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 deteriorating image quality. Gadopiclenol recently approved by the FDA is a high-relaxivity GBCA, designed to reveal high-quality images at half the conventional dose of other GBCAs.

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

Through case study reviews, Azam Eghbal, MD, will share clinical insights to achieve optimal image quality using a lower administered gadolinium dose when performing pediatric MRI. A focus on the selection and use of a high relaxivity, lower dose GBCA in vulnerable patients, receiving multiple MR contrast injections, 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:

• Explain the properties that distinguish gadopiclenol from other GBCAs.
• Apply clinical considerations for lower gadolinium dosing options using gadopiclenol for pediatric MRI.
• Implement gadopiclenol MR imaging protocols to achieve optimal imaging and diagnostic confidence in pediatric MRI.
• Employ the use of gadopiclenol in vulnerable patient populations who may experience repeat, lifetime dosing and scanning.

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

Dynamic contrast-enhanced breast MR imaging using gadolinium-based contrast agents (GBCAs) offers superior cancer detection to mammography and breast ultrasound due to the visualization of tumor neovascularity as a tumor-specific feature. Despite the clear advantages of breast MR imaging, it is currently recommended only for patients with a high lifetime risk of breast cancer, but recent data shows that there is also a benefit for women at a greater than average risk

While 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 where possible. One technique for reducing gadolinium exposure is to use a high-relaxivity GBCA that can be administered at a lower dose than a conventional GBCA without deteriorating image quality. Gadopiclenol recently received FDA approval and is a high-relaxivity GBCA that decreases gadolinium exposure.

This educational program provides a clinical rationale for lowering the administered gadolinium dose when performing breast MRI on patients who may receive repeat MR contrasted exams throughout their lifetime for breast cancer screening. Through a review of case studies, Dr. Pinker-Domenig will provide insight on how to achieve optimal imaging while lowering the gadolinium dose with Gadopiclenol for breast MRI.

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

• Understand and employ the clinical indications for dynamic-contrast enhanced breast MRI.
• Access clinical considerations and apply lower gadolinium dosing options for patients who may experience repeat, lifetime dosing of a GBCA for breast MRI.
• Implement breast MR imaging protocols to achieve the most accurate breast cancer diagnosis.

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

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. 

CT Technology continues to evolve with modern platforms now being designed with improved patient comfort, increased workflow, and advanced applications supporting comprehensive diagnoses, precise treatment plans and better patient outcomes.

In this CE accredited Expert Forum Webinar, Rick Banner, RT (R), Senior Director of Marketing, Fujifilm Medical Systems U.S.A., Inc. shares insights into the design of advanced CT platforms that are addressing today’s clinical challenges while reducing the total cost of ownership. These advanced features will be supported by Dr. Lawrence N. Tanenbaum’s personal experience on how these advanced features are making a clinical difference in the day-to-day operations in busy imaging departments.

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

• Implement advanced CT applications
• Effectively manage obese and claustrophobic patients
• Implement workflow considerations with improved CT service and reliability

Supported through an educational grant from FUJIFILM Medical Systems U.S.A., Inc.

In September 2022, Gadopiclenol injection, which is both macrocyclic (stable) and has high relaxivity properties received FDA marketing approval and may provide dosing options that can decrease gadolinium exposure, particularly in vulnerable patients.

In this accredited Expert Forum webinar, the assessment of Gadopiclenol injection in neuro, body, and pediatric MR imaging will be presented by a panel of MR imaging experts and will include commentary from Lawrence N. Tanenbaum, MD. To encourage audience participation, a live Q & A session will follow the discussion.

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

• Explain the properties that distinguish Gadopiclenol injection from the other high-relaxivity and conventional gadolinium-based contrast agents.
• Describe the clinical use of Gadopiclenol injection in neuro, body, and pediatric MRI applications.
• Describe the clinical development program of Gadopiclenol injection for neuro and body MRI applications.
• Apply clinical considerations and dosing options when selecting a macrocyclic, high relaxivity, MRI contrast in vulnerable patient populations.

This program has been sponsored by Guerbet LLC.

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.

Applied Radiology has developed this two-part, on-demand webinar and accompanying digital monograph to increase overall understanding of the properties, clinical benefits, and safety considerations of iodinated and gadolinium-based contrast agents (GBCAs). The goal of this program is to fully prepare pharmacy personnel to make informed decisions regarding contrast media selection.

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.

This educational program featuring Dr. Shreyas Vasanawala will cover pediatric MR imaging applications using Gadopiclenol, a recently approved gadolinium-based contrast agent (GBCAs).

Following a brief review of the literature and the currently available GBCAs, Dr. Vasanawala will discuss practice considerations as they relate to MRI contrast media selection and dose administration. Additionally, Dr. Vasanawala will share several case studies demonstrating the clinical value and benefits of Gadopiclenol for patients who may present with complex pathology and/or who may be subject to repeat contrast-enhanced MRI exams over their lifetime.

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

• Explain the properties that distinguish gadopiclenol injection from the other high relaxivity gadolinium-based contrast agents (GBCAs).
• Employ the FDA-approved indications and clinical applications for gadopiclenol injection in pediatric patients.
• Apply clinical considerations and dosing options for gadopiclenol administered to vulnerable patient populations who may experience repeat, lifetime dosing of a GBCA.

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.

This On-Demand version of this Expert Forum webinar, attendees heard about liver magnetic resonance image acquisition utilizing a hepatobiliary agent. You will learn more about Eovist (gadoxetate sodium) including details on its properties, applications in liver imaging and important safety information.
Through a case study review, details on how your liver imaging protocols and workflow can be optimized will be discussed

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.

As technology continues to improve and redefine the instrumentation used to acquire X-rays. This CE accredited Expert Forum Webinar will focus on key innovations in digital radiography and its impact on technique selection and image quality.

Please join Matthew Hoerner, Ph.D., DAB and Gregg Cretella for a review of these innovations and how you can optimize techniques in a bucky-less DR department. Following the presentation questions from the audience were addressed in a moderated Q&A session.

Learning Objectives

• Implement techniques to optimize image quality regardless of patient size.
• Utilize optimization techniques to manage exposure and deviation index.
• Utilize the proper technique without the use of a Bucky.

Supported through an educational grant from Fujifilm Healthcare Americas Corporation

Through comprehensive case study reviews and panel discussions, imaging experts in the field of neuroradiology will provide insights into the effective implementation of contrast-enhanced perfusion MRI protocols and functional imaging techniques designed to improve visualization of the anatomy and physiology.

A review of a recently revised ACR guidance document will empower radiologists when performing perfusion MRI applications and may improve both their clinical confidence and their consultative roles when communicating with the patient’s care team

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

• State the clinical benefits of MR perfusion and/or functional imaging in the diagnosis of glioblastomas.
• Implement impactful MR perfusion imaging protocols in their practice.
• Participate in patient and referring physician conversations in a more consultative role with improved knowledge and communication skills.

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

This 3-part on-demand program is designed to increase the participant's understanding about the oversight, management, and dispensing of saline for medical imaging. Specifically developed for pharmacists, it is intended to increase pharmacy personnel’s knowledge about the clinical benefits of saline utilization during imaging; intended to improve patient care. Radiologic technologists and others healthcare professionals that support imaging, may find this accredited program of interest.

The complete online program has been approved for up to 1.25 ACPE and Category A ARRT and CRA continuing educational credits.

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