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.

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.

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.).

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.).

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.

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.

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.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which has determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care. Under MACRA, participating providers will be paid based on the quality and effectiveness (value) of care they provide rather than the volume of care they provide under the current system.

This Expert Forum webcast features a panel of experts who will review the importance of MACRA and what it means to the radiology community. They will provide an overview of what MACRA involves and define which providers must begin planning immediately. In addition, the program will describe the Merit-based Incentive Payment System (MIPS) and the four performance categories, which will ultimately determine how radiologists and other physicians are reimbursed for their services.

The panel is moderated by Dr. Gregory N. Nicola, Vice President, Hackensack Radiology Group and will answer questions from the online audience.

Educational Objectives

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

• Describe what MACRA is and how it will affect radiologists.
• Understand the performance category measurements.
• Describe the necessary steps to be MACRA Ready by 2019. ​

Supported Through An Unrestricted Educational Grant from Bracco Diagnostics, Inc.

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.

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.

Computed Tomography (CT) continues to be the modality of choice in most emergency departments and is respected for its ability to quickly capture cross sectional images of the body, allowing ED physicians to quickly assess patients.

In recent years, several manufacturers have developed scanners with the ability acquire images at varying energy levels, which allow imaging professionals to differentiate the various elements of the body based on their material density and atomic numbers.

This technique has the potential to revolutionize the way we depict and interpret CT scans. In this Expert Forum Webcast, Dr. Gopal Punjabi will share his clinical experiences with the use of Spectral CT in the Emergency Department with a focus on body imaging.

Educational Objectives

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

• Describe scenarios where spectral CT can enhance diagnosis.
• Describe the types of images that can be obtained with spectral CT.
• Understand how to interpret the additional data acquired in spectral CT imaging.

Supported through an unrestricted educational grant from Philips Healthcare.

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.

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.

Open MRI Systems have evolved enormously since their inception in the 1980’s and today true high-field systems offer an excellent, patient centric alternative to closed, cylindrical bore systems for imaging of basic and advanced applications throughout the body.

In this final installment of this 2-Part series, which is being chaired and moderated by Dr. Lawrence N. Tanenbaum, we will hear from Dr. John Feller who will address the advantages of high-field open MRI systems for MSK imaging. Specifically, he will cover patient comfort, image quality, isocentric imaging, metal artifact reduction scanning (MARS), solenoid coil technology, fat suppression, operational efficiency, and marketability.

Following the presentation, Dr. Tanenbaum will moderate a live Q&A where questions from the audience will be addressed.

Educational Objectives

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

• Describe how market forces including patient centric imaging are impacting today’s radiology departments.
• Describe how modern Open MRI Systems align with value-based care and are changing the way that imaging facilities do business.
• Understand the technical specifications of High-Field Open MRI Systems.
• Understand the concept of isotropic imaging and new fat suppression technologies.
• Describe the increased image quality and range of applications in MSK imaging.

Supported through an unrestricted educational grant from Hitachi Healthcare Americas

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.