Online Courses for Radiology Administrator

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.

Anyone who enters 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 desiring preparation for safety training as, Level 2 MR Personnel.

With more than 30 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

Gadolinium-based contrast agents (GBCAs) are essential for enhancing the quality of MRI scans to make it easier for radiologists to identify pathology. The US Food and Drug Administration (FDA) and the American College of Radiology (ACR) recommend limiting patient exposure to gadolinium where possible.

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 were addressed during a live Q&A session.

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

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

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.

Educational Objectives:
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.

Published by Applied Radilogy

This Publication is an educational activity supported by Guerbet LLC.

All Infectious diseases acquired within the healthcare system are a serious and at times fatal problem facing healthcare providers and patients. Due to increases in antibiotic-resistance infections and Covid-19, it is essential that healthcare personnel understand how pathogens are transmitted and ways to prevent infection. Studies have confirmed the presence of infectious bacteria on equipment within the radiology suite and solidified the importance of proper decontamination. One study found a contaminated surface bore of the MRI unit to be positive for the presence of MRSA. Another study evaluating contamination of radiographic markers found that 92% of these devices were contaminated.

When discussing COVID-19 specifically, it has been discussed within recent literature that radiologic technologists who perform CT scans are at an increased risk of exposure to COVID-19. This also applies to radiology department staff performing other types of radiologic tests. Becoming familiar with the procedures set in place is essential in protecting radiologic technologists and those working with patients in the radiology setting from exposure to COVID-19 and other infectious diseases in all areas of radiology.

Following completion of this program participants should be able to:

• Understand and discuss the types of infectious diseases
• Describe drug resistance
• Discuss the inappropriate use of antibiotics and its effect on infections
• Differentiate between gram positive versus gram negative bacteria
• List gram-positive and gram-negative bacteria
• Describe the characteristics of hospitalized patients that contribute to transmission of infectious diseases
• Define the guidelines for effective hand-hygiene in healthcare settings
• Describe types of isolation precautions
• Discuss how to prevent infectious diseases in radiology
• Discuss how to properly transport a patient within the healthcare facility
• Understand and discuss aseptic technique in interventional radiology

Magnetic resonance imaging (MRI) with gadolinium-based contrast agents (GBCAs) plays a critical role in the diagnosis, evaluation, and follow-up of many CNS disorders. However, as with all drugs, the risks versus benefits must be assessed prior to each use. GBCAs are widely used and have shown a very good safety profile. Although rare, acute hypersensitivity reactions, a condition known as nephrogenic systemic fibrosis in patients with abnormal renal function, and more recently the long-term retention of gadolinium in the body has been associated with GBCA use.

Donna Roberts, MD, MS, discusses the current landscape of GBCA usage in patients with CNS disorders. In addition, the webinar will review the current practice guidelines and future directs for maximizing the clinical benefits of GBCAs while reducing the exposure of patients to GBCAs.

Upon completion the participants will be better able to:
1. Discuss clinical indications for the appropriate use of MRI contrast agents.
2. Discuss considerations for selecting appropriate MRI contrast agents for specific patient populations including stability, efficacy, and patient factors.
3. Describe the risks versus benefits associated with MRI contrast agent usage.
4. Review recent updates to regulatory guidelines concerning MRI contrast agent usage.

Approved by the AHRA for Category A continuing education credit

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

Gadolinium based contrast agents are vital to many clinical applications of MR imaging and contribute greatly to MRI’s powerful diagnostic abilities. As physicians who prescribe, or technologists who administer these contrast agents, it is important to have a good understanding of how they work, and what the differences are between various formulations or “brands”. Gadolinium is a highly toxic heavy metal and is only rendered safe for human administration by tightly binding it to a molecular structure called a chelate. Different gadolinium formulations are characterized by different chelates. The structure of this chelate dictates everything about the agent, from its biodistribution, to its safety profile to how well it does its job of increasing image contrast to highlight different forms of pathology.

Join Jeffrey H Maki, MD, PhD, who discusses the basics of MR relaxation times and how these impact image formation, the mechanism by which MR contrast agents work to relax protons, the different ways the structure of the chelate can be designed to improve this relaxivity and the potential of increased relaxivity contrast agents to impact clinical MR imaging.

At the end of this dynamic discussion, attendees will have a much better understanding of the changing landscape of gadolinium-based contrast agents and be better equipped to most effectively choose and use the most appropriate agent for their patient’s needs.

After attending this webinar the participants will be better able to:
1. Explain the relationship between MR relaxation times and contrast agent relaxivity.
2. Describe what a chelate is and why it is important.
3. Discuss two ways a chelate can be constructed to increase relaxivity.
4. Rank the relaxivities and dosing of the currently available gadolinium contrast agents2.

