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.

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)
Terms and Conditions of Use: Click To View
This is a Pay-To-View program. Purchase is required for full program access.

Leonid Roshkovan, MD; Sharyn I. Katz, MD, MTR

Diagnostic interpretation of cross-sectional imaging of the mediastinum and pleura presents unique and significant challenges even to the experienced radiologist. The mediastinum is anatomically complex, comprising numerous structures ar-ranged into multiple anatomic compartments that can give rise to a wide range of pathologies. The pleural space is thin and multi-planar, which can confound evaluation and quantification of pleural abnormalities.

In this article, we will review imaging approaches to the mediastinum and pleura and present imaging pearls and pitfalls that can assist radiologic interpretation. This will include common masses that present in routine imaging of the chest and key imaging features that help to distinguish them using CT, MRI and FDG-PET/CT.

The knowledge of common mediastinal and pleural pa-thologies present on cross-sectional imaging will enable the radiologist to make informed diagnostic radiologic interpreta-tions and guide appropriate intervention and surveillance.

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.

RSNA 2019 Archived Program

This Expert Forum Symposium features two respected radiologists who share their clinical experience applying advanced artificial intelligence techniques in both MR and CT imaging.

MR and CT imaging are advancing at a rapid rate with new scanner and software technology finding its way into advanced imaging scanners each year. Artificial Intelligence is proving to play a major role in this expansion. In this one-hour accredited CME symposium, Dr. Gold and Dr. Prokop will provide insight into how they are putting new AI tools into everyday practice at their facilities and explain how these tools are providing better patient care and throughput. Following the presentations, the faculty will take question from the audience.

Advances in CT Imaging
Presented by: Mathias Prokop, MD

Advances in MSK MR Imaging
Presented by: Garry E. Gold, MD

Educational Objectives

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

1. Practice two new novel approaches for advanced joint imaging with MR
2. Describe the clinical value of deep learning reconstruction techniques in CT
3. Discuss and implement Artificial Intelligence into clinical practice today

This program was originally presented live at RSNA 2019 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Canon Medical Systems.

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.

Adam C. Riegel, PhD, DABR

The purpose of this article is to review recent advancements in artificial intelligence (AI) as they specifically pertain to head-and-neck radiation oncology. The main focus will be applications and clinical impact of these techniques. Specifically, this article addresses autosegmentation of organs at risk (OARs), autosegmentation of target volumes, treatment planning and predictive dose calculation, image-guided adaptive radiation therapy, prognosis and outcome prediction, and quality assurance.

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.

In this Expert Forum, Dr. Lawrence Tanenbaum and Dr. William Baughman provide a comprehensive review of what the COVID-19 virus is, how it’s transmitted, as well as, how it presents clinically on various imaging modalities. Additionally, a review of “real-world” clinical findings of COVID positive patients, who present with additional symptoms that are manifested from coronavirus will be shared. Following the presentations, a moderated discussion will take place where questions from the audience will be addressed.

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

• Explain the clinical manifestations and impact of COVID
• Describe the clinical findings and presentations of COVID
• Differentiate the image findings of COVID positive patients

Supported through an unrestricted educational grant from FUJIFILM Medical Systems U.S.A., Inc.

Victor E. Chen, MD; Joseph F. Lombardo, DO, PharmD; Serguei A. Castaneda, MD; Karen M. Winkfield, MD, PhD; Scot A. Fisher, DO; Eric L. Gressen, MD; Shari B. Rudoler, MD; Weisi Yan, MD, PhD; Shefali R. Gajjar, MD

This review article describes key factors that contribute to lung cancer disparities for Black patients and discusses strategies and future directions for radiation oncologists to bridge the gap. Topics discussed are contributing factors for disparities in lung cancer incidence, disparities in lung cancer prevention, disparities in lung cancer treatment and outcomes, and potential strategies to overcome barriers.

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.

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.

Blair A Winegar, MD; Ethan A Neufeld, MD; Wayne S Kubal, MD

Many acute infectious conditions of the face and neck resulting from common sources, such as pharyngitis, dental infection, and penetrating trauma, are evaluated in the emergency department. The clinical features of these conditions overlap, and clinical evaluation is often insufficient to localize or determine the extent of infection within the deep spaces of the neck.

This article showcases the classic imaging features and locations of a variety of acute face and neck infections encountered in the emergency department. In addition, the imaging findings of potentially life-threatening complications, such as mediastinitis resulting from retropharyngeal abscess and septic pulmonary emboli resulting from Lemierre syndrome, are described.

In the emergency setting, the radiologist’s ability to correctly identify and categorize acute face and neck infections and their complications is paramount to direct appropriate surgical and medical 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.

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.

