Wednesday, December 3
Innovation and Translational Research: How to Promote Each Within Your Organization
B. J. Erickson, M.D., Ph.D.
- Understand the differences and similarities between translational research and innovation
- Recognize the types of optimal environments for research and innovation
- Understand how to mesh the two environments in your organization
Translational research and innovation are often commingled because they both involve “new stuff.” But they are actually very different. Translational research is the process of taking something proven to work in the lab and making necessary adaptations to make it work “for real.” Innovation is fundamentally disruptive and often involves the use of a tool designed for one task and adapting it to address a different problem. It is NOT a process that involves multiple, well-defined steps. Translational research and innovation are fundamentally different and generally competitive, but they are potentially complementary. Although they are both about “new stuff,” innovation and translation tend to be in opposition to each other. The fundamental values that guide them are polar opposites.
In this session, key aspects of innovation and research will be examined. Ways to encourage both will be reviewed. Some of the challenges of innovation and research will also be identified. At the end of the session, attendees should be able to recognize aspects of their organization that promote and hinder innovation and research. They might also identify ways that they can encourage both in their environment.
K. L. Schreibman, Ph.D., M.D.
- Review the three-dimensional anatomy of the shoulder, with attention to the complex anatomy of the scapula
- Demonstrate the standard radiographic views of the shoulder, with attention to proper patient positioning
- Discuss techniques for optimizing computed tomography of the shoulder, including anatomic reformatting planes
- Illustrate the radiographic appearance of shoulder dislocations, with emphasis on posterior dislocations
The goal of this session is to gain a better three-dimensional understanding of the shoulder, with attention to relational anatomy and optimization of imaging techniques.
The presenter will review the three bones and two joints that comprise the shoulder, focusing on the complex 3-D anatomy of the scapula. He will then share how this bony and articular anatomy is viewed using standard radiographic projections, emphasizing the importance of the oblique and axillary views.
Next, the presenter will discuss the indications for cross-sectional imaging of the shoulder and ways to optimize CT positioning and reformatting techniques. The anatomy of the rotator cuff muscles and tendons will also be illustrated.
During the final portion of the course, the presenter will discuss radiographs as the primary modality for imaging dislocations, and he will review the staging system for acromioclavicular joint dislocations. He will also demonstrate the difference between anterior and posterior shoulder dislocations, and he will explain how to avoid missing posterior dislocations.
The PDF and PowerPoint for this presentation and all of Dr. Schreibman’s lectures are located under “Lecture Materials” on his website.
Expanding the Role of the Radiographer in the Quality Assurance Triangle
T. J. Blackburn, Ph.D.
- Describe quality measures in radiologic imaging
- List regulatory, advisory and accrediting bodies that monitor quality performance
- Identify the increasing role of the radiologic technologist in quality initiatives
Improvement of image quality is an ongoing process within any radiology department. A quality assurance triangle is often used to describe the contributions from the technologist, radiologist and medical physicist. Alone, each member of the quality improvement team is not as effective as the collective whole. The radiologic technologist plays a key role in this synergistic process. Preventive maintenance and equipment evaluations might be performed annually, but the technologist uses the equipment on a daily basis. The technologist is typically the first person to notice a change in equipment performance. It is imperative that any such changes are reported to ensure quality imaging. Regulatory and accrediting agencies are placing greater emphasis on quality improvement initiatives. Improved outcomes will require more participation from radiologic technologists.
The Miracle of Breast MR Imaging
D. A. Strahle, M.D.
- Explain the role dense fibroglandular tissue plays in hiding breast cancer
- List four advantages screening breast MR imaging has over screening mammograms
- Discuss how often screening breast MR images should be obtained on a routine basis in women with dense breast tissue
- Discuss the potential of a national MR screening program to save lives and reduce costs
- Identify eight financial advantages for insurance carriers who pay for annual screening breast MR exams
Mammograms have been the only screening imaging modality accepted for early detection of breast cancer for almost 50 years. Historically, breast MR imaging has been used to define the extent of breast cancer only after identification by mammograms.
