When considering the benefits of breast screening protocols multiple challenges and considerations are involved. The potential benefits of using an abbreviated breast MRI (AB-MRI) protocol are shared with the goal of increased access and early detection of cancers. Patient clinical considerations regarding selection of GBCAs are covered as well as key influences on their selection. Chris Comstock, MD and a panel of MRI discuss the clinical considerations, patient benefits and potential use of AB-MRI for breast cancer screening.

Educational Objectives

• Describe the benefits of breast screening protocols
• Discuss the potential benefits of using abbreviated breast MRI (AB-MRI) as a screening tool
• List the key influencers in the trend towards macrocyclic GBCA use
• Summarize the current challenges and opportunities to utilizing AB-MRI for breast cancer screening

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

This program compares the physicochemical properties of the current FDA approved gadolinium-based MR contrast agents (GBCAs). This includes the molecular design as well as properties such as ionicity, molar concentration, relaxivity, biodistribution and excretion. Dosing considerations based on relaxivity are presented along with data from peer-reviewed publications. Stability metrics are defined and compared. Adverse events including acute, physiologic events as well as the chronic adverse reaction, NSF are discussed along with the most recent information regarding gadolinium deposition and retention.

Gadopiclenol solution for injection, 485.1 mg.mL, was approved by the FDA in Sept 2022. For a presentation about the Practical Considerations for Use of this product, please choose the online course "Gadopiclenol Injection | Practical Considerations for Use" from the list of RADU accredited programs.

Educational Objectives

At the completion of this program, participants will be able to:

• Describe the difference between linear and macrocyclic molecules
• Cite the least stable type of GBCA
• Define relaxivity
• Describe how to calculate volume of administration based on molar concentration
• Define thermodynamic and kinetic stability
• Cite the agents currently contraindicated in patients with eGFR below 30
• Identify agents associated with retention of gadolinium

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

In this educational program, Dr. Kristin Porter reviews the historical context of contrast enhanced MR and discusses the current recommendations for gadolinium-based contrast agents (GBCA), and briefly considers the future of contrast enhanced MR imaging.

Educational Objectives

• Review the History of Contrast Enhanced MRI.
• Examine the Development and Characteristics of MR Contrast Agents.
• Assess the Safety of MR Contrast.
• Discuss the current recommendations for MR contrast and briefly deliberate the future of MR contrast agents.

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

This educational program featuring Dr. Shreyas Vasanawala will cover pediatric MR imaging applications using Gadopiclenol, a recently approved gadolinium-based contrast agent (GBCAs).

Following a brief review of the literature and the currently available GBCAs, Dr. Vasanawala will discuss practice considerations as they relate to MRI contrast media selection and dose administration. Additionally, Dr. Vasanawala will share several case studies demonstrating the clinical value and benefits of Gadopiclenol for patients who may present with complex pathology and/or who may be subject to repeat contrast-enhanced MRI exams over their lifetime.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Explain the properties that distinguish gadopiclenol injection from the other high relaxivity gadolinium-based contrast agents (GBCAs).
• Employ the FDA-approved indications and clinical applications for gadopiclenol injection in pediatric patients.
• Apply clinical considerations and dosing options for gadopiclenol administered to vulnerable patient populations who may experience repeat, lifetime dosing of a GBCA.

This program is made possible through an unrestricted educational grant from Bracco Diagnostics Inc.

When preforming Pediatric MRI, careful clinical and safety considerations of this special patient population should be reviewed. The administration of gadolinium-based contrast agents (GBCAs) to determine the extend of disease as well as the frequency of GBCA administration over the life time of the child, can impact the type of MR contrast selected and the amount of gadolinium required to achieve diagnostic accuracy. In this accredited program, Lorna Brown. MD and a panel of MR imaging experts discuss these clinical considerations that are impacting Pediatric MRI.

Educational Objectives

• Assess practice trends impacting Pediatric MRI
• Review the different GBCAs chelates approved for Pediatric MR imaging (Macrocyclic vs Linear)
• Discuss important clinical considerations and challenges of GBCAs utilization in Pediatric MRI
• Apply best practice guidelines for GBCA administration (dosing, frequency, non-contrasted exams)

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

Since the 1990’s, multi-patient contrast administration has been available in the form of the Pharmacy Bulk Package (PBP), which is still offered by several contrast vendors. The FDA required that all related Prescribing Information (PI) sheets for the PBP include specific directions for the dispensing of the contrast from the PBP container. The PI language describes withdrawing the contrast from the bottle in a suitable work area, specifically “a laminar flow hood, using aseptic techniques”. However, this method is not possible in most CT Suites, as laminar flow hoods are generally located in the Pharmacy, not the CT suite.

Therefore, during the last decade, regulators have begun to have concerns about the use of PBP. In 2009, The Joint Commission began citing imaging providers who were using PBP to fill power injector syringes in what they considered an unsuitable work area, as described in the manufacturer’s PBP guidelines for the dispensing of contrast.

