North branch meeting day 2: contrast study day

Contrast study day Meeting organised by the North Branch of The British Institute of Radiology Friday 24 January 2014 Liverpool Medical Institute

09:00

Registration, tea and coffee

Chair:

Dr Elspeth Whitby, Senior Lecturer/Honorary Consultant, University of Sheffield

09:20

Welcome

09:30

General applications for CT Dr Matthew Bull, Consultant Radiologist, Sheffield Teaching Hospitals NHS Trust

10:00

General applications for MR Mr Kieran Murphy, Superintendent Radiographer MRI, The Liverpool Heart & Chest Hospital

Incorporated by Royal Charter Patron - Her Majesty The Queen

President Prof Andrew Jones BSc MSc FIPEM CSci FBIR Chief Executive Ms Jacqueline Fowler BA, MInstF(Cert)

The British Institute of Radiology 48-50 St John Street London EC2M 4DG

T : +44(0)20 3668 2226 E : admin@bir.org.uk www.bir.org.uk

Registered Charity No. 215869 VAT Registration No. GB 233 7553 63

10:30

Dynamics of blood flow within the body Dr Douglas Turner, Consultant Vascular Radiologist, Sheffield Teaching Hospitals NHS Trust

11:00

MR contrast in children Dr Gurdeep Mann, Consultant Radiologist, Alder Hey Children’s Hospital

11:20

Tea and coffee

11:40

MR contrast agents and acquisition techniques Professor Andrew Jones, Consultant Clinical Scientist, The Christie NHS Foundation Trust

12:00

Contrast and CT colonography Dr Milan Sapundzieski, Consultant Radiologist, Pennine Acute Hospitals NHS Trust

12:30

Small bowel imaging Dr Hannah Lambie, Consultant Radiologist, St James’s University Hospital

13:00

Questions and discussion

13:10

Lunch

14:00

CT angiography Dr Douglas Turner, Consultant Vascular Radiologist, Sheffield Teaching Hospitals NHS Trust

14:30

MR angiography Dr Douglas Turner, Consultant Vascular Radiologist, Sheffield Teaching Hospitals NHS Trust

15:00

Safety aspects of contrast media (CT and MR) Professor Andrew Jones, The Christie NHS Foundation Trust Dr Matthew Bull, Consultant Radiologist, Sheffield Teaching Hospitals NHS Trust

15:30

Tea and coffee

15:50

CT and MR of the liver Dr Tony Blakeborough, Consultant Radiologist, Sheffield Teaching Hospitals NHS Trust

16:20

Future directions of the BIR and the implications for education Professor Andrew Jones, Consultant Clinical Scientist, The Christie NHS Foundation Trust

16:40

Questions and discussion

17:00

Close of meeting CPD: 6 credits Please complete the meeting evaluation survey online at: https://www.surveymonkey.com/s/Contrast_day2 We will email your CPD certificate upon collation of your feedback.

We are most grateful to

For supporting this conference

Bayer HealthCare has provided sponsorship for the cost of the exhibition stand only at this meeting.

Speaker profiles and abstracts (where supplied) Biography Dr Matthew Bull, Consultant Radiologist, Sheffield Teaching Hospitals NHS Trust Matthew Bull is a Consultant Radiologist, Honorary Senior Lecturer and Clinical Director in Sheffield Teaching Hospitals. His first exposure to CT was a medical student accompanying an ill patient across the Pennines from Sheffield to Manchester for a body scan in 1979 (in a list of only 4 patients the whole day). He trained in Sheffield and New York. He has been a consultant since 1990 specialising in chest and endocrine imaging and has been involved in CT all through his career.

Abstract General applications for CT The basic concept of contrast in imaging especially CT will be discussed demonstrating methods of improving contrast. The various types of added contrast media and limitations will be discussed. Several specific protocols including trauma scanning will be shown. The benefits of contrast, nephrotoxicity and other potential hazards and future trends will also be presented.

Safety aspects of contrast media (CT and MR)

The brief talk will cover 1. Treatment of contrast reactions.

2. Management of contrast in renal impairment 3. Management of patients on metformin receiving contrast.

Biography Dr Gurdeep Mann, Consultant Radiologist, Alder Hey Children’s Hospital Gurdeep is a paediatric radiologist with a specialist interest in body imaging. He qualified from the University of Birmingham and after obtaining the MRCP (UK) undertook general radiology training in Leicester and paediatric cardiac MR at Great Ormond Street. He subsequently completed a paediatric radiology fellowship at British Columbia Children’s Hospital, Vancouver, Canada. His main areas of interest are cardiac cross-sectional imaging, MR imaging of inflammatory bowel disease, paediatric gynaecological disease and prenatal MRI. Abstract

MR contrast in children Gadolinium based contrast agents (GBCA) are widely used in paediatric practice with a relatively low risk of side-effects. The indications and contraindications for GBCA are broadly similar to those in adults. Off-label use of GBCA in children is common practice.

