Faculty Bibliography

There are many challenges associated with the safe use of fluoroscopy. These challenges include but are not limited to highly variable regulatory requirements, scope of practice concerns, inconsistent education and training, and lack of staff empowerment. Challenges are further compounded by the increasing use of fluoroscopy across a wide range of medical specialties. To facilitate consensus on how to address the issues, the ACR convened the multidisciplinary Blue Ribbon Panel on Fluoroscopy Safety (BRP-FS), with 32 organizations represented. The goal of the BRP-FS is to establish multi- and interspecialty consensus standards for the safe use of fluoroscopy in health care, including minimum and uniform standards for the education and training of fluoroscopy users that apply across geographic and professional boundaries, for the benefit of all patients and health care providers. Recommendations are made for local practices, professional organizations, industry, regulatory agencies, and accreditation bodies. Foundational to the recommendations of the BRP-FS are the personnel training and procedure classification frameworks in National Council on Radiation Protection and Measurement Commentary No. 33.

PURPOSE/OBJECTIVE:Cardiac imaging is an integral part of modern diagnostic imaging and a subject heavily tested on the Radiology Core exam. Therefore, radiology residency programs should provide adequate training in this area. This study aims to investigate the current state of cardiac imaging training within radiology residency programs in the United States. MATERIALS AND METHODS/METHODS:Survey questionnaires using the Research Electronic Data Capture (REDCap) platform were sent to heads of cardiac/cardiothoracic sections in all US radiology residency programs for which valid email addresses were available. RESULTS:Of 163 questionnaires sent, there were 70 responses, with 82.9% completing the entire survey. In total, 85.9% reported having a cardiac imaging rotation, with 58.8% being 4 weeks, mostly in a single block. Sixteen programs (31.4%) offered a longer cardiac experience (6 to 12 wk). In total, 90.7% reported having a designated person responsible for cardiac imaging, a radiologist in 68.5% and a combined radiologist and cardiologist in 22.2%. The responsible person for reporting cardiac CT was a radiologist in 40.7%, with a combined radiologist and cardiologist in 59.3%. For cardiac MRI studies, there was combined responsibility in 69.0%, either on alternate days of coverage or with the radiologist interpreting noncardiac findings. A total of 65.5% reported having ≥6 cardiac case conferences yearly, and 75.9% had ≥6 cardiac lectures. In total, 65.6% of programs offered cardiothoracic fellowships, with 87.2% dedicating ≥3 months to cardiac imaging. Only 18.6% had dedicated cardiovascular fellowships. CONCLUSION/CONCLUSIONS:Our research offers crucial insights into the current trends in cardiac imaging education and practice within radiology residency programs, so that professional societies can develop guidelines to structure a more uniform and thorough approach toward cardiac imaging education.

Although lymphoscintigraphy is most commonly used for sentinel lymph node mapping, it can also be helpful for evaluating lymphedema, lymphatic malformations, lymphatic leaks, chylous ascites, and chylothorax. Assessment for lymphedema is important because this condition poses significant clinical challenges, and early diagnosis is essential for timely intervention and prevention of complications. Lymphoscintigraphy is a valuable radiologic tool for distinguishing lymphatic causes of edema from nonlymphatic ones, with findings of lymphedema including absent, asymmetric, or delayed drainage from the injection site; dermal backflow; and reduced activity in the inguinal or axillary lymph nodes at lower extremity and upper extremity lymphoscintigraphy. Other supporting evidence of lymphedema may include collateral lymphatic channels and visualization of the deep lymphatic nodes. Additional imaging modalities, such as fluorescence lymphangiography, US, and MR lymphangiography, can also aid in lymphedema assessment. The authors provide an overview of lymphatic physiology, image acquisition, and image interpretation. ^©RSNA, 2025.

Sarcoidosis is a complex multisystem inflammatory disease characterized by noncaseating granulomas and variable clinical manifestations, most commonly affecting the lungs, skin, heart, and nervous system. Imaging is central in its diagnosis, staging, and management, providing essential insights into organ involvement and disease activity. Pulmonary manifestations remain the hallmark, with modalities such as high-resolution chest computed tomography (CT) and chest radiography offering critical diagnostic clues. Imaging techniques, including Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) and cardiac magnetic resonance imaging, are invaluable for identifying cardiac and systemic involvement, including cutaneous and musculoskeletal, while abdominal MRI and ultrasound help delineate hepatic and splenic manifestations. Neurosarcoidosis requires MRI for precise evaluation, supplemented by FDG-PET to guide biopsy and monitor treatment response. This chapter synthesizes the imaging features of sarcoidosis across organ systems, emphasizing practical approaches to diagnosis and management while identifying key areas for future research.

Cerebrospinal fluid (CSF) is an essential component of the central nervous system, and disruption of normal CSF flow from the lateral ventricles to the subarachnoid spaces around the brain and spinal canal can have serious consequences. Nuclear imaging may be useful to help diagnose abnormalities in CSF flow; cisternograms can be used to assess for CSF leaks or normal-pressure hydrocephalus, and shuntograms can be used to evaluate for CSF shunt malfunction. The authors review normal and pathologic findings and pitfalls of cisternography and shuntogram examinations. ^©RSNA, 2025.

The modified barium swallow study (MBSS) is a diagnostic examination that visualizes the functional anatomy and physiology of the oral pharyngeal swallowing mechanism in real time. The MBSS, a videofluoroscopic imaging method, is indicated for patients with known or suspected oropharyngeal dysphagia and ideally involves the combined expertise of a radiologist and speech pathologist. The MBSS provides critical diagnostic insights that help in identifying and assessing the type and severity of physiological swallowing impairments, evaluating the safety of oral intake, testing the effectiveness of evidence-based interventions, and developing treatment plans. This manuscript aims to present an overview of MBSS standards from an interdisciplinary perspective, emphasizes key areas of best practices, and reviews the common morphologic abnormalities seen on MBSS exams.

Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.

Various radiologic examinations and other diagnostic tools exist for evaluating gastrointestinal diseases. When symptoms of gastrointestinal disease persist and no underlying anatomic or structural abnormality is identified, the diagnosis of functional gastrointestinal disorder is frequently applied. Given its physiologic and quantitative nature, scintigraphy often plays a central role in the diagnosis and treatment of patients with suspected functional gastrointestinal disorder. Most frequently, after functional gallbladder disease is excluded, gastric emptying scintigraphy (GES) is considered the next step in evaluating patients with suspected gastric motility disorder who present with upper gastrointestinal symptoms such as dyspepsia or bloating. GES is the standard modality for detecting delayed gastric emptying (gastroparesis) and the less commonly encountered clinical entity, gastric dumping syndrome. Additionally, GES can be used to assess abnormalities of intragastric distribution, suggesting specific disorders such as impaired fundal accommodation or antral dysfunction, as well as to evaluate gastric emptying of liquid. More recently, scintigraphic examinations for evaluating small bowel and large bowel transit have been developed and validated for routine diagnostic use. These can be performed individually or as part of a comprehensive whole-gut transit evaluation. Such scintigraphic examinations are of particular importance because clinical assessment of suspected functional gastrointestinal disorder frequently fails to accurately localize the site of disease, and those patients may have motility disorders involving multiple portions of the gastrointestinal tract. The authors comprehensively review the current practice of gastrointestinal transit scintigraphy, with diseases and best imaging practices illustrated by means of case review. ^©RSNA, 2024 See the invited commentary by Maurer and Parkman in this issue.