Our research used breast MR imaging to determine the presence of occult cancers missed by screening mammograms and the relationship of those cancers to dense breast tissue. In addition, we were able to identify a limited number of MR imaging sequences that are now being used for annual screening of women who have dense breasts without any other breast abnormalities.
For two years, 671 women received a breast MR exam at no cost following a negative screening mammogram. Eighteen parameters were recorded, including the density of the fibroglandular tissue and the location of any lesions inside or outside the fibroglandular tissue.
Numerous lesions (benign and malignant) missed by mammography were clearly identified by MR imaging. MR detected cancer at a rate of 16.3 per 1,000 women vs. the mammogram detection rate of 2.7 per 1,000 women. This correlates to a major shift in time of cancer detection, occurring six years earlier compared with mammography screening of the same women.
Only three different MR imaging sequences detected all the cancers, reducing scan time to only 12 minutes. Further, we were able to reduce unnecessary biopsies significantly compared with mammography.
As a result of our research, effective Nov. 18, 2013, the first insurance carrier in the nation began paying for annual screening breast MR exams for all women with dense breast tissue aged 40 to 80 years. They have estimated significant savings across eight major financial categories. In addition, the number of lives saved because of early detection is expected to be high, resulting in a major marketing advantage for the insurance industry.
Dual Energy Computed Tomography
M. J. Siegel, M.D.
St. Louis, Missouri
- Discuss the general principles of dual-energy CT
- Describe radiation dose aspects of dual-energy CT
- Understand clinical applications of dual-energy CT in clinical patient care
Dual-energy CT (DECT) refers to the acquisition of CT data sets at two different energy spectra (80/140, 100/140 or 70/150). The acquisition of CT data at different photon energies enables differences in material composition to be detected based on differences in photon absorption at the two kVp settings. There are two basic approaches to DECT: rapid voltage switching and dual-source CT. The latter allows simultaneous acquisition of data from two x-ray tubes operating at different tube potentials in a single CT acquisition. This presentation will focus on the dual-source DECT approach.
The images acquired can be viewed as low or high (or both) kVp images and as a mixed or blended data set that integrates two kVp acquisitions in a single image for immediate clinical evaluation. Image blending can be linear or nonlinear. Linear blending is a continuous function with equal weighting of the noise characteristics of the high-energy scan and the contrast characteristics of the low-energy scan. Nonlinear blending is based on modified sigmoid blending and operates in a voxel-by-voxel fashion.
In addition, use of dual-energy postprocessing can generate software virtual unenhanced CT images; iodine maps; color-coded images superimposing iodine distribution on the virtual nonenhanced data; bone-subtraction images for CT angiographic studies; and renal stone content analytic images. Monoenergetic images, in which the density for each voxel is extrapolated to a certain energy (range 50-190 keV) from the two density values at the acquired photon energies, can be performed.
Clinical applications are CT angiography; assessment of lung perfusion and ventilation; characterization of renal stones, liver, pancreatic, adrenal and renal masses; and assessment of myocardial perfusion. The monoenergetic application allows removal of metal artifacts at higher keVs. The radiation dose from DECT is comparable to that with single-energy CT.
Tuberous Sclerosis Complex (TSC) as It Relates to Diagnostic Imaging
St-Pierre-Jolys, Manitoba, Canada
- Identify the role of diagnostic imaging in the diagnosis and treatment of tuberous sclerosis complex
- Recognize the limitations of various modalities in the diagnosis of specific pathologies
- Compare the utility and efficacy of CT, MR, ultrasound and plain film radiography in identification of the common pathologic conditions associated with TSC
- Understand the patient’s perspective — and the family’s perspective — in diagnostic imaging departments
The presenter will discuss a case report of a patient with all the typical lesions of tuberous sclerosis complex: renal angiomyolipoma, renal cysts, cardiac rhabdomyoma cortical tubers and subependymal nodules. The case also demonstrates atypical findings in TSC (abdominal aortic aneurysm and renal cell carcinoma). Although a brief overview of the disease will be presented, most of the discussion will focus on the vital role that diagnostic imaging plays in the diagnosis and treatment planning of this complex disease.
