In this Expert Forum, Dr. Matthew Covington shares his understanding of the benefits and limitations of contrast-enhanced mammography, as compared to contrast-enhanced breast MRI, and how this imaging technique can be incorporated into clinical practice. Following the presentation questions from the audience were addressed in a moderated Q&A session.

Learning Objectives

• Dictate the strengths and limitations of contrast-enhanced mammography compared to contrast-enhanced breast MRI.
• Recognize indications for the appropriate use of contrast-enhanced mammography.
• Implement a contrast-enhanced mammography program.

This program is made possible through an unrestricted educational grant from FUJIFILM Healthcare Americas Corporation.

This program reviews fundamental MRI safety information and meets the annual training recommendations from the American College of Radiology. Importantly, MRI facilities must now comply with the revised requirements for diagnostic imaging from The Joint Commission and document that MRI technologists participate in ongoing education that includes annual training on safe MRI practices in the MRI environment. Notably, Advanced MRI Safety Training for Healthcare Professionals, Level 2 MR Personnel covers each MRI safety topic specified by The Joint Commission, as well as many additional subjects that will expand the knowledge-base of healthcare professionals involved with MRI technology.

With 35 years of experience in the field of MRI, the author of the best-selling textbook series, the Reference Manual for Magnetic Resonance Safety, Implants and Devices, and the creator of the internationally popular website, MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present the information in this program.

Advanced MRI Safety Training for Healthcare Professionals (4th Edition), Level 2 MR Personnel is a 2 hour and 45 minute program that is divided into three different sections.

Educational Objectives

• Understand the safety issues related to MRI.
• Describe the bioeffects associated with the static magnetic field, time-varying magnetic fields, and radiofrequency fields.
• Present guidelines that prevent projectile-related accidents.
• Describe polices that avoid issues related to acoustic noise.
• Review procedures that prevent burns associated with MRI.
• Explain and demonstrate appropriate pre-MRI screening procedures.
• Identify techniques to manage patients with claustrophobia, anxiety, or emotional distress.
• Describe guidelines to handle medical emergencies in the MRI setting.
• Understand the safety considerations for gadolinium-based contrast agents.

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

Applied Radiology and William Faulkner & Associates are pleased to introduce “The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD)”. This comprehensive program, focusing on MR Safety, covers many aspects relating to the safety practices of the Magnetic Resonance Imaging (MRI) environment. It is designed for those individuals who are either currently serving as their facility’s MRSO and/or MRMD, or those who are preparing to assume these responsibilities. The content of this course will be helpful for those preparing for the American Board of Magnetic Resonance Safety MRSO and MRMD examinations.

The content of The Online Course for MR Safety Officers and MR Medical Directors is based upon current FDA and ACR guidelines, including the ACR Guidance Document for MR Safe Practices, as well as those promulgated by industry regulatory bodies such as the International Electrotechnical Commission.

The complete online program has been approved for up to 10 AMA PRA Category 1 credits™ (CME) and 10 Category A ARRT continuing educational credits (CE).

The Online Course for MR Safety Officers (MRSO) and MR Medical Directors (MRMD) is not affiliated with, nor endorsed by the American Board of Magnetic Resonance Safety (ABMRS)
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This is a Pay-To-View program. Purchase is required for full program access.

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.

Arash Mirrahimi, MD, MSc; Charlotte Gallienne, MD; Hournaz Ghandehari, MD, FRCPC

Acute mesenteric ischemia (AMI) is a true surgical emergency and a rare life-threatening condition, accounting for 0.01% of hospital admissions, with extremely high mortality rates (up to 69%). Poor outcomes remain prevalent despite advances in both diagnostic and treatment options over the last two decades

Early diagnosis and management are particularly important given that the highest incidence of AMI occurs in the elderly population, who often have multiple comorbidities leading to a worse prognosis. Biphasic contrast enhanced multidetector computed tomography (MDCT) images have become the mainstay and standard of care for investigation and timely diagnosis of AMI.

As such, the importance of recognizing imaging features of AMI and timely communication of findings with the referring physicians is of utmost importance for diagnostic radiologists and always a worthwhile topic for review. We have therefore endeavored to provide a brief summary of the presentation of AMI, its causes, relevant anatomy, and most importantly, illustrated review of CT findings that delineate ischemic changes of the bowel and mesentery.

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

Adam C. Riegel, PhD, DABR

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

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

Often there is lack of knowledge amongst imaging professionals regarding IV contrast dynamics and the relationship between contrast injection, observed enhancement, and scan acquisition timing. The design of appropriate imaging protocols leads to effective and consistent cardiovascular exams; especially when applied to complex clinical scenarios.

This CME/CE accredited program will review contrast-saline dynamics and discuss rational protocol design for cardiac and vascular CT angiography. Effective cardiovascular imaging protocols, utilizing multiple CT injector platforms to achieve optimal imaging, will be reviewed. We invite you to join Dr. Richard Hallett for a comprehensive discussion and case study review of this important topic.

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

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

• Understand the relationship between bolus contrast media injection and observed enhancement.
• Implement methods to design rational contrast injection / scan acquisition protocols.
• Review various models of CT contrast injectors and discuss benefits, limitations, and injection protocol adjustments for each.
• Apply customized contrast-saline injection / scan principles to complex cardiovascular disease cases.

Made possible through an unrestricted educational grant from Bracco Diagnostics, Inc.

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

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

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

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

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

Kaitlyn Lapen, MD; Noah J. Mathis, BS; C. Jillian Tsai, MD, PhD; Jonathan T. Yang, MD, PhD; Erin F. Gillespie, MD

The authors review published prospective trials and protocols on stereotactic radiation therapies for metastatic disease to determine whether the terms SBRT and SABR are being used differentially based on intent of treatment, defined by primary study outcome, and propose a distinct definition of each.

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.

Laura E Minton; Renu Pandit; WR Willoughby, PhD; Kristin K Porter, MD, PhD

Gadolinium (Gd)-based contrast agents (GBCAs) dominate the current contrast-enhanced magnetic resonance imaging (CE-MRI) market and are proven to increase the efficacy of diagnostic magnetic resonance imaging (MRI) scans. However, in the future it is likely that a personalized combination of contrast enhancement and image processing techniques will be used to optimize diagnosis and treatment planning while minimizing risk and cost. This activity is designed to educate radiologists about the future of MRI contrasts agents, including high relaxivity macrocyclic GBCAs, alternatives to GBCAs, and imaging processing techniques.

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.