Deborah R. Shatzkes, MD

“Nomenclature has been the major obstacle to our understanding and management of vascular anomalies.” These words were written by John Mulliken over 30 years after publishing his seminal paper on the biologic basis of vascular anomalies in 1982. The intervening decades have brought tremendous progress in classification, diagnosis and therapy of this diverse group of lesions. Still, much confusion exists in the medical community, in no small part because of inaccurate and inconsistent use of nomenclature both in the liter-ature and in clinical practice.

The multidisciplinary International Society for the Study of Vascular Anomalies (ISSVA) was formed in 1992 to promote research in the field of vascular anomalies and to create a uniform nomenclature that would facilitate research and clinical practice. ISSVA created a comprehensive classi-fication scheme based on Mulliken’s work on the biologic basis of disease, updated most recently in 2014 and available at issva.org/classification. The ISSVA classification and its associated nomenclature are widely accepted as the gold standard by the numerous medical specialties involved in clinical care and research related to vascular anomalies.

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.

Stephanie R. Rice, MD; Adeel Kaiser, MD; Elizabeth Nichols, MD

This review examines the role of trimodality therapy in the management of esophageal cancer, focusing on controversies surrounding the optimal total neoadjuvant RT dose employed. Current and past technologies for radiation treatment delivery and their impact on overall survival and toxicity are discussed. The authors also detail the data driving the management of resectable esophageal carcinoma, reviewing studies comparing neoadjuvant CRT followed by surgery to definitive CRT, neoadjuvant CRT followed by surgery to surgery alone, and controversies in radiation dose and planning considerations for preoperative resectable esophageal cancer.

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 program describes the Joint Commission’s requirements for annual training on specific MRI safety practices. In addition, it covers procedures to manage patients undergoing MRI with recommendations to prevent ferromagnetic objects from entering the MRI environment; claustrophobia, anxiety, or emotional distress; guidelines to screen patients with medical implants and devices; procedures to prevent thermal injuries; methods to handle patients requiring urgent or emergent medical care; contrast agent safety including information for nephrogenic systemic fibrosis, and techniques to avoid problems related to acoustic noise.

Educational Objectives

1. Describe the latest requirements from The Joint Commission for MRI with an emphasis on safety and training.
2. Present procedures for managing claustrophobic patients, screening prior to MRI, preventing ferromagnetic accidents, avoiding MRI-related thermal injuries, handling emergencies, and preventing acoustic noise issues.
3. Define methods to ensure compliance with the latest requirements from The Joint Commission for MRI safety.
4. Summarize The Joint Commission’s requirements for annual training on specific MRI safety practices.

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

Muhammed M. Fareed, MD; Monica Krishnan, MD; Tracy A. Balboni, MD, MPH; Hsiang-Hsuan Michael Yu, MD

Palliative radiation oncology is an integral part of radiation oncology practice with practical implications in common clinical scenarios including bone metastases, brain metastases, malignant spinal cord and cauda equina compression, tumor related bleeding, fungation, obstruction and visceral metastases. Further education and research is needed as part of residency training and beyond to enhance the spectrum of care for advanced cancer patients delivered by radiation oncologists. Supportive and palliative care skills must expand beyond the technical aspects of radiation therapy delivery to generalist palliative care competencies, including symptom management basics, communication and goals of care, advance care planning, psychosocial issues, cultural considerations, spiritual needs and ethical/legal issues.

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.

Wende N. Gibbs, MD, MA, and Lawrence N. Tanenbaum, MD, FACR

Hydrocephalus is a a mechanical complication of different pathologic conditions and a disease process itself.  The morphologic features are easily recognizable, but the patho-physiology remains incompletely understood.  Nearly all hydrocephalus is due to cerebrospinal fluid (CSF) obstruction at some point between the ventricles and the systemic venous circulation.  Classification is important as it informs optimal treatment. 

