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.

Samuel J. Tate, MD; Jeffrey Lin, DO, MPH; John P. McGahan, MD

Lung ultrasound (LUS) has become a powerful bedside tool in diagnosing pathology, guiding procedures, and directing management. Knowledge and interpretation of artifactual patterns, true parenchymal structures, and signs unique to LUS will allow providers to utilize this modality in their care of patients. This activity is designed to educate radiologists about basic findings of lung ultrasound to help interpret images and refine differentials with this modality.

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.

Mark Wieland, MD; George Morcos, MD; Irina Kapustina, MD, PhD; Derik L. Davis, MD

A variety of imaging signs for worrisome and incidentally encountered primary bone tumors or tumor-like conditions are encountered in daily clinical practice on knee radiographs. Knowledge of their clinical presentations, imaging characteristics and outcomes helps to inform radiologists when further clinical evaluation is needed or to bestow peace of mind when no additional workup is required. This activity is designed to educate radiologists and radiologists in training about imaging signs of worrisome, and incidentally encountered, primary bone tumors and tumor-like conditions on knee radiographs to help guide clinical 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.

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.

Zachary K. Englander, MD, MS; Christopher Troy, MD; Masih Tazhibi, BA; Nina Yoh, MD; Hong-Jian Wei, PhD; Neil Feldstein, MD; Elisa Konofagou, PhD; Luca Szalontay, MD; Cheng-Chia Wu, MD, PhD,

The blood-brain barrier (BBB) remains a significant blockade for effective drug delivery in treating diffuse intrinsic pontine glioma (DIPG). Low-frequency focused ultrasound (FUS) therapy in conjunction with intravenous microbubbles can transiently disrupt the BBB in a localized manner to facilitate drug delivery. This review examines recent preclinical studies evaluating the safety and feasibility of FUS-mediated BBB opening in the brainstem. The authors also discuss the published phase 0-2 clinical trials of low-frequency FUS therapy in the adult glioma population, and phase 1 clinical trials in DIPG that are underway.

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.

In this CME program three MR imaging experts will provide unique perspectives on managing patients with passive implants and devices. The panel will discuss important MRI safety information and details on how to safely image these patients, including a review of screening policies, implant and device manufacturers’ information and resources, and the implementation plan for a MRI safety program, designed to mitigate the potential risks to patients presenting with passive implants and devices.

Learning Objectives

• Identify challenges associated with imaging patients with passive implants on low field (<1.5-T) MR systems.
• Review MRI considerations in order to safely manage patients that present with passive implants referred for scans on low field MR systems.
• Implement protocols to safely scan patients presenting with passive implants that are not labeled for low field scanners, including 1.2-T MR systems.
• Increase the number of patients eligible for MRI exams.

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

In this CME/CE accredited program Dr. Howard Rowley reviews important efficacy considerations of the FDA approved gadolinium-based contrast agents (GBCAs), including clinical utility, safety issues, and practical approaches for selecting a GBCA when considering patient history, pathology and related risks.

Following Dr. Rowley's presentation, Dr. Rowley joins a panel of MR imaging experts in discussion about this important topic, followed by a moderated Q & A session with audience participation.

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

• List the key considerations in the choice of GBCAs, while balancing safety and efficacy.
• Describe the transient effects of T1 and T2 relaxation during a GBCA bolus.
• Understand the impact of high relaxivity gadolinium agents vs macrocyclic agents.
• Design MRI protocols to optimize exam efficiency and enhanced lesion detection.
• Implement GBCA protocols for special patient populations after considering risk assessment.

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

Learning Objectives

• Implement digital breast tomosynthesis protocols in clinical practice.
• Differentiate characteristics of synthetic 2D mammography by manufacturer.
• Discuss differences between wide vs narrow angle DBT acquisition and its effect of angular range on synthetic-2D image generation.

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.

Leila T. Tchelebi, MD; Nicholas G. Zaorsky, MD, MS; Jennifer Rosenberg, MD; Kujtim Latifi, PhD; Sarah Hoffe, MD

While MR-guided radiation therapy (MRgRT) offers many benefits, it is a costly and resource-intensive investment that can strain radiation oncology clinics not adequately prepared to incorporate this treatment. This work reviews clinical advantages and practical limitations of MRgRT, and suggests ideal patients for this technology. The authors also provide a practical guide for centers acquiring MRI-based linear accelerators to foster seamless integration.

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 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.

Ana Mitchell, MD; Austin Kwong, MD; Simran Sekhon, MD; John P McGahan, MD, FACR

Given that ovarian and adnexal masses are commonly encountered in daily clinical practice, it is important to be able to recognize worrisome features on MRI. Once these are identified, it is important to accurately classify ovarian masses according to criteria ranging from low-risk to high-risk lesions. Recognizing and categorizing ovarian masses is important for determining that no further treatment or imaging is required for benign or low-risk lesions. Similarly, recognition of a worrisome feature and proper classification of high-risk masses are necessary to permit appropriate referral of these patients to a surgical oncologist.

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.

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. 

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.