BIR UK MRI course by BIR Publishing

British Institute of Radiology UK MRI Course 8 - 11 October 2013 Aston Conference Centre Birmingham 24 RCR CPD credits

Course programme

Welcome and thank you for coming to the â&#x20AC;&#x2DC;BIR UK MRI courseâ&#x20AC;&#x2122; organised by the British Institute of Radiology. This booklet contains the abstracts and biographies for each speaker (where supplied). This course has been awarded 24 RCR category I CPD credits (6 per day). CPD certificates will be distributed by email within 2 weeks of the course after the online delegate surveys have been completed. Please complete the online delegate surveys using the below links. We will use your valuable feedback to improve future conferences. https://www.surveymonkey.com/s/MRI_day1 https://www.surveymonkey.com/s/MRI_day2 https://www.surveymonkey.com/s/MRI_day3 https://www.surveymonkey.com/s/MRI_day4

We hope you find the event interesting and enjoyable. BIR MRI organising committee We are most grateful to

for supporting this conference

Tuesday 8 October 2013 Physics / business 09:00 Registration and refreshments 09:40 Welcome and introduction 09:45 Basic physics refresher Dr Peter Wright, Sheffield Teaching Hospitals NHS Foundation Trust

10:15 Image contrast Dr Martin Graves, Cambridge University Hospitals NHS Trust 10:45 Basics of k-space: implications for image quality Dr Geoff Charles-Edwards, Guy’s & St Thomas’ NHS Foundation Trust 11:15 Refreshments 11: 45 Artefacts Mrs Sarah Prescott, University Hospital of North Staffordshire 12:15 1.5T versus 3T Dr Peter Wright, Sheffield Teaching Hospitals NHS Foundation Trust 12:45 Basics of k-space: faster imaging Dr Geoff Charles-Edwards, Guy’s & St Thomas’ NHS Foundation Trust 13:15 MRI business cases Mrs Daina Dambitis, Leeds Teaching Hospitals NHS Trust 13:45 Lunch 14:30 Procurement Mrs Carole Burnett, Leeds Musculoskeletal Biomedical Research Unit 15:00 Installation Mrs Carole Burnett, Leeds Musculoskeletal Biomedical Research Unit Dr Martin Graves, Cambridge University Hospitals NHS Trust 15:30 Safety update Mrs Sarah Prescott, University Hospital of North Staffordshire 16:00 Refreshments 16:15 Dealing with the difficult patient Ms Celia O’Meara, University College London Hospitals NHS Foundation Trust 16:45 Question and answer 17:15 Close

Speaker profiles (where supplied) Mrs Carole Burnett NIHR Fellow, Leeds Musculoskeletal Biomedical Research Unit I qualified as a Radiographer in 1989 and have specialised in Magnetic Resonance Imaging for the last 16 years. I have had a varied career working within the private sector, industry and National Health service in clinical and managerial positions. In November 2010 I was awarded a National Institute of Health Research Clinical Doctoral Research Fellowship. This is a 4 year grant to allow me to undertake my PhD investigating ‘Improving the safety and patient experience in the magnetic resonance imaging of arthritis: Magnetic resonance imaging of synovitis without the use of intravenous gadolinium’. I was appointed the Lead Radiographer for the London Olympic and Paralympic Games in 2012. Dr Geoff Charles-Edwards Principal Clinical Scientist, Guy’s & St Thomas’ NHS Foundation Trust After training as a clinical physicist, Geoff Charles-Edwards obtained a PhD in Magnetic Resonance from the Institute of Cancer Research, before moving to Guy’s & St Thomas’ hospitals in 2003 where he is now Principal Clinical Scientist. He is also a HEFCE-NIHR Senior Clinical Lecturer and an Honorary Senior Lecturer at King’s College London. Mrs Daina Dambitis Service manager MRI, Leeds Teaching Hospitals NHS Trust Daina qualified as a radiographer in1980 from Leeds General Infirmary, she then worked as a radiographer in the Middle East in the 1980’s. Daina returned to Yorkshire working in Nuclear Medicine and CT at St James’s Hospital Leeds. Daina set up CT service at Harrogate. Daina trained in MRI at Leeds General Infirmary, worked a split post as a research radiographer. Daina set up a new MRI service at Cookridge oncology hospital and new oncology wing at St James’s Hospital Leeds. Daina is now working as Service manager for Leeds Trust MRI. Dr Martin Graves Consultant Clinical Scientist, Cambridge University Hospitals NHS Trust Martin Graves is a Consultant Clinical Scientist at Cambridge University Hospitals NHS Trust and an Affiliated Lecturer in the University of Cambridge Clinical School. He has nearly 30 years of experience working in clinical and research MRI in both London and Cambridge. He is a fellow of the Institute of Physics and Engineering in Medicine and the Higher Education Academy. He is active on a number of national and international committees including the BIR MR Special Interest Group as well as the ISMRM Education and Annual Meeting Programme Committees. He has coauthored over 130 publications as well as the award winning MRI text book MRI: from Picture to Proton.

