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.

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.

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.

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.).

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.).

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.

With a wide selection of gadolinium-based contrast agents now available in the US Market; MR imaging professionals must understand the chemical structure, differences in stability and relaxivity and safety profiles of each of these FDA approved MR agents.

Following Dr. Tanenbaum's presentation, questions from the audience will be addressed.

Educational Objectives

At the completion of this program, participants will:

• Refresh their understanding of the various contrast agents now FDA approved and available in the US market.
• Understand the safety profiles of the available agents as well as the relationship to the individual physiochemical properties and stability.
• Develop a better understanding of how recent knowledge affects the selection, use and screening before contrast use.

Supported Through An Unrestricted Educational Grant from Guerbet, LLC.

As technology continues to impact how healthcare is practiced, this presentation on Image-Guided Interventional Radiology Procedures Using a Combined Angiography CT Systems will highlight through the clinical experiences of an Expert Faculty; how they are maximizing the latest advances to increase patient care, satisfaction and throughput.

This program was originally presented live at RSNA 2016 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Toshiba America Medical Systems.

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.

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.

Uncertainty still exists regarding the appropriate and effective routine assessment of myocardial disease with contrast-enhanced MRI. Today more recent and novel MRI myocardial characterization techniques exist, such as T1 and T2 mapping. However, insufficient awareness of the pitfalls in cardiac MRI diagnosis frequently contribute to missed diagnosis in the workup of patients with myocardial infarction and other diseases of the heart muscle.

This Expert Forum featuring Dr. Joseph Schoepf will address these issues and provide a review of the basic principles and recent advances in contrast-enhanced Cardiac MR imaging. Particular emphasis will be placed on the MR assessment of diseases of the myocardium and novel methods for their granular characterization. Following Dr. Schoepf's presentation, a short Q&A was conducted where questions from the audience were answered.

Educational Objectives

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

• Select suitable approaches for the routine assessment of myocardial disease with contrast-enhanced MRI.
• Discuss current developments in the MR characterization of the myocardium.
• Implement methods to improve accuracy of Cardiac MRI for the granular, comprehensive diagnosis of myocardium infarction and fibrosis.

Supported through an unrestricted educational grant from Guerbet, LLC.

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.

Fetal MRI is a relatively new area of imaging, which is technically challenging. It is important to understand the safety implications when imaging a fetus. In addition, given that the fetus is not sedated, it is important that technical knowledge of the imaging and a planned approach to the procedure is in place.

In this educational lecture, the preparation, positioning, planning for and obtaining of images as well as problem solving during the procedure will be discussed. The importance of anatomic imaging leading to accurate interpretation will be reinforced in cased-based examples of imaging singleton and twin gestations.

Following Dr. Kline-Fath's presentation questions from the audience were addressed in a moderated Q&A session.

Educational Objectives

• Review the safety of fetal MR Imaging.
• Describe the technical approach to fetal MR Imaging.
• Describe cases in which fetal MRI was helpful in the evaluation of singleton and twin gestations.

Supported Through An Unrestricted Educational Grant from Philips Healthcare.

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 first webcast of a 2-Part Series, Dr. Lawrence N. Tanenbaum discusses the advantages of High Field Open MRI in Neuro imaging.

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 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 Neuro imaging.

Supported through an unrestricted educational grant from Hitachi Healthcare Americas