Daniel M. Koffler, MD; Daniel K. Ebner, MD, MPH; Eric J. Lehrer, MD; Fatemeh Fekrmandi, MD; Felix Ehret, MD; Morteza Mahmoudi, PhD; Chris Beltran, PhD; Daniel M. Trifiletti, MD; Laura Vallow, MD; Michael S. Rutenberg, MD, PhD; Jacob Eckstein, MD; Bhargava Chitti, MD; Bryan Johnson, MD; Joseph M. Herman, MD; Walter Tinganelli, PhD

The authors describe advanced high linear energy transfer (LET) techniques, including LET painting, biologically guided spatial fractionation, and multi-ion therapy, as potential methods to selectively ablate cancer stem cells while sparing normal tissue. The article highlights recent imaging advances that could help define highrisk tumor subvolumes and outlines logistical and clinical challenges to widespread implementation, making a compelling case for heavy particle therapy as a means of augmenting systemic cancer control.

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

Individuals entering 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, the security of facility staff members, and others. This program, Basic MRI Safety Training (5th Edition), Level 1 MR Personnel, accomplishes the training that is necessary to ensure safety in the unique setting associated with the MRI system and includes information pertaining to MRI technology, describes common hazards and unique dangers associated with the MRI setting, and presents vital guidelines to prevent accidents and injuries.

With more than 40 years of experience in the field of MRI, the author of the best-selling textbooks, the Reference Manual for Magnetic Resonance Safety, Implants and Devices (19 editions), and the creator of the internationally popular website, www.MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present the information provoded in this program.

Educational Objectives

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

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)
Terms and Conditions of Use: Click To View
This is a Pay-To-View program. Purchase is required for full program access.

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.

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.

Malick Bio Idrissou, PhD; Anusha Muralidhar, PhD; Reinier Hernandez, PhD; Quaovi H. Sodji, MD, PhD

Radiopharmaceutical therapy (RPT) and immune checkpoint inhibitors (ICIs) represent transformative approaches to treating metastatic cancers. This review article discusses how RPT delivers targeted radiation to primary and metastatic tumors and the therapeutic advantages of combining RPT with ICIs while focusing on outcomes and challenges such as toxicity, immunosuppressive tumor microenvironment, and logistical barriers.

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

Ronald Chow, MS; Minglei Kang, PhD; Shouyi Wei, PhD; J. Isabelle Choi, MD; Robert H. Press, MD; Shaakir Hasan, DO; Arpit M. Chhabra, MD; Keith A. Cengel, MD, PhD; Haibo Lin, PhD; Charles B. Simone, II, MD

In this manuscript, the authors review the proposed mechanisms of action for FLASH radiation therapy (FLASH RT), summarize early preclinical results, discuss the first-in-human treatments with a focus on proton FLASH, and highlight challenges and future considerations of FLASH RT.

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.

While gadolinium-based contrast agents (GBCAs) are essential to performing breast MR imaging, guidance from the US Food and Drug Administration (FDA) and the American College of Radiology (ACR) includes the recommendation of limiting a patient's gadolinium exposure. Gadopiclenol injection, a macrocyclic, high-relaxivity GBCA can address this recommendation by providing high-quality images with half the gadolinium dose as compared to other conventional GBCAs.

This educational program features Dr. Margarita Zuley’s clinical expertise and practice experience. Through case study examples she will share the indications for abbreviated breast MRI and the clinical rationale for implementing optimal imaging protocols using a lower gadolinium dose and clinical examples of the management of MRI detected findings.

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

• Explain the clinical benefits of abbreviated breast MRI for patients with dense breast and/or high-risk factors.
• Implement lower gadolinium dosing protocols for patients who may experience repeat breast MRI scans.
• Understand the clinical paradigms and indications for breast MRI as it relates to other imaging modalities.

This program is made possible through an unrestricted educational grant from Bracco Diagnostics Inc.