He co-edited Carotid Disease: the Role of Imaging in Diagnosis and Management and has recently published Physics MCQs for the Part 1 FRCR. He teaches on a number of MRI courses both nationally and internationally and has received ISMRM Outstanding Teacher awards in 2006 and 2011. His current research interests are in the development of techniques for morphological and functional cardiovascular imaging and interactive MRI. Mrs Sarah Prescott Clinical Scientist, University Hospital of North Staffordshire Sarah started training to be a clinical scientist at University Hospitals Coventry and Warwickshire (UHCW). As part of this training she undertook an MSc in Medical and Radiation Physics at the University of Birmingham. After successfully completing the first part of her training in the areas of MRI, Nuclear Medicine and Radiotherapy, she then went on to complete the second half of her training at University Hospital of North Staffordshire (UHNS) where she specialised in MRI and Nuclear Medicine. She currently works at UHNS as a Clinical Scientist in MRI and Diagnostic Radiology. Ms Celia O’Meara Superintendent Radiographer - PETMR, University College London Hospitals NHS Foundation Trust Since March 2012, I have been responsible for providing the PET-MR service at UCLH. This is the first simultaneous PET-MR scanner sited in the UK, and the current workload includes oncology, neurology and cardiology. This is an interesting and challenging post as there is both a clinical and research aspect to each working day. Prior to my current post, I have worked at Guy’s and St Thomas’ NHS Foundation Trust and the Royal Marsden NHS Foundation Trust as a Radiographer. In January 2013, I was awarded best technologist abstract at the annual SCMR conference. Dr Peter Wright Clinical Scientist, Sheffield Teaching Hospitals NHS Foundation Trust Peter Wright has recently joined Sheffield after previously being at the University Hospital of North Staffordshire where he supported the commissioning of three new Siemens MR systems and subsequent protocol setup and image quality improvement. Prior to UHNS Peter spent 3 years as the in-house physicist at Leeds Musculoskeletal and Biomedical Research Unit (LMBRU), an NIHR funded unit at Leeds NHS Trust. This role included his clinical medical physics training. Prior to this he obtained his PhD at the University of Nottingham in functional MRI and related parameters using 7 T and 3 T MRI systems.

Abstracts (where supplied) Basic physics refresher Dr Peter Wright Education Aims • Origins of the MR Signal • Signal acquisition and spatial encoding • Introduction to longitudinal (T1)and transverse (T2) relaxation mechanisms • Basic pulse sequences – gradient echo and spin echo By the end of the lecture delegates should be familiar with the origins of the MR signal and how it is manipulated to produce an image. This includes the use of magnetic field gradients and radiofrequency (RF) pulses to spatially encode the signal to be acquired. Delegates will be introduced to relaxation techniques, T1 and T2 and the basic spin echo (SE) and gradient echo (GE) sequences in preparation for subsequent lectures.