Where possible children should be ‘imaged gently’ and the indiscriminate use of GBCA is to be avoided. Although there is no proven clinical risk, ideally GBCA should not be administered to children aged less than one year and in particular newborns and the unborn child as they have physiological ‘transitional nephrology’. Strategies to avoid gadolinium use include phase contrast and time of flight angiography, non contrast MR coupled with Doppler ultrasound.

Objectives: 

Discuss the licensing, safety profile and contraindications for GBCA in children.



Discuss the main indications of GBCA using case studies.



Discuss strategies to avoid unnecessary GBCA administration in children.

Biography Professor Andrew Jones, Consultant Clinical Scientist, The Christie NHS Foundation Trust Andrew is a Consultant Clinical Scientist within Christie Medical Physics and Engineering at The Christie, Manchester and is Group Leader for Non-ionising Imaging. The groups MR section provides scientific support to MRI users across the North West region. He is a frequent lecturer covering a variety of subjects within clinical MRI. Andrew is currently President of the BIR. Abstract MR contrast agents and acquisition techniques 

An understanding of the nature and action of different MR contrast agents



An awareness of the differing agents available in the market along with their applications and special characteristics



An overview of the nature of MR data capture and implications for the resulting image appearances



A basic understanding of spatial frequency properties of k-space and the different filling regimens



An appreciation of the use of different methods of k-space filling and their advantages for MR angiography techniques



A general understanding of the basic physics that underpins contrast enhanced MR angiography



An understanding of bolus timing and data acquisition strategies used in MR angiography

Biography Dr Milan Sapundzieski, Consultant Radiologist, Pennine Acute Hospitals NHS Trust Dr Milan Sapundzieski is a Consultant Radiologist from The Pennine Acute Hospitals NHS Trust, Manchester. Besides general radiology, his special interest is gastrointestinal and abdominal radiology and paediatric radiology. Sub special interest is imaging of the large and small bowel. Milan is QA lead for radiology for

the North West of England, Bowel Cancer Screening Program. He also teaches at the University of Salford, School of Radiography on the topics of gastrointestinal radiology.

Abstract

Contrast and CT colonography CTC took over as a primary imaging for suspected colonic pathology, especially polyps and cancer. Sensitivity for large polyps and cancers is very high, where the sensitivity for flat and small polyps, less than 6mm, is much smaller. It is not indicated in IBD due to false positive findings.

Besides symptomatic patients, CTC is the only approved imaging modality for Bowel Cancer Screening Patients, as alternative for incomplete or contraindicated colonoscopy.

CTC involves specially trained radiographers, to perform and specially trained radiologist to report the investigation to high standards.

Learning objectives: 

What are technical requirements for successful CTC



How to do bowel preparation: standard , limited or none regime



Hypotonic medication and better patient comfort-iv Buscopan



How to do faecal tagging-oral contrast



How to do bowel distension-automatic CO2 insufflations vs. room air insufflations



When to use iv contrast



What is standard report for CTC

References: 1. GUIDELINES FOR THE USE OF IMAGING IN THE NHS BOWEL CANCER SCREENING PROGRAMME -Second Edition; NHSBCSP Publication No 5 ,09 November 2012 2. The second ESGAR consensus statement on CT colonography, European Radiology, Springer, September 2012 (published on line)

Biography Dr Hannah Lambie, Consultant Radiologist, St James’s University Hospital

Hannah Lambie trained as a radiologist in Leeds/W Yorkshire and is a Consultant Radiologist specialising in gastro-intestinal radiology at St James’s University Hospital, Leeds.

Abstract Small bowel imaging Educational Aims: 

To explore the different methods to assess the small bowel, when to use them and the contrast media used in imaging the small bowel

Talk outline: The different methods to assess the small bowel including endoscopic and radiological methods will be discussed. The pros and cons of each method and their relative uses will be reviewed. Particular reference will be made to the contrast media used to image the small bowel.

Learning outcomes: 

Describe the methods used to assess the small bowel



Understand the indications for imaging the small bowel and when to use the different imaging techniques



Know which contrast media are used and the rationale for using then

Biography Dr Doug Turner, Consultant Vascular Radiologist, Sheffield Teaching Hospitals NHS Trust

I work as a Consultant Vascular Radiologist at the Sheffield Vascular Institute.

