From The ViewBox

This is the conclusion of the two-part series on the basics of MR imaging safety beginning with Episode 9. In this episode we discuss the components of the MRI system 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. MR contrast safety and screening will be discussed separately in a future episode.

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

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

Resources:

• A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Leo L. Tsai , Aaron K. Grant, Koenraad J. Mortele, Justin W. Kung, Martin P. Smith. Radiographics 2015; 35:1722-1737; DOI:10.1148/rg.2015150108

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

This is a special episode recorded during the Covid-19 pandemic focusing on the diagnosis and imaging features of Covid-19 infection. Our guest is Dr. Maria Barile, our local expert in the Division of Cardiothoracic Imaging. We discuss the following topics:

1. Epidemiology of COVID-19 infection

2. Utility and role of PCR, XR, and CT in screening and diagnosis

3. Imaging appearances of COVID-19 (typical, indeterminate, atypical) and progression of disease as well as recommended radiology reporting practices

4. Fleischner Society recommendations for imaging PUI or COVID-19 positive patients

Guest: Maria Barile, MD. Assistant Professor of Radiology, Division of Cardiothoracic Radiology, UMMS Dept of Radiology.

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

Resources:

1. Jeffrey P. Kanne , Brent P. Little, Jonathan H. Chung, Brett M. Elicker, Loren H. Ketai. Essentials for Radiologists on COVID-19: An Update—Radiology Scientific Expert Panel. Radiology. 2020. Feb 27. https://doi.org/10.1148/radiol.2020200527

2. Scott Simpson et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiology: Cardiothoracic Imaging. 2020. Vol. 2, No. 2. https://doi.org/10.1148/ryct.2020200152

3. Fengxiang Song*, Nannan Shi*, Fei Shan, Zhiyong Zhang, Jie Shen, Hongzhou Lu, Yun Ling, Yebin Jiang. Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia. Radiology. Vol. 295, No.1. https://doi.org/10.1148/radiol.2020200274

4. Geoffrey D Rubin et al. The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Radiology. 2020. Published Online:Apr 7 2020https://doi.org/10.1148/radiol.2020201365

5. RSNA Covid-19 resources: https://www.rsna.org/covid-19

In this episode we discuss the components of the MRI system 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. This is part one of a two-part series on the basics of MR imaging safety. MR contrast safety and screening will be discussed separately in a future episode.

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:

• A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Leo L. Tsai , Aaron K. Grant, Koenraad J. Mortele, Justin W. Kung, Martin P. Smith. Radiographics 2015; 35:1722-1737; DOI:10.1148/rg.2015150108

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

Summary:

1. Staging - know where to look (based on primary site but also pathology)

2. Restaging - know what to expect (based on type of treatment - XRT, chemo, immunotherapy)

3. Big picture - same, better, worse; critical lesions that may require treatment (impending fractures, spinal cord involvement)

4. Chose words carefully - careful about using “progression” unless you are going to calculate that this meets RECIST criteria - consider using “increased tumor burden” instead

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

Guest: Lacey J McIntosh DO, MPH. Assistant Professor of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, UMMS Dept of Radiology.

Resources:

Wang, G. X., Kurra, V., Gainor, J. F., Sullivan, R. J., Flaherty, K. T., Lee, S. I., & Fintelmann, F. J. (2017). Immune checkpoint inhibitor cancer therapy: spectrum of imaging findings. Radiographics, 37(7), 2132-2144.

Summary:

1. How functional imaging is different from anatomic imaging

2. Different tracers - FDG, NAF, DOTATATE, AXUMIN, PSMA

3. Limitations (size, lack of contrast in some places)

4. Pitfalls - know expected physiologic uptake and other processes that cause uptake

5. Future of PET - exciting implications for therapies

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

Guest: Lacey J McIntosh DO, MPH. Assistant Professor of Radiology, Divisions of Abdominal Imaging and Nuclear Medicine, UMMS Dept of Radiology.

Resources:

1. Kapoor, V., McCook, B. M., & Torok, F. S. (2004). An introduction to PET-CT imaging. Radiographics, 24(2), 523-543..

2. Bar-Shalom, R., Valdivia, A. Y., & Blaufox, M. D. (2000, July). PET imaging in oncology. In Seminars in nuclear medicine (Vol. 30, No. 3, pp. 150-185). WB Saunders.