Image contrast Dr Martin Graves Signal in MRI can arise primarily from three main physical characteristics of the tissue 1. Proton density (): the relative numbers of tissue protons within each voxel 2. T1: the longitudinal relaxation time of tissue within each voxel 3. T2: the transverse relaxation time of tissue within each voxel. Due to tissue magnetic susceptibility (the degree a tissue can become magnetised), combined with the non-uniformity of the static magnetic field, this transverse relaxation time can be shortened and is known as T2*. The relative contribution of these relaxation times to the contrast in an image is dependent upon the pulse sequence used and the timing/other parameters within that sequence. The contrast in a standard imaging sequence is a mixture of , T1 and T2 or T2* but the imaging parameters are chosen to emphasize one of these over the others, hence the use of the term “weighted” to indicate the primary contrast mechanism. The aim of this lecture is to provide an overview of the mechanisms and methods that affect contrast in MR images. At the end of this lecture the participants will be expected to: 1. Describe the physical principles of T1, T2 and T2*relaxation mechanisms 2. Compare spin echo and gradient echo pulse sequences 3. Explain how pulse sequences parameters can be manipulated to produce weighted images demonstrating the desired contrast Further reading McRobbie DW, Moore EA, Graves MJ and Prince MR. MRI: from Picture to Proton 2nd Ed. Cambridge University Press. ISBN 9780521683845

Basics of k-space: implications for image quality Dr Geoff Charles-Edwards Educational aims: A basic understanding of the concept of k-space. Learning outcomes: An understanding of how k-space relates to the MR acquisition and to the resulting MR image, and how certain areas of k-space contribute differently to image contrast, SNR and spatial resolution. The concept of k-space and Fourier transforms is often a daunting one, but it is central to MR imaging. A good understanding provides a solid base on which to understand image quality issues and how different acquisition options impact on the final image. This talk will introduce the concept of k-space and describe some of the relationships that exist, both between k-space and the physical state of the magnetisation, and k-space and the resulting image. Artefacts Mrs Sarah Prescott Learning Outcomes: (1) Recognise MRI artefacts (2) Understand the physics which causes artefacts (3) Suggested methods for overcoming artefacts There are a wide range of artefacts that can be introduced into MRI. Some of these degrade the images so that they are non-diagnostic, whilst others can cause confusion by mimicking pathology. This talk illustrates a range of artefacts to help you identify these in the future. Simple artefacts such as motion and wrap will be discussed, as well as more advanced artefact identification such as cross-talk and in plane flow artefacts. The physics behind these artefacts will be explained, and methods to overcome or reduce these artefacts will be suggested. 1.5T versus 3T Dr Peter Wright Education aims: • Theory behind benefits and disadvantages of higher field strength systems • Real world comparisons of 1.5T and 3T clinical systems • Benefits of higher field strength for advanced techniques • Equipment considerations when procuring a 3 T system The potential benefits of higher field strength systems are well known, but how are they achieved in reality? This lecture will introduce the theory behind the benefits of 3T systems in comparison to 1.5T as well as the trade-offs that may be necessary to achieve those benefits. Real-world examples of 1.5T versus 3T images will be discussed, including reduced scan time and increased resolution examples. However, there are issues to be resolved with 3T systems. Some of these will be identified with suggestions in how to reduce their effect as well as examining extra considerations for 3 T compared to 1.5 T when going through the procurement process.

