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"Radiology is an adventure, a voyage of discovery." (1) - Paul M. Parizel, MD Paul Parizel, MD, PhD Chairman of the Department of Radiology at the Antwerp University Hospital, and tenured Professor of Radiology, University of Antwerp, Belgium | Past President of the European Society of Radiology and the European Congress of Radiology​ Paul M. Parizel graduated summa cum laude as M.D. from the Faculty of Medicine, University of Antwerp, Belgium, in 1982. He is a board-certified radiologist, and completed fellowships in neuroradiology at Massachusetts General Hospital, Harvard Medical School (Prof. Dr. Juan M. Taveras), and at Hôpital Erasme, University of Brussels (Prof. Dr. Danielle Balériaux). He developed the neuroradiology division at Antwerp University Hospital. In 2016 Prof. Parizel was elected as the first radiologist to be President of both the European Society of Radiology (ESR) and the European Congress of Radiology (ECR) at the same time. (2)In 1994, he obtained a Ph.D. degree with a dissertation entitled “The influence of field strength on magnetic resonance imaging (a comparative study in physicochemical phantoms, isolated brain specimens and clinical applications).” He was able to continue his research thanks to a 3-year ‘Fundamental Clinical Research’ grant from the “Foundation for Scientific Research” in Belgium.Since 2003, he is Chairman of the Department of Radiology at the Antwerp University Hospital, and tenured Professor of Radiology in the Faculty of Medicine and Health Sciences, University of Antwerp. He is a member of the Board of Trustees of the University of Antwerp, representing the Faculty of Medicine and Health Sciences.Prof. Parizel has authored or co-authored more than 300 peer-reviewed scientific papers (listed in PubMed) and more than 30 book chapters. He is editor and co-editor of several books, including “Clinical MR Imaging, a Practical Approach” (Reimer P, Parizel PM, Meaney JFM, Stichnoth F-A, Eds.) and “Spinal Imaging” (Van Goethem J, van den Hauwe L, Parizel PM, Eds.). His main fields of interest are neuroradiology and MRI, with a focus on integrating basic science with clinical applications. Throughout his career he has always strived to combine scientific research with patient-oriented imaging. He has presented invited lectures in many scientific meetings and courses on neuroradiology.Prof. Parizel received several international awards, including the prize of the European Society of Neuroradiology, ECR best presentation award, CompuRAD Exhibition Award. His national awards include the Award of the Belgian Government, Kodak Grant of the Royal Belgian Society of Radiology, and the “Astra Foundation Chair” for Lectures in Medicine. In 2014 he presented the Honorary Wilhelm Conrad Röntgen Honorary Lecture during the European Congress of Radiology (ECR 2014) in Vienna. During the Swiss Congress of Radiology (SCR) in May 2018 Prof. Parizel was awarded the Swiss Society of Radiology's highest honour- The Schinz Medal.Prof. Parizel is an active member of many scientific societies and organizations. He served as President of the Royal Belgian Radiological Society (RBRS) from 1999 to 2000, was chairman of the Scientific Program Committee of the 2003 ESMRMB meeting in Rotterdam, and chairman of the Postgraduate Educational Course Programme for ECR 2011 in Vienna. From 2010 to 2012, he served as President of the European Society of Neuroradiology(ESNR). From March 2016 to March 2017 he was the President the European Society of Radiology (ESR) which is the largest radiology society in the world with more than 65,000 members. Since March 2017, he has been the Chairperson of the ESR Board of Directors. He is an Honorary Fellow of the Royal Australian and New-Zealand College of Radiology (2002), honorary member of the Serbian Society of Neuroradiology (2012) and honorary and founding member of Russian National Society of Neuroradiology (2012). He became Honorary Member of the Serbian Society of Radiology (2013) and Honorary Member of the Societatea Radiologie și Imagistică Medicală din România (2015). In 2016 he became honorary member of the Sociedad Española de Radiología Médica, the European Society of Neuroradiology, the Société Française de Radiologie, the Israel Radiological Association and the Hellenic Radiological Society. In 2017, he became the Honorary Member of the American Society of Neuroradiology and the Iranian Society of Radiology.He has been a member of the Harvard Club of Belgium for almost twenty years.​ References: 1. Parizel identifies youth as central theme for ECR 2017. By Julia Patuzzi. March 7, 2016. Accessed July 26, 2018. https://www.auntminnie.com/index.aspx?sec=rca&sub=ecr_2016&pag=dis&ItemID=113648 2. Paul Parizel, MD: 10 Things to Know about the ECR 2017 President. By Philip Ward. February 15, 2017. Accessed July 26, 2018. https://www.auntminnie.com/index.aspx?sec=rca&sub=ecr_2017&pag=dis&ItemID=116558 ​Image of Prof. Dr. Paul M. Parizel from Linkedin via Wim Van Hecke. https://www.linkedin.com/feed/update/urn:li:activity:6379224435911647232

