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, 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 preparing for safety training as Level 2 MR Personnel.

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 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. 

In this CME/CE accredited program Dr. Howard Rowley reviews important efficacy considerations of the FDA approved gadolinium-based contrast agents (GBCAs), including clinical utility, safety issues, and practical approaches for selecting a GBCA when considering patient history, pathology and related risks.

Following Dr. Rowley's presentation, Dr. Rowley joins a panel of MR imaging experts in discussion about this important topic, followed by a moderated Q & A session with audience participation.

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

• List the key considerations in the choice of GBCAs, while balancing safety and efficacy.
• Describe the transient effects of T1 and T2 relaxation during a GBCA bolus.
• Understand the impact of high relaxivity gadolinium agents vs macrocyclic agents.
• Design MRI protocols to optimize exam efficiency and enhanced lesion detection.
• Implement GBCA protocols for special patient populations after considering risk assessment.

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

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.

Steven Sireci, MD

Barium-containing contrast media contain barium sulfate (BaSO₄), as well as a number of additives. The BaSO₄ provides radiodensity (ie, radio-opacity) and physical density (g/mL) to the suspension. Depending on the intended use of the contrast, the specific combination of additives provide other useful properties, including: BaSO₄ particle suspension; mucosal coating; viscosity and texture; sweetness; filling and laxative effects; preservation; foaming prevention; and flavoring. Here we describe the purpose of each ingredient and additive found in BaSO₄ contrast media products currently available for fluoroscopic and radiographic examinations. In addition, we review the role of these products in anatomic radiographic evaluation of the gastrointestinal (GI) tract and in evaluation of the physiology of swallowing. Finally, we review barium preparations used in computed tomography (CT) applications.

At the conclusion of this activity, participants will be able to:

• Explain the role that BaSO₄ plays in barium-containing contrast media;
• Review the purpose of each ingredient/additive found in BaSO₄ contrast media products available for fluoroscopic and radiographic examinations;
• Describe the formulation of barium products that are appropriate for single- and double-contrast anatomic radiographic evaluation of the gastrointestinal (GI) tract;
• Summarize qualities of the barium-containing contrast media used in evaluation of swallowing that make them most appropriate for that application; and,
• State the properties of barium-containing contrast media used in computed tomography (CT) applications.

This program has been supported through an educational grant from Bracco Diagnostics, Inc.

The complete online program has been approved for up to 2.5 ACPE and Category A ARRT continuing educational credits.

This program was supported through an educational grant from Bracco Diagnostics, Inc.

After decades of administrations, substantial evidence has accumulated for the efficacy and safety of gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI). However, their excellent performance has led to increased use and dosing for many neuro and cardiovascular applications in adults and children.
As a result, concern has been growing in the radiology community, particularly with respect to use of the less stable agents, which are generally linear and, therefore, bind less tightly to the gadolinium (Gd) ion. While recognizing the value of these agents, the US Food and Drug Administration (FDA) and the American College of Radiology (ACR) now recommend limiting patient Gd exposure where possible.

One technique for reducing Gd exposure is to use a high-relaxivity GBCA that can be used at a lower dose than a conventional GBCA without impact on image quality. Until recently, however, the GBCA with the highest relaxivity was a linear agent. Consequently, it has been widely recognized for some time that it would be preferable if a GBCA was both macrocyclic in structure and high relaxivity, and that such an agent could be used to reduce Gd exposure by decreasing the amount of Gd injected.

A new GBCA that is both macrocyclic and high relaxivity has been developed and received FDA marketing approval in September 2022. A group of radiologists with extensive experience in contrast-enhanced (CE)-MRI convened to discuss this new GBCA, Elucirem™ (gadopiclenol) injection, and this monograph presents a summary of this expert panel forum.

At the conclusion of this activity, participants will be able to:

• Describe the properties that distinguish Elucirem from the other high-relaxivity and conventional GBCAs;
• Demonstrate an understanding of the clinical development program of Elucirem for neuro and body imaging;
• Define the patient populations that are most vulnerable to higher and/or repeat dosing of GBCAs; and,
• Explain the factors to be considered when deciding to use MRI contrast in vulnerable patient populations.

This content is supported by Guerbet, LLC.

Since the 1990’s, multi-patient contrast administration has been available in the form of the Pharmacy Bulk Package (PBP), which is still offered by several contrast vendors. The FDA required that all related Prescribing Information (PI) sheets for the PBP include specific directions for the dispensing of the contrast from the PBP container. The PI language describes withdrawing the contrast from the bottle in a suitable work area, specifically “a laminar flow hood, using aseptic techniques”. However, this method is not possible in most CT Suites, as laminar flow hoods are generally located in the Pharmacy, not the CT suite.

Therefore, during the last decade, regulators have begun to have concerns about the use of PBP. In 2009, The Joint Commission began citing imaging providers who were using PBP to fill power injector syringes in what they considered an unsuitable work area, as described in the manufacturer’s PBP guidelines for the dispensing of contrast.

This Expert Forum will review the steps taken by the contrast media industry and the FDA to develop a safe and compliant solution for multi-patent contrast administration in CT. This solution is now available as the Imaging Bulk Package (IBP) which is approved for use in the CT Suite. This panel will also share their comprehensive process for incorporating IBP into their clinical practice.

