|Wednesday, December 2
Face Transplantation and Surgical Planning — MSRT41
Frank J. Rybicki, M.D., Ph.D.
- Understand the principles of face transplantation from a surgical perspective.
- Discuss protocols for evaluation of bony structures, including 3-D printed models.
- Explain pre- and post-face transplantation vascular imaging to define and follow-up the vascular anastomoses.
- Detail insights of transplantation biology enable by 320-detector computed tomography.
Face transplantation is now the only accepted option to restore form and function in patients with severe facial deformity. The transplanted tissue comes from an organ donor and is called an “allograft.” The allograft tissues can include bone, regions of forehead, eyelid, nose, lips, chin and cheeks. Surgical planning uses computed tomography, magnetic resonance and 3-D models typically printed from CT images. For all steps, the radiologic technologist plays a critical role working in concert with the radiologists and surgeons. Bone is shown in 3-D reformatted images and 3-D printed models. The vascular anastomosis is the most critical aspect for successful engraftment. CT angiography noninvasively images vessels for anastomoses. Patients typically have altered vascular anatomy of the external carotid circulation because of the injury or lesions that lead them to face transplantation. Both arterial and venous mapping is required. Postoperatively, both CT angiography and MR angiography are used for surveillance and when potential complications arise. Volumetric rendering of all relevant structures is important in surveillance and can be achieved by 3-D printing soft tissue structures. Postoperative CT angiography has yielded insights to the vascular physiology and pathology of tissue transplantation.
Working With Obese Patients in Radiography — MSRT42
Barbara Smith, M.S., R.T.(R)(QM), FASRT, FAEIRS
- Explain obesity statistics and issues related to radiography.
- Discuss sensitivity training and communication.
- Identify transportation and transfer of obese patients to ensure safety of patient and personnel.
- Describe imaging challenges and how to locate anatomical landmarks.
- Examine exposure-related issues.
Obesity affects an increasing number of people throughout the world and is a growing global health problem. This presentation defines degrees of obesity, reviews statistics and discusses some of the health effects. The speaker also will discuss equipment specifically designed for the transportation and transfer of obese patients, as well as radiographic equipment designed to image obese patients. Because patient dignity should be kept in mind, issues such as sensitivity training and communication are crucial. Many imaging challenges are associated with obese patients. For example, although the bony skeleton and organ locations do not change, it can be difficult to locate common positioning landmarks. A new technique for locating anatomical landmarks will be presented to assist with positioning accuracy, and exposure factor use for images and how it affects the radiographic tube will be covered. Additional considerations will be discussed relating to image receptor size, collimation, focal spot size, grid use, AEC and dose.
Best Practices in Digital Radiography — MSRT43
Donna Long, M.S.M., R.T.(R)(M)(QM), FASRT
- Discuss best practices in digital radiography.
- Comprehend ASRT position statements and practice standards pertinent to best practices.
- Analyze the effects of technical factor selection on the digital image.
- Apply quality control in digital imaging.
- Understand exposure indicator systems and values.
Digital radiography has been in practice for quite some time. However, we are still working to provide education and best practices for technologists and students regarding the use of digital imaging vs. film-screen equipment. This presentation covers best practices in digital radiography referencing the ASRT white paper, position statements and practice standards. Recommendations regarding future research will also be presented.
Famous Feet: Weber, Lisfranc and Jones. The Fractures. The Men. — MSRT44
Ken L. Schreibman, M.D., Ph.D.
- Understand common fracture patterns in the foot and ankle.
- Discuss ankle twisting injuries and the Weber staging system.
- Explain fractures and dislocations of the Lisfranc joint.
- Describe fractures of the proximal fifth metatarsal, distinguishing between avulsion and Jones fractures.
Dr. Schreibman returns to ASRT@RSNA for the third straight year with his dynamic, fast-paced, animated PowerPoint presentations. This year he will discuss “Famous Foot Fractures: Weber, Lisfranc and Jones.” During the lecture he will review the normal anatomy and proper radiographic imaging techniques for the ankle and foot. He will then describe the mechanisms and imaging findings of these common fractures of the ankle joint, tarsal-metatarsal joint and fifth metatarsal. Along the way, Dr. Schreibman will provide some historical footnotes regarding the men for whom these fractures are named.
Interventional Cardiovascular Magnetic Resonance (iCMR): Clinical and Preclinical Applications — MSRT45
Jonathan Mazal, M.S., R.R.A., R.T.(R)(MR)
Toby Rogers, B.A., B.M., BCh, MRCP
- Define interventional cardiovascular magnetic resonance.
- Compare advantages and disadvantages of MR vs. other imaging modalities to guide cardiovascular interventions.
- Describe personnel and infrastructure requirements to start an iCMR program.
- Identify current clinical applications of iCMR.
- Review preclinical applications of iCMR to inform future clinical directions.
This interactive session examines the potential benefits of performing cardiovascular interventions using magnetic resonance imaging guidance rather than x-ray fluoroscopy. The presenters will discuss the key differences from the perspective of both patient and medical staff. MR-guided cardiac catheterization is a clinical reality in specialist centers in the United States today, and real patient cases will accompany the presentation. Finally, attendees will explore future directions of interventional CMR through a review of innovative preclinical applications.
Prostate Cancer and MR Imaging: What To See and How To See It — MSRT46
James Stirling, M.Sc., D.C.R., D.M.S.
Middlesex, United Kingdom
- Describe the anatomy and common pathology of the prostate gland.
- Discuss the factors and how to optimize prostate sequences, including T1, T2 and STIR whole pelvis sequences; small field of view T2 axial, sagittal and coronal sequences; diffusion-weighted imaging; and contrast-enhanced T1 and T2* dynamic sequences.
- Explain how different sequences are used with primary, secondary and metastatic prostate cancer.
- Explore hybrid PET-MR 18F Choline imaging.
Over the past few years magnetic resonance imaging of prostate cancer has moved from just T1 and T2 imaging to multiparametric, multimodality imaging. To produce high-quality images, sequence parameter factors have to be optimized, balancing clinical requirements with patient comfort, total on-table time, scanner capabilities and limitations. This course includes prostatic anatomy and how different sequences can characterize benign and malignant disease. The presenter will show the sequences needed and how to optimize them, including T2 small field of views, diffusion-weighted imaging, T1 and T2* dynamic contrast-enhanced sequences and intrinsic susceptibility weighted imaging. As prostate cancer develops and is treated, the imaging protocols change and might include surveillance and staging before progressing to recurrence and metastatic whole-body imaging. MR is now being fused with PET in hybrid machines to combine the strengths of both modalities. This course also shows how MR imaging of malignant prostate disease changes as the disease progresses.