This program reviews fundamental MRI safety protocols 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. As such, 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.

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.

Advanced MRI Safety Training for Healthcare Professionals, Level 2 MR Personnel is a 150-minute program that is divided into three sections.

Educational Objectives

• Understand the safety issues related to MRI.
• Describe the bioeffects associated with the static magnetic field, time-varying magnetic, and radiofrequency fields.
• Present guidelines that prevent projectile-related accdents.
• 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.
• Identify safety considerations for gadolinium-based contrast agents.

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

This program describes the Joint Commission’s requirements for annual training on specific MRI safety practices. In addition, it covers procedures to manage patients undergoing MRI with recommendations to prevent ferromagnetic objects from entering the MRI environment; claustrophobia, anxiety, or emotional distress; guidelines to screen patients with medical implants and devices; procedures to prevent thermal injuries; methods to handle patients requiring urgent or emergent medical care; contrast agent safety including information for nephrogenic systemic fibrosis, and techniques to avoid problems related to acoustic noise.

Educational Objectives

1. Describe the latest requirements from The Joint Commission for MRI with an emphasis on safety and training.
2. Present procedures for managing claustrophobic patients, screening prior to MRI, preventing ferromagnetic accidents, avoiding MRI-related thermal injuries, handling emergencies, and preventing acoustic noise issues.
3. Define methods to ensure compliance with the latest requirements from The Joint Commission for MRI safety.
4. Summarize The Joint Commission’s requirements for annual training on specific MRI safety practices.

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.

As new technological advances in Computed Tomography continue to impact how healthcare professionals diagnose and treat patients with stroke, pancreatic and biliary cancer and other oncological disease; this program from RSNA 2017 features the following presentations. Each will provide insight into how advanced imaging is improving patient outcomes.

Saving Brain and Improving Patient Outcomes with a Better Acute Stroke Protocol
by Dr. Kenneth Snyder
Can UHR CT Improve Outcomes with Better Detection, Diagnosis and Staging of Pancreatic and Biliary Cancer
by Dr. Miyuki Sone
Improving Oncologic Outcomes Using a Unique 4DCT Solution
by Dr. Junsung Choi.

Educational Objectives

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

• Describe how advanced physiologic imaging is transforming the treatment of acute ischemic stroke.
• Describe the limitations of conventional CT in the diagnosis of pancreatic and biliary disease.
• Be familiar with the clinical utility of Ultra High Resolution CT Imaging.
• Describe how hybrid Angio/CT systems are providing clinical utility in interventional oncologic imaging.

This program was originally presented live at RSNA 2017 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Toshiba America Medical Systems (now Canon Medical Systems USA, Inc.).

Jason Liu, BS; Heath B. Mackley MD, FACRO

This review article identifies demographic, clinical, and treatment variables associated with the abscopal effect— the phenomenon in which radiation induces a regression of tumor cells outside the field of irradiation. Authors describe the current state of knowledge regarding these variables and examine research on the influence of tumor type, patient’s immune system, overall tumor burden, and radiation therapy parameters on the abscopal effect.

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.

Tamara Vern-Gross, DO, FAAP

Because of the low incidence of pediatric malignancies, no consensus has been reached on the best practices for the delivery of pediatric palliative radiation therapy. As a result, current practice is extrapolated from adult literature and single institutional series. In addition to the technologies for palliation of pediatric patients are essential components of communication for meeting medical and psychosocial needs of the families and patients; these needs are not always addressed. A multidisciplinary approach with appropriate care and communication addressing patient questions and needs provides meaning and improved quality of life during this phase of treatment.

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

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

Learning Objectives

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

Supported through an unrestricted educational grant from Philips Healthcare.

This technique, known as Multi-Energy CT, Dual Energy CT or Spectral CT, to name a few, has the potential to revolutionize the way we depict and interpret CT scans. In this Expert Forum Webcast, Dr. Kevin Smith will share his clinical experiences with the use of Multi-Energy CT in a community hospital setting.

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

Learning Objectives

• Understand how Dual Energy CT compares to conventional imaging.
• Review common dual energy reformats and post-processing at our institution.
• Review clinical cases in which DECT has been deployed and added value in a community setting.
• Review the radiologists workflow for handling extra series and images.

This program is supported through an unrestricted educational grant from Philips Healthcare

Wende N. Gibbs, MD, MA, and Lawrence N. Tanenbaum, MD, FACR

Hydrocephalus is a a mechanical complication of different pathologic conditions and a disease process itself.  The morphologic features are easily recognizable, but the patho-physiology remains incompletely understood.  Nearly all hydrocephalus is due to cerebrospinal fluid (CSF) obstruction at some point between the ventricles and the systemic venous circulation.  Classification is important as it informs optimal treatment. 

Optimized imaging is vital to the success of flow diversion.  Current treatments are limited and invasive: CSF diversion via catheter or endoscopic third ventriculostomy.  Decision making relies upon high resolution imaging to determine the site of obstruction and anatomic features that may complicate the procedure.

Morphologic and physiologic imaging are used to evaluate suspected normal pressure hydrocephalus (NPH).  Several morphologic measures individually and in combination have shown high positive predictive value in identifying individuals who will respond to treatment with ventricular shunting and in differentiating NPH from Alzheimer disease, which can have a similar imaging appearance.

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.

