These supplements cover a variety of applications in CT and MR imaging and provide practical guidance to Radiologic Technologists and related healthcare professionals. To review a course, select the appropriate profession. To complete the post test and earn CE credits you must be registered and signed-in to appliedradiology.org.

Vueway™ (Gadopiclenol): Practical Considerations for Use

William Faulkner, BS,RT(R)(MR)(CT), FSMRT, MRSO (MRSC™)

Estimated time for completion: .75 hour   •   Date of Release: May 1, 2024   •   Expiration Date: April 30, 2027

Prior to 2023, six extracellular fluid magnetic resonance imaging (MRI) contrast agents were available in the US: ProHance® (gadoteridol), Gadavist® (gadobutrol), Dotarem® (gadoterate meglumine; Clariscan™ (gadoterate meglumine); Omniscan™ (gadodiamide); and MultiHance® (gadobenate dimeglumine). These gadolinium-based contrast agents (GBCAs) vary with respect to chelate structure (ionic vs nonionic; macrocyclic vs linear), molar concentration (the number of Gd molecules per mL), and relaxivity.

With decades of use, these agents were demonstrated to be quite safe; however, since 2006, concerns about the safety of GBCAs have come to light, particularly with regard to the less stable (linear, nonionic) agents. Specifically, nephrogenic systemic fibrosis (NSF) and Gd retention were seen more readily with the use of these less-stable agents. It became apparent that a macrocyclic, high-relaxivity GBCA would be ideal, optimizing patient safety without compromising image quality.

In 2023, the US Food and Drug Administration approved Vueway™ (gadopiclenol) injection, a macrocyclic, high relaxivity agent that represents a significant advancement in terms of efficacy and safety. This paper compares the properties, mechanism-of-action, dosing, efficacy, and safety of the currently available GBCAs to the new agent Vueway.

Learning Objectives

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

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 0.75 "Category A" ARRT continuing education credit.

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

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Modified Barium Swallow Study ACR-SPR Practice Parameter: 2023 Update

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

Estimated time for completion: 1 hour   •   Date of release and review: March 1, 2024   •   Expiration Date: March 31, 2027

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.

Learning Objectives

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

Disclosures

Jessica G. Zarzour, MD: Financial disclosures for Dr. Zarzour include: Consulting contract with Bracco Diagnostics, Inc.;
Honorarium for her participation in this monograph. She has no nonfinancial relationships to disclose.

Bonnie Martin-Harris: Financial disclosures for Dr. Martin-Harris include: Principal Investigator, NIH/NIDCD K23DC005764; Standardized assessment of swallowing impairment, 2003-2010; Principal Investigator, NIH/NIDCD 2K24DC012801-0, Data Science; Applications in Communication and Swallowing Disorders, 2013-2024; Clinical Impact of Respiratory- Swallow Training on Refractory Dysphagia in OP HNC, VA Merit Review Award 5101RX002352 2018-2022; Machine Vision Fellowship, Bracco Diagnostics, Inc. 2020-2021; MBSImP royalty recipient from the Medical University of South Carolina; Honorarium received from participation in this monograph.

Nonfinancial disclosure includes owner and license guarantor to Northern Speech Services (NSS).

Jeanne Hill, MD: Financial disclosure for Dr. Hill include: Honorarium for her participation in this monograph. She has no nonfinancial relationships to disclose.

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

ASHA CE Provider approval does not imply endorsement of course content, specific products or clinical procedures.

This course is offered for 0.1 ASHA CEUs (Intermediate Level)

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

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Clinical Utility of Barium Sulfate Products: Formulation Determines Appropriate Use

Steven Sireci, MD

Estimated time for completion: .75 hour   •   Date of Release: June 14, 2021  •   Expiration Date: July 31, 2026

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.

Learning Objectives

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

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 0.75 "Category A" ARRT continuing education credit.

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

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Diagnosis and Management of Swallowing Physiology:

Standardized Contrast, the MBSImP™ & the IDDSI Framework

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

Estimated time for completion: 1 hour   •   Date of release and review: May 1, 2021   •   Expiration Date: May 31, 2026

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 si¬multaneously 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.

Learning Objectives

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

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

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The Modified Barium Swallow Study: When, How, and Why?

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

Estimated time for completion: 1 hour   •   Date of Orignal Release: September 01, 2019  •   Updated Release: September 27, 2023  •   Expiration Date: September 30, 2026

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.

Learning Objectives

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

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

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Fluoroscopic Evaluation of the Bariatric Surgery Patient

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

Estimated time for completion: 1 hour   •   Date of Orignal Release: November 01, 2020  •   Updated Release: December 21, 2023  •   Expiration Date: December 31, 2026

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.

Learning Objectives

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

Accreditation

This course is approved by The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

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MRI Contrast Selection: Greater Stability or Higher Relaxivity?

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

Estimated time for completion: 1.0 hour   •   Date of Release: July 1, 2022  •   Expiration Date: June 30, 2024

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.

Learning Objectives

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

Accreditation

This course is approved by the The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.

Commercial Support

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

To view and complete the Post-Exam and claim credits select Profession below.

(Site Registration/Login Required)