Applied Radiology
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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.
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:
  • 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 American Healthcare Radiology Administrators (AHRA) for 1.0 "Category A" ARRT continuing education credit.
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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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A Review of MR Contrast Agents: Why Gadolinium Matters Today
David Enterline, MD, FACR; John Karis, MD; Michael Malinzak, MD, PhD; Kristin K. Porter, MD, PhD; James Sancrant, DO; Jorge A. Soto, MD
Estimated time for completion: 1 hour   •   Date of Release: January 01, 2021  •   Expiration Date: December 31, 2022
Here we present a summary of discussions that occurred at an Expert Panel Forum on Advancing Clinical Practice in MR Imaging, in which the experts explored the real and perceived risks associated with GBCA use. They also addressed when contrast use is appropriate and necessary and, when deemed necessary, the best practices for its use in select applications, including neuroradiology/stroke imaging, breast MR screening, and abdominal imaging.
Learning Objectives
At the conclusion of this activity, participants should be able to:
  • Explain recent events that have occurred that have altered the perception that all GBCAs are equally safe, including NSF and Gd retention
  • Describe the various available GBCAs and their properties, with emphasis on those properties that may impact safety
  • Review the relative risks and benefits of the available macrocyclic and linear GBCAs
  • Summarize best practices for GBCA use in select applications, including neuroradiology/stroke imaging, breast MR screening, and abdominal imaging
  • Define administrative and cost considerations that may relate to contrast use in the MR suite
Accreditation
This course is approved by the American Healthcare Radiology Administrators (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)
Fluoroscopic Evaluation of the Bariatric Surgery Patient
Cheri Canon, MD, and Jayleen Grams, MD, PhD
Estimated time for completion: 1 hour   •   Date of Release: November 01, 2020  •   Expiration Date: October 31, 2022
Obesity has been linked to increases in several clinically significant comorbidities. To address these related health issues, the number of bariatric procedures is growing. This monograph describes the role Fluoroscopy plays in the evaluation of the bariatric patient including a review of the imaging protocols and their necessary findings; designed to guide clinical decisions regarding which bariatric procedure is most appropriate for the patient.
Learning Objectives
At the conclusion of this activity, participants should be able to:
  • Review the incidence of obesity and the role of bariatric surgery as a strategy to address it
  • Explain the advantages of fluoroscopy in the evaluation of the bariatric patient
  • Summarize the considerations when performing fluoroscopic evaluation of the pre- and post-operative bariatric patient
  • Describe the protocols for fluoroscopic imaging of the gastrointestinal (GI) tract, including single- and dual-phase esophagrams and upper GI examinations
  • Detail the main challenges to performing fluoroscopy in bariatric patients
  • Relate the value of communication between the radiologist and bariatric surgeon
Accreditation
This course is approved by the American Healthcare Radiology Administrators (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 Release: September 01, 2019  •   Expiration Date: August 31, 2021
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 American Healthcare Radiology Administrators (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)
Use of ProHance® (Gadoteridol): A Safe, Effective, and Versatile
Contrast Agent for MR Imaging
Matthew J. Kuhn, MD
Estimated time for completion: 1 hour   •   Date of Orignal Release: November 01, 2016  •   Updated Release: March 01, 2019  •   Expiration Date: March 31, 2022
This article is 1 in a series that discusses the use of macrocyclic GBCAs in MRI.
A question-and-answer session with Matthew J. Kuhn, MD, Clinical Professor at the University of Illinois College Of Medicine at Peoria, Illinois.
Learning Objectives
At the conclusion of this activity, participants should be able to:
  • Describe the currently-available, FDA-approved, gadolinium-based contrast agents (GBCAs) and their main distinguishing properties.
  • Understand the evidence supporting the excellent safety profile of the macrocyclic GBCA ProHance (gadoteridol).
  • Summarize the literature comparing ProHance (gadoteridol) to other GBCAs, including the 1M agent Gadavist (gadobutrol; ie, the TRUTH study).
  • Explain how the macrocyclic GBCA ProHance (gadoteridol) provides versatility in a number of clinical setting.
Accreditation
This course is approved by the American Healthcare Radiology Administrators (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)