Basics of k-space: faster imaging Dr Geoff Charles-Edwards Educational aims: A basic understanding of common methods to speed up image acquisition Learning outcomes: An understanding of zero-filling, partial Fourier and parallel imaging: their requirements, pros and cons. Increasing demands on more time efficient MRI protocols has led to a range of methods that can be used to speed up image acquisition times by missing out portions of k-space. Zero-filling exploits the fact that the outermost areas of k-space contribute least in terms of contrast and SNR to the resulting image and setting these areas to zero prior to Fourier transform rather than spend time acquiring these data often gives satisfactory results with only a slight reduction in spatial resolution. Partial Fourier techniques generally utilise the symmetry of k-space to miss out up to nearly half of it and calculate what it should have been from the acquired side. Finally, the additional spatial information that is provided by the use of phased array coils can be exploited to essentially calculate missing lines of k-space. The pros, cons and limitations of each of these methods will be discussed. MRI business cases Mrs Daina Dambitis Good business planning is essential if we are to deliver a good service to our patients. Small and large hospitals need to ensure their equipment as flexible and versatile as possible. Business cases need to reflect the needs of the service and be matched to finance available. Although many radiographers may not be directly involved in the purchase, scanner replacement or writing of the business case, it is important that everyone understands the value of the taxpayers money and how we spend it. In this climate there will be a compelling argument to keep equipment running as long as possible and a purchase such as a MRI scanner will leave a huge deficit in any budget. We need to consider what should be included in a business case. What options are available other than outright purchase, and how to evaluate what the service actually needs. Procurement Mrs Carole Burnett This talk will cover the basic steps and decisions that are made when buying a MRI scanner. The talk will contain the following subjects: What to buy Who to buy from How to buy Where to place the scanner What to include in the purchase What to look out for in the small print Lesson that I have learnt There will be the opportunity to ask questions at the end of the talk.

The main learning points will be: What to include in procurement package What not to forget to include The basics of procurement Lessons I have learnt Installation Mrs Carole Burnett Dr Martin Graves The installation of an MRI system is a complex project that often falls to members of the Radiology department to specify and in some cases manage. Despite being a relatively mature technology, there are still a number of issues that can occur after the installation of a system that could have been addressed beforehand. This is particularly true if the installation is not “turn-key”. Sites should not necessarily expect that all NHS Estates departments and their contractors have extensive MRI installation knowledge and experience. As with any project, there are always cases where different contractors will blame each other for problems making resolution of the issue very difficult or expensive. Comprehensive acceptance testing of the system before clinical use is recommended to ensure that the system operates within the vendors performance criteria and to establish appropriate quality control criteria. The aim of this lecture is to present some “lessons-learnt” from previous installations so that sites may try to avoid the mistakes of others. At the end of this lecture the participants will be expected to: 1. State a number of “lessons-learnt” from previous installations 2. Identify some potential installation issues 3. Describe the processes involved in acceptance testing and routine quality control Further Reading MHRA. Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use - DB 2007(03) Quality Control in Magnetic Resonance Imaging. The Institute of Physics and Engineering in Medicine. Report No. 80, 1998. Acceptance Testing and Quality Assurance Procedures for Magnetic Resonance Imaging Facilities. American Association of Physicist in Medicine. Report 100, December 2010

Safety update Mrs Sarah Prescott Learning Outcomes: 1. Update on current safety guidelines 2. Safety implications of 3T 3. How to ensure patients are scanned quickly and safely This talk provides an update on the current safety guidelines associated with MRI. After recapping the key hazards associated with MRI, the focus of this talk switches to patient safety. The three categories of implanted devices are discussed (MR Safe, MR Conditional and MR Unsafe), and examples are given of each. One of the current issues in MRI Safety is that there has been an increase in the number of 3T scanners in clinical service. Some implants which are safe at 1.5T may not be safe at 3T, and this will be discussed in more detail. The talk will end with the answer to the critical question – how do you get your patient through the system safely but quickly? Dealing with the difficult patient Ms Celia O’Meara The aim of this presentation is to evaluate who can be considered a difficult patient and then to discuss techniques to obtain an optimal MRI scan, whilst ensuring a positive patient experience. There are many patient presentations that fall into this category when undertaking MRI scans. Patients for whom English is not a first language, patients with learning disabilities, paediatric patients, geriatric patients, claustrophobic patients – the list sometimes feels limitless! A prepared and competent operator can gain the confidence and co-operation of the patient and obtain high quality images. This presentation will feature methods that can be implemented in a MRI department effectively. The learning outcomes of this presentation are: 1. To provide operators with methods to safely screen patients prior to them entering the scan room 2. To increase the awareness of operators of fast imaging techniques currently available from manufacturers 3. To explain techniques available to operators to minimise patient movement 4. To ensure that operators understand that patient experience is also important whilst undertaking scans

Please complete the meeting evaluation survey online at: https://www.surveymonkey.com/s/MRI_day1 Upon collation of your feedback, we will email you your CPD certificate.