This Expert Forum will review the steps taken by the contrast media industry and the FDA to develop a safe and compliant solution for multi-patent contrast administration in CT. This solution is now available as the Imaging Bulk Package (IBP) which is approved for use in the CT Suite. This panel will also share their comprehensive process for incorporating IBP into their clinical practice.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Implement Joint Commission guidelines for multi-patient contrast administration.
• Describe the differences between Pharmacy Bulk Package (PBP) and Imaging Bulk Package (IBP) and define which is FDA approved for multi-patient use.
• Discuss the clinical and economic benefits of multi-patient contrast administration using Imaging Bulk Package (IBP).

This program has been supported through an educational grant from Bracco Diagnostics, Inc.

In MR Imaging, a careful review of the safety criteria for the selection of a Gadolinium-based Contrast Agents (GBCAs) should be considered for pediatric and neonatal patients. The program will provide a comprehensive review of the supporting research that addresses Gadolinium selection in this special patient population. Both chronic and long-term effects of GBCAs will be discussed.

As a Pediatric Neuroradiologist, Dr. Shah is uniquely qualified to share his experience which includes a discussion of risk vs benefits, supported by practical protocols for the administration of MR contrast; including limiting the amount of contrast given to patients that may receive several lifetime doses.

Educational Objectives

• Explain the differences between available MR contrast agents and any associated adverse events.
• Improve clinical management decisions about when to administer MR contrast (risk vs benefit).
• Apply FDA guidelines regarding MRI contrast agents to clinical practice.

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

This accredited program provides a comprehensive overview of MRI safety including the radiologist's responsibilities and liabilities, MRI staff education and patient safety. It is designed specifically for practicing radiologists, fellows, residents, and healthcare professionals who oversee MRI services and will provide practical guidance from two respected MRI safety educators who present information on accepted safety standards of care based on the 2020 ACR Manual on MR Safety, the 2021 FDA Guidance Document, and a review of the literature.

Program Considerations: It is critical to have established MRI safety protocols and to have a clear understanding of the basics of MRI Safety. The ACR Manual on MR Safety states that the Radiologist is responsible for the safety of the patient undergoing the MRI Exam. They are also responsible for implementing MR Safety policies and procedures and ensuring that the facilities’ personnel adhere to them at all time. These MRI safety policies should be reviewed and updated annually in order to prevent patient injury.

Educational Objectives

• Describe the difference between Level 1 & Level 2 MR personnel.
• Differentiate and identify the ACR-designated Safety Zones.
• Implement safety considerations for the static magnetic field, time-varying gradient magnetic fields, and radiofrequency fields.
• Employ procedures and protocols to prevent RF-related burns and methods to manage SAR levels.
• Manage acute and chronic gadolinium-based contrast agent adverse events.

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

Autoimmune encephalitis is a difficult clinical diagnosis due to the similarities in the clinical, imaging and laboratory findings of many forms of autoimmune and infectious encephalitis.¹ Many cases have no imaging findings, especially early in the course of the disease. MRI with contrast is considered the most sensitive imaging modality, and findings are present in over half of individuals.²

In this program, Dr. Maklinzak discusses the diagnosis of Autoimmune Encephalotomies using CE MR and explains how this modality can help guide acute treatment and antibody testing procedures.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712273/
2. Radiopaedia.org Autoimmune encephalitis Dr Francis Fortin and Radswiki et al.

Educational Objectives

At the completion of this program, participants will be able to:

• Review MRI contrast considerations and imaging protocols relating to Pediatric Neuro MRI in the diagnosis of Autoimmune Encephalotomies
• Understand the clinical imaging patterns of ADEM (acute disseminated encephalomyelitis), optic neuritis & transverse myelitis, limbic encephalitis, and MS
• Describe the movement toward antibody diagnoses with improved prognostic value and targeted therapy
• State how MRI findings can guide acute treatment and antibody testing

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

Prior to 2023, six extracellular fluid magnetic resonance imaging (MRI) contrast agents were available in the US: ProHance® (gadoteridol), Gadavist® (gadobutrol), Dotarem® (gadoterate meglumine; Clariscan™ (gadoterate meglumine); Omniscan™ (gadodiamide); and MultiHance® (gadobenate dimeglumine). These gadolinium-based contrast agents (GBCAs) vary with respect to chelate structure (ionic vs nonionic; macrocyclic vs linear), molar concentration (the number of Gd molecules per mL), and relaxivity.

With decades of use, these agents were demonstrated to be quite safe; however, since 2006, concerns about the safety of GBCAs have come to light, particularly with regard to the less stable (linear, nonionic) agents. Specifically, nephrogenic systemic fibrosis (NSF) and Gd retention were seen more readily with the use of these less-stable agents. It became apparent that a macrocyclic, high-relaxivity GBCA would be ideal, optimizing patient safety without compromising image quality.

In 2023, the US Food and Drug Administration approved Vueway™ (gadopiclenol) injection, a macrocyclic, high relaxivity agent that represents a significant advancement in terms of efficacy and safety. This paper compares the properties, mechanism-of-action, dosing, efficacy, and safety of the currently available GBCAs to the new agent Vueway.

This program has been supported through an educational grant from Bracco Diagnostics, Inc