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.

Bindu V. Manyam, MD; Naichang Yu, PhD; Tim Meier, RTT; John H. Suh, MD; Samuel T. Chao, MD

With increases in complexity of radiation delivery and patient volume, vulnerable sources for errors may exist within radiation oncology workflow. Patterns of care recommendations are outlined by the American College of Radiology and the National Comprehensive Cancer Network guidelines; however, departmental and institutional policies and standards for quality and patient safety may vary. This article examines initiatives to mitigate errors and enhance safety, and describes efforts to incorporate quality improvement and patient safety into resident education.

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 2017 Archived Program

As new technological advances in Magnetic Resonance & Ultrasound continue to impact how healthcare professionals diagnose and treat sports related injuries; this program from RSNA 2017 features:

The Future of MR in MSK
by Dr. Christine Chung
Unique Ultrasound Solutions in MSK and Sports Medicine
by Dr. Jon Jacobson

Each provides insight into how these modalities are transforming patient care. Also included is a live USD scanning session with Dr. Jacobson, where he provides a detailed description of his scanning techniques.

Educational Objectives

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

• Describe imaging techniques that can reduce scan time without decreasing image quality.
• Describe how the infrastructure of MSK tissue provides a rationale for the development of a qualitative pulse sequence.
• Be familiar with the normal appears of tendons under USD
• Recognize the common MSK pathology seen on USD
• Describe applications where dynamic USD is used in MSK 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.).

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.

RSNA 2017 Archived Program

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.

Recent technological advances challenge traditional PET acquisition procedures in order to leverage the benefits of digital technology to improve diagnostic capabilities, patient experience, quantification and new indications. Precision medicine is a call to action to radically advance capabilities in the era of molecular targeted medicine.

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.

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.

Nicholas Hardin, DO; Shaked Laks, MD; Carola Mullins, MD; Osvaldo Padilla, MD; Lisa Kafchinski, MD; and Crysela Smith, MD

Hand masses are commonly encountered entities that often cause clinical and diagnostic dilemmas due to their nonspecific clinical presentation and overlapping imaging findings. This article systematically reviews the most commonly encountered hand masses in clinical practice in order to help the radiologist gain a structured diagnostic approach and familiarity with typical clinical presentations. Furthermore, this review will strengthen the radiologist’s ability to recognize pertinent MR imaging findings and gain knowledge of the underlying pathology on a cellular level.

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.

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.

Prostate MRI can be an effective tool in preventive as well as diagnostic and ongoing patient care for patients with statistical likelihood and/or risk factors predisposing them to the diagnosis of prostatic neoplasia. Used efficiently, MR contributes to early detection, accurate staging and localization, and reduction in unnecessary biopsies and treatment.

Skilled reporting provides allied health professionals with critical results to serve patients optimally, allocate resources effectively and improve treatment and surgical outcomes for their patients. This Expert Forum webcast will include a series of case reviews that incorporate and elucidate these concepts.

Following Dr. Pomeranz's 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:

• Identify the clinical indications for effective utilization of MR of the prostate.
• Be familiar with signal characteristics of prostate neoplasia on MRI, and understand the application of ACR standard PI-RADS scale to this type of imaging pathology.
• Describe MRI's key role as a diagnostic tool for screening, active surveilance, staging, recurrence, identification, treatment planning and treatment response evaluation.

Supported through an unrestricted educational grant from Hitachi Medical Systems.

Nadia Saeed, BA

There is a critical role for integrating radiation concepts in medical school education, with the goal of continuing to attract students to the specialty. However, several medical schools lack formal teaching of radiation, and many students receive little exposure to the field. The question of how to improve integration of radiation oncology into medical education remains up for debate. This article examines the current limitations to and the various methods of implementing radiation education in medical school curricula.