Wednesday 9 October 2013 Neuro â&#x20AC;&#x201C; spine 08:45 Registration 09:00 Lecture A - Physics of spine imaging Dr Peter Wright, Sheffield Teaching Hospitals NHS Foundation Trust 09:30 Lecture B - MR imaging of the paediatric spine Dr Ruth Batty, Royal Hallamshire Hospital 10:00 Lecture C - Spinal infections Dr Ian Craven, Leeds General Infirmary 10:30 Lecture D - Spinal tumours Dr Deborah Annesley-Williams, Queenâ&#x20AC;&#x2122;s Medical Centre, Nottingham 11:00 Refreshments 11:30

Workshop session 1 - topics A&B and C&D

12:15

Workshop session 2 - topics C&D and A&B

13:00

Lunch

14:00

Lecture E - Spinal trauma Dr Curtis Offiah, The Royal London Hospital

14:30 15:00

Lecture F - Myelopathy Dr Fintan Sheerin, Oxford University Hospitals NHS Trust

15:45

Refreshments

16:15

Panel discussion reviewing complex cases

17:00

Workshop session 3 - topics E&F

Speaker profiles (where supplied) Dr Deborah Annesley-Williams Consultant Neuroradiologist, Queen’s Medical Centre, Nottingham I was born and brought up in Ireland and was educated at Alexandra College Dublin. Following my secondary school education, I moved to Germany and went to medical school at the University of Cologne, qualifying in 1990. I then held busy clinical jobs in the UK before starting my general radiology training in Stoke-on-Trent. My Neuroradiology training has been through departments in Manchester, Dublin and Newcastle. I was appointed a Consultant at Frenchay Hospital in Bristol in 2000 and obtained an MD from the University of Manchester in 2002. I moved to Queen’s Medical Centre, Nottingham in 2003. I have established a special interest in the spine, supported by on-going research and regular presentations and publication. Dr Ruth Batty Consultant Neuroradiologist, Royal Hallamshire Hospital and Sheffield Children’s Hospital Dr Ruth Batty is a Consultant Neuroradiologist at the Royal Hallamshire Hospital, Sheffield and Sheffield Children’s Hospital and Honorary Senior Clinical Lecturer in the Academic Unit of Medical Education at the University of Sheffield. Ruth graduated from the University of Newcastle Upon Tyne in 1998 with distinction. She trained in general medicine in the UK and Australia and passed the MRCP in 2001. Following training in Clinical Radiology in Leeds she was a clinical fellow in Neuroradiology in Sheffield. Ruth went on to obtain the European Qualification in Neuroradiology. She has worked as a consultant in Sheffield since 2008. Ruth is currently involved in research related to open spinal dysraphism. She has published over 50 peer-reviewed articles. She is deputy training programme director for radiology south for Health Education Yorkshire and the Humber. She is a RCR clinical radiology examiner on the Anatomy Working Group. Dr Ian Craven Consultant Neuroradiologist, Leeds General Infirmary I am a Consultant Neuroradiologist from Leeds General Infirmary with a subspecialist interest in paediatric neuroradiology. I trained in Sheffield where I am still a member of the university, studying for a PhD in imaging normal children. I have a keen interest in education both locally as Specialist Interest Lead in the Leeds Radiology Academy and generally as Co-Founder of the Aunt Minnie Radiology FRCR course. I am currently doing a Post-Graduate Certificate in Medical Education at the University of Cambridge. In my spare time I support Manchester United, coach hockey and play with my 11-month old daughter.

