This program reviews fundamental MRI safety information and meets the annual training recommendations from the American College of Radiology. Importantly, MRI facilities must now comply with the revised requirements for diagnostic imaging from The Joint Commission and document that MRI technologists participate in ongoing education that includes annual training on safe MRI practices in the MRI environment. Notably, Advanced MRI Safety Training for Healthcare Professionals, Level 2 MR Personnel covers each MRI safety topic specified by The Joint Commission, as well as many additional subjects that will expand the knowledge-base of healthcare professionals involved with MRI technology.

With 35 years of experience in the field of MRI, the author of the best-selling textbook series, the Reference Manual for Magnetic Resonance Safety, Implants and Devices, and the creator of the internationally popular website, MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present the information in this program.

Advanced MRI Safety Training for Healthcare Professionals (4th Edition), Level 2 MR Personnel is a 2 hour and 45 minute program that is divided into three different sections.

Educational Objectives

• Understand the safety issues related to MRI.
• Describe the bioeffects associated with the static magnetic field, time-varying magnetic fields, and radiofrequency fields.
• Present guidelines that prevent projectile-related accidents.
• Describe polices that avoid issues related to acoustic noise.
• Review procedures that prevent burns associated with MRI.
• Explain and demonstrate appropriate pre-MRI screening procedures.
• Identify techniques to manage patients with claustrophobia, anxiety, or emotional distress.
• Describe guidelines to handle medical emergencies in the MRI setting.
• Understand the safety considerations for gadolinium-based contrast agents.

This is a Pay-To-View program. Purchase is required for full program access.

Applied Radiology and William Faulkner & Associates are pleased to introduce “The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD)”. This comprehensive program, focusing on MR Safety, covers many aspects relating to the safety practices of the Magnetic Resonance Imaging (MRI) environment. It is designed for those individuals who are either currently serving as their facility’s MRSO and/or MRMD, or those who are preparing to assume these responsibilities. The content of this course will be helpful for those preparing for the American Board of Magnetic Resonance Safety MRSO and MRMD examinations.

The content of The Online Course for MR Safety Officers and MR Medical Directors is based upon current FDA and ACR guidelines, including the ACR Guidance Document for MR Safe Practices, as well as those promulgated by industry regulatory bodies such as the International Electrotechnical Commission.

The complete online program has been approved for up to 10 AMA PRA Category 1 credits™ (CME) and 10 Category A ARRT continuing educational credits (CE).

The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD) is not affiliated with, nor endorsed by the American Board of Magnetic Resonance Safety (ABMRS)
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This is a Pay-To-View program. Purchase is required for full program access.

Lisa Singer, MD, PhD; Benjamin H. Kann, MD; Daniel N. Cagney, MD; Jonathan E. Leeman, MD; Sue S. Yom, MD, PhD; David Kozono, MD, PhD

While traditionally CT- and x-ray based, lung stereotactic body radiation therapy (SBRT) practices will likely be impacted by the emerging availability of MR guidance. This review provides an overview of the role of MR guidance in SBRT for the treatment of lung cancers. Limitations, data, and future directions for treatments are reviewed with a focus on peripheral, central, and ultracentral lung cancers.

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Mustafa M. Basree, DO, MS; Ryan Hutten, MD; Quaovi Sodji, MD, PhD; Michael F. Bassetti, MD, PhD; Jacob A. Miller, MD

Anal squamous cell carcinoma (ASCC) is a rare but increasingly prevalent disease, predominantly driven by human papillomavirus infection, with decreasing prevalence among individuals of vaccination-eligible age. This review examines the current standard of care for managing ASCC and explores how advancements in molecular biomarkers are paving the way for personalized treatment strategies. The authors also discuss the potential of immunotherapy as an adjunct to standard-of-care management in all stages of disease.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

One technique for reducing this exposure is to use a high relaxivity GBCA that can be administered at a lower dose than a conventional GBCA, without any impact on image quality. GBCA selection for interventional procedures such as radiosurgery is one such example, where the selection of a GBCA can play a role in patient management and outcomes.