Steven Benitez, MD; Ryan Holland, MD; Richard Zampolin, MD; Andrew Brook, BA, MS; Joshua Hirsch, MD; Allan L Brook, MD, Deepak Khatri, MD

As thrombectomy has become the standard of care for large vessel/arterial occlusions, the indications are initiated by proper imaging and understanding of the brain blood flow physiology. This two-part series examines the standard of care for acute stroke imaging and the latest techniques. The second part of this activity on stroke intervention will appear in the November-December issue of Applied Radiology.

Available for CME Credit. To receive 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.

In MR Imaging, a careful review of the safety criteria for the selection of a Gadolinium-based Contrast Agents (GBCAs) should be considered for pediatric and neonatal patients. The program will provide a comprehensive review of the supporting research that addresses Gadolinium selection in this special patient population. Both chronic and long-term effects of GBCAs will be discussed.

As a Pediatric Neuroradiologist, Dr. Shah is uniquely qualified to share his experience which includes a discussion of risk vs benefits, supported by practical protocols for the administration of MR contrast; including limiting the amount of contrast given to patients that may receive several lifetime doses. Following the presentation, the audience is invited to join Dr. Shah for an interactive Q & A session.

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

• Explain the differences between available MR contrast agents and any associated adverse events
• Improve clinical management decisions about when to administer MR contrast (risk vs benefit)
• Apply FDA guidelines regarding MRI contrast agents to clinical practice.

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

This accredited program provides a comprehensive overview of MRI safety considerations for passive / active implants, and devices.

When considering patient safety during MR imaging, it is critical to assess the patient’s history and have a clear understanding of any passive and or active implants and/or devices. The ACR Manual on MR Safety states that the Radiologist is responsible for the safety of the patient undergoing the MRI Exam. They are also responsible for implementing MR Safety policies and procedures and ensuring that the facilities’ personnel adhere to them at all time. Regarding implants and devices, regular reviews and updates to the MRI safety policy should be completed.

With more than 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, www.MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present this important MRI Safety information designed for MRI Imaging professionals.

Educational Objectives

• Name and describe the current labeling terminology for implants & devices.
• Safely image patients with passive and active, MR Conditional implants and devices.
• Establish a comprehensive MRI Safety protocol for imaging implants & devices.

Program support provided by Bracco Diagnostics, Inc.

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

Ana Mitchell, MD; Simran Sekhon, MD; Kriti Gwal, MD; John McGahan, MD

A variety of intrathoracic masses may present in the fetus and present as a mimic to congenital diaphragmatic hernia. Knowledge of their locations, ultrasound characteristics, and MRI findings helps limiting the differential diagnosis and guiding treatment. Jointly provided by IAME and Anderson Publishing Inc., this activity is designed to educate radiologists about fetal intrathoracic masses and distinguishing imaging features that will help in guiding management. Knowledge of the ultrasound and MRI features of these masses will help in differentiate these masses from congenital diaphragmatic hernia. Once this diagnosis can be made ultrasound and MRI may also be used to predict residual pulmonary tissue and other findings, such as liver herniating into the thorax, which will help guide fetal and neonatal therapy.

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

Pooja Agrawal, MD; Carolyn M. Audet, PhD; Laura L. Ernst, BA; Katie Lang, MS; Sonya A. Reid, MD, MPH; Katie M. Davis, DO; Rebecca Selove, PhD, MPH; Maureen Sanderson, PhD; Lucy B. Spalluto, MD, MPH

Numerous risk assessment models are available to calculate a woman’s lifetime risk of developing and/or carrying a gene mutation that may predispose her to developing breast cancer. Knowledge of risk may help to inform individual screening practices. Further understanding and evaluation of risk assessment models are needed to increase their utilization.

The purpose of this activity is to 1) introduce breast cancer risk assessment models for estimating an individual’s risk of developing breast cancer or risk for carrying a gene mutation that may predispose to developing breast cancer, 2) review the strengths and limitations of each model and the model’s applicability to underrepresented populations, and 3) provide an example that demonstrates the use of risk assessment models.