Dr Curtis Offiah Consultant Neuroradiologist, The Royal London Hospital I am a Consultant Neuroradiologist working at Barts Health NHS Trust incorporating the Royal London Hospital and St Bartholomewâ&#x20AC;&#x2122;s Hospital. I have a number of subspecialty and research interests including neurotrauma. I have lectured nationally and internationally in neurotrauma and have published papers in peer-reviewed radiological journals on neuroradiological aspects of trauma. I also advise Coroner services and police forces on relevant criminal neurotrauma cases. The Royal London Hospital is a level 1 trauma centre and one of the four delegated major trauma units for London and sees a wealth of varied trauma cases including those pertaining to the head, neck and spine. Dr Fintan Sheerin Consultant Neuroradiologist, Oxford University Hospitals NHS Trust Dr Sheerin is a Consultant Neuroradiologist at Oxford University Hospitals NHS Trust. He trained in Cambridge, London and Oxford and is a Scholar of St Catharineâ&#x20AC;&#x2122;s College Cambridge. His subspecialty interests are in Craniofacial, Stroke, Head and Neck and Spinal imaging. Dr Peter Wright Clinical Scientist, Sheffield Teaching Hospitals NHS Foundation Trust Peter Wright has recently joined Sheffield after previously being at the University Hospital of North Staffordshire where he supported the commissioning of three new Siemens MR systems and subsequent protocol setup and image quality improvement. Prior to UHNS Peter spent 3 years as the in-house physicist at Leeds Musculoskeletal and Biomedical Research Unit (LMBRU), an NIHR funded unit at Leeds NHS Trust. This role included his clinical medical physics training. Prior to this he obtained his PhD at the University of Nottingham in functional MRI and related parameters using 7 T and 3 T MRI systems.

Abstracts (where supplied) Physics of spine imaging Dr Peter Wright Education Aims 1. Recap relaxation principles and T1 and T2 weighted images 2. Fat and fluid signal nulling techniques 3. Flow compensation techniques 4. Signal saturation techniques

The lecture will start with the principles of relaxation and T1/T2 weighted images followed by examining standard spine protocols. Certain sequences in protocols may require either fat or fluid signal to be nulled to better view possible pathologies. However, certain artefacts can mimic pathology, such as CSF flow artefact and we will examine the background of flow artefact and flow compensation techniques. Breathing and cardiac motion can also have a detrimental effect on image quality so will examine techniques to avoid this type of image quality degradation. MR imaging of the paediatric spine Dr Ruth Batty Aims The lecture aims to cover: 1) When and how to image the paediatric spine MR imaging protocols Imaging of the spine in certain intracranial pathologies: Encephalopathy Infection Demyelination Trauma: non-accidental and accidental head injury Phakomatosis and brain tumours which CSF seed Techniques for MR imaging in paediatric patients 2) An approach to reporting paediatric MR spine examinations 3) Imaging examples of spinal pathologies. This will mainly concentrate on spinal dysraphisms and congenital malformations of the spine. This will include an overview of open and closed spinal dysraphism with reference to normal embryology with imaging examples. Learning Outcomes: 1) MR imaging protocols for the paediatric spine for specific indications 2) Be aware of brain pathologies in which the spine should also be imaged 3) Tips for MR imaging the paediatric patient 4) A logical approach to reporting paediatric MR spine examinations 5) A better understanding of spinal dysraphism

