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.

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

While gadolinium-based contrast agents (GBCAs) are essential to performing 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. One technique for reducing gadolinium exposure is to use a high-relaxivity gadolinium-based contrast agent (GBCA) that can be administered at a lower dose than a conventional GBCA without negatively impacting image quality. Gadopiclenol is an FDA-approved, macrocyclic, high relaxivity GBCA that reveals high-quality images at half the conventional dose of other GBCAs and is approved for body MRI applications.

This educational program provides the clinical rationale for adopting the use of Gadopiclenol for Body MRI.

Through case study reviews, Bachir Taouli MD, will share clinical insights to achieve optimal image quality using a lower administered gadolinium dose during body MRI. A focus on the safety, selection and utilization of a high relaxivity, lower dose GBCA will be supported by clinical evidence and imaging protocols. Audience participation will be encouraged during the Q & A session following the presentation.

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

• State the properties of the FDA-approved GBCAs (gadolinium-based contrast agents).
• Understand the clinical risks and safety considerations of GBCA selection and utilization.
• Implement the use of Gadopiclenol in Body MRI applications.

This program is an educational activity sponsored by Guerbet, LLC.

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.

One technique for reducing this exposure is to use a high relaxivity GBCA that can be administered at a lower dose than a conventional GBCA, without any impact on image quality. GBCA selection for interventional procedures such as radiosurgery is one such example, where the selection of a GBCA can play a role in patient management and outcomes.

In this program, an experienced neuroradiologist and neuro oncologist will present their clinical experiences with the use of stereotactic localization radiosurgery, following the administration of a high relaxivity GBCA. Through case study examples, the clinical impact of contrast selection will be demonstrated. Following the presentation, questions from the audience will be addressed during a live Q&A.

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

• Review the role of stereotactic radiosurgery (SRS) for brain metastases and the role of pre-operative localization MRI exams for stereotactic radiosurgery.
• Outline the differences between gadopiclenol and other group II gadolinium-based contrast agents.
• Discuss the use of gadopiclenol in specific case-based scenarios for stereotactic localization exams and its impact on patient management.

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

Depending on its intended application in Fluoroscopy or CT, Barium Sulfate (BaSO4) contains specific combinations of additional ingredients that support the diagnosis of disease, define treatment options, and improve patient outcomes. When used for the anatomical evaluation of the GI tract or the physiology of swallowing, a comprehensive understanding of the clinical utility of Barium products and their additives, is needed. This accredited program explains the differences and the benefits of each additive and is designed to increase knowledge about the clinical applications of Barium.

Dr. Sireci will provide a comprehensive overview of each Barium product, its indication and intended use. Following the presentation, the audience is invited to join Dr. Sireci for lively Q & A session.

Educational Objectives:
At the completion of this activity, participants should 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 currently 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.
• State the properties of barium-containing contrast media used in computed tomography (CT) applications

Educational Credits
One (1) AHRA CRA Credit

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

In this Expert Forum, Lawrence Tanenbaum, MD, FACR and Suzie Bash, MD review considerations for optimizing contrast-enhanced MRI in neuroimaging, extending from patient tolerance to standardizing procedures. Following the presentation questions from the audience were addressed in a moderated Q&A session.

Educational Objectives:

• Manage issues related to patient tolerability and acute adverse events.
• Implement standardized and optimized MR contrast-enhanced protocols.
• Identify clinical indications for contrast-enhanced MRI for brain and spine imaging

Supported by GE Healthcare

Catriona M. Steele, PhD, Bonnie Martin-Harris, PhD, Memorie Gosa, PhD, Stephanie Edwards Allen, BSRT, MBA

The MBSS, also known as a video fluoroscopic swallow study (VFSS), is a barium-sulfate–enhanced fluoroscopic motion study used to evaluate anatomy and swallowing physiology si­multaneously in real time. Varibar, an FDA-approved barium sulfate product for evaluation of dysphagia, together with The Modified Barium Swallow Impairment Profile (MBSImP), are used to ensure standardization and reproducibility in the MBSS. This monograph explains the relationship between Varibar, the MBSImP, and the International Dysphagia Diet Standardisation (IDDSI) framework in evaluation of swallowing in clinical practice.

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

• Explain how the modified barium swallow study (MBSS), The Modified Barium Swallow Impairment Profile (MBSImP), and barium sulfate products are used to evaluate dysphagia
• Describe the development of FDA-approved barium sulfate products used to assess dysphagia
• Review the International Dysphagia Diet Standardisation (IDDSI) framework: what it is and how it was developed
• Define the relationship between the MBSS, the MBSImP, barium sulfate, and IDDSI, and how they are used in clinical practice
• Summarize pediatric and clinical-practice considerations in performing the MBSS

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

Cheri Canon, MD, and Jayleen Grams, MD, PhD

Obesity has been linked to increases in several clinically significant comorbidities. To address these related health issues, the number of bariatric procedures is growing. This monograph describes the role Fluoroscopy plays in the evaluation of the bariatric patient including a review of the imaging protocols and their necessary findings; designed to guide clinical decisions regarding which bariatric procedure is most appropriate for the patient.

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

• Review the incidence of obesity and the role of bariatric surgery as a strategy to address it
• Explain the advantages of fluoroscopy in the evaluation of the bariatric patient
• Summarize the considerations when performing fluoroscopic evaluation of the pre- and post-operative bariatric patient
• Describe the protocols for fluoroscopic imaging of the gastrointestinal (GI) tract, including single- and dual-phase esophagrams and upper GI examinations
• Detail the main challenges to performing fluoroscopy in bariatric patients
• Relate the value of communication between the radiologist and bariatric surgeon

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

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.

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.

Jessica G. Zarzour, MD • Bonnie Martin-Harris, PhD • Jeanne Hill, MD

The modified barium swallow study (MBSS) is a videofluoroscopic imaging study used to evaluate oral and pharyngeal swallowing function and airway protection. The exam is typically performed by a radiologist together with a speech-language pathologist (SLP). The American College of Radiology (ACR) creates and periodically updates Practice Parameters and Technical Standards for various radiologic procedures, including the MBSS. The goal of these Practice Parameters is to “promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills, and techniques,” and to “narrow the variability among radiology practices and provide guidance to achieve quality in radiology.” In 2023, the ACR partnered with the Society of Pediatric Radiology (SPR) to update the MBSS Practice Parameter. The updated ACR-SPR Practice Parameter for the Performance of the Modified Barium Swallow Study is summarized herein.

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

• Explain how the modified barium swallow study (MBSS), The Modified Barium Swallow Impairment Profile (MBSImP), and barium sulfate products are used to evaluate dysphagia
• State the clinical benefits and indications for the modified barium swallow study (MBSS);
• Detail the clinical benefit of standardized, validated protocols and commercially available barium sulfate products to reduce variability of the MBSS exam;
• Describe the technical and patient considerations associated with the MBSS;
• Implement the imaging protocol for a standardized MBSS examination;
• Demonstrate opportunities for improved communication between radiologists and speech-language pathologists.

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

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 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.

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

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.

Learning Objectives

• Implement digital breast tomosynthesis protocols in clinical practice.
• Differentiate characteristics of synthetic 2D mammography by manufacturer.
• Discuss differences between wide vs narrow angle DBT acquisition and its effect of angular range on synthetic-2D image generation.

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

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.