Hypoxia in a Neonate • Xray of the Week What is the diagnosis? Figure 1. Frontal chest and abdomen radiographs. What is the diagnosis? Figure 2. Annotated frontal chest and abdomen radiographs. The orogastric tube (blue arrow) is in a blind ending pouch due to esophageal atresia. The presence of air in the bowel indicates that there is a tracheoesophageal fistula. T7 is a butterfly vertebral body (yellow arrow). There is hypoplasia of the sacrum with multiple lumbar appearing vertebral bodies (green arrow). There is also a small right pneumothorax (red arrow). Figure 3. A different patient with VACTERL. Note the orogastric tube (blue arrow) coiled in a blind ending pouch due to esophageal atresia. There is also a left sided hemivertebra at L3-4 (green arrow). Discussion VACTERL association is not a syndrome, but due to an constellation of congenital anomalies involving several systems. The incidence is approximately 1 in 10,000 to 1 in 40,000 live-born infants and the etiology of the disorder is unknown. At least 3 of the following anomalies must be ​present to confirm the diagnosis: V- vertebral body defects A - anal atresia C - cardiac anomalies T- tracheoesophageal fistula E - esophageal atresia R- renal anomalies L- limb anomalies (especially radial) Fortunately, VACTERL is not associated with neurocognitive impairment. Treatment is variable depending on the malformations and is typically focused on severe gastrointestinal malformations such as anal atresia and tracheoesophageal fistula as well as any significant cardiac anomaly. References: 1. Solomon BD. VACTERL/VATER Association. Orphanet Journal of Rare Diseases 2011;6 (1): 56. doi:10.1186/1750-1172-6-56. Kellie Greenblatt, MD Pediatric Radiologist, RIMA A native of the Bay Area, Dr. Greenblatt attended the University of California at Berkeley where she earned a BA in Human Biodynamics. Following graduation, Dr. Greenblatt performed basic research for four years in the toxicology laboratory at Lawrence Livermore Laboratory focusing on carcinogens found naturally in cooked meat. Following her work at Lawrence Livermore, Dr. Greenblatt attended medical school at the Chicago Medical School. Following medical school, Dr. Greenblatt did two years of residency training in Surgery before entering a Diagnostic Radiology residency. She completed her Radiology Residency at Kaiser Permanente in Los Angeles, California, then did a one year fellowship in Pediatric Radiology at Children’s Hospital Los Angeles. Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chief of staff and Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice co-founded Global Radiology CME with Natalie Rice to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" Award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

LLQ Abdominal pain • Xray of the Week 2018 An 83 yo F presented to the Emergency Department with suspected diverticulitis. What is the diagnosis? Figure 1. Axial (A) and coronal (B) non-contrast CT of the abdomen and pelvis. Figure 2. Axial (A) and sagittal (B) non-contrast CT of the abdomen and pelvis. Red arrow: Spigelian hernia with surrounding mesenteric fat stranding indicative of incarceration and small amount of fluid. Green arrow: lateral border of the rectus abdominis muscle. Figure 3. Axial non-contrast CT of the pelvis. Right sided Spigelian hernia containing only mesenteric fat. Discussion: Spigelian hernia is a rare abdominal hernia, which accounts for about 1% of ventral hernias. The peak incidence is in the 4th to 7th decades. The orifice of a Spigelian hernia is located in the Spigelian fascia, between the lateral border of the rectus abdominis muscle and the semilunar line, through the transversus abdominis aponeurosis. As seen in this case, there is a high risk of bowel incarceration and strangulation. (Fig. 1-2) The most common symptom is pain which varies depending on the location and contents of the hernia. Since the hernia lies deep to a muscle and there frequently is no abdominal wall bulge, it is difficult to diagnose clinically. CT is usually diagnostic, demonstrating a hernia sac protruding through the linea semilunaris containing bowel or fat.(Fig. 1-3) Sonography may suggest the diagnosis with a complex mass in the anterolateral aspect of the abdominal wall, which may contain fluid or gas-filled loops of bowel. Treatment is surgical and there is a low risk of recurrence. References: 1. Spangen L. Spigelian hernia. World J Surg. 1989;13 (5): 573-80. 2. Harrison LA, Keesling CA, Martin NL et-al. Abdominal wall hernias: review of herniography and correlation with cross-sectional imaging. Radiographics. 1995;15 (2): 315-32. 3. Mittal T, Kumar V, Khullar R et-al. Diagnosis and management of Spigelian hernia: A review of literature and our experience. J Minim Access Surg. 2008;4 (4): 95-98. 4. Rettenbacher T, Hollerweger A, Macheiner P, et al. Abdominal Wall Hernias: Cross-Sectional Imaging Signs of Incarceration Determined with Sonography AJR Am J Roentgenol. 2001;177 (5): 1061-1066 5. Kirby, R. Strangulated Spigelian hernia. Postgraduate Medical Journal (1987) 63, 51-52 6. Stabile Ianora AA, Midiri M, Vinci R, et al. Abdominal wall hernias: imaging with spiral CT. European Radiology. June 2000, Volume 10, Issue 6, pp 914–919 7. Aguirre DA, Casola G, Sirlin C. Abdominal wall hernias: MDCT findings. AJR Am J Roentgenol. 2004;183 (3): 681-90. Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chief of staff and Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice co-founded Global Radiology CME with Natalie Rice to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Global Radiology is deeply honored to be awarded the British Institute of Radiology official seal of approval for our Imaging in England conference in Oxford, UK June 3-6, 2018. Be part of history at this extraordinarily exciting time to visit the U.K. Join Global Rads from around the world and study with the luminaries in radiology at the iconic University of Oxford! With a royal baby due in April and the the wedding of Prince Harry to Meghan Markle on May 26, 2018 England will be THE place to visit this summer. For those who have already registered, we strongly recommend that you make your travel plans early to ensure best selection. For those who have not yet registered, we urge you to register soon and join us for this unforgettable experience. For more information please visit the conference website here: Meeting at BIR with (left to right) Kevin Rice- President of Global Radiology CME, Carole Cross- BIR