Soehartati Gondhowiardjo, MD, PhD; Sri Mutya Sekarutami, MD, PhD; Angela Giselvania, MD; Steven Octavianus, MD; Muhamad Iqbal Assegab

To date, the exponential rates of population growth and cancer incidence often outpace the linear rate of radiation therapy services growth, especially in developing countries such as Indonesia. There are many challenges faced in closing this gap and improving radiation therapy facilities and services. This review article summarizes the challenges and the efforts to overcome them.

Muhammed M. Fareed, MD; Monica Krishnan, MD; Tracy A. Balboni, MD, MPH; Hsiang-Hsuan Michael Yu, MD

Palliative radiation oncology is an integral part of radiation oncology practice with practical implications in common clinical scenarios including bone metastases, brain metastases, malignant spinal cord and cauda equina compression, tumor related bleeding, fungation, obstruction and visceral metastases. Further education and research is needed as part of residency training and beyond to enhance the spectrum of care for advanced cancer patients delivered by radiation oncologists. Supportive and palliative care skills must expand beyond the technical aspects of radiation therapy delivery to generalist palliative care competencies, including symptom management basics, communication and goals of care, advance care planning, psychosocial issues, cultural considerations, spiritual needs and ethical/legal issues.

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.

Hina Arif-Tiwari, MBBS, MD, DNB; Philip Taylor, DO; Bobby T. Kalb, MD; and Diego R. Martin MD, PhD, FRCPC

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) is a chronic debilitating inflammatory disease that currently lacks a single gold standard diagnostic test. Magnetic resonance enterography (MRE) is an excellent modality for assessing IBD because it demonstrates a greater ability to depict submucosal pathology in comparison to other diagnostic modalities.

Although patient preparation for MRE often involves ingestion of various osmotic agents, recent research suggests that this may be unnecessary, as the high level of bowel wall contrast is sufficient even without bowel distention.

The ability to distinguish between acute forms of IBD and non-acute forms of IBD is an important role for MRI imaging. Acute flares will demonstrate mural increased T2 signal, best appreciated on fat saturation T2-weighted sequences. MRE also plays a role in the diagnosis of extra-enteric complications of IBD such as perirectal abscess or sclerosing cholangitis.

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.

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

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

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 three (3) 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.

Advanced and Emerging Ultrasound Technologies for Assessment of Liver Disease
by Andrew Trout, MD
Ultrasound Fusion Technology with Auto-Registration
by Nami Azar, MD, MBA
Advancements in Interventional Radiology Using A Combined CT & Angiography System
by Bela Kis, MD. PhD

Educational Objectives

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

• Identify clinical scenarios where ultrasound fusion imaging can be implemented.
• Review the role of shearwave elastography in the assessment of diffuse liver disease.
• Describe the value of the hybrid CT/angiography system in liver tumor embolization cases.

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.

Nadia Saeed, BA

Radiation therapy remains one of the more misunderstood treatment modalities in cancer care. This article discusses the evolution of patient education in radiation oncology, discussing current education tools and practices as well as new innovations and future directions, including virtual reality, social media, apps and more.

Alysha Vartevan, DO; Crystal May, DO; and Craig E. Barnes, MD

Bone tumors are one of the most common lesions encountered by radiologists. Fortunately, most pediatric bone tumors are benign. Although cross sectional imaging such as CT or MRI can be useful, the most important imaging modality in the initial workup of a bone tumor is the plain radiograph.

Differentiating between benign and malignant bone tumors is not always straightforward; however, it is possible to distinguish between them by carefully evaluating charac-teristics such as the lesion’s type of margin, pattern of bone destruction, type of periosteal reaction and presence of an associated soft tissue mass. In addition, matrix type and tumor location can help narrow the differential 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.

Nadia Saeed, BA

Compared to many other fields, quality and safety is a relatively new discipline within medicine. Many efforts to improve quality and safety in healthcare are aimed at training practicing physicians and residents through efforts such as safety courses, quality improvement project participation, and continuing medical education sessions. However, there has been increasing interest in beginning quality and safety education earlier in physicians’ training. Upstream interventions during medical education can introduce future physicians to this crucial aspect of medical practice early in their careers and have the potential to significantly improve patient safety and quality of healthcare delivery. This article discusses the considerations and dimensions of quality and safety training in medical education.

Andrew Kennedy, MD; Susan Garwood, MD; Allison Grow, MD, PhD; Ryan Lipscomb, MS

Multidisciplinary team members treating lung cancers may not be aware of the complexity and coordination required for delivery of stereotactic body radiation therapy (SBRT) to lung masses. Shifts in practice have occurred in management of early stage non-small cell lung cancer (NSCLC), particularly with regard to the role of the specialized pulmonologist (interventional pulmonology), which involves different staging techniques than traditional mediastinoscopy. This review provides key information to foster a deeper understanding and appreciation for patient selection, work up, behind-the-scenes critical quality assurance tasks, and clinical pearls for stereotactic radiation therapy for lung 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.

Elizabeth M. Nichols, MD; Shafiq Ur Rahman, MBA, MS; Byongyong Yi, PhD

On the rise, health-related cyberattacks are generally categorized into four groups: data loss, monetary theft, attacks on medical devices and infrastructure attacks. Breaches in cybersecurity can levy drastic consequences in radiation treatment delivery and health care overall. This review article describes experiences and unique needs and strategies pertaining to radiation oncology IT infrastructure, electronic medical records, automatic time outs, treatment planning and delivery, plan verification, screen locking and more to help prevent and overcome a cyber disaster.

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.

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.