Applied Radiology
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Available Programs and Courses FOR Physician

A complete listing of currently available online programs is provided below. To view course materials click an available viewing format provided with each listing (PDF, HTML, Interactive). To access online exams and claim credit you must be registered and logged in.  To add courses to your "MyAR Archives" user account select the "Add To Cart" button provided with each course title and follow the prompts. 

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* Actualizing Risk-Adapted Thoracic Stereotactic Body Radiation Therapy with MR Guidance
Released: September 01, 2021 Expires: August 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19851

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.

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* Integrating MR-Guided Radiation Therapy Into Clinical Practice: Clinical Advantages and Practical Limitations
Released: September 01, 2021 Expires: August 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19850

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.

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* MR-Guided Radiation Therapy for Oligometastatic Malignancies
Released: September 01, 2021 Expires: August 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19849

Brittany R. Derynda, BA; *Casey L. Liveringhouse, MD; John M. Bryant, MD; Stephen A. Rosenberg, MD, MS

This review article describes technical advantages for MR-guided radiation therapy (MRgRT) that lead to the rationale for use in the oligometastatic setting. The authors summarize existing data demonstrating the feasibility, safety, and efficacy of MRgRT for various disease sites. Finally, the authors discuss ongoing clinical trials utilizing MRgRT, which will continue to define and expand its role.

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.

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* Advanced MRI Safety Training For Healthcare Professionals (4th Edition): Level 2 MR Personnel
Released: April 22, 2020 Expires: April 30, 2022 CE credits: 3.0 Cost: $50.00
Faculty: Frank G. Shellock, PhD, FACC, FACR, FACSM
18586

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.

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* Basic MRI Safety Training (4th Edition): Level 1 MR Personnel
Released: April 01, 2021 Expires: April 30, 2023 CE credits: 1.0 Cost: $30.00
Faculty: Frank G. Shellock, PhD, FACC, FACR, FACSM
19390

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. 

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* The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD)
Released: September 23, 2019 Expires: September 30, 2022 CE credits: 10.0 Cost: $975.00
Faculty: William Faulkner, B.S.,R.T.(R)(MR)(CT), FSMRT | Kristan Harrington, MBA, R.T.(R)(MR), ARRT, MRSO
17958

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).

Module 1: Basic MRI Physics Relevant to MRI Safety
Module 2: Static Field: Bioeffects and Access Control
Module 3: Gradient Magnetic Fields: Bioeffects and Safety
Module 4: Radio Frequency Field: Bioeffects and Safety
Module 5: Implants and Devices
Module 6: Gadolinium-Based MR Contrast Agents
Module 7: MR Safety Screening
Module 8: Managing Emergent Situations and Patient Considerations: Quench and Patient Anxiety & Patient Monitoring

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.

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A Clinical Review: Benefits of Tomosynthesis in Daily Practice
Released: December 15, 2019 Expires: December 14, 2021 CE credits: 1.0 Cost: $0.00
Faculty: Dean J. Phillips, DO
18257

Annual mammography screening can save lives because breast cancer is a progressive disease and early detection enables improved prognosis due to appropriate treatment of small nonpalpable node-negative cancers. Multiple randomized controlled trials and observational studies have shown that mammography can reduce breast cancer mortality by 30% or more.

Digital breast tomosynthesis (DBT) first entered the breast imaging clinical arena when the Food and Drug Administration (FDA) approved DBT in 2011. Multiple studies have shown that DBT is effective in both mammography screening and diagnostic settings. Tomosynthesis has quickly emerged as a practice-changing standard that improves the clinical accuracy of a mammogram by increasing both sensitivity and specificity; thus, reducing the masking effect of overlapping fibroglandular tissue, thereby improving breast cancer detection. The improved accuracy and overall efficiency that DBT provides, will enhance radiologists’ performance and improve the patient experience.

Learning Objectives

  • Discuss the importance of breast screening mammography.
  • Incorporate the differences between, and benefits of 2D and 3D mammography into routine clinical practice.
  • Apply 3D tomosynthesis to improve patient care, particularly in the management of patients with dense breasts.