Communications Manager, Natalie Rice- Vice-President of Global Radiology CME, and Abbey Shaw- BIR Events Manager. The Imaging in England 2018 conference will be held in Oxford, UK from June 3 to June 6, 2018, at the Mathematical Institute on the campus of The University of Oxford. Condé Nast recently named the University of Oxford as one of the top 50 most beautiful places to visit in Europe. Click here for more information--> REGISTRATION INFORMATION Join the Luminaries in Radiology in magical Oxford, UK for an educational and fun experience. Our outstanding faculty will include, Drs. Donald Resnick, László Tabár, Phillip Tirman, Blake Johnson, Neil Rofsky, Vikas Shah, David Wilson, Simon Blease, and Sanjay Prabhu. In addition to a cutting edge scientific program which will include lectures on Artificial Intelligence in Radiology we will be offering our attendees ample opportunities for networking in relaxed social settings, including a welcome reception at the iconic Macdonald Randolph hotel and an evening of delicious food, fine wine and punting at the Cherwell Boathouse. Who attended our last congress? We had registrants from: Australia, Austria, Canada, China, Denmark, France, Greece, Hungary, Indonesia, Ireland, Israel, Kenya, Lithuania, New Zealand, Slovenia, South Africa, Sweden, Switzerland, Turkey, and the USA. Kevin Rice, MD serves as the Medical Director of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a Member of Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice launched Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD Natalie Rice is the co-founder of Global Radiology CME Natalie graduated from the University of Manitoba majoring in Economics. After completing her economics degree she attended Business School, majoring in accounting. Her work experiences include Dunwoody Accounting Firm, The Conference Board of Canada, and Principal of a Religious School. Having sat on numerous community boards, she is well connected and knows how to see a project to completion. Natalie has planned numerous successful international events throughout Canada, the Middle East, and the USA. Most recently, Natalie spearheaded Global Radiology’s inaugural conference in Israel. Successfully managing 250 delegates from 20 different countries and overseeing all aspects of the congress including faculty management, venue selection, registration, itinerary and social programming.

Radiography technologists have an opportunity to greatly assist the radiologists by performing high quality exams. Unfortunately there is variable quality seen in radiography. I explain how these top ten quality tips will greatly reduce errors in the radiology department and improve the ability for radiologists to make an accurate diagnosis. Dr. Rice’s Radiography Top Ten: 1. Verify that all images and notes are in PACS for the radiologist. 2. Use a lead side marker with your initials. 3. Remove all clothing, jewelry, and other foreign objects from the field. 4. Use a metal pointer on the area of maximal bone or joint pain. 5. Abdomen x-ray must show both sides of diaphragm and lesser trochanters. 6. Shoulder x-ray must collimate to the shoulder and have 3 views. 7. Wrist X-ray must include a scaphoid view if patient is age 10 or older. 8. CXR must include both lung apices and both lung bases. 9. Accession #, order, and study description for the exam must match the images in PACS. 10. Indication must be available to the radiologist. See full post here: https://www.globalradcme.com/single-post/2015/05/01/Dr-Rice-Radiography-Top-Ten Kevin M. Rice, MD serves as the Chair of the Radiology Department at Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice together with Natalie Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Hematemesis and severe abdominal pain • Xray of the Week 2016 A 33 year old female with chronic renal failure and kidney transplant presented to the Emergency Department with severe abdominal pain and hematemesis. What is the diagnosis? Figure 1. Axial (A) and coronal (B) non-contrast CT of the abdomen and pelvis. Figure 2. Axial (A) and sagittal (B) non-contrast CT of the abdomen and pelvis. Red arrow: gas in the wall of the stomach. Green arrow: Renal transplant. Discussion: Emphysematous gastritis is a rare cause of gastric emphysema, and usually refers to infectious gastritis. The condition is due to mucosal disruption and gastric wall infection with gas producing organisms such as Escherichia coli and Clostridium perfringens. Although gas may be visualized with plain radiographs, CT is the best modality for detection of intramural gas. Radiologist play vital role in early detection of the disease. Treatment includes broad spectrum intravenous antibiotics and IV fluids. Surgery may be required in cases of gastric infarction, perforation or failed medical treatment. The mortality rate is high (60%–80%) even with aggressive medical or surgical management. References: 1. Wong YY, Chu WC. Emphysematous gastritis associated with gastric infarction in a patient with adult polycystic renal disease: CT diagnosis. AJR Am J Roentgenol. 2002;178 (5): 1291 2. Loi TH, See JY, Diddapur RK, Issac JR. Emphysematous gastritis: a case report and a review of literature. Ann Acad Med Singapore. 2007;36:72-3. 3. Viswanath S, Jain AKC. Emphysematous gastritis: A rare diagnosis with unique presentation. OA Case Reports 2014 Feb 25;3(2):11. 4. Fidvi SA, Klein SA. Emphysematous gastritis. Applied Radiology. 2002;31(3):1-2. 5. Kussin SZ, Henry C, Navarro C, Stenson W, Clain DJ. Gas within the wall of the stomach: report of a case and review of the literature. Dig Dis Sci 1982; 27:949–954. 