This program reviews fundamental MRI safety information 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. Notably, 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 involved with MRI technology.

With 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, MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present the information in this program.

Advanced MRI Safety Training for Healthcare Professionals (4th Edition), Level 2 MR Personnel is a 2 hour and 45 minute program that is divided into three different sections.

Educational Objectives

• Understand the safety issues related to MRI.
• Describe the bioeffects associated with the static magnetic field, time-varying magnetic fields, and radiofrequency fields.
• Present guidelines that prevent projectile-related accidents.
• 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.
• Understand the 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.

Annual mammography screening can save lives because breast cancer is a progressive disease and early detection enables improved prognosis due to appropriate treatment of small nonpalpable node-negative cancers. Multiple randomized controlled trials and observational studies have shown that mammography can reduce breast cancer mortality by 30% or more.

Digital breast tomosynthesis (DBT) first entered the breast imaging clinical arena when the Food and Drug Administration (FDA) approved DBT in 2011. Multiple studies have shown that DBT is effective in both mammography screening and diagnostic settings. Tomosynthesis has quickly emerged as a practice-changing standard that improves the clinical accuracy of a mammogram by increasing both sensitivity and specificity; thus, reducing the masking effect of overlapping fibroglandular tissue, thereby improving breast cancer detection. The improved accuracy and overall efficiency that DBT provides, will enhance radiologists’ performance and improve the patient experience.

Learning Objectives

• Discuss the importance of breast screening mammography.
• Incorporate the differences between, and benefits of 2D and 3D mammography into routine clinical practice.
• Apply 3D tomosynthesis to improve patient care, particularly in the management of patients with dense breasts.

No special educational preparation is required for this CME/CE Activity!

Supported through an unrestricted educational grant from FUJIFILM Medical Systems U.S.A., Inc.

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 2019 Archived Program

This Expert Forum Symposium features two respected radiologists who share their clinical experience applying advanced artificial intelligence techniques in both MR and CT imaging.

MR and CT imaging are advancing at a rapid rate with new scanner and software technology finding its way into advanced imaging scanners each year. Artificial Intelligence is proving to play a major role in this expansion. In this one-hour accredited CME symposium, Dr. Gold and Dr. Prokop will provide insight into how they are putting new AI tools into everyday practice at their facilities and explain how these tools are providing better patient care and throughput. Following the presentations, the faculty will take question from the audience.

Advances in CT Imaging
Presented by: Mathias Prokop, MD

Advances in MSK MR Imaging
Presented by: Garry E. Gold, MD

Educational Objectives

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

1. Practice two new novel approaches for advanced joint imaging with MR
2. Describe the clinical value of deep learning reconstruction techniques in CT
3. Discuss and implement Artificial Intelligence into clinical practice today

This program was originally presented live at RSNA 2019 and sponsored by the Institute for Advanced Medical Education (IAME) and supported through an unrestricted educational grant from Canon Medical Systems.

Matthew Schwenke, MD; Manu Singh, MD; and Bernard Chow, MD

Injuries to the anterior cruciate ligament (ACL) are increasing over time, with younger women at elevated risk. Meniscal tears are also a significant source of morbidity in both the younger and older populations. Surgical repair of both conditions may alleviate symptoms and allow resumption of athletic activities. Understanding of the pathogenesis, associated findings, and appearance of these injuries on all imaging modalities is critical to their accurate diagnosis and timely treatment. Radiographs may show indirect signs of ACL and meniscal injuries. Ultrasonography is being utilized more often in the workup of these conditions as an adjunct to physical exam and as an initial screening tool. Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions, though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography. ACL and meniscal tears can also be graded and classified according to their appearance on imaging which helps guide the surgeon during arthroscopy.

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; Arezoo Modiri, PhD; Pranshu Mohindra, MD, MBBS

Cardiotoxicity can be an unfortunate side effect from cancer therapies including chemotherapy, hormonal therapy, and radiation therapy (RT). Sub-acute cardiotoxicity can occur during systemic therapies but is often considered a late effect from RT. This manuscript reviews the current literature regarding the clinical impact of radiation-induced cardiotoxicity in the setting of breast cancers and thoracic malignancies including lung cancer, esophageal cancer and mediastinal lymphomas.

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, Dr. Lawrence Tanenbaum and Dr. William Baughman provide a comprehensive review of what the COVID-19 virus is, how it’s transmitted, as well as, how it presents clinically on various imaging modalities. Additionally, a review of “real-world” clinical findings of COVID positive patients, who present with additional symptoms that are manifested from coronavirus will be shared. Following the presentations, a moderated discussion will take place where questions from the audience will be addressed.

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

• Explain the clinical manifestations and impact of COVID
• Describe the clinical findings and presentations of COVID
• Differentiate the image findings of COVID positive patients

Supported through an unrestricted educational grant from FUJIFILM Medical Systems U.S.A., Inc.

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.

