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.

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.

Anyone who enters the magnetic resonance imaging (MRI) environment, whether on a regular or infrequent basis, must be properly trained to ensure their safety, the protection of patients, and the security of other facility staff members. This program, Basic MRI Safety Training, Level 1 MR Personnel accomplishes the initial training that is necessary to ensure safety in the unique setting associated with the MRI system. It includes information pertaining to MRI technology, describes common hazards and unique dangers associated with the MRI setting, and presents vital recommendations and guidelines to prevent accidents and injuries. Importantly, this program provides the fundamental MRI safety information for Level I MR Personnel recommended by the American College of Radiology and may be utilized by individuals desiring preparation for safety training as, Level 2 MR Personnel.

With more than 30 years of experience in the field of MRI, the author of the best-selling textbook series, the Reference Manual for Magnetic Resonance Safety, Implants and Devices, and the creator of the internationally popular website, www.MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present the information in this program.

Educational Objectives

• Appreciate the importance of MRI
• Identify the hazards associated with MRI
• Understand the screening process
• Describe steps to prevent accidents and injuries

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

Samir Mehta, MD, and Jonathan Dorff, MD

The discovery of incidental asymptomatic pancreatic masses has gone up dramatically with the advent and increasing accessibility of CT and MRI.

It is imperative to understand the different imaging features and behaviors of these masses on CT and MRI to construct an appropriate differential diagnosis, as recommendations based on these masses are very different. Knowledge of the relevant clinical history and patient populations affected is also important to formulate an accurate diagnosis. It is also important to recognized pitfalls in diagnosing the masses, as there are both typical and atypical appearances.

There are also mimics of pancreatic masses that lead to unnecessary follow-up and workup, for which the radiologist should be aware. A multimodality approach is frequently needed to narrow the differential diagnosis, though tissue sampling is usually required for a definitive 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.

Lisa M. Ho, MD

Imaging plays a critical role in the work-up and clinical management of adrenal disease. Because masses in the adrenal glands are one of the most commonly encountered incidentalomas, the American College of Radiology (ACR) has developed specific recommendations on how to manage incidentally discovered adrenal masses in the adult population. The purpose of this article is to review the imaging appearance of common adrenal diseases and provide a diagnostic imaging algorithm for work-up of the “adrenal incidentalomas.”

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.

Joel Yarney, MD; Hannah Ayettey Anie, MD; Verna Vanderpuye, MD; Francis Adumata Asamoah, MD; Baffuor Awuah, MD; Clement Edusa, MD; Samuel Tagoe, PhD; Samuel Denyo, BTech; Pearl Aba Scott, MD; Francis Doughan, MPhil; Kofi Adesi Kyei, PhD; Charles Aidoo, HND; Bismark Dwobeng, MD; Rebecca Wong, MD; Horia Vulpe, MD; Shivanshu Awasthi, MPH, PharmD; Angelina Fink, MPH; Stuart Wasserman, MS; Peter Johnstone, MD; Louis Harrison, MD; Kosj Yamoah, MD, PhD

Oncologists may not be familiar with the utilization and operation of radiation therapy facilities in limited-resource settings. Additionally, oncologists interested in global radiation oncology need to understand the challenges and opportunities pertinent to the field. This article describes innovative international efforts regarding quality assurance, capacity building, and research and training that address unmet needs and improve radiation treatment for patients in Ghana, a major hub for radiation treatment in Africa.

Krissia Margarita Rivera Perla, ScB; Ollin Gomez Venegas, BA; Steven A. Toms, MD, MPH

Authors review the North American and European guidelines for chemoradiation of GBM created as a result of the new 2016 WHO classification system, focusing specifically on age, performance status, molecular markers, and disease recurrence. They also discuss factors such as socioeconomic and insurance status that impact radiation treatment compliance and GBM outcomes.

PET/CT using Fluorodeoxyglucose (FDG) has been used for many years as an adjunct modality to conventional imaging. Until recently, PET/CT’s main utility was in oncology and to a lesser degree cardiology and neurology. However, new radiotracers were approved by the FDA; increasing the application of PET/CT in clinical practice. This Expert Forum aims to educate medical imaging professionals about the common indications of Time of Flight (TOF) PET/CT scans using various radiotracers that include: F18- FDG, F18-Fluciclovine, GA68-DOTA-TATE, and F18-Florbetapir.

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

Educational Objectives

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

• Describe the importance of PET/CT quality.
• Describe common FDG applications.
• Describe the legacy and new FDA-approved radiotracers, their indications and cost.

This program was originally broadcast live as part of a webinar sponsored by IAME and supported through an unrestricted educational grant from Philips Healthcare.

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

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

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

IV contrast extravasation is a not uncommon complication in the performance IV contrast enhanced CT examinations. In this accredited Expert Forum Webcast, we will review the different complications related to IV contrast administration. This will be followed by analysis of different factors that contribute to IV contrast-extravasation and subsequent discussion of best practices that can reduce the incidence of IV contrast extravasation. A novel method which reduced contrast extravasation by over 50% will also be presented.

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

Learning Objectives

• Discuss the different types of complications associated with IV contrast extravasation.
• Describe the various factors that can contribute to IV contrast extravasation.
• Apply best practices to reduce the incidence of IV contrast extravasation.

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

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

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.