6. Grayson DE, Abbott RM, Levy AD, et al. Emphysematous Infections of the Abdomen and Pelvis: A Pictorial Review. RadioGraphics 2002; 22:543–561. Kevin M. Rice, MD is president of Global Radiology CME and serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Developing architectural distortion in 68F • Xray of the Week 2017 • Week #42 This 68-year old woman was treated for an 8 mm tubular cancer in her left breast at age 48. She is asymptomatic but was called back from screening for assessment of an architectural distortion in the upper portion of her right breast and an enlarged lymph node in the right axilla. Clinical breast examination revealed a large palpable thickening in the central portion of the right breast and a palpable right axillary lymph node. No tumor was palpable in the left breast. Figure 1. Bilateral mammogram Figure 2. Bilateral mammogram 26 months later. Figure 3: Progression of architectural distortion in the right breast over time. Note the development of extensive architectural distortion which eventually fills the entire central portion of the breast. The breast has correspondingly decreased in size. There is a pathological right axillary lymph node. Figure 4: Automated breast ultrasound (ABUS) of the right breast, lateral compression, showing a series of images of 2 mm thick, consecutive coronal tissue slices. The images demonstrate the obvious, extensive architectural distortion and a large tissue defect, caused by the cancer. Figure 5 a-g. Breast MRI, axial (a-c), sagittal (d-g) images. Description of the MRI finding: There is a 6.0 x 5.7 x 7.3 cm region of diffuse, heterogeneous contrast enhancement in the right breast, characteristic for diffusely infiltrating breast cancer. Note the enlarged draining veins in the right breast, causing an asymmetry in vessel size between the right and left breasts. Also, pathological lymph nodes were seen in the right axilla. Left breast: scar following previous surgery, causing the nipple to deviate laterally. Five cm deep to the nipple there is a 9 x 1.3 x 1.1 cm lesion with radiating structure and contrast enhancement, suggesting a local recurrence (encircled). MRI exam courtesy: Mats Ingvarsson, M.D. Due to the suspicious appearance on mammography, ultrasound, and MRI, ultrasound guided biopsy was performed followed by right axillary lymph node biopsy. Figure 6: Ultrasound and mammogram image of a pathologic lymph node in the right axilla and the histologic confirmation of the 14-g core biopsy specimen. Histopathology images show this diffusely infiltrating breast cancer at the cellular level. Histology images are courtesy of Tibor Tot, MD PhD - Associate Professor, Department of Pathology and Clinical Cytology, Central Hospital Falun, Falun, Sweden Because of the extent of disease, mastectomy was required. Histology from the right mastectomy was a 7.5 x 5.0 cm diffusely infiltrating breast cancer. pN 1/7. Biomarkers: ER/PR +ve, HER2 –ve, Ki67 1%. Figure 7: Correlation of the mastectomy specimen slice with large format thick section (3D) histopathology. The extensive proliferation of the fibrous tissue (mesenchyme) dominates the image, accounting for the findings at ABUS and mammography. This diffusely infiltrating invasive carcinoma occupied the entire central and retroareolar region of the breast. Histology images are courtesy of Tibor Tot, MD PhD - Associate Professor, Department of Pathology and Clinical Cytology, Central Hospital Falun, Falun, Sweden. A spiculated lesion in the left breast was also noted on followup mammography. This was subsequently biopsied and was shown to be invasive breast cancer. Figure 8: Mammography of the left breast demonstrating a spiculated mass. Ultrasound shows the irregular hypoechoic mass with marked shadowing. This was subsequently biopsied and was shown to be well differentiated invasive breast cancer. Histology images are courtesy of Tibor Tot, MD PhD - Associate Professor, Department of Pathology and Clinical Cytology, Central Hospital Falun, Falun, Sweden The patient elected for left mastectomy. Histology of the left mastectomy was 1.5 x 1.2 cm unifocal, well differentiated invasive breast cancer. pNX. Biomarkers: ER/PR+ve, HER2-ve, Ki67 1%. Figure 9: Mammographic-histologic correlation of the solitary breast cancer detected in the left breast. Histology images are courtesy of Tibor Tot, MD PhD - Associate Professor, Department of Pathology and Clinical Cytology, Central Hospital Falun, Falun, Sweden Discussion The diffusely infiltrating breast cancers are notoriously missed on the mammograms. They are usually 5-9 cm in size at the time of detection and have a poor long-term outcome. The ability to evaluate the global anatomy of the breast using automated breast ultrasound can readily detect the presence of extensive architectural distortion. We propose that the diffusely infiltrating breast cancers may originate from mesenchymal stem cells (progenitors) through a complex process of mesenchymal-epithelial transformation (MET). The imaging findings of diffusely infiltrating breast cancer are strikingly different from the imaging findings of breast malignancies originating either from the TDLUs (AAB) or the lactiferous ducts (DAB), suggesting that it may have a different site of origin. The spider’s web-like mammographic presentation of diffusely infiltrating breast cancer may be difficult to detect, even in predominantly adipose breasts, regardless of a large tumor size, while stellate and circular tumors (AAB) can be mammographically detectable in an adipose breast at the size of a few mm. The predominance of mesenchyme in the diffusely infiltrating breast malignancy allows it to be imaged with greater sensitivity by ultrasound than by mammography. The thin sheets or veils of tissue reflect the ultrasound waves, but are relatively easily penetrated by X-rays. There is a lack of extensive neoangiogenesis within the massive fibrous tissue, accounting for an initial slow or moderate contrast enhancement