Spinal infections Dr Ian Craven This lecture will concentrate on the common findings on MRI in typical and atypical spinal infections. The involvement of different spinal compartments has important consequences for both the patient and clinicians. Specific cases will help illustrate how to differentiate between these whilst trying to highlight the important infection mimics. Interesting cases will then be used to emphasise less common conditions that should remain in the differential. Finally the focus will turn to the complex subject of post-operative spinal infection with practical tips aimed to help those involved with such cases. By the end of the lecture the learner should be more confident in their approach to protocolling MR imaging in patients who have suspected spinal infection. They should recognise the pertinent findings and be able to exclude important differential diagnoses. Further cases will be presented in the subsequent workshop to help consolidate the lecture material and allow discussion of the more difficult aspects. Spinal tumours Dr Deborah Annesley-Williams Aim: The aim of this study is to describe the imaging characteristics of spinal tumours, correlated with the operative findings, at Nottingham University Hospitals over the last five years. Method: A retrospective database search over a period of 5 years between 2008-2013 under a neurosurgeon, with a special interest in spinal tumour surgery. For the purposes of this study, 111 cases were identified. M:F ratio was 1:1. Age range was 13-80 years with a mean of 50.1. Radiology and histological correlation was available in all the cases included in this study. Results: 22 cases (19.8%) of spinal tumours were intramedullary, 65 cases (58.6%) were intradural, 19 cases (17.1%) both intra and extradural and 5 cases (4.5%) were extradural tumours. Amongst the intramedullary lesions, ependymomas were common in the cervical and lumbar spinal cord, with astrocytomas more often seen in the thoracic cord. Rarer entities encountered included haemangioblastoma, ganglioglioma, metastasis, dermoids, epidermoids and dysraphic cysts. The most frequently identified intradural extramedullary compartmental tumours were schwannoma (31 cases, 10 involving both ID & ED compartments, with 3 occurring in the ED region alone) and meningioma (28 cases). Schwannomas were most commonly found in the lumbar spine whereas meningiomas were located in the thoracic spine. Rare entities in this region included paragangliomas, bronchogenic cysts, neurenteric cysts and sarcomatous lesions. Schwannomas were the most frequently encountered extradural tumours in our case series.

Conclusion: This 5 year review of spinal tumours at our tertiary referral centre reveals results that are comparable to internationally published data. Learning onjectives: The ability to decide whether a spinal tumour is predominantly located in the intramedullary, extramedullary, intradural or extradural compartment and to suggest an appropriate differential for each type of tumour. Spinal trauma Dr Curtis Offiah Accurate interpretation of magnetic resonance imaging (MRI) of spinal trauma can be very challenging but is central to the appropriate management and prognostication of significantly compromised and frequently obtunded patients as well as paramount in limiting morbidity in surviving patients of significant trauma. The lecture will provide insight into potential artefacts that may be encountered in MRI of spinal trauma, the technical challenges of MRI in such patients and the limitations of such imaging. Normal anatomy and correlative MRI appearances will be discussed. MRI considerations of blunt and sharp penetrating trauma of the spine will be covered and, where relevant, correlation made with emergency CT imaging which will usually have been performed in the first instance. The slightly more complex normal anatomy, traumatic injury and MRI correlation of the craniocervical junction trauma will also be specifically addressed. Educational Aims and Learning Outcomes: 1. Understanding the normal anatomy of the craniocervical junction and spine. 2. Understanding the urgency of MRI assessment in the severely injured intubated and ventilated patient with spinal injury. 3. Understanding the concept of “the stable” versus “the unstable” spinal injury. 4. Understanding the fracture and ligamentous injury patterns associated with some of the more typical spinal injuries including high energy mechanism injuries. 5. Understanding prognostic MRI features in cord injury associated with spinal trauma. Myelopathy Dr Fintan Sheerin Imaging of the spinal cord parenchymal lesions; from traumatic myelopathies to cord tumours.

Phillip Wardle is a Consultant Radiologist and Clinical Director at Cwm T Please complete the meeting evaluation survey online at: https://www.surveymonkey.com/s/MRI_day2 Upon collation of your feedback, we will email you your CPD certificate.

Thursday 10 October 2013 MSK – upper limb 08:45 Registration 09:00 Lecture A - MR Physics for MSK Imaging Dr Richard Hodgson, University of Manchester 09:30

Lecture B - MRI of the paediatric upper limb Dr Karl Johnson, Birmingham Children’s Hospital