In this program, an experienced neuroradiologist and neuro oncologist will present their clinical experiences with the use of stereotactic localization radiosurgery, following the administration of a high relaxivity GBCA. Through case study examples, the clinical impact of contrast selection will be demonstrated. Following the presentation, questions from the audience will be addressed during a live Q&A.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Review the role of stereotactic radiosurgery (SRS) for brain metastases and the role of pre-operative localization MRI exams for stereotactic radiosurgery.
• Outline the differences between gadopiclenol and other group II gadolinium-based contrast agents.
• Discuss the use of gadopiclenol in specific case-based scenarios for stereotactic localization exams and its impact on patient management.

This program is made possible through an unrestricted educational grant from Guerbet.

Ronald Chow, MS; Minglei Kang, PhD; Shouyi Wei, PhD; J. Isabelle Choi, MD; Robert H. Press, MD; Shaakir Hasan, DO; Arpit M. Chhabra, MD; Keith A. Cengel, MD, PhD; Haibo Lin, PhD; Charles B. Simone, II, MD

In this manuscript, the authors review the proposed mechanisms of action for FLASH radiation therapy (FLASH RT), summarize early preclinical results, discuss the first-in-human treatments with a focus on proton FLASH, and highlight challenges and future considerations of FLASH RT.

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

While gadolinium-based contrast agents (GBCAs) are essential to performing breast MR imaging, guidance from the US Food and Drug Administration (FDA) and the American College of Radiology (ACR) includes the recommendation of limiting a patient's gadolinium exposure. Gadopiclenol injection, a macrocyclic, high-relaxivity GBCA can address this recommendation by providing high-quality images with half the gadolinium dose as compared to other conventional GBCAs.

This educational program features Dr. Margarita Zuley’s clinical expertise and practice experience. Through case study examples she will share the indications for abbreviated breast MRI and the clinical rationale for implementing optimal imaging protocols using a lower gadolinium dose and clinical examples of the management of MRI detected findings.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Explain the clinical benefits of abbreviated breast MRI for patients with dense breast and/or high-risk factors.
• Implement lower gadolinium dosing protocols for patients who may experience repeat breast MRI scans.
• Understand the clinical paradigms and indications for breast MRI as it relates to other imaging modalities.

This program is made possible through an unrestricted educational grant from Bracco Diagnostics Inc.

Steven Benitez, MD; Ryan Holland, MD; Richard Zampolin, MD; Andrew Brook, BA, MS; Joshua Hirsch, MD; Allan L Brook, MD, Deepak Khatri, MD

As thrombectomy has become the standard of care for large vessel/arterial occlusions, the indications are initiated by proper imaging and understanding of the brain blood flow physiology. This two-part series examines the standard of care for acute stroke imaging and the latest techniques. The second part of this activity on stroke intervention will appear in the November-December issue of Applied Radiology.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Suhana Fatima Shahid; Tooba Ali, MBBS; Agha Muhammad Hammad Khan, MBBS, FCPS; Nabeel Ashfaque Sheikh, MBBS; Ahmed Nadeem Abbasi, FFR,RCSI

This review article discusses the relationship between artificial intelligence (AI) and radiomics in oncology decision-making, exploring the fundamentals of AI-powered radiomics, its workflow, and the role of radiomic features. The article also describes the integration of AI in radiology, radiation oncology, and medical oncology, particularly its impact on multidisciplinary tumor board (MDT) decision-making, treatment planning, and predicting treatment responses, prognosis, and disease progression. Additional highlights include the role of machine learning algorithms and their impact on MDT decision-making, as well as challenges and implications of AI-driven radiomics in MDTs regarding ethical, financial, and regulatory aspects.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Ryan Holland, MD; Steven Benitez, MD; Addison Fortunel, MD; Andrew Brook, BA, MS; Deepak Khatri, MD; Allan Brook, MD

As thrombectomy has become the standard of care for large vessel/arterial occlusions, operators need an understanding of the techniques as well as the factors important for the device and vascular approach choices. This two-part article examines the latest techniques for endovascular treatment of acute stroke. The first part of this activity appeared in the September-October 2021 issue of Applied Radiology.