Optimized imaging is vital to the success of flow diversion.  Current treatments are limited and invasive: CSF diversion via catheter or endoscopic third ventriculostomy.  Decision making relies upon high resolution imaging to determine the site of obstruction and anatomic features that may complicate the procedure.

Morphologic and physiologic imaging are used to evaluate suspected normal pressure hydrocephalus (NPH).  Several morphologic measures individually and in combination have shown high positive predictive value in identifying individuals who will respond to treatment with ventricular shunting and in differentiating NPH from Alzheimer disease, which can have a similar imaging appearance.

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.

Andrew Kennedy, MD; Susan Garwood, MD; Allison Grow, MD, PhD; Ryan Lipscomb, MS

Multidisciplinary team members treating lung cancers may not be aware of the complexity and coordination required for delivery of stereotactic body radiation therapy (SBRT) to lung masses. Shifts in practice have occurred in management of early stage non-small cell lung cancer (NSCLC), particularly with regard to the role of the specialized pulmonologist (interventional pulmonology), which involves different staging techniques than traditional mediastinoscopy. This review provides key information to foster a deeper understanding and appreciation for patient selection, work up, behind-the-scenes critical quality assurance tasks, and clinical pearls for stereotactic radiation therapy for lung cancer.

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.

Kelly W. Capel, MD, and Lynn S. Broderick, MD, FACR

Given that pulmonary embolism (PE) is the third-leading cause of cardiovascular death and that the signs and symptoms of PE are often nonspecific, many care providers obtain CTA in the acute-care setting to evaluate for any life-threatening or urgent pathology.

While most of these patients will likely not have an underlying PE, this article showcases several alternative potential pathologies, ranging from common intrathoracic conditions such as pneumonia, to acute aortic syndrome and intra-abdominal pathology, which may be partially captured via subtle clues on CTA examinations.

In the acute-care setting, the radiologist’s ability to recognize other potential sources of pain and shortness of breath as well as coexisting pathology in patients being evaluated for PE with CTA is critical.

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.

As new technological advances in Computed Tomography continue to impact how healthcare professionals diagnose and treat patients with stroke, pancreatic and biliary cancer and other oncological disease; this program from RSNA 2017 features the following presentations. Each will provide insight into how advanced imaging is improving patient outcomes.

Saving Brain and Improving Patient Outcomes with a Better Acute Stroke Protocol
by Dr. Kenneth Snyder
Can UHR CT Improve Outcomes with Better Detection, Diagnosis and Staging of Pancreatic and Biliary Cancer
by Dr. Miyuki Sone
Improving Oncologic Outcomes Using a Unique 4DCT Solution
by Dr. Junsung Choi.

Educational Objectives

At the completion of this program, participants will be able to:

• Describe how advanced physiologic imaging is transforming the treatment of acute ischemic stroke.
• Describe the limitations of conventional CT in the diagnosis of pancreatic and biliary disease.
• Be familiar with the clinical utility of Ultra High Resolution CT Imaging.
• Describe how hybrid Angio/CT systems are providing clinical utility in interventional oncologic imaging.

This program was originally presented live at RSNA 2017 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Toshiba America Medical Systems (now Canon Medical Systems USA, Inc.).

Anyone who enters 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 desiring preparation for safety training as, Level 2 MR Personnel.

With more than 30 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. 

Open MRI Systems have evolved enormously since their inception in the 1980’s and today, true high-field systems offer an excellent, patient centric alternative to closed, cylindrical bore systems for imaging of basic and advanced applications throughout the body.

In this first webcast of a 2-Part Series, Dr. Lawrence N. Tanenbaum discusses the advantages of High Field Open MRI in Neuro imaging.

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

Educational Objectives

At the completion of this program, participants will be able to:

• Describe how market forces including patient centric imaging are impacting today’s radiology departments.
• Describe how modern Open MRI Systems align with value-based care and are changing the way that imaging facilities do business.
• Understand the technical specifications of High-Field Open MRI Systems.
• Understand the concept of isotropic imaging and new fat suppression technologies.
• Describe the increased image quality and range of applications in Neuro imaging.