I undertook a vascular radiology fellowship at the same institution, following general radiology training on the Cambridge scheme.

My job comprises all aspects of vascular disease diagnosis and intervention outside the coronary and intracranial circulations.

Abstract

CT angiography Computed tomography angiography (CTA) is an important tool in the diagnosis of vascular disease. Technological developments in scanner design in the last 20 years, along with huge advances in computational power, have allowed greatly improved spatial and temporal resolution imaging to be manipulated in powerful postprocessing algorithms; acquired isotropic volumetric data can be reformatted in any plane, and luminal centre-line techniques for example, allow accurate stenosis assessment and endovascular device sizing.

This presentation hopes to highlight the current role of CT angiography in the diagnosis of vascular conditions, and to do this, we will review the technological advances allowing effective CT angiographic imaging, touch upon the variables contributing to successful image acquisition, and highlight some of the applications of the technique. I will allude to some practical points regarding patient preparation and scanning protocols, as well as avoiding pitfalls in image interpretation.

Abstract Professor Andrew Jones, Christie Medical Physics and Engineering The Christie NHS Foundation Trust Dr Matthew Bull, Sheffield Teaching Hospitals NHS Trust Safety aspects of MR contrast agents (CT and MR) Learning objectives:



An appreciation of the general safety profile of gadolinium based MR contrast agents



An awareness of differences between various types of MR contrast agents in terms of their basic chemistry and excretion paths in-vivo



An understanding of the risks posed by nephrogenic systemic fibrosis (NSF) and the relationship with gadolinium contrast agents



An understanding of the differing nature of various MR contrast products and the associated risk factors for NSF



A knowledge of the licence implications around NSF for high risk agents



An awareness of the most up to date guidance on the safe use of gadolinium contrast agents and their implications for clinical practice

Dr Tony Blakeborough, Consultant Radiologist, Sheffield Teaching Hospitals NHS Trust Trained in Leeds, where he did a fellowship in Liver MRI Been a consultant in Sheffield since 1997, specialising in GI radiology, especially liver MRI. Abstract CT and MR of the liver Educational objectives: 

To understand the dual blood supply of the liver and its impact on enhancement of both normal liver and pathology.



To illustrate the differences between imaging the liver with CT and MRI, with typical examples of focal lesions.



To describe the advantages of liver specific contrast agents for liver MRI.

Our platinum sponsors

GE Healthcare provides transformational medical technologies and services to meet the demand for increased access, enhanced quality and more affordable healthcare around the world. GE (NYSE: GE) works on things that matter - great people and technologies taking on tough challenges. From medical imaging, software & IT, patient monitoring and diagnostics to drug discovery, biopharmaceutical manufacturing technologies and performance improvement solutions, GE Healthcare helps medical professionals deliver great healthcare to their patients.

Philips is a diversified health and well-being company and a world leader in healthcare, lifestyle and lighting. Our vision is to make the world healthier and more sustainable through meaningful innovation.

We develop innovative healthcare solutions across the continuum of care, in partnership with clinicians and our customers to improve patient outcomes, provide better value, and expand access to care.

As part of this mission we are committed to fuelling a revolution in imaging solutions, designed to deliver greater collaboration and integration, increased patient focus, and improved economic value. We provide advanced imaging technologies you can count on to make confident and informed clinical decisions, while providing more efficient, more personalised care for patients.

The Siemens Healthcare sector is one of the world’s largest suppliers to the

healthcare industry and a trendsetter in medical imaging, laboratory diagnostics, medical information technology and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare.

By optimising clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more costeffective. For further information please visit: /www.siemens.co.uk/healthcare

FORTHCOMING EVENTS

Radiology errors 31 January 2014 London

Scottish Branch meeting: Recent advances in diagnostic imaging 14 February 2014 Glasgow

3rd Annual SPECT/CT symposium: Current status and future directions of SPECT/CT imaging 24 February 2014 London

Multi-parametric imaging of prostate cancer can it facilitate a paradigm shift in management?

28 February 2014 London

Biological optimisation of radiotherapy 13 March 2014 London

Paediatric body MRI course 1 April 2014 London

Management and radiology - a guide to current and future management issues in radiology 2 May 2014 London

Radiotherapy - meeting the current and future workforce challenges for patient care in a changing context 19 May 2014 London

Molecular radiotherapy dosimetry 4 June 2014 Oxford

VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

NOTES ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ NOTES ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ NOTES ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ NOTES ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

____________________________________________________________________________________