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. 

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.

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.

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.

Elizabeth M. Nichols, MD; Arezoo Modiri, PhD; Pranshu Mohindra, MD, MBBS

Cardiotoxicity can be an unfortunate side effect from cancer therapies including chemotherapy, hormonal therapy, and radiation therapy (RT). Sub-acute cardiotoxicity can occur during systemic therapies but is often considered a late effect from RT. This manuscript reviews the current literature regarding the clinical impact of radiation-induced cardiotoxicity in the setting of breast cancers and thoracic malignancies including lung cancer, esophageal cancer and mediastinal lymphomas.

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.

Jack Bennett, Cynthia Peterson, MPH, RDMS, RVT; Richard G. Barr MD, PhD

Ultrasound (US) is often the initial imaging modality for evaluation of renal diseases. Non-enhanced US faces limitations in the assessment of focal renal masses and complex cysts. Contrast-enhanced ultrasound (CEUS) on the kidneys can overcome these shortcomings.

There are several advantages of CEUS over contrast-enhanced CT or contrast-enhanced MRI. These include the fact that the narrow US beam allows for improved visualization of vascularity in small structures such as septations or small mural nodules; high temporal resolution with real time assessment of vascularity; lack of radiation; and no renal impairment.

Excluding inflammatory masses, vascular abnormalities and pseudotumors, most solid enhancing renal masses are malignant. Complicated cystic lesions with enhancing soft tissue components, excluding the actual cyst wall, are malignant. Using enhancement pattern, renal masses can be characterized with high sensitivity and specificity

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 Webcast, Michael V. Knopp, MD, PhD will provide an overview of current digital PET technologies and how leveraging these digital advances improves PET imaging using clinical cases. He will demonstrate how new concepts result in acceleration of acquisition time, dose reduction and dynamic imaging to help improve quality and the patient and staff experience. These new applications apply to the clinical practice for oncology, neurology and orthopedics / sports medicine.

Learning Objectives

• Describe current PET technologies.
• Describe the benefits of digital photon counting.
• Understand the benefit of improved time of flight timing.
• Understand the benefit of reduced voxel size and higher matrix reconstruction.
• Describe ultra-fast whole-body imaging.
• Describe the benefits of imaging at lower tracer doses.
• Describe the benefits of dynamic PET imaging.
• Describe the use of Y-90 for post-therapy assessment.

Supported through an unrestricted educational grant from Philips Healthcare.

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.

G. Daniel Grass, MD, PhD; Matthew N. Mills, MD; Jacob G. Scott, MD, DPhil; Steven A. Eschrich, PhD; Javier Torres-Roca, MD

Genomics and radiomics provide an opportunity to increase the precision of radiation delivery in selection of dose and spatial delivery. Further understanding of host and tumor differences with interrogative approaches may provide opportunity to precisely deliver radiotherapy beyond spatial and anatomic features to one guided by intrinsic tumor biology. This article addresses how tumor genomic blueprints can be exploited for radiation therapy; radiomics as a noninvasive means to assessing tumor biology; clinical applications regarding treatment response, treatment planning, and toxicity; and radiogenomics utility.

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.

James Thomas Patrick Decourcy Hallinan, MBChB; Mini N. Pathria, MD; and Brady K. Huang, MD

Brachial plexus disorders are a diagnostic challenge due to the complex anatomy and nonspecific symptomatology. MRI remains the best modality for assessing the brachial plexus (BP), due to its superior soft-tissue contrast compared to CT or ultrasound. Traumatic lesions are the most common cause of BP dysfunction, closely followed by neoplastic infiltration. Infection, inflammation and iatrogenic causes are less common.

This review article will provide an overview of anatomy and practical, up-to-date BP imaging techniques for general radiologists, followed by a step-wise discussion of common pathology. Clinically relevant advances such as dynamic tho-racic outlet MRI will also be discussed.

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.

