
(Site Registration/Login Required)
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:
  • Review the causes and incidence of dysphagia
  • Describe technical and patient considerations associated with performing a fluoroscopic modified barium swallow study (MBSS) to evaluate dysphagia
  • Explain how the MBSS contributes to the evaluation and treatment of patients with dysphagia by assessing the cause of dysphagia and allowing implementation of compensatory strategies in real-time
  • Explain the importance of the relationship between the radiologist and speech-language pathologist (SLP) during performance of the MBSS
  • Explain how use of a standardized series of barium sulfate contrast agent products, as well as use of the Modified Barium Swallowing Impairment Profile (MBSImP), have contributed to standardization of the MBSS examination
  • Detail the benefits of MBSS standardization on the robustness and consistency of the examination
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)