on breast MRI, followed by a persistent enhancement pattern, as opposed to the more intense initial enhancement and washout pattern characteristic of DAB & AAB (Ref.: Tabár, L, T Tot, PB Dean, O Puchkova: Diffusely Infiltrating Breast Cancer, Part I. Vol XI of the 3D book series). Regarding the left breast lesion, stellate or circular invasive tumors originate from the acinar cells of the terminal ductal lobular unit(s), producing acinar adenocarcinoma of the breast (AAB). These tumors are often situated at the periphery of the dense fibroglandular tissue, causing subtle parenchymal contour changes (the contour may be either retracted or protruding), leading to perception problems. References: Kim MJ, Kim EK,Kwak JY et al, Bilateral Synchronous Breast Cancer in an Asian Population: Mammographic and Sonographic Characteristics, Detection Methods, and Staging. AJR. American Journal of Roentgenology. 2008;190: 208-213. 10.2214/AJR.07.2714 Other breast imaging cases on Global Radiology CME: Invasive Ductal Carcinoma of the Breast in 27 Year Old Phyllodes Tumor Medullary Breast Cancer Breast Hemangioma Radial Scars and Invasive Breast Cancer Juvenile Papillomatosis László Tabár, MD, FACR (Hon) the Professor Emeritus of Radiology Uppsala University, Faculty of Medicine, Sweden and the Medical Director Emeritus of the Department of Mammography, Falun Central Hospital, Sweden. Through his company, Mammography Education, Inc, he has also been the course director and principal lecturer at more than 300 mammography courses on 6 continents. His pioneering research has laid the foundation for early detection through modern mammographic screening. Dr. Tabár is the recipient of numerous awards including the Gold Medal from the Society of Breast Imaging, American Cancer Society's Distinguished Service Award, and the first Alexander Margulis Award for Scientific Excellence from the Radiological Society of North America (RSNA). All Posts by László Tabár, MD All Breast Imaging Posts

Bilateral Upper Extremity Defects • Xray of the Week A one-day old infant presents with bilateral upper extremity defects. What is the diagnosis? Figure 1. Right and left hand radiographs of the one-day old infant presenting with bilateral upper extremity defects. Figure 2. R. The right hand consists of 4 rays (between red arrows) consisting of metacarpal bones with a triangular rudimentary proximal phalanx present (white arrow) laterally along the right hand. The medial deviated digits contain 2 phalanges while 2 more medial digits contain 3 phalanges (between yellow arrows). Minimal carpal ossification is present. Figure 2. L. The left hand consists of only 3 rays (between blue arrows) containing a metacarpal and a proximal, middle, and distal phalanx (between green arrows). No left thumb is present. Minimal carpal ossification is present. Discussion Holt-Oram Syndrome (HOS) is an autosomal dominant disease that occurs at a frequency of 1 out of 100,000 (4). Also, called “Heart-Hand Syndrome” or atriodigital dysphasia, this syndrome is the result of a premature stop code on the product of the TBX5 gene located on the long arm of the 12q2 chromosome (1,4). The TBX5 gene is a T-box containing transcription factor with the primary role in cardiac and forelimb development (2). The mutation thus results in upper extremity and cardiac defects. Patients with HOS present with abnormalities with varying degrees of severity ranging from minor hypoplasia or aplasia of upper extremities, to life threatening cardiac defects. The most commonly affected structure is the thumb while other affected structures include the upper and lower arm, wrist, hand and other fingers (1,3). Additional abnormalities can include the clavicle and scapula thus compromising the pectoral girdle. The skeletal anomalies can be unilateral or bilateral with the left side typically being more severe than the right (5). Approximately 85-95% of patients with HOS have cardiac defects (2,3). The most common congenital cardiac anomaly is the ostium secundum type atrial septal defect (ASD) (4). However, ventricular septal defects, patent ductus arteriosus, and ostium primum ASD are other manifestations of HOS cardiac anomalies. Treatment: Due to the varying degree of HOS manifestations, it is difficult to ascertain the extent of the effects of the abnormalities. However, based on phenotypic observations, planar x-rays, and ECG, one may be able to determine if an orthopedic and cardiologist consultation is required. Future surgery may be required to repair defects to improve quality of life for the patient. References: 1. Basson, C. T., Cowley, G. S., Solomon, S. D., Weissman, B., Poznanski, A. K., Traill, T. A., Seidman, J.G., & Seidman, C. E. (1994). The clinical and genetic spectrum of the Holt-Oram syndrome (heart-hand syndrome). New England Journal of Medicine, 330(13), 885-891. 2. Bruneau, B. G., Nemer, G., Schmitt, J. P., Charron, F., Robitaille, L., Caron, S., ... & Seidman, J. G. (2001). A murine model of Holt-Oram syndrome defines roles of the T-box transcription factor Tbx5 in cardiogenesis and disease. Cell, 106(6), 709-721. 3. Newbury-Ecob RA, Leanage R, Raeburn JA, et al. Holt-Oram syndrome: a clinical genetic study. Journal of Medical Genetics 1996;33:300-307. 4. Li, Q. Y., Newbury-Ecob, R. A., Terrett, J. A., Wilson, D. I., Curtis, A. R., Yi, C. H., Gebuhr, T., Bullen, P. J., Robson, S. C., Strachan, T., Bonnet, D., Lyonnet, S., Young, I. D., Raeburn, J. A., Buckler, A. J., Law, D. J., Brook, J.D. (1997). Holt-Oram syndrome is caused by mutations in TBX5, a member of the Brachyury (T) gene family. Nature genetics, 15(1), 21-29. 5. Smith, A. T., Sack, G. H., & Taylor, G. J. (1979). Holt-Oram syndrome. The Journal of pediatrics, 95(4), 538-543. Christopher Williamson, MSMP 1st year medical student Medical College of Georgia at Augusta University Yulia Melenevsky, MD Assistant Professor, Musculoskeletal Imaging Department of Radiology Medical College of Georgia at Augusta University

