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

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 the first of a two part series. Key discussion points in this episode include: - Diagnosis of HCC on imaging, with emphasis on MRI. - Importance of imaging for considering patients for liver transplantation. - Common complications after 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

In this episode we welcome a special guest, Dr. Max Rosen – Chair of Radiology at UMMS. Dr. Rosen provides an overview of the department, including its history and growth. We discuss the organization of the department and introduce the clinical, research and educational missions of the department. Dr. Rosen shares his thoughts on what a prospective trainee or faculty member might want to know about the department. 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: Max P. Rosen, MD, MPH. Professor and Chair, UMMS Dept of Radiology. References: UMass Radiology. Message from the Chair. https://www.umassmed.edu/radiology/about-us/message-from-the-chair/

In this episode our guest, Dr. Carolynn Debenedectis rejoins us to discusses BI-RADS classification. This podcast is designed to give junior residents the basics they need to know to understand and use BI-RADS on their breast imaging rotation. Host: 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: Carolynn Debenedectis, MD. Associate Professor of Radiology, Division of Breast Imaging, UMMS Dept of Radiology. Resources: • Rao A, Feneis J, Lalonde C, Ojeda-Fournier, H. A Pictorial Review of Changes in the BI-RADS Fifth Edition. 2016; 36:623-639. https://pubs.rsna.org/doi/10.1148/rg.2016150178

In this episode our guest, Dr. Ryan Tai discusses septic arthritis and the radiologist’s role in its work-up, diagnosis and management. The learning objectives for this podcast include: 1. Describe the pathophysiology of septic arthritis 2. Discuss the clinical manifestations of septic arthritis 3. Understand the role of imaging in the work-up of septic arthritis 4. Understand the role of joint aspiration in the diagnosis of septic arthritis 5. Briefly describe the treatment of septic arthritis Host: 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: Ryan Tai, MD. Assistant Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Resources: • Karchevsky, M et al. MRI Findings of Septic Arthritis and Associated Osteomyelitis in Adults. AJR 2004;192:119-122. • Greenspan, A and Tehransadeh J. Imaging of Infectious Arthritis. Radiology Clinics of North America 2001;39(2):267-276.

In this episode our guest, Dr. Carolynn Debenedectis - Residency Program Director and Vice Chair of Education, will summarize what programs directors are looking for in your application to radiology residency. We will also discuss how COVID is changing the application season this year. Host: 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: Carolynn Debenedectis, MD. Associate Professor of Radiology, Division of Breast Imaging, UMMS Dept of Radiology. Resources: • COVID-19 and the Radiology Match: A Residency Program’s Survival Guide to the Virtual Interview Season. Acad Radiol 2020; July. DOI:10.1016/j.acra.2020.06.023 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340060/

In this episode our guest, Dr. Carolynn Debenedectis, discusses what to do during your first year of radiology to be successful. We will discuss the top 3 things program directors look for in the ideal 1st year radiology resident. Host: 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: Carolynn Debenedectis, MD. Associate Professor of Radiology, Division of Breast Imaging, UMMS Dept of Radiology. Resources: • Getting Started: A Guide to Year One of Radiology Residency. https://www.acr.org/-/media/ACR/Files/RFS/RFS_Guide_Final.pdf

In this episode our guest, Dr. Byron Chen, continues his discussion from Episode 14 on the art of taking a case in radiology. In part 2 of the series, Dr. Chen continues the step-by-step primer based on his approach. This episode includes a discussion of presenting differential diagnosis and management, as well as suggestions and insight for trainees taking cases orally. Guest: Byron Chen, MD. Assistant Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology. Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology. Resources: • Gunderman, Richard B., and Henry Y. Chou. The future of radiology consultation. Radiology (2016): 6-9. https://doi.org/10.1148/radiol.2016152781 • Currie, S., et al. How confident are general practitioners in interpreting neuroradiology reports? Clinical radiology 73.11 (2018): 944-950. https://doi.org/10.1016/j.crad.2018.06.013

