Through comprehensive case study reviews and panel discussions, imaging experts in the field of neuroradiology will provide insights into the effective implementation of contrast-enhanced perfusion MRI protocols and functional imaging techniques designed to improve visualization of the anatomy and physiology.

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.

Individuals entering the magnetic resonance imaging (MRI) environment, whether on a regular or infrequent basis, must be properly trained to ensure their safety, the protection of patients, and the security of other facility staff members. This program, Basic MRI Safety Training, Level 1 MR Personnel accomplishes the initial training that is necessary to ensure safety in the unique setting associated with the MRI system. It includes information pertaining to MRI technology, describes common hazards and unique dangers associated with the MRI setting, and presents vital recommendations and guidelines to prevent accidents and injuries. Importantly, this program provides the fundamental MRI safety information for Level I MR Personnel recommended by the American College of Radiology and may be utilized by individuals preparing for safety training as Level 2 MR Personnel.

With more than 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, www.MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present the information in this program.

Educational Objectives

• Appreciate the importance of MRI
• Identify the hazards associated with MRI
• Understand the screening process
• Describe steps to prevent accidents and injuries

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

Kimberly R. Gergelis, MD; Kimberly S. Corbin, MD; Kaitlin W. Qualls, MD; Yuhchyau Chen, MD, PhD; Nadia N. Laack, MD

Despite limited studies on burnout among radiation oncologists in the United States, especially when compared with data from other countries, there is a prevalence of burnout among radiation oncologists of all career stages, including trainees, attendings, program directors, and academic chairs. This narrative review summarizes articles reporting on burnout and well-being among attending and resident radiation oncologists in the United States, examines burnout at career stages, discusses the impact of COVID-19, and provides strategies to reduce burnout in the radiation oncology field.

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.

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.

Arash Mirrahimi, MD, MSc; Charlotte Gallienne, MD; Hournaz Ghandehari, MD, FRCPC

Acute mesenteric ischemia (AMI) is a true surgical emergency and a rare life-threatening condition, accounting for 0.01% of hospital admissions, with extremely high mortality rates (up to 69%). Poor outcomes remain prevalent despite advances in both diagnostic and treatment options over the last two decades

Early diagnosis and management are particularly important given that the highest incidence of AMI occurs in the elderly population, who often have multiple comorbidities leading to a worse prognosis. Biphasic contrast enhanced multidetector computed tomography (MDCT) images have become the mainstay and standard of care for investigation and timely diagnosis of AMI.

As such, the importance of recognizing imaging features of AMI and timely communication of findings with the referring physicians is of utmost importance for diagnostic radiologists and always a worthwhile topic for review. We have therefore endeavored to provide a brief summary of the presentation of AMI, its causes, relevant anatomy, and most importantly, illustrated review of CT findings that delineate ischemic changes of the bowel and mesentery.

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.

Often there is lack of knowledge amongst imaging professionals regarding IV contrast dynamics and the relationship between contrast injection, observed enhancement, and scan acquisition timing. The design of appropriate imaging protocols leads to effective and consistent cardiovascular exams; especially when applied to complex clinical scenarios.

This CME/CE accredited program will review contrast-saline dynamics and discuss rational protocol design for cardiac and vascular CT angiography. Effective cardiovascular imaging protocols, utilizing multiple CT injector platforms to achieve optimal imaging, will be reviewed. We invite you to join Dr. Richard Hallett for a comprehensive discussion and case study review of this important topic.

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:

• Understand the relationship between bolus contrast media injection and observed enhancement.
• Implement methods to design rational contrast injection / scan acquisition protocols.
• Review various models of CT contrast injectors and discuss benefits, limitations, and injection protocol adjustments for each.
• Apply customized contrast-saline injection / scan principles to complex cardiovascular disease cases.

Made possible through an unrestricted educational grant from Bracco Diagnostics, Inc.

IV contrast extravasation is a not uncommon complication in the performance IV contrast enhanced CT examinations. In this accredited Expert Forum Webcast, we will review the different complications related to IV contrast administration. This will be followed by analysis of different factors that contribute to IV contrast-extravasation and subsequent discussion of best practices that can reduce the incidence of IV contrast extravasation. A novel method which reduced contrast extravasation by over 50% will also be presented.

Following the presentation questions from the audience were addressed in a moderated Q&A session.

Learning Objectives

• Discuss the different types of complications associated with IV contrast extravasation.
• Describe the various factors that can contribute to IV contrast extravasation.
• Apply best practices to reduce the incidence of IV contrast extravasation.

No special educational preparation is required for this CME/CE Activity!

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

Anurag Saraf, MD; Graham Boyd, MD; Alexandra De Leo, MD; Phylicia D. Gawu, DO; Chelsea C. Pinnix, MD, PhD; Steve Braunstein, MD, PhD; Rachel Jimenez, MD; Idalid Franco, MD, MPH; Lisa Singer, MD, PhD

Medical education must develop and adapt through robust education scholarship, applying novel teaching with evidence-based best practices to optimally convey new concepts. Continued growth in undergraduate, graduate and continuing medical education as well as in diversity, equity, and inclusion efforts, are critical for the future of radiation oncology. This review article explores how education scholarship can facilitate these advances in areas from artificial intelligence to technology-oriented teaching.