Douglas H. Sheafor, MD, FSAR

In postoperative bariatric patients, internal hernias are one of the most common, and dreaded postoperative complications; unfortunately, these hernias are also challenging to diagnosis clinically and radiographically. This article highlights several keys to correct diagnosis of the postoperative internal hernia, including understanding the common postoperative anatomy, optimizing CT imaging using oral contrast and multiplanar reformats, and combining findings such as swirling of the mesentery, bowel obstruction and other CT abnormalities to increase the specificity of diagnosis. In the acute-care setting, radiologists should have a high index of suspicion for internal hernias in the setting of prior RYGB surgery and signs of obstruction, particularly given their association with closed loop obstruction and bowel ischemia mandating prompt surgical intervention.

Michael D. Chuong, MD; Shahed Badiyan, MD; Matthew Hall, MD, MBA; Smith Apisarnthanarx, MD

Although there is general awareness that modern radiation technologies both reduce normal organ dose while permitting safe dose escalation in nonoperable EC patients, there is lack of consensus about how these technologies should be routinely employed in the clinic. There clearly is need for well-designed clinical trials to guide clinical decision making in this regard, several of which are being planned (NCT01102088) or already underway (NCT01512589). This course examines how contemporary radiation technologies can improve the therapeutic index, including both reduced cardiopulmonary and hematologic toxicity and higher tumor control, for nonoperable esophageal cancer patients receiving definitive chemoradiation.

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 2018 Archived Program

As technological advances in MR, CT, USD, and Combined Angiography/CT systems continue to impact how healthcare is practiced, this Expert Forum Symposium Series, featuring two (2) individual presentations from experts in their respective fields; will highlight through their clinical experiences, how they are maximizing the latest advances in imaging, and assess the growing impact that artificial intelligence is having on improved patient outcomes, satisfaction and throughput.

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

Deep Learning Reconstruction
by Mathias Prokop, MD
Enhanced Value of Neuro MR Imaging Using Deep Learning Reconstruction Denoising Methods
by Vincent Dousset, MD, PhD

Educational Objectives

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

• Discuss the clinical value of new deep learning reconstruction techniques in CT.
• Implement new de-noising methods in neuro MR imaging.

This program was originally presented live at RSNA 2018 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Canon Medical Systems.

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

Jennifer Shaffer Ngo, MD, and Gary R. Schooler, MD,

Pediatric musculoskeletal injuries often manifest differently from adult injuries and similar mechanisms may present differently depending on the degree of skeletal maturity. This article outlines many of the common pediatric injuries that the general radiologist may encounter in practice. Select topics include physeal injuries, elbow fractures, developmental dysplasia of the hip, slipped capital femoral epiphysis, and Blount disease. Knowledge of these unique pathologies and anatomic variants will help the radiologist recognize these entities sooner, ultimately helping facilitate the most expeditious and appropriate care.

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.

Advances in technology have led computed tomography (CT) to become one of the main diagnostic tools utilized today in modern healthcare, as it provides a safe and low risk anatomical visualization of the human body. However, these advances have also introduced new challenges related to the administration of contrast, which is a fundamental component of many CT imaging exams, particularly in cardiac CT.

This Expert Forum aims to help a wider audience of radiology professionals understand how to use iodine contrast safely, by using a weight-based contrast strategy, which allows technologists and radiologists to image safely while obtaining optimal results. In addition, we will discuss the value of including saline in your protocols, which can result in contrast savings, but also provides the ability to optimize the contrast injection process to improve image quality and patient safety.

Learning Objectives

• Gain insight into weight-based imaging strategies and how to implement them in clinical practice.
• Identify when saline may be a helpful addition to an injection strategy.

Supported through an unrestricted educational grant from Bracco Diagnostics Inc.

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

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

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

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

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Saira E. Alex, BS; Eric D. Brooks, MD; Emma B. Holliday, MD

Based on current standards, colon cancer is treated with surgical resection and chemotherapy, and rectal cancer is treated with preoperative radiotherapy. This review of the literature suggests the potential for improved local control and reduced toxicity when treating colorectal cancer with proton therapy compared to the current treatment paradigms. Additionally, surgery and ablative techniques have traditionally been used to treat metastatic colorectal cancer. This review discusses how proton therapy could offer an alternative approach to reduce toxicity and act in lieu of surgery in the metastatic setting.

Benjamin O. Spieler, MD; Lorraine Portelance, MD; Eric A. Mellon, MD, PhD

This review article discusses the major indications for stereotactic ablative radiation therapy for liver cancer, as well as the technologies available and/or necessary for safe treatment delivery. Specific areas discussed include hepatocellular carcinoma, intrahepatic cholangiocarcinoma, dose, image guidance and respiratory management, emerging techniques, and radiation-induced liver disease.

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.

Shekinah Nefreteri Cluff Elmore, MD, MPH, is at Harvard Medical School, Boston. Gregorius Ben Prajogi, MD; Jose Alfredo Polo Rubio, MD; Eduardo Zubizarreta, MD, are at the International Atomic Energy Agency, Vienna.

This review examines the capacity gap in RT through the lens of human resource needs. The authors model radiation oncologist training needs, investigate the disparity between HMICs vs LMICs, and explore solutions for training/licensure and regional collaboration.

Shwetha Manjunath, MD; Jacob E. Shabason, MD, MTR

To date, there is little consensus on how to best combine radiation and immune checkpoint blockade (ICB) to maximize therapeutic gains while minimizing the potential for serious overlapping toxicities. This review summarizes relevant clinical data related to both safety and efficacy of the combination of ICB and radiation. 

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.

Deborah R. Shatzkes, MD

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

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

Available for SA-CME Credit. To receive SA–CME credit, you must complete the post exam and review the discussion and references provided with the exam results.