G. Daniel Grass, MD, PhD; Matthew N. Mills, MD; Jacob G. Scott, MD, DPhil; Steven A. Eschrich, PhD; Javier Torres-Roca, MD

Genomics and radiomics provide an opportunity to increase the precision of radiation delivery in selection of dose and spatial delivery. Further understanding of host and tumor differences with interrogative approaches may provide opportunity to precisely deliver radiotherapy beyond spatial and anatomic features to one guided by intrinsic tumor biology. This article addresses how tumor genomic blueprints can be exploited for radiation therapy; radiomics as a noninvasive means to assessing tumor biology; clinical applications regarding treatment response, treatment planning, and toxicity; and radiogenomics utility.

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.

Blair A Winegar, MD; Ethan A Neufeld, MD; Wayne S Kubal, MD

Many acute infectious conditions of the face and neck resulting from common sources, such as pharyngitis, dental infection, and penetrating trauma, are evaluated in the emergency department. The clinical features of these conditions overlap, and clinical evaluation is often insufficient to localize or determine the extent of infection within the deep spaces of the neck.

This article showcases the classic imaging features and locations of a variety of acute face and neck infections encountered in the emergency department. In addition, the imaging findings of potentially life-threatening complications, such as mediastinitis resulting from retropharyngeal abscess and septic pulmonary emboli resulting from Lemierre syndrome, are described.

In the emergency setting, the radiologist’s ability to correctly identify and categorize acute face and neck infections and their complications is paramount to direct appropriate surgical and medical management.

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.

Daniel Koffler, MD; Sewit Teckie, MD; Louis Potters, MD, FACR, FASTRO, FABS

The acute redeployment of health care resources toward COVID-19 has had an immediate impact across the entire health care continuum and, in particular, to the treatment of cancer. The ability to perform surgery, biopsies, procedures, and to offer other ancillary clinical and supportive services, has been significantly impacted. Much has been done to proactively prepare for COVID-19 and to implement policies. The purpose of this review article is to outline how the department of radiation medicine in an epicenter location has managed the COVID-19 crisis to date.

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.

Qiuji Wu, MD, PhD; Xiting Yang, MS; Fengyang Wu, MS; Yahua Zhong, MD, PhD

The rapid spread of the new coronavirus disease (COVID-19) identified toward the end of 2019 significantly impacted everyone in China, and all over the world. Head and neck (HN) cancers are a common malignant tumor type in China, with chemoradiation the standard of care for locally advanced disease. However, the COVID-19 epidemic interrupted the routine diagnosis and treatment of all cancers, including HN cancers, which can progress quickly if treatment is significantly delayed. Cancer patient care at the epicenter of COVID-19 was particularly challenged. Based on the management experience of patients with HN cancer during the outbreak of COVID-19 at a cancer institute in Wuhan, the authors summarize management strategies of patients with HN cancer to provide reference for health care providers facing similar challenges.

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.

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

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.

Pamela Samson, MD, MPHS; Geoff Hugo, PhD; Kaitlin Moore, BSN; Nels Knutson, PhD; Philip Cuculich, MD; Clifford Robinson, MD

Noninvasive cardiac radioablation using stereotactic body radiation therapy (SBRT) techniques has emerged as a potential salvage treatment option for patients with ventricular tachycardia who have either failed procedural or medical management, or have contraindications to receive those therapies again. The recently published phase I/II Electrophysiology-Guided (EP) Noninvasive Cardiac Radioablation for Ventricular Tachycardia trial (ENCORE-VT, NCT02919618) demonstrated early safety and efficacy of this novel use of SBRT. This article reviews the lessons learned from ENCORE-VT, current use and workflow for treatment refractory ventricular tachycardia patients, and future directions for this emergent treatment modality

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.

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.

Angela Y. Jia, MD, PhD; Matthew P. Deek, MD; and Ryan M. Phillips, MD, PhD

This review provides a perspective regarding barriers to expansion of radiation treatments in low- and middle-income countries (LMICs). The authors review the benefit of expanding radiation treatment to patients with oligometastatic disease based on several recent clinical trials including SABR-COMET, ORIOLE, and others. The authors also discuss limitations and barriers to receiving radiation treatment in less developed countries including the sparsity of treatment machines, personnel expertise, and distribution of resources in urban vs rural environments. They further discuss technological advances that may help to develop and increase access to radiation therapy in LMICs.

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.

Digital breast tomosynthesis, also known as 3D DBT first entered the clinical arena in 2011 when the FDA approved its use. Multiple studies have since shown that tomosynthesis is effective in both the screening and the diagnostic setting. This technology has quickly emerged as a practice-changing standard by increasing both sensitivity and specificity, thereby improving breast cancer detection and the clinical accuracy of mammograms.

This Expert Forum educational program focuses on the impact of digital breast tomosynthesis and the role it plays in all aspects of breast screening. In this program, you will hear from an expert panel consisting of four (4) healthcare professionals from various specialties; who are all involved in the diagnosis, treatment and care of breast cancer patients and who will share their clinical insights and experience.

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

• Discuss the importance of breast screening mammography.
• Compare the differences between 2D and 3D mammography.
• Explain how the use of 3D DBT will benefit their patients.
• Increase the collaboration between radiologists and referring physicians.
• Implement best practices for concise communication across the continuum of care.

Supported through an unrestricted educational grant from FUJIFILM Medical Systems U.S.A., Inc.

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.