Supported through an unrestricted educational grant from Hitachi Healthcare Americas

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which has determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care. Under MACRA, participating providers will be paid based on the quality and effectiveness (value) of care they provide rather than the volume of care they provide under the current system.

This Expert Forum webcast features a panel of experts who will review the importance of MACRA and what it means to the radiology community. They will provide an overview of what MACRA involves and define which providers must begin planning immediately. In addition, the program will describe the Merit-based Incentive Payment System (MIPS) and the four performance categories, which will ultimately determine how radiologists and other physicians are reimbursed for their services.

The panel is moderated by Dr. Gregory N. Nicola, Vice President, Hackensack Radiology Group and will answer questions from the online audience.

Educational Objectives

At the completion of this program, participants will be able to:

• Describe what MACRA is and how it will affect radiologists.
• Understand the performance category measurements.
• Describe the necessary steps to be MACRA Ready by 2019. ​

Supported Through An Unrestricted Educational Grant from Bracco Diagnostics, Inc.

With a wide selection of gadolinium-based contrast agents now available in the US Market; MR imaging professionals must understand the chemical structure, differences in stability and relaxivity and safety profiles of each of these FDA approved MR agents.

Following Dr. Tanenbaum's presentation, questions from the audience will be addressed.

Educational Objectives

At the completion of this program, participants will:

• Refresh their understanding of the various contrast agents now FDA approved and available in the US market.
• Understand the safety profiles of the available agents as well as the relationship to the individual physiochemical properties and stability.
• Develop a better understanding of how recent knowledge affects the selection, use and screening before contrast use.

Supported Through An Unrestricted Educational Grant from Guerbet, LLC.

As technology continues to impact how healthcare is practiced, this presentation on Image-Guided Interventional Radiology Procedures Using a Combined Angiography CT Systems will highlight through the clinical experiences of an Expert Faculty; how they are maximizing the latest advances to increase patient care, satisfaction and throughput.

This program was originally presented live at RSNA 2016 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Toshiba America Medical Systems.

Prostate MRI can be an effective tool in preventive as well as diagnostic and ongoing patient care for patients with statistical likelihood and/or risk factors predisposing them to the diagnosis of prostatic neoplasia. Used efficiently, MR contributes to early detection, accurate staging and localization, and reduction in unnecessary biopsies and treatment.

Skilled reporting provides allied health professionals with critical results to serve patients optimally, allocate resources effectively and improve treatment and surgical outcomes for their patients. This Expert Forum webcast will include a series of case reviews that incorporate and elucidate these concepts.

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

Educational Objectives

At the completion of this program, participants will be able to:

• Identify the clinical indications for effective utilization of MR of the prostate.
• Be familiar with signal characteristics of prostate neoplasia on MRI, and understand the application of ACR standard PI-RADS scale to this type of imaging pathology.
• Describe MRI's key role as a diagnostic tool for screening, active surveilance, staging, recurrence, identification, treatment planning and treatment response evaluation.

Supported through an unrestricted educational grant from Hitachi Medical Systems.

In today’s healthcare environment, working in a vascular laboratory is extremely demanding, requiring a multitude of critical skills and abilities from today’s sonographer. The renal artery duplex examination is often viewed as the single most difficult examination performed. This lecture will cover a detailed description of the examination from patient preparation, to stenosis criteria and a broad array of tips and tricks in both a variety of normal and pathological settings. Sonography is very dependent on strong visual and motor skills along with critical thinking abilities.

This presentation is designed to help the sonographers and physicians formulate a plan to deal with difficult clinical presentations.

Educational Objectives
Upon completion of this webinar one should be able to:

• Understand the common indications for performing the renal artery duplex examination.
• Note the importance of knobology and image optimization while insonating the renal arterial and venous system.
• Identify the importance of direct and indirect renal artery assessment.
• Discuss how to obtain a clinically diagnostic renal artery duplex examination.