Qiuji Wu, MD, PhD; Xiting Yang, MS; Fengyang Wu, MS; Yahua Zhong, MD, PhD

The rapid spread of the new coronavirus disease (COVID-19) identified toward the end of 2019 significantly impacted everyone in China, and all over the world. Head and neck (HN) cancers are a common malignant tumor type in China, with chemoradiation the standard of care for locally advanced disease. However, the COVID-19 epidemic interrupted the routine diagnosis and treatment of all cancers, including HN cancers, which can progress quickly if treatment is significantly delayed. Cancer patient care at the epicenter of COVID-19 was particularly challenged. Based on the management experience of patients with HN cancer during the outbreak of COVID-19 at a cancer institute in Wuhan, the authors summarize management strategies of patients with HN cancer to provide reference for health care providers facing similar 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.

Nathaniel Goldman, BA*; Matthew Gallitto, MD*; Cheng-Chia Wu, MD, PhD

This review article provides a thorough outline of various modalities to help guide implementation of strategies to reduce anxiety in treatment facilities. Categories include interventions before treatment (psychoeducational interventions, play therapy) and during treatment (specialized staff, environmental modifications, distraction, reward/incentive systems).

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.

Courtney C Moreno, MD; Thuy-Van P Hang, MD; Joel P Wedd, MD, MPH

Screening for hepatocellular carcinoma (HCC) has been shown to improve overall survival by detecting earlier stage, more treatable disease. For some patients with HCC, liver transplant is the preferred treatment. However, donor livers are a scarce resource. Accurate identification and description of HCC with MRI is important in the determination of which patients will receive a liver transplant.

This article reviews background information about cirrhosis and hepatocellular carcinoma, the role of screening, transplant priority determination, and diagnostic criteria for HCC.

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.

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.

In this second of a 3 Part Series, Dr. Laurie Fajardo discusses the benefits of digital breast tomosynthesis (DBT) for detecting and diagnosing breast cancer and things to consider when planning or implementing DBT into breast imaging practices.

Dr. Fajardo discusses the importance of radiation dose reduction with synthetic 2D, reviews the published literature on the performance of synthetic 2D mammography, and shares how DBT can impact data storage and network data transmission across your PACS and enterprise system.

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

• Describe the efficacy of synthetic 2D from DBT.
• Implement procedures for managing DBT data volumes and workflow.
• Develop an approach to interpreting DBT images.

Supported through an unrestricted educational grant from FUJIFILM Medical Systems U.S.A., Inc.

Andrew Ong, MD; Lisa A Mullen, MD; Susan C. Harvey, MD

Pregnancy associated breast cancer (PABC) is a subset of breast cancer that is typically diagnosed at more advanced stages and carries a worse prognosis. The physiological breast changes that occur during pregnancy and lactation can often make clinical and radiological evaluation difficult.

Ultrasound is the primary imaging modality in the evaluation of pregnancy associated breast lesions with high sensitivity and lack of radiation. Mammography is generally considered safe during pregnancy and lactation and may also be used to assess for PABC. Dynamic contrast enhanced breast MRI is not recommended during pregnancy; however, it may safely be performed in lactating women to evaluate extent of disease or for high risk screening.

This article reviews appropriate imaging evaluation of the pregnant or lactating woman, and showcases the imaging features of benign and malignant lesions occurring during pregnancy and lactation. Many benign lesions, including fibroadenoma and lactating adenoma, can mimic malignancy. New or growing solid masses occurring during pregnancy and lactation should be further evaluated with imaging and biopsy, to avoid a delay in a potential cancer diagnosis.

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.

Angela Y. Jia, MD, PhD; Matthew P. Deek, MD; and Ryan M. Phillips, MD, PhD

This review provides a perspective regarding barriers to expansion of radiation treatments in low- and middle-income countries (LMICs). The authors review the benefit of expanding radiation treatment to patients with oligometastatic disease based on several recent clinical trials including SABR-COMET, ORIOLE, and others. The authors also discuss limitations and barriers to receiving radiation treatment in less developed countries including the sparsity of treatment machines, personnel expertise, and distribution of resources in urban vs rural environments. They further discuss technological advances that may help to develop and increase access to radiation therapy in LMICs.

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.

Digital breast tomosynthesis, also known as 3D DBT first entered the clinical arena in 2011 when the FDA approved its use. Multiple studies have since shown that tomosynthesis is effective in both the screening and the diagnostic setting. This technology has quickly emerged as a practice-changing standard by increasing both sensitivity and specificity, thereby improving breast cancer detection and the clinical accuracy of mammograms.

This Expert Forum educational program focuses on the impact of digital breast tomosynthesis and the role it plays in all aspects of breast screening. In this program, you will hear from an expert panel consisting of four (4) healthcare professionals from various specialties; who are all involved in the diagnosis, treatment and care of breast cancer patients and who will share their clinical insights and experience.

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

• Discuss the importance of breast screening mammography.
• Compare the differences between 2D and 3D mammography.
• Explain how the use of 3D DBT will benefit their patients.
• Increase the collaboration between radiologists and referring physicians.
• Implement best practices for concise communication across the continuum of care.

Supported through an unrestricted educational grant from FUJIFILM Medical Systems U.S.A., Inc.