Naziya Samreen, MD; Candice A. Bookwalter, MD, PhD; Tatnai L. Burnett, MD; Myra Feldman, MD; Shannon P. Sheedy, MD; Christine Menias, MD; and Wendaline M. VanBuren, MD

Endometriosis affects a significant number of reproductive age women and can continue to be present after menopause. The disease is much more complex than ovarian endometriomas, and understanding histology, disease location, and the limitations and benefits of imaging can aid in the diagnosis and management of these patients.

A dedicated MRI protocol and key imaging features are used to optimize disease detection. Comprehensive cases will broaden the capacity for pattern recognition of pelvic morphologic changes, secondary associations, and features of malignant degeneration

Shauna R. Campbell, DO; Ehsan H. Balagamwala, MD; Neil M. Woody, MD, MS; Kevin L. Stephans, MD

Authors examine modern treatment approaches to limited liver metastases from colorectal cancer, discussing the intent and sequencing of treatment, chemotherapy, surgical resection, radiofrequency ablation/cryoablation, chemoembolization, radioembolization, external-beam radiation therapy, stereotactic body radiation therapy (SBRT), and proton therapy and the indication for each modality. The review also describes circumstances in which SBRT is preferred over other liver-directed therapies.

In this program Dr. Laurie Fajardo shares her experience with the set-up and use of digital breast tomosynthesis (DBT) in clinical practice. Participants will hear about system design, the impact on clinical performance, and how to best manage recall rates. In addition through carefully selected cases, Dr. Fajardo will share her approach to image interpretation and how one can manage DBT workflow effectively.

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

• Explain the technology behind digital breast tomosynthesis (DBT).
• Describe the impact DBT has on clinical performance.
• Implement an approach to DBT interpretation.

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

In this final segment of this 3-part series, Dr. Laurie Fajardo addresses the radiologist’s challenges associated with dense breast imaging and interpretation through discussion and case presentation of interval breast cancer. This includes issues associated with assigning breast cancer risk to breast density and qualitative versus quantitative methods for assessing, and reporting breast density and risk assessment.

Further Dr. Fajardo will discuss how to incorporate breast cancer risk assessment into your breast imaging practice and closes the program with a discussion on the current impact of Artificial Intelligence on breast imaging and how it can enhance workflow.

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

• Articulate issues associated with assessing and reporting breast density and its associated cancer risk.
• Explain the benefits of incorporating comprehensive risk assessment into breast imaging practices.
• Implement the use of artificial intelligence to enhance breast imaging practice workflow and performance.

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.

This educational webinar features a panel of experts from Nuclear Medicine, Urology and Oncology, who are involved in the diagnosis and management of Prostate Cancer. By understanding the benefits of PSMA imaging, a Urologist’s timely referral can positively impact the patient’s journey and ultimately their quality of life. The clinical benefits of a prompt and accurate diagnosis of Prostate CA, using PSMA-11 PET/CT, will be reviewed by the faculty.

Upon completion of this CME activity the healthcare provider should be able to:

1. Discuss the clinical benefits of PSMA Imaging for the diagnosis and management of prostate cancer
2. Describe patient considerations for ⁶⁸GA PSMA-11 PET/CT
3. Articulate the clinical implications supporting the timely diagnosis of prostate cancer
4. Implement guidelines of when to order ⁶⁸GA PSMA-11 vs other imaging modalities (Bone scan, CT, MRI)
5. Implement PSMA Imaging practice considerations to improve outcomes and patient management

This program is made possible through an unrestricted educational grant from Telix Pharmaceuticals

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.

Daniel Y. Kim, BS*; Jimmy A. Guo, BA*; Daniel Zhao, BA; Errol J. Philip, PhD; Yun R. Li, MD, PhD

While numerous mechanisms impact sensitivity to radiation, the authors examine the transcriptional alterations and gene expression programs that allow neoplastic cells to withstand radiation. They review the recurring mechanisms co-opted by cancer cells in radiation resistance: upregulation of DNA repair, suppression of apoptotic programs, hypoxia, immune evasion and exhaustion, cellular plasticity, as well as aberrant intracellular signaling. They also explore the therapeutic implications of these preclinical findings.

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.