Thursday, December 4
Contrast Media - Adverse Reactions and Management
G. K. Sabharwal, M.D.
- Identify risk factors that may increase incidence of an adverse reaction to contrast media
- Understand pathogenesis of the reactions to contrast media
- Describe different types of contrast reactions
- Review management of the different types of contrast reactions
- Be aware of premedications that can help prevent contrast reactions
Contrast media is the most commonly used pharmacological agent in radiology. It is associated with many adverse reactions. Although these reactions are relatively uncommon, some of them can be severe and even fatal. It is important to recognize these reactions and appropriately manage them. Patients with known prior reactions to contrast media and with other risk factors should be medicated prior to the administration of this agent.
Stomach Esophageal Pathology
J. Crowley, B.S., R.R.A.
- Understand the structure and function of the esophagus
- Discuss radiographic pathology of disease processes of the esophagus and the stomach
- Describe the structure and function of the stomach
- Participate in case studies that involve disease processes of the esophagus and stomach
The presenter will provide an overview of the structure and function of the stomach and esophagus. Using radiographic findings, several common disease processes will be discussed. During the final portion of the course, the presenter will share case studies that address some of the disease processes discussed.
Practice Standards and Ethical Considerations in Daily Practice
A. Obergfell, J.D.
Fort Wayne, Indiana
- Know how to access the ASRT Practice Standards for Medical Imaging and Radiation Therapy and the ARRT Rules of Ethics
- Be able to analyze practice scenarios to determine if the practice meets acceptable professional performance
- Apply the ARRT Rules of Ethics to determine if behavior complies with professional expectations and patient safety guidelines
The changing health care environment might produce anxiety among imaging professionals as they navigate new clinical expectations and balance them with professional performance guidelines. The presenter will discuss the ASRT Practice Standards for Medical Imaging and Radiation Therapy, the Standards of Ethics adopted and enforced by the ARRT, and the application and implication of each on daily practice. Specific scenarios related to practice will be analyzed using the Practice Standards to determine the appropriateness of practice and using the Standards of Ethics to ascertain professional ethical compliance.
Advanced Radiographic Practice in Adult Chest Imaging
11:45 a.m.-12:45 p.m.
N. Woznitza, B.Sc.
- Consider the role of the advanced radiographer practitioner in the United Kingdom
- Recognize the contribution that advanced radiographer practitioners make to patients, clinicians and radiologists, using anonymized real case scenarios
- Review the current evidence base, which supports advanced radiographer practice including radiographer reporting of adult chest x-rays
Increasing cost and activity pressures on health systems worldwide has led to advanced radiographer practice models developing internationally. In the United Kingdom, radiographer reporting has evolved from the reporting of trauma skeletal x-rays by trained radiographers to include the interpretation of adult chest x-rays, CT head scans, MR imaging of the knee and lumbar spine, mammography, ultrasound and gastrointestinal examinations.
Advanced radiographer practice encompasses the entire spectrum of imaging, from justifying the referral to obtaining high-quality images, performing initial image review and delivering a definitive clinical report. In this course, the presenter will highlight the contributions that advanced radiographer practitioners make at patient, departmental and hospital levels. The positive influence on improved patient care and the service provided to referring clinicians will be illustrated through real case scenarios. Departmental and hospital benefits of radiographer role extension will be explored through presentation of a service review.
The Royal College of Radiologists and the College of Radiographers are united in their position that all radiographers who expand their scope of practice must perform at a level comparable to a consultant radiologist. The growing body of evidence supporting adult chest x-ray interpretation by trained radiographers will be explored, including performance at the end of accredited postgraduate training, audit of radiographer chest x-ray reporting in clinical practice, and agreement between expert consultant chest radiologists and clinical reports, both radiologist and radiographer.