Supported through an unrestricted educational grant from Bracco Diagnostics Inc.

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

• Describe the key properties and application of Eovist.
• Implement protocols to optimize workflow.
• Characterize lesions associated with various liver disease through a review of case examples.

This program has been sponsored by Bayer Healthcare.

In this CE/CME program three MR imaging experts will provide unique perspectives on managing patients with passive implants and devices. The panel will discuss important MRI safety information and details on how to safely image these patients, including a review of screening policies, implant and device manufacturers’ information and resources, and the implementation plan for a MRI safety program, designed to mitigate the potential risks to patients presenting with passive implants and devices.

Learning Objectives

• Identify challenges associated with imaging patients with passive implants on low field (<1.5-T) MR systems.
• Review MRI considerations in order to safely manage patients that present with passive implants referred for scans on low field MR systems.
• Implement protocols to safely scan patients presenting with passive implants that are not labeled for low field scanners, including 1.2-T MR systems.
• Increase the number of patients eligible for MRI exams.

This program is made possible through an unrestricted educational grant from FUJIFILM Healthcare Americas Corporation.

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.

This CME and CE accredited program aims to provide a comprehensive overview of new artificial intelligence applications supporting cardiac CT. Through clinical case study reviews, Dr. Dinesh Kalra will share his clinical knowledge and insights into cardiovascular imaging and provide examples of super-resolution, deep-learning reconstructive technologies that are improving cardiac CT image quality and the overall diagnostic confidence in cardiovascular case interpretations.

Dr. Kalra stated, “I'm able to better see the same segments that were difficult to see with older generation scanners. The image sharpness, the resolution, and the low-contrast detection rates have all improved and there's no trade-off, so one doesn’t sacrifice resolution for radiation dose. This allows us to deliver less radiation, see less noise, while obtaining superb image quality.” 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:

• Describe the various reconstruction techniques and their clinical utility in coronary CT.
• Incorporate advanced AI processing solutions that achieve higher resolutions into cardiac CT imaging protocols in order to improve clinical outcomes.
• Increase diagnostic confidence in the interpretation of stenosis and plaque characterization.

This program has been sponsored by Canon Medical Systems, USA

Margaret M. Fynes, MD; Christine Smith, MS; and Martin B. Brodsky, PhD, ScM

Dysphagia is a common clinical challenge, particularly in the elderly. The modified barium swallow study (MBSS), initially developed by radiologists and speech-language pathologists (SLPs) at The Johns Hopkins Hospital, is critically important for evaluation and treatment of dysphagia. In this article, the authors, radiologist Margaret M. Fynes, MD, and two SLPs, Christine Smith, MS, and Martin B. Brodsky, PhD, ScM, review the technical and patient considerations for optimal performance of the MBSS according to The Johns Hopkins protocol. Because both perspectives, radiologist and SLP, are included, the article is able to highlight the importance of the role of each, as well as how they work together. Elements of the MBSS that have become more standardized over time, specifically the barium sulfate contrast agent products used, and the scoring and reporting of the examination with the Modified Barium Swallowing Impairment Profile (MBSImP), are described, and the contribution of this standardization to the overall accuracy and reliability of the MBSS is discussed.

At the conclusion of this activity, participants will be able to:

• Review the causes and incidence of dysphagia
• Describe technical and patient considerations associated with performing a fluoroscopic modified barium swallow study (MBSS) to evaluate dysphagia
• Explain how the MBSS contributes to the evaluation and treatment of patients with dysphagia by assessing the cause of dysphagia and allowing implementation of compensatory strategies in real-time
• Explain the importance of the relationship between the radiologist and speech-language pathologist (SLP) during performance of the MBSS >
• Explain how use of a standardized series of barium sulfate contrast agent products, as well as use of the Modified Barium Swallowing Impairment Profile (MBSImP), have contributed to standardization of the MBSS examination
• Detail the benefits of MBSS standardization on the robustness and consistency of the examination

This Program Has Been Supported Through An Unrestricted Educational Grant from Bracco Diagnostics, Inc.

Gadolinium-based contrast agents (GBCAs) differ in structure and ionicity which, in turn affects their stability and safety profiles. The more stableagents are associated with a lower risk of nephrogenic systemic fibrosis (NSF) and less Gd deposition in brain, bone, and other tissues. Several patient populations are considered vulnerable to Gd exposure, including children, the elderly, the renally impaired, and those that require repeat MRI exams.

In these cases, GBCA utilization should be limited to studies where the results contribute significantly to the diagnosis and/or patient management.

In the following webinar and corresponding monograph, Lawrence N. Tanenbaum, MD, FACR and Donna Roberts, MD share case examples including MRI applications and considerations for understanding at risk adult and pediatric patient populations when performing Neuro MRI.

• Identify patient populations at increased risk of experiencing an adverse event following administration of a GBCA.
• Understand and discuss risk factors related to the use of GBCA's in specific patient populations.
• Implement alternative approaches for the clinical management of at risk patients.

Supported through an educational grant from GE Healthcare