Aurela Clark, MD; Xiaoqin Wang, MD; Riham El Khouli, MD; Margaret Szabunio, MD

Imaging the pregnant patient is challenging as it involves both the parent and the fetus and, consequently, several medical, ethical, or legal considerations. Theoretically, all available imaging modalities may be used to evaluate the pregnant patient; however, in practice, confusion regarding the safety of the fetus often results in unnecessary avoidance of useful diagnostic tests, especially those involving ionizing radiation. This review is part 2 of a 2-part series and focuses on specific clinical scenarios (nonobstetric and obstetric) in pregnant patients and the recommended imaging modalities to answer clinical questions while focusing on fetal and parental safety.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Suhana Fatima Shahid; Tooba Ali, MBBS; Agha Muhammad Hammad Khan, MBBS, FCPS; Nabeel Ashfaque Sheikh, MBBS; Ahmed Nadeem Abbasi, FFR,RCSI

This review article discusses the relationship between artificial intelligence (AI) and radiomics in oncology decision-making, exploring the fundamentals of AI-powered radiomics, its workflow, and the role of radiomic features. The article also describes the integration of AI in radiology, radiation oncology, and medical oncology, particularly its impact on multidisciplinary tumor board (MDT) decision-making, treatment planning, and predicting treatment responses, prognosis, and disease progression. Additional highlights include the role of machine learning algorithms and their impact on MDT decision-making, as well as challenges and implications of AI-driven radiomics in MDTs regarding ethical, financial, and regulatory aspects.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Paul Wojack, MD; Suzanne McElligott, MD; Pamela Walsh, MD; Nina Vincoff, MD; Ekta Gupta, MD

Incidental musculoskeletal findings are fairly common when reading breast MRI, as the ribs and sternum are included in the field of view. It is important that radiologists be familiar with the appearance of benign and malignant chest wall lesions on breast MRI in order to appropriately direct diagnosis and treatment, as well as to avoid unnecessary workup of benign lesions.

This activity is designed to educate radiologists about the wide range of both benign and malignant lesions which can be detected incidentally on breast MRI by reviewing the imaging findings and other pertinent demographic considerations regarding these lesions.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Sara Beltran Ponce, MD*; Amy LoTemplio*; Erin Kaya, MD; Katie Lichter, MD; Shradda M. Dalwadi, MD; Sumi Sinha, MD; Lois Wairiri, MD; William Stadtlander; Mary McGunigal, MD; Reshma Jagsi, MD, DPhil; Virginia W. Osborn, MD; Elizabeth Jeans, MD; Gabrielle W. Peters, MD; Jenna M. Kahn, MD
*Co-first authors March

The COVID-19 pandemic led to a shift from traditional work environments to working from home (WFH). The specific benefits and challenges of WFH in radiation oncology are currently unknown. To address this gap in knowledge, a survey-based study was conducted to assess WFH policies and perceptions of their impact, as well as explore the role of departmental gender composition in remote work policies.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Pooja Agrawal, MD; Carolyn M. Audet, PhD; Laura L. Ernst, BA; Katie Lang, MS; Sonya A. Reid, MD, MPH; Katie M. Davis, DO; Rebecca Selove, PhD, MPH; Maureen Sanderson, PhD; Lucy B. Spalluto, MD, MPH

Numerous risk assessment models are available to calculate a woman’s lifetime risk of developing and/or carrying a gene mutation that may predispose her to developing breast cancer. Knowledge of risk may help to inform individual screening practices. Further understanding and evaluation of risk assessment models are needed to increase their utilization.