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

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

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A Multimodality Approach to Imaging the Mediastinum and Pleura: Pearls and Pitfalls
Released: March 01, 2020 Expires: February 28, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18596

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.

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Acquired Pericardial Pathologies: Imaging Features, Clinical Significance, and Management
Released: March 01, 2021 Expires: February 28, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19354

Pegah Khoshpouri, MD; Mahdie Hosseini, MD; Arya M Iranmanesh, MD; Bahar Mansoori, MD; Arash Bedayat, MD; Holman P McAdams, MD; Hamid Chalian, MD

There are several acquired diseases involving the pericardium. The clinical signs and symptoms of most of the pericardial disease are similar. This underscores the importance of medical imaging in identification of specific pericardial diseases.

Unfortunately, there are also similarities between the imaging features of several pericardial diseases. Therefore, familiarity with imaging features of different pericardial diseases is very important in the proper management of these patients. It is also of great importance that radiologists understand the clinical significance and management of different pericardial diseases so that they can better communicate with referring clinicians.

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.

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Advances in MR and CT Imaging: Emphasis on Artificial Intelligence:
RSNA 2019 Archived Program
Released: January 01, 2020 Expires: January 01, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Mathias Prokop, MD, Ph.D. | Garry E. Gold, MD
18369
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.

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An Emergent Role For Radiomic Decision Support In Lung Cancer
Released: December 01, 2019 Expires: November 30, 2021 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18367

Gleb A. Kuzmin, PhD;* Mishka Gidwani, BS;* Tianjun Ma, PhD;* Tingliang Zhuang, PhD; Mohamed E. Abazeed, MD, PhD

This review article discusses recent developments in radiomics—a computational image evaluation technique that integrates medical images, clinical data, and machine learning—its applications to lung cancer treatments, and the challenges associated with radiomics as a tool for precision diagnostics and theranostics.

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An Overview of Acute Mesenteric Ischemia
Released: January 01, 2021 Expires: December 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19259

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.

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Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review
Released: January 01, 2020 Expires: December 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18417

Matthew Schwenke, MD; Manu Singh, MD; and Bernard Chow, MD

Injuries to the anterior cruciate ligament (ACL) are increasing over time, with younger women at elevated risk. Meniscal tears are also a significant source of morbidity in both the younger and older populations. Surgical repair of both conditions may alleviate symptoms and allow resumption of athletic activities. Understanding of the pathogenesis, associated findings, and appearance of these injuries on all imaging modalities is critical to their accurate diagnosis and timely treatment. Radiographs may show indirect signs of ACL and meniscal injuries. Ultrasonography is being utilized more often in the workup of these conditions as an adjunct to physical exam and as an initial screening tool. Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions, though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography. ACL and meniscal tears can also be graded and classified according to their appearance on imaging which helps guide the surgeon during arthroscopy.

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.

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Applications of Artificial Intelligence in Head and Neck Radiation Therapy
Released: March 01, 2021 Expires: February 28, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19367

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.

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Cardiotoxicity and Radiation Therapy: A Review Of Clinical Impact In Breast and Thoracic Malignancies
Released: March 01, 2020 Expires: February 28, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18652

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.

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Cardiovascular Imaging: Complex Applications in Cardiac CT and CT Angiography
Released: June 08, 2021 Expires: June 30, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Richard Hallett, MD
19445
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.

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Contrast-enhanced Ultrasound of Renal Masses
Released: November 01, 2020 Expires: October 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19171

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.

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COVID-19 Facts, Findings, and Imaging Manifestations
Released: July 02, 2020 Expires: July 02, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Lawrence N. Tanenbuam, MD, FACR | W. Christopher Baughman, MD
18925
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.

