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

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

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 post-

processing 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

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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!

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