The purpose of this activity is to 1) introduce breast cancer risk assessment models for estimating an individual’s risk of developing breast cancer or risk for carrying a gene mutation that may predispose to developing breast cancer, 2) review the strengths and limitations of each model and the model’s applicability to underrepresented populations, and 3) provide an example that demonstrates the use of risk assessment models.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Kimberly R. Gergelis, MD; Kimberly S. Corbin, MD; Kaitlin W. Qualls, MD; Yuhchyau Chen, MD, PhD; Nadia N. Laack, MD

Despite limited studies on burnout among radiation oncologists in the United States, especially when compared with data from other countries, there is a prevalence of burnout among radiation oncologists of all career stages, including trainees, attendings, program directors, and academic chairs. This narrative review summarizes articles reporting on burnout and well-being among attending and resident radiation oncologists in the United States, examines burnout at career stages, discusses the impact of COVID-19, and provides strategies to reduce burnout in the radiation oncology field.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Navpreet Kaur Khurana, MBBS; Saurabh Jha, MD

Cardiac involvement in light chain and transthyretin amyloidosis is commonly encountered by radiologists. Cardiac MRI is the primary imaging modality for cardiac amyloid (CA) with high sensitivity and specificity. However, other cardiac conditions can mimic CA, potentially affecting the accuracy of diagnosis. Knowledge of these mimics will help improve diagnosis and management of CA.

This activity is designed to educate trainees and radiologists on the typical and atypical findings of cardiac amyloidosis on cardiac MRI and nuclear medicine. This will reduce positive and false negative interpretations and lead to improved diagnosis.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Lisa Singer, MD, PhD; Benjamin H. Kann, MD; Daniel N. Cagney, MD; Jonathan E. Leeman, MD; Sue S. Yom, MD, PhD; David Kozono, MD, PhD

While traditionally CT- and x-ray based, lung stereotactic body radiation therapy (SBRT) practices will likely be impacted by the emerging availability of MR guidance. This review provides an overview of the role of MR guidance in SBRT for the treatment of lung cancers. Limitations, data, and future directions for treatments are reviewed with a focus on peripheral, central, and ultracentral lung cancers.

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.

Leila T. Tchelebi, MD; Nicholas G. Zaorsky, MD, MS; Jennifer Rosenberg, MD; Kujtim Latifi, PhD; Sarah Hoffe, MD

While MR-guided radiation therapy (MRgRT) offers many benefits, it is a costly and resource-intensive investment that can strain radiation oncology clinics not adequately prepared to incorporate this treatment. This work reviews clinical advantages and practical limitations of MRgRT, and suggests ideal patients for this technology. The authors also provide a practical guide for centers acquiring MRI-based linear accelerators to foster seamless integration.

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.

Amir Hossein Mostafavi Sterabadi, BS; Hassan Anbari, MBChB; Minhaj S. Khaja, MD, MBA; Baljendra S. Kapoor, MD

Liver biopsy is an invaluable adjunct to laboratory findings in diagnosing and treating varioius liver diseases. However, the various methods of obtaining liver samples, their indications and contraindications, as well as the nuances and rationale behind choosing one method over another are not all well understood by interventional radiologists.

This activity is designed to explain different ways of performing liver biopsy and some other ancillary interventions to obtain liver tissue samples. We aim to explain the indications, contraindications, efficacy, patient selection, and potential complications associated with these procedures.

Available for CME Credit. To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Kaitlin M Zaki-Metias, MD; Mehrvaan Kaur, MD; Huijuan Wang, MD; Bilal Turfe; Nicholas Mills, MD; Yanruo Lu, MD; Bashir H Hakim, MD; Leslie S Allen, MD

Pregnant patients infrequently undergo CT given the risk of radiation to the developing fetus. As such, when CT is performed on pregnant patients in emergent situations, radiologists may be unfamiliar with the appearance of the placenta on CT and its normal evolution throughout gestation. This activity is designed to educate radiologists about the normal appearance of the placenta on CT and its evolution throughout pregnancy, as well as differentiation of these findings from placental abruption.

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.

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

Anurag Saraf, MD; Graham Boyd, MD; Alexandra De Leo, MD; Phylicia D. Gawu, DO; Chelsea C. Pinnix, MD, PhD; Steve Braunstein, MD, PhD; Rachel Jimenez, MD; Idalid Franco, MD, MPH; Lisa Singer, MD, PhD

Medical education must develop and adapt through robust education scholarship, applying novel teaching with evidence-based best practices to optimally convey new concepts. Continued growth in undergraduate, graduate and continuing medical education as well as in diversity, equity, and inclusion efforts, are critical for the future of radiation oncology. This review article explores how education scholarship can facilitate these advances in areas from artificial intelligence to technology-oriented teaching.