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Disparities in Colorectal Cancer Outcomes Among Young Adults and African Americans in the United States
Released: December 01, 2020 Expires: November 30, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19231

Maya C. Graves, MS; Janna Z. Andrews, MD

This article reviews current literature continuing to highlight persistent disparities in the diagnosis, treatment and survival outcomes in colorectal cancer in young adults and Black individuals. Topics discussed include screening recommendations, age disparity, racial disparity, and differences in outcomes between Black and White patients in the growing cohort of young adult 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.

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Disparities In Lung Cancer for Black Patients In The US: An Overview of Contributing Factors and Potential Strategies for Radiation Oncologists To Bridge the Gap
Released: December 01, 2020 Expires: November 30, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19230

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.

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Elbow Effusion: Utility and Limitations of Radiography in Pediatric Injuries
Released: May 01, 2021 Expires: April 30, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19429

Sachin S Kumbhar, MD

Fractures of the elbow are one of the commonest pediatric injuries. Some of these fractures can be occult on initial radiographs, an elbow effusion being the only initial finding. Elbow effusion can be detected on an adequately obtained lateral radiographic projection of the elbow by identifying the visibility and shape of the anterior and posterior fat pads. To maximize the accuracy of detecting elbow effusions, radiologists should be aware of conditions that can affect the visibility of these fat pads.

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.

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FLASH Radiation Therapy: Review of the Literature and Considerations for Future Research and Proton Therapy FLASH Trials
Released: June 01, 2021 Expires: May 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19585

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.

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Genomics and Radiomics: Tools To See The Unseen To Personalize Radiation Therapy
Released: December 01, 2019 Expires: November 30, 2021 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18368

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.

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Imaging Acute Face and Neck Infections
Released: May 01, 2020 Expires: April 30, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18694

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.

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Imaging Brachial Plexus Pathology
Released: November 01, 2019 Expires: October 31, 2021 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18104

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.

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Imaging in Stroke Diagnosis and Treatment: An Update
Released: September 01, 2021 Expires: August 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19811

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.

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Leading a Radiation Medicine Department from the Epicenter of the COVID-19 Pandemic in the United States
Released: June 01, 2020 Expires: May 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18911

Daniel Koffler, MD; Sewit Teckie, MD; Louis Potters, MD, FACR, FASTRO, FABS

The acute redeployment of health care resources toward COVID-19 has had an immediate impact across the entire health care continuum and, in particular, to the treatment of cancer. The ability to perform surgery, biopsies, procedures, and to offer other ancillary clinical and supportive services, has been significantly impacted. Much has been done to proactively prepare for COVID-19 and to implement policies. The purpose of this review article is to outline how the department of radiation medicine in an epicenter location has managed the COVID-19 crisis to date.

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.

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Management of Head and Neck Cancer Patients During the Epidemic of COVID-19 in Wuhan
Released: June 01, 2020 Expires: May 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18912

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.

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Management of Oligometastatic Prostate Cancer
Released: September 01, 2020 Expires: June 30, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19013

James R. Broughman, MD; Christopher W. Fleming, MD; Omar Y. Mian, MD, PhD; Kevin L. Stephans, MD; Rahul D. Tendulkar, MD

Recent data suggests that aggressive treatment of the primary tumor or metastasis-directed therapy may confer a survival advantage in carefully selected patients with metastatic prostate cancer. This review outlines treatment approaches for these patients, while highlighting existing literature, ongoing trials, and important areas for future study.

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.

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Managing Anxiety and Minimizing Sedation Requirements in the Pediatric Radiation Oncology Population
Released: March 01, 2021 Expires: February 28, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19368

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.

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MR Contrast Agents: A Review of the Current Agents & Their Safety Profile
Released: December 01, 2020 Expires: December 01, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Lawrence N. Tanenbuam, MD, FACR
19190
Today, with such a wide selection of gadolinium-based contrast agents available to choose from; imaging professionals must be aware of the chemical make-up when selecting a MR agent for a particular exam.

This CME/CE accredited webinar with Lawrence N. Tanenbaum, MD, FACR,  provides a review of the currently available FDA-approved MR contrast agents and their safety profiles. Following Dr. Tanenbaum's 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:

  • Discuss the available FDA-approved contrast agents in the US market.
  • Review the chemical structure, indications, and safety profile of these agents.
  • Develop a better understanding of how selection of contrast can affect patient outcomes.

