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

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.

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.

In this Expert Forum, Dr. Matthew Covington shares his understanding of the benefits and limitations of contrast-enhanced mammography, as compared to contrast-enhanced breast MRI, and how this imaging technique can be incorporated into clinical practice. Following the presentation questions from the audience were addressed in a moderated Q&A session.

Learning Objectives

• Dictate the strengths and limitations of contrast-enhanced mammography compared to contrast-enhanced breast MRI.
• Recognize indications for the appropriate use of contrast-enhanced mammography.
• Implement a contrast-enhanced mammography program.

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

Ryan Lee, MD, MBA • Daniel Karolyi, MD • Matthew Kuhn, MD, FACR • Mahmud Mossa-Basha, MD • Joseph Cavallo, MD, MBA

This CE accredited program will provide an educational resource that addresses current and future iodinated contrast media shortages and its clinical impact.

By bringing together a group of radiologists with expertise in CT, MRI, NM/PET, US & AI, who have experienced this crisis in their imaging departments and who have established ‘best practices and procedures’ designed to address clinical and operational alternatives in order to deliver safe and effective patient care throughout Radiology; this comprehensive program will cover the following topics:

• The operational impact of contrast media waste.
• The use of saline supporting contrast optimization with improved image quality.
• Patient safety considerations & imaging challenges when moving to alternative imaging methods.
• When and how to implement emergency protocols, based on iodinated contrast availability.
• The use of AI to provide improved outcomes without the use of contrast.

Clinical scenarios that include IV and oral contrast administration, patient management, non-contrast imaging options, and the use of Barium and other contrast media will be discussed.

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

• Identify which imaging exams may be affected by a shortage of iodinated contrast media.
• Implement emergency protocols to continue providing safe and effective patient care.
• Manage clinical challenges associated with moving from one preferred imaging modality to another (i.e., CT vs MRI vs NM vs US)
• Employ the use of AI solutions to support imaging capabilities and address patient specific imaging outcomes.

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

In this Expert Forum, Dr. Lawrence Tanenbaum, MD, FACR, will review the classification of Gadolinium MR contrast agents according to their molecular structure, ionicity, and stability. The impact of these properties and supporting clinical data for safety considerations in choosing an agent will be discussed with the goal of providing insight that can be applied in everyday clinical practice. Following the presentation questions from the audience were addressed in a moderated Q&A session.

Educational Objectives:

• To review the current landscape of Gadolinium-based contrast agents and their classification according to their molecular structure, ionicity, and stability.
• To understand how these properties impact the safety and efficacy of GBCAs.
• To review the important clinical data that impact safety considerations in choosing an MR contrast agent and how that applies to everyday clinical practice.

Supported by GE Healthcare

Howard Rowley, MD, FACR; Lorna P. Browne, MD; Kevin J. Chang, MD, FACR; Christopher Comstock, MD, FACR; J. Paul Finn, MD; Scott Reeder, MD, PhD; Max Wintermark, MD

Currently, 6 general-use gadolinium-based contrast agents (GBCA) are available and approved for a variety of MRI indications, including brain, body, and breast imaging, in adults and children. Gadolinium-based contrast agents comprise a gadolinium (Gd) ion bound to an organic ligand to form a chelate. Whether the chelate is linear or macrocyclic and ionic or nonionic impacts the size and stability of the Gd-chelate complex, as well as its distribution and elimination. In addition, the chelate structure also impacts the relaxivity, or r value, of the GBCA, which dictates the ability to provide contrast enhancement relative to background. Understanding the different safety and efficacy profiles of GBCAs can be valuable when selecting a GBCA. Here, we present discussions from a recent Expert Panel Forum focused on the safety and efficacy of GBCAs, as well as specific considerations related to their selection for neuroimaging, pediatric imaging, body imaging, and breast imaging applications.

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

• Describe the distinguishing properties of the available gadolinium-based contrast agents (GBCAs) currently used for magnetic resonance imaging (MRI);
• Review how the structure of the gadolinium (Gd)-chelate complex determines the stability of a GBCA, and how stability relates to both Gd retention and nephrogenic systemic fibrosis (NSF);
• Explain what a “high-relaxivity” GBCA is and summarize results of crossover studies comparing standard- and high-relaxivity GBCAs for MRI; and,
• State the key considerations when selecting a GBCA for neuro MRI, pediatric MRI, body MRI, and breast MRI.

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

This accredited program provides a comprehensive overview of MRI safety including the radiologist's responsibilities and liabilities, MRI staff education and patient safety. It is designed specifically for practicing radiologists, fellows, residents, and healthcare professionals who oversee MRI services and will provide practical guidance from two respected MRI safety educators who present information on accepted safety standards of care based on the 2020 ACR Manual on MR Safety, the 2021 FDA Guidance Document, and a review of the literature.

Program Considerations: It is critical to have established MRI safety protocols and to have a clear understanding of the basics of MRI Safety. 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. These MRI safety policies should be reviewed and updated annually in order to prevent patient injury.

Educational Objectives

• Describe the difference between Level 1 & Level 2 MR personnel.
• Differentiate and identify the ACR-designated Safety Zones.
• Implement safety considerations for the static magnetic field, time-varying gradient magnetic fields, and radiofrequency fields.
• Employ procedures and protocols to prevent RF-related burns and methods to manage SAR levels.
• Manage acute and chronic gadolinium-based contrast agent adverse events.

Program support provided by Bracco Diagnostics, Inc.

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

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