Topic: Imaging of Acute Trauma, Solid Organ Injury

Summary: In this episode, we continue a discussion of imaging acute trauma. This part emphasizes the imaging of solid organ injury. The organs discussed are the liver, spleen, kidney, pancreas, adrenal gland and gallbladder. We focus on recent changes in diagnostic criteria since 2018 and their significance in the daily diagnosis and management of trauma patients.

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Guest: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Resources:

Kozar, R. A., Crandall, M., Shanmuganathan, K., Zarzaur, B. L., Coburn, M., Cribari, C., & AAST Patient Assessment Committee. (2018). Organ injury scaling 2018 update: spleen, liver, and kidney. Journal of Trauma and Acute Care Surgery, 85(6), 1119-1122.

AAST Injury Scoring Scale. https://www.aast.org/resources-detail/injury-scoring-scale

Lee, J. T., Slade, E., Uyeda, J., Steenburg, S. D., Chong, S. T., Tsai, R.,& LeBedis, C. A. (2021). American Society of Emergency Radiology Multicenter Blunt Splenic Trauma Study: CT and Clinical Findings. Radiology, 202917.

Summary:

In this episode, we discuss the basics of imaging acutely traumatized patients. We explain the difference between Level 1 and Level 2 trauma centers. We discuss the idea of trauma activation in the emergency room, using the local UMass experience as an example. We describe the diagnostic evaluation process in the trauma bay. Finally, we discuss the modern imaging protocol, again using our local experience as an example.

Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Guest: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Resources:

Trauma Center Levels Explained. American Trauma Society website. https://www.amtrauma.org/page/TraumaLevels

ACS TQIP BEST PRACTICES GUIDELINES IN IMAGING. In conjunction with ACR, ASER; 2018. https://www.facs.org/-/media/files/quality-programs/trauma/tqip/imaging_guidelines.ashx

Classifying and categorizing ovarian masses can feel like a daunting task for radiology trainees. In this episode Dr. Alan Goldstein will discuss with us his approach to these lesions to help simplify the process. First, a few mimics and pitfalls will be presented. Then Dr. Goldstein will break down the three basic types of ovarian tumors with an emphasis on imaging features:

1. First, make sure the mass is truly ovarian in origin

(A) Appendiceal mucocele, peritoneal inclusion cyst, hydrosalpinx, subserosal fibroid, endometrioma, metastasis

2. Then break it down

(A) Epithelial tumors (cystic with solid components)

- Benign

- Borderline

- Malignant

(B) Sex cord stromal tumors (solid with cystic components)

- Fibroma

- Other stuff

(C) Germ cells tumors (bizarre masses in young patients)

- Dermoid cyst

- Other stuff

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Alan Goldstein, MD. Assistant Professor of Radiology & Division Chief of Abdominal Imaging, UMMS Dept of Radiology.

Resources:

ACR Ovarian-Adnexal Reporting and Data System (O-RADS). Multiple links at: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/O-Rads

Foti P, Attina G, Spadola S, et al. MR imaging of ovarian masses: classification and differential diagnosis. Insights Imaging. 2016 Feb; 7(1): 21-41.

More advanced: Halankar J, Lo G, and Metser U. MRI classification and characterization of complex ovarian masses. Applied Radiology. https://www.appliedradiology.com/articles/mri-classification-and-characterization-of-complex-ovarian-masses

In this episode we continue our discussion of Gadolinium-based contrast agents (GBCA) from our introduction in Ep 27. Building on previous discussions of MRI safety (Ep9 & 11) and Contrast and Adverse Reactions from Ep 5 & 6, this episode will review specific considerations of gadolinium use in pregnancy and breast feeding. We also explore the non-acute adverse reactions of NSF and GDD.

This is part two of the two-part series on the basics of GBCA.

Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Resources:

• Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update. J. Ramalho, R.C. Semelka, M. Ramalho, R.H. Nunes, M. AlObaidy, and M. Castillo.AJNR Am J Neuroradiol 37:1192–98. dx.doi.org/10.3174/ajnr.A4615

• Gadolinium Deposition Disease: A New Risk Management Threat. H. Benjamin Harvey, Vrushab Gowda, Glen Cheng. J Am Coll Radiol 2020;17:546-550. doi.org/10.1016/j.jacr.2019.11.009. creativecommons.org/licenses/by-nc-nd/4.0/

• ABR Noninterpretative Skills Guide 2020. www.theabr.org/wpcontent/uploads/2020/02/NIS-Study-Guide-2020.pdf

In this episode we discuss Gadolinium-based contrast agents (GBCA) or media (GBCM). Building on previous discussions of MRI safety (Ep9 & 11) and Contrast and Adverse Reactions from Ep 5 & 6, this episode will introduce MRI contrast agents (GBCA or GBCM), their make-up, categories and general safety profiles. m including some of the inherent safety issues that arise from them; the concept of safety zones and its importance; examples of unique safety issues in MRI, and the screening process. Summary of some common GBCA and their trade names includes:

Gadoteridol (ProHance) - Macrocyclic - Nonionic

Gadobutrol (Gadavist) - Macrocyclic - Nonionic

Gadoterate (Dotarem) - Macrocyclic - Ionic

Gadodiamide (Omniscan) - Linear - Nonionic

Gadoversetamide (Optimark) - Linear - Nonionic

Gadobenate (MultiHance) - Linear - Ionic

Gadopentetate dimeglumine (Magnevist) - Linear - Ionic

This is part one of a two-part series on the basics of GBCA.

Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Resources:

• Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Matthew S. Davenport, Mark A. Perazella, Jerry Yee, Jonathan R. Dillman, Derek Fine, Robert J. McDonald, Roger A. Rodby, Carolyn L. Wang, Jeffrey C. Weinreb. Radiology 2020; 294:660–668; https://doi.org/10.1148/radiol.2019192094

• ABR Noninterpretative Skills Guide 2020. www.theabr.org/wp content/uploads/2020/02/NIS-Study-Guide-2020.pdf

In this fourth and concluding episode on the economic history of radiology, Prof. Levy discusses prior attempts of outsourcing and artificial intelligence machine learning of today.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Frank Levy, PhD. Daniel Rose Professor (Emeritus) at MIT.

References:

Levy, Frank, and Max P. Rosen. "How Radiologists Are Paid: An Economic History, Part III: The Bubble Years." Journal of the American College of Radiology (2020). DOI:https://doi.org/10.1016/j.jacr.2020.02.012 .

Remus, Dana and Levy, Frank S., Can Robots Be Lawyers? Computers, Lawyers, and the Practice of Law (November 27, 2016). Available at SSRN: https://ssrn.com/abstract=2701092 or http://dx.doi.org/10.2139/ssrn.2701092

In this episode we continue discussing a historical perspective of the economics of radiology. In part 3 of this 4 part series, Prof. Levy continues discussing the bubble years of the 1990s.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Frank Levy, PhD. Daniel Rose Professor (Emeritus) at MIT.

References:

Levy, Frank, and Max P. Rosen. "How Radiologists Are Paid: An Economic History, Part III: The Bubble Years." Journal of the American College of Radiology (2020). DOI:https://doi.org/10.1016/j.jacr.2020.02.012 .

Remus, Dana and Levy, Frank S., Can Robots Be Lawyers? Computers, Lawyers, and the Practice of Law (November 27, 2016). Available at SSRN: https://ssrn.com/abstract=2701092 or http://dx.doi.org/10.2139/ssrn.2701092

In this episode we continue discussing a historical perspective of the economics of radiology. In part 2 of this 4 part series, Prof. Levy and Dr. Rosen present changes which occurred in radiology after Medicare, including advanced imaging and how this affected cost and the radiology job market. We continue by discussing how these changes led to the bubble years of the 1990s.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guests: Frank Levy, PhD. Daniel Rose Professor (Emeritus) at MIT.

Max P. Rosen, MD, MPH. Professor and Chair, UMMS Dept of Radiology.

References:

Levy, Frank, and Max P. Rosen. "How Radiologists Are Paid: An Economic History, Part II: Advanced Imaging and Radiologists’ Incomes." Journal of the American College of Radiology (2020). DOI:https://doi.org/10.1016/j.jacr.2020.02.013 .

Levy, Frank, and Max P. Rosen. "How Radiologists Are Paid: An Economic History, Part III: The Bubble Years." Journal of the American College of Radiology (2020). DOI:https://doi.org/10.1016/j.jacr.2020.02.012 .

Remus, Dana and Levy, Frank S., Can Robots Be Lawyers? Computers, Lawyers, and the Practice of Law (November 27, 2016). Available at SSRN: https://ssrn.com/abstract=2701092 or http://dx.doi.org/10.2139/ssrn.2701092

In this episode we welcome special guest, Frank Levy, PhD - an economist and Professor(Emeritus)at MIT. Professor Levy joins Max Rosen, MD – Chair of Radiology at UMMS to discuss a historical perspective of the economics of radiology. In part 1 of the series, Prof. Levy and Dr. Rosen begin by sharing how they begin to collaborate on this topic. We continue by discussing the radiology landscape before Medicare and the radiologists' fight for independent billing.

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guests: Frank Levy, PhD. Daniel Rose Professor (Emeritus) at MIT.

Max P. Rosen, MD, MPH. Professor and Chair, UMMS Dept of Radiology.

References: Levy, Frank, and Max P. Rosen. "How Radiologists Are Paid: An Economic History, Part I: The Fight for Independent Billing." Journal of the American College of Radiology (2020). DOI: 10.1016/j.jacr.2020.02.014

In this episode, we discuss the imaging of hepatocellular carcinoma and liver transplantation with our guest Dr. Mark Masciocchi, Director of Body MRI. This is part 2 of a two part series. Key points of discussion in this episode include:

- Living liver donor transplantation

- Anatomic and radiologic considerations for potential living liver donors

- Common pitfalls in the imaging of HCC and liver transplantation

Hosts: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology.

Guest: Mark Masciocchi, MD. Assistant Professor of Radiology, Division of Abdominal Imaging, UMMS Dept of Radiology.

References:

Catalano OA, Singh AH, Uppot RN, Hahn PF, Ferrone CR, Sahani DV. Vascular and Biliary Variants in the Liver: Implications for Liver Surgery. RadioGraphics. 2008;28(2):359-378. doi:10.1148/rg.282075099

Vascular and Biliary Variants in the Liver: Implications for Liver Surgery | RadioGraphics. Accessed August 24, 2020. https://pubs.rsna.org/doi/full/10.1148/rg.282075099