Supported through an unrestricted educational grant from GE Healthcare

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MRI Screening for Hepatocellular Carcinoma
Released: July 01, 2020 Expires: June 30, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18936

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.

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Noninvasive Cardiac Radioablation at Washington University: Past, Present and Future Directions for the Treatment of Ventricular Tachycardia
Released: March 01, 2020 Expires: February 28, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18653

Pamela Samson, MD, MPHS; Geoff Hugo, PhD; Kaitlin Moore, BSN; Nels Knutson, PhD; Philip Cuculich, MD; Clifford Robinson, MD

Noninvasive cardiac radioablation using stereotactic body radiation therapy (SBRT) techniques has emerged as a potential salvage treatment option for patients with ventricular tachycardia who have either failed procedural or medical management, or have contraindications to receive those therapies again. The recently published phase I/II Electrophysiology-Guided (EP) Noninvasive Cardiac Radioablation for Ventricular Tachycardia trial (ENCORE-VT, NCT02919618) demonstrated early safety and efficacy of this novel use of SBRT. This article reviews the lessons learned from ENCORE-VT, current use and workflow for treatment refractory ventricular tachycardia patients, and future directions for this emergent treatment 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.

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Ovarian Masses and O-RADS: A Systematic Approach to Evaluating and Characterizing Adnexal Masses with MRI
Released: July 01, 2021 Expires: June 30, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19566

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.

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Part 1 | The Foundation of Integrating DBT Into Your Practice
Released: October 06, 2020 Expires: October 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Laurie L. Fajardo, MD
18974

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.

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Part 2 | The Application of Integrating DBT Into Your Practice
Released: October 13, 2020 Expires: October 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Laurie L. Fajardo, MD
18975

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.

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Part 3 | DBT, Breast Density and Artificial Intelligence
Released: October 23, 2020 Expires: October 31, 2022 CE credits: 1.5 Cost: $0.00
Faculty: Laurie L. Fajardo, MD
18976

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.

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Pregnancy-associated Breast Cancer and Other Breast Disease: A Radiologic Review
Released: September 01, 2020 Expires: August 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
18973

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.

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PSMA Imaging: Current Status & Prospects
Released: October 29, 2020 Expires: October 31, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Jeremie Calais, MD, MSc | Jeffrey R. Karnes, MD | Oliver Sartor, MD
19151

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

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Radiotherapeutic Management of Oligometastatic Disease in Low- and Middle-Income Countries: The Current State of Affairs and Perspectives on Future Implementation
Released: September 01, 2020 Expires: June 30, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19012

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.

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Technological Basis for Clinical Trials in FLASH Radiation Therapy: A Review
Released: June 01, 2021 Expires: May 31, 2023 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19584

*Yufan (Fred) Wu, MD; *Hyunsoo Joshua No, MD, CMD; Dylan Y. Breitkreutz, PhD; Anthony E. Mascia, PhD; Raphaël Moeckli, PhD; Jean Bourhis, MD, PhD; Emil Schùˆler, PhD; †Peter G. Maxim, PhD; †Billy W. Loo Jr., MD, PhD

With a steady increase in FLASH-RT human clinical trials underway, this review discusses the technological basis for FLASH-RT clinical trials and explores the modalities, treatment parameters, technical limitations, and potential indications of current ultrahigh dose RT (UHDR-RT) technologies.

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.

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The Role of Digital Breast Tomosynthesis in Breast Cancer Screening, Diagnosis, and Continued Patient Management
Released: August 01, 2020 Expires: July 31, 2022 CE credits: 2.0 Cost: $0.00
Faculty: Applied Radiology
18945

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.

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Transcriptional Mechanisms of Radioresistance and Therapeutic Implications
Released: March 01, 2020 Expires: February 28, 2022 CE credits: 1.0 Cost: $0.00
Faculty: Applied Radiology
19014

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.

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