Global Radiology is pleased to announce we will be working in association with The British Institute of Radiology on Imaging in England 2018. Founded in 1897, The British Institute of Radiology (BIR) is the oldest and one of the most prestigious radiological societies in the world. Publications of the BIR include the British Journal of Radiology (BJR) which is essential reading for radiologists, medical physicists, radiotherapists, radiographers and radiobiologists. By working with the BIR, we plan on synergistically using resources to benefit the members of the BIR as well as the medical professionals who utilize the educational material produced by Global Radiology CME. The Imaging in England 2018 conference will be held in Oxford, UK from June 3 to June 6, 2018, at the Mathematical Institute on the campus of The University of Oxford. Condé Nast recently named the University of Oxford as one of the top 50 most beautiful places to visit in Europe. Click here for more information--> REGISTRATION INFORMATION Join the Luminaries in Radiology in magical Oxford, UK for an educational and fun experience. Our outstanding faculty will include, Drs. Donald Resnick, László Tabár, Phillip Tirman, Blake Johnson, Neil Rofsky, Vikas Shah, David Wilson, Simon Blease, and Sanjay Prabhu. In addition to a cutting edge scientific program which will include lectures on Artificial Intelligence in Radiology we will be offering our attendees ample opportunities for networking in relaxed social settings, including a welcome reception at the iconic Macdonald Randolph hotel and an evening of delicious food, fine wine and punting at the Cherwell Boathouse. Who attended our last congress? We had registrants from: We have registrants from: Australia, Austria, Canada, China, Denmark, France, Greece, Hungary, Indonesia, Ireland, Israel, Kenya, Lithuania, New Zealand, Slovenia, South Africa, Sweden, Switzerland, Turkey, and the USA. The official Symplur Twitter conference hashtag for Imaging in England - 2018 is #iie2018. Follow us on Twitter: ​@GlobalRadCME Follow us on Facebook: GlobalRadCME Imaging in England-2018: #iii2018 Kevin Rice, MD serves as the Medical Director of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a Member of Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice launched Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD Natalie Rice is the co-founder of Global Radiology CME Natalie graduated from the University of Manitoba majoring in Economics. After completing her economics degree she attended Business School, majoring in accounting. Her work experiences include Dunwoody Accounting Firm, The Conference Board of Canada, and Principal of a Religious School. Having sat on numerous community boards, she is well connected and knows how to see a project to completion. Natalie has planned numerous successful international events throughout Canada, the Middle East, and the USA. Most recently, Natalie spearheaded Global Radiology’s inaugural conference in Israel. Successfully managing 250 delegates from 20 different countries and overseeing all aspects of the congress including faculty management, venue selection, registration, itinerary and social programming.

The Imaging in England 2018 #iie2018 conference will be held in Oxford, UK from June 3 to June 6, 2018, at the Mathematical Institute on the campus of The University of Oxford. Condé Nast recently named the University of Oxford as one of the top 50 most beautiful places to visit in Europe. Click here for more information--> REGISTRATION INFORMATION Join the Luminaries in Radiology in magical Oxford, UK for an educational and fun experience. The outstanding faculty for Imaging in England 2018 includes, Drs. Donald Resnick, László Tabár, Phillip Tirman, Blake Johnson, Neil Rofsky, Vikas Shah, David Wilson, Simon Blease, Gerardine Quaghebeur, and Sanjay Prabhu. A cutting edge scientific combined will be combined with ample opportunities for networking in relaxed social settings. Punting at the Cherwell Boathouse 1.Go punting If you enjoy boating on beautiful canals there is no better way to spend a sunny Oxford day than to engage in one of the most quintessential Oxonian pastimes by renting a punt and boating along the Cherwell River. Social functions included with your 3 day registration is a welcome reception of British canapes and wine at the iconic Macdonald Randolph hotel and an evening of delicious food, fine wine, jazz music and punting at the Cherwell Boathouse. The entrance to the world renowned Ashmolean Museum 2. Visit the Ashmolean While in Oxford, visit the world famous Ashmolean Museum, located across the street from the Macdonald Randolph Hotel. The museum opened in 1683 was the first to welcome the public. The Sheldonian Theater - an architectural masterpiece by Sir Christopher Wren 3. Take a walking tour. Explore Oxford Castle, showcasing 1000 years of Oxford history. Harry Potter fans will enjoy a walking tour of all the filming locations. Stop by the Sheldonian Theater built in 1664 still used for music concerts, lectures, and University ceremonies. The Bear Inn opened its doors in 1242 3. Tour historic pubs After all your exploring enjoy a pint of ale or a bite at a local pub- check out the Eagle and Child a J.R.R. Tolkien favorite, or visit Oxford’s oldest pub The Bear Inn which opened its doors in 1242. Drop by the popular but well-hidden historic Turf Tavern which Bill Clinton frequented while attending Oxford as a Rhodes Scholar. Bicycles can be found lining the campus streets 4. Go for a bike ride In the mood for some exercise, Oxford is a renowned "cycling city" with beautiful trails