3. Wallitt, K., Yusuf, S., Soneji, N., Khan, S. R., Win, Z., & Barwick, T. D. (2018). PET/CT in Oncologic Imaging of Nodal Disease: Pearls and Pitfalls: RadioGraphics Fundamentals| Online Presentation. RadioGraphics, 38(2), 564-565.

4. Wang, G. X., Kurra, V., Gainor, J. F., Sullivan, R. J., Flaherty, K. T., Lee, S. I., & Fintelmann, F. J. (2017). Immune checkpoint inhibitor cancer therapy: spectrum of imaging findings. Radiographics, 37(7), 2132-2144.

Summary: This is part two of a two-part series on iodinated intravascular contrast. In this episode, we conclude our discussion the types of intravascular iodinated contrast media and their acute adverse reactions. Two additional practical case scenarios are provided.

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:

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

2. American Collegeof Radiology. ACR Manual on Contrast Media (version 10.3). American College of Radiology Website. https://www.acr.org/Clinical- Resources/Contrast-Manual.

3. Beckett, K. R., Moriarity, A. K., & Langer, J. M. (2015). Safe use of contrast media: what the radiologist needs to know. Radiographics, 35(6), 1738-1750.

Summary: In this episode, we discuss the types of intravascular iodinated contrast media and their acute adverse reactions. Four practical case scenarios help review the diagnosis and management of acute contrast reactions, premedication for history of allergic type contrast reaction, and acute contrast extravasation. This is part one of a two part series on iodinated intravascular contrast.

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:

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

2. American Collegeof Radiology. ACR Manual on Contrast Media (version 10.3). American College of Radiology Website. https://www.acr.org/Clinical- Resources/Contrast-Manual.

3. Beckett, K. R., Moriarity, A. K., & Langer, J. M. (2015). Safe use of contrast media: what the radiologist needs to know. Radiographics, 35(6), 1738-1750.

Summary: Dr. Sereni discusses basic meniscal anatomy, reviews the basic types of meniscal tears (horizontal, vertical longitudinal, radial), and provides a way to visualize them using kitchen implements. He briefly discusses the evolution of a basic tear into a complex/displaced tear. Complex tears and complications will be discussed in a future episode.

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

Guest: Christopher Sereni, MD. Assistant Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology.

Resources:

• Saad SS, Gorbachova T, Saing M (2015) Meniscal tears: scanned, scoped, and sculpted. Radiographics 35(4):1138–1139

• De Smet AA. How I diagnose meniscal tears on knee MRI. AJR Am J Roentgenol 2012;199(3):481–499.

Summary: Hao and Chris discuss three Aunt Minnies in CT evaluation of Stroke with Dr. Aly Abayazeed from the division of Neuroradiology.

1. Hyperdense vessel sign.

2. Insular ribbon sign.

3. Delayed vessel sign.

Resources:

• Prognostic value of the hyperdense middle cerebral artery sign and stroke scale score before ultraearly thrombolytic therapy.T Tomsick, T Brott, W Barsan, J Broderick, E C Haley, J Spilker, J Khoury. American Journal of Neuroradiology Jan 1996, 17 (1) 79-85;

• State-of-the-Art Imaging of Acute Stroke. Ashok Srinivasan, Mayank Goyal, Faisal Al Azri, and Cheemun Lum. RadioGraphics 2006 26:suppl_1, S75-S95

• Improved Detection of Anterior Circulation Occlusions: The “Delayed Vessel Sign” on Multiphase CT Angiography. D. Byrne, G. Sugrue, E. Stanley, J.P. Walsh, S. Murphy, E.C. Kavanagh, P.J. MacMahon. American Journal of Neuroradiology Oct 2017, 38 (10) 1911-1916; DOI: 10.3174/ajnr.A5317

Summary: Dr. Cerniglia presents a simple “ABCDEs” pneumonic (adapted from ABCs of Dr. Forrester’s original monograph Radiology of Joint Disease) to structure an approach to hand and wrist radiographs in patients with suspected or known arthritis:

A = Alignment

B = Bone production & density

C = Cartilage space

D = Distribution

E = Erosions

S = Soft tissues

The possible findings of each of these radiographic features are introduced. Specific arthritis features will be discussed in more details in upcoming episodes.

Host: Hao Lo, MD. Assistant 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:

• Brewer, AC, Flemming, DJ, Bernard, SA (2012). Chapter 2: Evaluation of the Hand Film. Arthritis in Black and White, 3rd edition. Philadelphia, PA. Elsevier.