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

Aurela Clark, MD; Xiaoqin Wang, MD; Riham El Khouli, MD; Margaret Szabunio, MD

The techniques described in this article will aid the radiologist in performing and interpreting a US exam for appendicitis. The article details assessment criteria pertaining to the normal appendix and acute appendicitis, differential diagnosis and potential pitfalls, and considerations for the reporting of right lower quadrant US findings.

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

Nikhil G. Thaker, MD, MHA, MBA; Brian De, MD; Chirag Shah, MD; Sudhir Manda, MD; Trevor J. Royce, MD, MS, MPH; Sushil Beriwal, MD, MBA

As health care systems transform from traditional care delivery models to digital health models, IoT will enable integration of electronic health records and nonhealth care data with therapeutic augmented reality, wearable technologies, smart voice assistants, digital medicines, robots with artificial intelligence capabilities, continuous and Bluetooth-enabled monitors, and smart cameras. This review discusses the digital transformation of health care systems, IoT technology in cancer care, its practical applications in radiation oncology, and ongoing opportunities and challenges.

To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Navpreet Kaur Khurana, MBBS; Saurabh Jha, MD

Cardiac involvement in light chain and transthyretin amyloidosis is commonly encountered by radiologists. Cardiac MRI is the primary imaging modality for cardiac amyloid (CA) with high sensitivity and specificity. However, other cardiac conditions can mimic CA, potentially affecting the accuracy of diagnosis. Knowledge of these mimics will help improve diagnosis and management of CA.

This activity is designed to educate trainees and radiologists on the typical and atypical findings of cardiac amyloidosis on cardiac MRI and nuclear medicine. This will reduce positive and false negative interpretations and lead to improved diagnosis.

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

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.

Through comprehensive case study reviews and panel discussions, imaging experts in the field of neuroradiology will provide insights into the effective implementation of contrast-enhanced perfusion MRI protocols and functional imaging techniques designed to improve visualization of the anatomy and physiology.

A review of a recently revised ACR guidance document will empower radiologists when performing perfusion MRI applications and may improve both their clinical confidence and their consultative roles when communicating with the patient’s care team

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

• State the clinical benefits of MR perfusion and/or functional imaging in the diagnosis of glioblastomas.
• Implement impactful MR perfusion imaging protocols in their practice.
• Participate in patient and referring physician conversations in a more consultative role with improved knowledge and communication skills.

This program is made possible through an unrestricted educational grant from Bayer HealthCare.

Kaitlin M Zaki-Metias, MD; Mehrvaan Kaur, MD; Huijuan Wang, MD; Bilal Turfe; Nicholas Mills, MD; Yanruo Lu, MD; Bashir H Hakim, MD; Leslie S Allen, MD

Pregnant patients infrequently undergo CT given the risk of radiation to the developing fetus. As such, when CT is performed on pregnant patients in emergent situations, radiologists may be unfamiliar with the appearance of the placenta on CT and its normal evolution throughout gestation. This activity is designed to educate radiologists about the normal appearance of the placenta on CT and its evolution throughout pregnancy, as well as differentiation of these findings from placental abruption.

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.

Chipo Raranje, MS; Ryan Mueller, MD; Alex T. Price, PhD; Lauren E. Henke, MD; Xiaodong Zhao, PhD; Hyun Kim, MD; Eric Laugeman, MS; Joshua P. Schiff, MD

The authors describe practical treatment planning considerations for implementing a cone-beam CT-guided adaptive radiation therapy (CTgART) program with a specific focus on a template-based treatment planning methodology. The article discusses diseasesite- specific treatment planning considerations for the delivery of CTgART to the thorax, abdomen, prostate, and bladder, and examines future directions for this technology, which is becoming increasingly accessible and utilized in radiation oncology.

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