and country roads catering to all levels of cyclists. Dining Hall in Christ Church 5. Christ Church College Founded in 1546 by King Henry VIII, Christ Church College, is one of the constituent colleges on The University of Oxford Campus. Designed by Christopher Wren it is an architectural masterpiece. Harry Potter fans will recognize their famous dining hall and quad used as inspiration for many of the scenes from the Harry Potter movies. Blenheim Palace in the Cotswolds 6. Get out of town Ready to explore the beautiful English countryside, a short drive will take you to the Cotswolds, Stratford Upon Avon- the birthplace of Shakespeare and Bath. If prehistoric monuments interest you, nearby Stonehenge dating back to the bronze age is regarded as a British cultural icon. Blenheim Palace, the birthplace of Winston Churchill is just a short drive. This is a unique opportunity to meet radiologists from all corners of the globe in an intriguing location, and learn from some of the best specialists in their field. Indulge all your senses and join the Global Rads for the trip of a lifetime to Oxford, England in June, 2018! We have registrants from: Australia, Belgium, Brazil, Bulgaria, Canada, China, France, Germany, Greece, Hungary, India, Israel, Netherlands, New Zealand, Norway, Philippines, Saudi Arabia, Singapore, South Africa, Sweden, Switzerland, Thailand, UK, and USA. The official Symplur Twitter conference hashtag for Imaging in England - 2018 is #iie2018. Follow us on Twitter: ​@GlobalRadCME Follow us on Facebook: GlobalRadCME Imaging in England-2018: #iie2018 Natalie Rice is the co-founder of Global Radiology CME Natalie graduated from the University of Manitoba majoring in Economics. After completing her economics degree she attended Business School, majoring in accounting. Her work experiences include Dunwoody Accounting Firm, The Conference Board of Canada, and Principal of a Religious School. Having sat on numerous community boards, she is well connected and knows how to see a project to completion. Natalie has planned numerous successful international events throughout Canada, the Middle East, and the USA. Most recently, Natalie spearheaded Global Radiology’s inaugural conference in Israel. Successfully managing 250 delegates from 20 different countries and overseeing all aspects of the congress including faculty management, venue selection, registration, itinerary and social programming.

Here is a step-by-step instruction on how to put in a critical notes message in Carestream native reporting module. Thanks to Mark Beller, MD for the images and instructions below. Here is how to do it: 1. Highlight the critical finding in your report. 2. Click on the critical notes button at the top. 3. The critical notes dialog will pop up, with the highlighted dialogue already inputted. 4. Type in the name of the person whom you spoke with. 5. Then click the red triangle with the green check mark (as below) 6. It will gray out and automatically mark it as critical results delivered. All done! Related posts: How To Add Hyperlinks to Your Carestream Reports Kevin Rice, MD is the president of Global Radiology CME Dr. Rice serves as the Chair of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a radiologist with Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice founded Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD

Imaging in England 2018, Presented by Global Radiology CME in association with the British Institute of Radiology, June 3-6, in Oxford, U.K. will cover this years Minnie's hottest and most controversial topics in radiology - Artificial Intelligence and 3D printing. We are pleased to welcome Dr. Sanjay P. Prabhu, Staff Pediatric Neuroradiologist at Boston Children's Hospital and Assistant Professor of Radiology at Harvard Medical School who will present lectures on the Radiologist's Role in Medical 3D Printing - Opportunities and Challenges and Artificial Intelligence in Pediatric Radiology - Current Applications and the Future. Dr. Prabhu will be joining our outstanding faculty that includes world renowned radiologists, Drs. Donald Resnick, László Tabár, Phillip Tirman, Blake Johnson, Neil Rofsky, Simon Blease, Vikas Shah, and David Wilson. Please join fellow Global Rads from around the world in Oxford June 2018, for an outstanding educational and networking experience! Sanjay Prabhu is a Staff Pediatric Neuroradiologist at Boston Children's Hospital and Assistant Professor of Radiology at the Harvard Medical School. He has served as the Director of the Advanced Image Analysis Lab at Boston Children’s Hospital since 2010. In 2013, Dr. Prabhu was appointed to the position of Clinical Director of the SIMPeds3D print program. Dr. Prabhu completed his radiology training in the United Kingdom in 2005 followed by fellowships in Pediatric Radiology in Melbourne, Australia and subspecialty fellowships in Pediatric Neuroradiology and Cardiac Imaging at Boston Children’s Hospital, including focus on epilepsy imaging, functional MRI, fetal neuroimaging, MR spectroscopy and pediatric cardiac imaging.His current research interests include 3D printing, imaging of pediatric epilepsy, use of augmented reality, clinical decision support, and machine learning in radiology. He has authored more than 100 peer-reviewed papers and 16 book chapters. He is currently working on building next generation clinical decision support tools with the hospital’s digital health team and industry partners. His work in the SIMPeds3D print program focuses on evaluating utility of 3D printed models for pediatric surgical simulation, training and patient education. With his team at SIMPeds3D print, he has helped create more than 500 bespoke 3D patient-specific models to help clinicians from various subspecialties in Boston and other parts of the world.He has