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Paul Wojack, MD; Suzanne McElligott, MD; Pamela Walsh, MD; Nina Vincoff, MD; Ekta Gupta, MD

Incidental musculoskeletal findings are fairly common when reading breast MRI, as the ribs and sternum are included in the field of view. It is important that radiologists be familiar with the appearance of benign and malignant chest wall lesions on breast MRI in order to appropriately direct diagnosis and treatment, as well as to avoid unnecessary workup of benign lesions.

This activity is designed to educate radiologists about the wide range of both benign and malignant lesions which can be detected incidentally on breast MRI by reviewing the imaging findings and other pertinent demographic considerations regarding these lesions.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Brittany R. Derynda, BA; *Casey L. Liveringhouse, MD; John M. Bryant, MD; Stephen A. Rosenberg, MD, MS

This review article describes technical advantages for MR-guided radiation therapy (MRgRT) that lead to the rationale for use in the oligometastatic setting. The authors summarize existing data demonstrating the feasibility, safety, and efficacy of MRgRT for various disease sites. Finally, the authors discuss ongoing clinical trials utilizing MRgRT, which will continue to define and expand its role.

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

This accredited program provides a comprehensive overview of MRI safety including the radiologist's responsibilities and liabilities, MRI staff education and patient safety. It is designed specifically for practicing radiologists, fellows, residents, and healthcare professionals who oversee MRI services and will provide practical guidance from two respected MRI safety educators who present information on accepted safety standards of care based on the 2020 ACR Manual on MR Safety, the 2021 FDA Guidance Document, and a review of the literature.

Program Considerations: It is critical to have established MRI safety protocols and to have a clear understanding of the basics of MRI Safety. The ACR Manual on MR Safety states that the Radiologist is responsible for the safety of the patient undergoing the MRI Exam. They are also responsible for implementing MR Safety policies and procedures and ensuring that the facilities’ personnel adhere to them at all time. These MRI safety policies should be reviewed and updated annually in order to prevent patient injury.

Educational Objectives

• Describe the difference between Level 1 & Level 2 MR personnel.
• Differentiate and identify the ACR-designated Safety Zones.
• Implement safety considerations for the static magnetic field, time-varying gradient magnetic fields, and radiofrequency fields.
• Employ procedures and protocols to prevent RF-related burns and methods to manage SAR levels.
• Manage acute and chronic gadolinium-based contrast agent adverse events.

Program support provided by Bracco Diagnostics, Inc.

This is a Pay-To-View program. Purchase is required for full program access.

This CME and CE accredited program aims to provide a comprehensive overview of new artificial intelligence applications supporting cardiac CT. Through clinical case study reviews, Dr. Dinesh Kalra will share his clinical knowledge and insights into cardiovascular imaging and provide examples of super-resolution, deep-learning reconstructive technologies that are improving cardiac CT image quality and the overall diagnostic confidence in cardiovascular case interpretations.

Dr. Kalra stated, “I'm able to better see the same segments that were difficult to see with older generation scanners. The image sharpness, the resolution, and the low-contrast detection rates have all improved and there's no trade-off, so one doesn’t sacrifice resolution for radiation dose. This allows us to deliver less radiation, see less noise, while obtaining superb image quality.” Following the presentation questions from the audience were addressed in a moderated Q&A session.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Describe the various reconstruction techniques and their clinical utility in coronary CT.
• Incorporate advanced AI processing solutions that achieve higher resolutions into cardiac CT imaging protocols in order to improve clinical outcomes.
• Increase diagnostic confidence in the interpretation of stenosis and plaque characterization.