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.

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.

Zachary K. Englander, MD, MS; Christopher Troy, MD; Masih Tazhibi, BA; Nina Yoh, MD; Hong-Jian Wei, PhD; Neil Feldstein, MD; Elisa Konofagou, PhD; Luca Szalontay, MD; Cheng-Chia Wu, MD, PhD,

The blood-brain barrier (BBB) remains a significant blockade for effective drug delivery in treating diffuse intrinsic pontine glioma (DIPG). Low-frequency focused ultrasound (FUS) therapy in conjunction with intravenous microbubbles can transiently disrupt the BBB in a localized manner to facilitate drug delivery. This review examines recent preclinical studies evaluating the safety and feasibility of FUS-mediated BBB opening in the brainstem. The authors also discuss the published phase 0-2 clinical trials of low-frequency FUS therapy in the adult glioma population, and phase 1 clinical trials in DIPG that are underway.

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.

Nikhil G. Thaker, MD, MHA, MBA; Brian De, MD; Chirag Shah, MD; Sudhir Manda, MD; Trevor J. Royce, MD, MS, MPH; Sushil Beriwal, MD, MBA

As health care systems transform from traditional care delivery models to digital health models, IoT will enable integration of electronic health records and nonhealth care data with therapeutic augmented reality, wearable technologies, smart voice assistants, digital medicines, robots with artificial intelligence capabilities, continuous and Bluetooth-enabled monitors, and smart cameras. This review discusses the digital transformation of health care systems, IoT technology in cancer care, its practical applications in radiation oncology, and ongoing opportunities and challenges.

To receive CME credit, you must complete the post exam and review the discussion and references provided with the exam results.

Praveen Pendyala, MD; Alexander G. Goglia, MD, PhD; Ronald D. Ennis, MD

The authors review the rationale behind the establishment of prior authorization (PA) by health care payers, discuss issues with the current system with a focus on radiation oncology, and propose multiple changes that could improve the system for clinicians, payers, and patients.

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.

Laura E Minton; Renu Pandit; WR Willoughby, PhD; Kristin K Porter, MD, PhD

Gadolinium (Gd)-based contrast agents (GBCAs) dominate the current contrast-enhanced magnetic resonance imaging (CE-MRI) market and are proven to increase the efficacy of diagnostic magnetic resonance imaging (MRI) scans. However, in the future it is likely that a personalized combination of contrast enhancement and image processing techniques will be used to optimize diagnosis and treatment planning while minimizing risk and cost. This activity is designed to educate radiologists about the future of MRI contrasts agents, including high relaxivity macrocyclic GBCAs, alternatives to GBCAs, and imaging processing techniques.

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.

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.

Ryan Holland, MD; Steven Benitez, MD; Addison Fortunel, MD; Andrew Brook, BA, MS; Deepak Khatri, MD; Allan Brook, MD

As thrombectomy has become the standard of care for large vessel/arterial occlusions, operators need an understanding of the techniques as well as the factors important for the device and vascular approach choices. This two-part article examines the latest techniques for endovascular treatment of acute stroke. The first part of this activity appeared in the September-October 2021 issue of Applied Radiology.

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.

Ronald Chow, MS; Minglei Kang, PhD; Shouyi Wei, PhD; J. Isabelle Choi, MD; Robert H. Press, MD; Shaakir Hasan, DO; Arpit M. Chhabra, MD; Keith A. Cengel, MD, PhD; Haibo Lin, PhD; Charles B. Simone, II, MD

In this manuscript, the authors review the proposed mechanisms of action for FLASH radiation therapy (FLASH RT), summarize early preclinical results, discuss the first-in-human treatments with a focus on proton FLASH, and highlight challenges and future considerations of FLASH RT.

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.

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. 

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.

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.