a special interest in trainee education and he has served as the Webmaster and social media education coordinator for the World Federation of Pediatric Imaging for the last 4 years. The #iie2018 conference will be held in Oxford, UK from June 3 to June 6, 2018, at the Mathematical Institute on the campus of The University of Oxford. Condé Nast recently named the University of Oxford as one of the top 50 most beautiful places to visit in Europe. Click here for more information--> REGISTRATION INFORMATION Dr. Prabhu's Lectures: Radiologist’s role in medical 3D Printing- opportunities and challenges In this talk, Dr. Prabhu will elaborate on the current role of bespoke 3D printing at Boston Children’s Hospital. He will discuss the typical clinical scenarios where a 3D printed model is most useful, step-by-step methods to create a 3D printed model from DICOM files, and compare in-house and outsourced pathways to create a usable print. Dr. Prabhu will also discuss imaging protocols to help create high quality models and highlight how close collaboration between the radiologist and clinician/surgeon can enhance a print. Using illustrative clinical examples and published studies from the Boston Children’s Hospital, Dr. Prabhu will look at case scenarios where 3D printing, surgical simulation and virtual surgical planning has been shown to impact patient outcomes. Artificial intelligence in pediatric radiology- current applications and the future With increasing numbers of images being produced at a rapid pace on modern scanners, radiologists are being inundated in the reading room by more data than they can analyze and interpret in a timely fashion, and more importantly, interact with care providers who are increasingly relying on imaging studies to plan patient management. Artificial intelligence and deep learning algorithms can help perform pattern recognition and help manage the avalanche of data in both the imaging and clinical realms. In this talk, Dr. Prabhu will discuss currently available deep learning algorithms to evaluate pediatric bone age, identifying positions of catheters, identify evidence of hypoxic injury in neonates and enable fracture detection on radiographs. Also, he will look at the role of machine learning in streamlining radiology work lists, increasing efficiency, prioritizing cases and recognizing relevant clinical information from electronic medical records and provide context to interpret imaging studies. Research endeavors discussed will include machine learning algorithms to recognize disease patterns, identifying and measuring rate of growth of neoplastic lesions, and ways of creating “heat maps” directing the radiologist’s attention to possible abnormalities on images. These innovations, if implemented correctly, will potentially help reduce error rates and improve patient outcomes. The issue of whether this development threatens the position of radiologists as members of the clinical care team, and ways to prepare for this inevitable revolution will also be discussed. Join the Luminaries in Radiology in magical Oxford, UK for an educational and fun experience. The outstanding faculty for Imaging in England 2018 will include, Drs. Donald Resnick, László Tabár, Phillip Tirman, Blake Johnson, Neil Rofsky, Vikas Shah, David Wilson, Simon Blease, and Sanjay Prabhu. In addition to a cutting edge scientific program which will include lectures on Artificial Intelligence in Radiology we will be offering our attendees ample opportunities for networking in relaxed social settings, including a welcome reception at the iconic Macdonald Randolph hotel and an evening of delicious food, fine wine and punting at the Cherwell Boathouse. Punting at the Cherwell Boathouse This is a unique opportunity to meet radiologists from all corners of the globe in an intriguing location, and learn from some of the best specialists in their field. Indulge all your senses and join the Global Rads for the trip of a lifetime to Oxford, England in June, 2018! The official Symplur Twitter conference hashtag for Imaging in England - 2018 is #iie2018. Follow us on Twitter: ​@GlobalRadCME Follow us on Facebook: GlobalRadCME Imaging in England-2018: #iii2018 Kevin Rice, MD serves as the Medical Director of the Radiology Department of Valley Presbyterian Hospital in Los Angeles, California and is a Member of Renaissance Imaging Medical Associates. Dr. Rice has made several media appearances as part of his ongoing commitment to public education. Dr. Rice's passion for state of the art radiology and teaching includes acting as a guest lecturer at UCLA. In 2015 Dr. Rice launched Global Radiology CME to provide innovative radiology education at exciting international destinations, with the world's foremost authorities in their field. In 2016, Dr. Rice was nominated and became a semifinalist for a "Minnie" award for the Most Effective Radiology Educator. Follow Dr. Rice on Twitter @KevinRiceMD All posts by Kevin M. Rice, MD Natalie Rice is the co-founder of Global Radiology CME Natalie graduated from the University of Manitoba majoring in Economics. After completing her economics degree she attended Business School, majoring in accounting. Her work experiences include Dunwoody Accounting Firm, The Conference Board of Canada, and Principal of a Religious School. Having sat on numerous community boards, she is well connected and knows how to see a project to completion. Natalie has planned numerous successful international events throughout Canada, the Middle East, and the USA. Most recently, Natalie spearheaded Global Radiology’s inaugural conference in Israel. Successfully managing 250 delegates from 20 different countries and overseeing all aspects of the congress including faculty management, venue selection, registration, itinerary and social programming.