In this episode our guest, Dr. Byron Chen, discusses the art of taking a case in radiology, starting with the historical perspective. He gives us a step-by-step primer based on his approach, filled with many do’s and don’ts. Finally, we discuss the past, present and future of consultative radiology. This is the first of a two-part series. Guest: Byron Chen, MD. Assistant Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology. Host: Hao Lo, MD, MBA. Associate Professor of Radiology, Division of Emergency Radiology, UMMS Dept of Radiology. Resources: • Gunderman, Richard B., and Henry Y. Chou. The future of radiology consultation. Radiology (2016): 6-9. https://doi.org/10.1148/radiol.2016152781 • Currie, S., et al. How confident are general practitioners in interpreting neuroradiology reports? Clinical radiology 73.11 (2018): 944-950. https://doi.org/10.1016/j.crad.2018.06.013

Eponyms in radiology have historically been used to describe many types of imaging findings. In this episode, Dr. Watts will discuss with us why we use eponyms and present a list of MSK eponym “categories”. Selected eponyms used in MSK imaging will be presented. Guest: George (Chip) Watts, MD. Assistant Professor of Radiology, Divisions of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. 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. Outline of the Eponyms reviewed in today’s podcast is included: MSK eponym ‘categories’ • Fractures and traumatic injury patterns • Tumors • Tumor-like lesions • Classification/grading systems • Congenital/metabolic/syndromic Upper extremity fractures and traumatic injury patterns • Shoulder -Hill-Sachs -Bankart • Elbow/Forearm -Essex-Lopresti -Galleazi -Monteggia • Wrist -Colles -Smith -Barton • Hand -Bennett -Rolando Lower extremity fractures and traumatic injury patterns • Knee -Segond -Pellegrini-Stieda • Lower leg/Ankle -Maisonneuve -Tillaux -Weber • Foot -Lisfranc -Jones • **Deferred - Head/Neck/Spine/Pelvis trauma • Tumors -Askin Tumor -Ewing Sarcoma -Evans Tumor -Kaposi Sarcoma -Mafucci Syndrome -Ollier Disease -Morton Neuroma Hunter TB, Peltier LF, Lund PJ. Musculoskeletal Eponyms: Who Are Those Guys? RadioGraphics. 2000; 20: 819-836. DOI: 10.1148/radiographics.20.3.g00ma20819 Hwang S., Schneider, R. Eponyms of Tumors and Tumorlike Lesions in the Musculoskeletal System: Who Were the People and What Are the Lesions? Pictorial Review. AJR 2010; 195: S50–S61. DOI: 10.2214/AJR.07.7137

Dr. Sereni returns to continue his discussion on meniscal injuries. In this podcast Dr. Sereni discusses the evolution of previously discussed basic tears into complex and displaced tears. Guest: Christopher Sereni, MD. Assistant Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Host: Christopher Cerniglia, DO, ME, FAOCR. Associate Professor of Radiology, Division of Musculoskeletal Imaging & Intervention, UMMS Dept of Radiology. Review •Abnormal signal or abnormal morphology •Three basic types of tears -Longitudinal vertical (aka the can-opener) -Horizontal (pita bread) -Radial (pizza slicer) -Complex tear - nonstandard combination of basic tear types Tears in the setting of an ACL injury - a frequently overlooked setting •Mensicocapsular separation •Wrisberg rip -ACL tear allows tibia to translate anteriorly -Ligament of Wrisberg causes traction on posterior horn of the lateral meniscus, causing vertical longitudinal tear Displaced tears •Longitudinal vertical --> bucket handle tear -central migration of inner portion with or without flipping -signs - not the be-all end-all -fragment in the notch -double anterior horn -double PCL -Small posterior horn/body •Horizontal tear --> flap tear -inferior flap tear could potentially go unnoticed on arthroscopy -boomerang sign -common displaced tear •Radial oblique tear --> Parrot beak tear -Displaced flap -Parrot beak appearance on axial sequence 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.

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.

Summary: Hao and Chris discuss the common diagnosis of CHF in the emergency department setting. The four most relevant radiographic findings are discussed. Important clinical and radiographic pitfalls are also considered. 1. Cardiomegaly 2. Pleural effusion 3. Interstitial edema 4. Airspace edema Resources: The Radiologic Distinction of Cardiogenic and Noncardiogenic Edema Milne et al American Journal of Roentgenology, Vol 144, Issue 5, 879-894 https://www.ajronline.org/doi/pdf/10.2214/ajr.144.5.879 Use of chest radiography in the emergency diagnosis of acute congestive heart failure Mueller-Lenke et al. Heart 2006;92:695–696. doi: 10.1136/hrt.2005.074583 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860911/pdf/695.pdf