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.

With the recent FDA approval of gadopiclenol injection, radiologists now have the choice of a macrocyclic gadolinium-based contrast agent (GBCA) with 2 – 3 times higher relaxivity at a lower standard dose as compared to other gadolinium-based contrast agents on the marke

Therefore, and because gadopiclenlol is different than other currently available GBCAs, a review of the clinical benefits of using a higher relaxivity GBCA at a lower administered dose is important. A clear understanding of relaxivity and calculation of the volume to be administered based on dosing considerations, is necessary

In this accredited webinar, Mr. Faulkner will provide insights into the differences of the current FDA-approved GBCAs and how these differences apply to MR imaging. Following the presentation, questions from the audience were addressed during a live Q&A.

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

• Identify the properties that distinguish gadopiclenol injection from the other high relaxivity and conventional gadolinium-based contrast agents (GBCAs).
• Employ the FDA-approved indications and clinical applications for gadopiclenol injection.
• Calculate and administer the proper volume dose of gadopiclenol, as compared to other conventional GBCAs.
• Apply clinical considerations and dosing options for gadopiclenol to vulnerable patient populations who may experience repeat dosing of GBCA.

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 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.

In this Expert Forum, Dr. Matthew Covington shares his understanding of the benefits and limitations of contrast-enhanced mammography, as compared to contrast-enhanced breast MRI, and how this imaging technique can be incorporated into clinical practice. Following the presentation questions from the audience were addressed in a moderated Q&A session.

Learning Objectives

• Dictate the strengths and limitations of contrast-enhanced mammography compared to contrast-enhanced breast MRI.
• Recognize indications for the appropriate use of contrast-enhanced mammography.
• Implement a contrast-enhanced mammography program.

This program is made possible through an unrestricted educational grant from FUJIFILM Healthcare Americas Corporation.

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.

In MR Imaging, a careful review of the safety criteria for the selection of a Gadolinium-based Contrast Agents (GBCAs) should be considered for pediatric and neonatal patients. The program will provide a comprehensive review of the supporting research that addresses Gadolinium selection in this special patient population. Both chronic and long-term effects of GBCAs will be discussed.

As a Pediatric Neuroradiologist, Dr. Shah is uniquely qualified to share his experience which includes a discussion of risk vs benefits, supported by practical protocols for the administration of MR contrast; including limiting the amount of contrast given to patients that may receive several lifetime doses. Following the presentation, the audience is invited to join Dr. Shah for an interactive Q & A session.

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

• Explain the differences between available MR contrast agents and any associated adverse events
• Improve clinical management decisions about when to administer MR contrast (risk vs benefit)
• Apply FDA guidelines regarding MRI contrast agents to clinical practice.

Made possible through an unrestricted educational grant from Bracco Diagnostics, Inc.

This accredited program provides a comprehensive overview of MRI safety considerations for passive / active implants, and devices.

When considering patient safety during MR imaging, it is critical to assess the patient’s history and have a clear understanding of any passive and or active implants and/or devices. 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. Regarding implants and devices, regular reviews and updates to the MRI safety policy should be completed.

With more than 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, www.MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present this important MRI Safety information designed for MRI Imaging professionals.

Educational Objectives

• Name and describe the current labeling terminology for implants & devices.
• Safely image patients with passive and active, MR Conditional implants and devices.
• Establish a comprehensive MRI Safety protocol for imaging implants & devices.

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 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.

Nikhil G. Thaker, MD, MHA, MBA; Brian De, MD; Chirag Shah, MD; Sudhir Manda, MD; Trevor J. Royce, MD, MS, MPH; Sushil Beriwal, MD, MBA

As health care systems transform from traditional care delivery models to digital health models, IoT will enable integration of electronic health records and nonhealth care data with therapeutic augmented reality, wearable technologies, smart voice assistants, digital medicines, robots with artificial intelligence capabilities, continuous and Bluetooth-enabled monitors, and smart cameras. This review discusses the digital transformation of health care systems, IoT technology in cancer care, its practical applications in radiation oncology, and ongoing opportunities and challenges.

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.

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.

Will Jin, MD;1* Santosh Mohan, MMCi, COPHIMS;2 Matt Adams, BS;3 Sarah Hoffe, MD;4 Edmondo Robinson, MD, MBA2

Recent studies have shown the emergence of digital therapeutics (DTx) as potential solutions in the cancer care continuum to improve medication adherence, chemotherapy tolerance, and overall survival, while potentially reducing financial toxicity. In this review, the authors examine these new modalities and possible future benefits for cancer patients.

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.

Kaitlin M Zaki-Metias, MD; Mehrvaan Kaur, MD; Huijuan Wang, MD; Bilal Turfe; Nicholas Mills, MD; Yanruo Lu, MD; Bashir H Hakim, MD; Leslie S Allen, MD

Pregnant patients infrequently undergo CT given the risk of radiation to the developing fetus. As such, when CT is performed on pregnant patients in emergent situations, radiologists may be unfamiliar with the appearance of the placenta on CT and its normal evolution throughout gestation. This activity is designed to educate radiologists about the normal appearance of the placenta on CT and its evolution throughout pregnancy, as well as differentiation of these findings from placental abruption.

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.