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

New MRI contrast agents continue to be developed, with a focus on continued improvements in stability and safety, as well as maximization of image clarity. These distinctions rest in the molecular structure of the particular gadolinium-based contrast agent. Understanding the relative safety and efficacy of these agents is important in the radiologic management of patients.

During this program, we’ll look closely at novel advances related to MRI contrast safety and management; understanding the risks associated with various agents as well as their efficacy

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

1. Identify the different Gadolinium-based contrast agent classifications.
2. Explain how Gadolinium-based contrast agent stability and safety is evaluated.
3. Describe the concept of gadolinium-based contrast agent "relaxivity".

Many studies have demonstrated that one of the major causes of the increase in healthcare costs is related to unexpected treatment needed as the result of a medical error, a Serious Reportable Events, and/or a healthcare acquired condition.  While many insurers, including the Centers for Medicare and Medicaid, have stopped reimbursing hospitals for care and treatment needed following the commission of specifically defined medical errors, those costs still remain part of patient care delivery, leading to a reduction in funding available for other components of healthcare.

All who are involved in the delivery of patient care should be knowledgeable of, and fully implement infection-control programs, as well as any initiative put in place to avoid Never-Events/Serious Reportable Events, from occurring in the healthcare setting. The transformation needs to occur in the culture of the provision of healthcare to include a clear expectation of the individual responsibility of EACH person who is providing care.

This program will educate the healthcare provider on ways they can make a difference in the commitment of errors and reportable events during patient care.

Following completion of this program participants should be able to:

• Identify the major events in history leading to the Deficit Reduction Act of 2005 addressing costs of never-events to the healthcare system
• Describe the basis for the transformation of inpatient care as this relates to the elimination of Serious Reportable Events
• Discuss the needed cultural changes to successfully implement the transformation of inpatient care to the level of safety desired
• Discuss critical aspects of infection control as they relate to the elimination of hospital-acquired infections
• List the benefits of patient-centered care as it relates to the prevention of medical errors and Serious Reportable Events
• Discuss the impact of identifying Serious Reportable Events and the potential for litigation if a Serious Reportable Event occurs
• Discuss the accountability factor as it relates to Serious Reportable Events
• Describe effective approaches to care delivery aimed at preventing Serious Reportable Event
• Discuss the importance of evolving infection prevention in the ever-changing health care environment

Published by Creative Training Solutions, Inc.

This Publication is an educational activity supported by Guerbet LLC.

It is generally noted that negative health outcomes are directly related to the amount of radiation to which one is exposed and the length of time of that exposure.  While the most common side effect of radiation is thought to be the development of cancerous cells, some additional side effects do occur, and they sometimes develop much faster than cancer. Some of these additional acute health effects are skin burns, weakness, hair loss, and illnesses such as nausea. Other negative health effects of radiation exposure include changes in organ functioning, congenital malformation, and death.

The most significant medical exposure for most comes in the form of diagnostic x-rays or tests that use forms of ionizing radiation. These tests include conventional x-rays, fluoroscopy, CT/CAT scans, and positron emission tomography (PET).

While no current data demonstrates that a CT, for example, increased the incidence of cancer, the Joint Commission reported that the 74 million CT scans performed in the U.S. in 2017 could cause a projected 29,000 cases of future cancer and 14,500 future deaths due to radiation. However, even without significant data, mainly focused on the relationship between radiation and cancer, there is sufficient experience over the last several years to indicate that radiation exposure carries a risk for cancer over time.

There are actions that organizations can take to minimize radiation exposures. First, staff should be aware of the contributing factors to, and activities that can help eliminate, avoidable radiation exposures.

Following completion of this program participants should be able to:

• Discuss the brief history of the development of x-rays using ionizing radiation
• Identify ways in which people are exposed to radiation.
• Discuss the intent of “As Low as Reasonably Achievable”.
• Describe the relationship between medication reconciliation and recording of radiation exposures.
• Define the dilemma that exists with the use of diagnostic radiation.
• List the negative effects of radiation exposure.
• Describe the intent of the Joint Commission Sentinel Event 47.
• Discuss the steps to reduce radiation exposure.
• Describe the Promoting Interoperability Program and radiology.
• Discuss Imaging Gently, Imaging Wisely, and Step Lightly.
• Discuss changes to gonadal shielding.
• Discuss strategies to address dose optimization.
• Discuss progress toward radiation dosing standards.
• Discuss Step Lightly’s recommendations for radiation safety in pediatric interventional radiology.

Published by Creative Training Solutions, Inc.

This Publication is an educational activity supported by Guerbet LLC.