This program has been sponsored by Canon Medical Systems, USA

Orest Kayder, MD; Hamed Kordbacheh, MD; Sai Srikar Kilaru, MD; Imad Zak, MD, FACR

A variety of non-neoplastic intracranial cystic lesions are frequently encountered on brain imaging. Knowledge of their locations, imaging characteristics, and clinical behavior helps limit the differential diagnosis and guiding treatment. Jointly provided by IAME and Anderson Publishing Inc, this activity is designed to educate radiologists about idiopathic and acquired intracranial cystic lesions encountered on imaging, including their frequency, clinical presentation, and distinguishing imaging features that will help in guiding management.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Amir Hossein Mostafavi Sterabadi, BS; Hassan Anbari, MBChB; Minhaj S. Khaja, MD, MBA; Baljendra S. Kapoor, MD

Liver biopsy is an invaluable adjunct to laboratory findings in diagnosing and treating varioius liver diseases. However, the various methods of obtaining liver samples, their indications and contraindications, as well as the nuances and rationale behind choosing one method over another are not all well understood by interventional radiologists.

This activity is designed to explain different ways of performing liver biopsy and some other ancillary interventions to obtain liver tissue samples. We aim to explain the indications, contraindications, efficacy, patient selection, and potential complications associated with these procedures.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Aurela Clark, MD; Xiaoqin Wang, MD; Riham El Khouli, MD; Margaret Szabunio, MD

Imaging the pregnant patient is challenging as it involves both the parent and the fetus and, consequently, several medical, ethical, or legal considerations. Theoretically, all available imaging modalities may be used to evaluate the pregnant patient; however, in practice, confusion regarding the safety of the fetus often results in unnecessary avoidance of useful diagnostic tests, especially those involving ionizing radiation. This review is part 2 of a 2-part series and focuses on specific clinical scenarios (nonobstetric and obstetric) in pregnant patients and the recommended imaging modalities to answer clinical questions while focusing on fetal and parental safety.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Sudha R. Amarnath, MD

This review article describes specific considerations for pelvic radiation therapy in the adolescent and young adult (AYA) cancer population, including fertility and premature ovarian insufficiency, sexual health, financial toxicity, and psychological impact. Awareness of these effects and available resources can help radiation oncologists to better communicate and counsel patients, set clear and realistic expectations, and proactively manage late side effects that can impair quality of life and long-term survivorship.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Elham Rahimy, MD;* Scott G. Soltys, MD

The growing use of stereotactic radiosurgery (SRS) for brain metastases has exposed several unknowns, which are under investigation. This review aims to discuss the existing data that support SRS use and can provide the reader with a basis for making judgements in clinical situations in need of answers. The article also discusses various major pending clinical trials.

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

A review of a recently revised ACR guidance document will empower radiologists when performing perfusion MRI applications and may improve both their clinical confidence and their consultative roles when communicating with the patient’s care team

Educational Objectives:
At the completion of this activity, participants should be able to:

• State the clinical benefits of MR perfusion and/or functional imaging in the diagnosis of glioblastomas.
• Implement impactful MR perfusion imaging protocols in their practice.
• Participate in patient and referring physician conversations in a more consultative role with improved knowledge and communication skills.

This program is made possible through an unrestricted educational grant from Bayer HealthCare.

Laura E Minton; Renu Pandit; WR Willoughby, PhD; Kristin K Porter, MD, PhD

Gadolinium (Gd)-based contrast agents (GBCAs) dominate the current contrast-enhanced magnetic resonance imaging (CE-MRI) market and are proven to increase the efficacy of diagnostic magnetic resonance imaging (MRI) scans. However, in the future it is likely that a personalized combination of contrast enhancement and image processing techniques will be used to optimize diagnosis and treatment planning while minimizing risk and cost. This activity is designed to educate radiologists about the future of MRI contrasts agents, including high relaxivity macrocyclic GBCAs, alternatives to GBCAs, and imaging processing techniques.

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Chipo Raranje, MS; Ryan Mueller, MD; Alex T. Price, PhD; Lauren E. Henke, MD; Xiaodong Zhao, PhD; Hyun Kim, MD; Eric Laugeman, MS; Joshua P. Schiff, MD

The authors describe practical treatment planning considerations for implementing a cone-beam CT-guided adaptive radiation therapy (CTgART) program with a specific focus on a template-based treatment planning methodology. The article discusses diseasesite- specific treatment planning considerations for the delivery of CTgART to the thorax, abdomen, prostate, and bladder, and examines future directions for this technology, which is becoming increasingly accessible and utilized in radiation oncology.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.