Abdominal and Pelvic Complications of Nonoperative Oncologic Therapy

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 9, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Abdomen and Pelvis: 1.00

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Body: 1.00

Nuclear Medicine Technology: 1.00
Procedures: 1.00
Endocrine and Oncology Procedures: 1.00

Registered Radiologist Assistant: 3.25
Procedures: 3.25
Abdominal Section: 3.25

Radiation Therapy: 3.25
Procedures: 3.25
Treatment Sites and Tumors: 3.25

Outline

1. Introduction
   1. Chemotherapeutic Agents
   2. Radiation Therapy
2. Effects of Chemotherapy
   1. Liver
      1. Fat Deposition
      2. Hepatic Capsular Retraction
      3. Portal Vein Thrombosis
      4. Hepatic Veno-occlusive Disease
      5. Hepatic Congestion
   2. Spleen
      1. Splenic Rupture
      2. Therapy-induced Splenomegaly
      3. Spleen after Use of Thorotrast
   3. Pancreas
   4. Bowel
      1. Enteritis
      2. Colitis
   5. Bowel Perforation, Fistulas, and Delayed Anastomotic Leak
      1. Perforation and Fistula
      2. Delayed Anastomotic Leak
      3. Graft-Versus-Host Disease
      4. Pneumatosis
   6. Vessels
      1. Vascular Complications
      2. Bleeding
      3. Peritoneum and Mesentery
3. Radiation-induced Changes
   1. Liver
   2. Pancreas
   3. Spleen
   4. Stomach and Duodenum
   5. Small Bowel
   6. Large Bowel and Presacral Space
   7. Kidney, Ureter, and Bladder
   8. Bone
   9. Radiation-induced Tumors
4. Summary

Objectives

Upon completion of this course, students will:

1. identify the primary imaging modality that is typically used for diagnosis, staging, and follow-up of cancer
2. know the cell types affected by cytotoxic agents
3. be familiar with Topoisomerase inhibitors and other chemotherapeutic agents
4. be familiar with targeted chemotherapeutic agents, their indications and side effects
5. identify the most common type of radiation therapy
6. be familiar with the complications of chemotherapeutic agents by organ
7. be familiar with the typical locations of focal fat deposition in the liver from oxidative stress from chemotherapy
8. be familiar with the complications of chemotherapeutic agents
9. understand why a clinician should be alerted to imaging findings of steatosis or steatohepatitis
10. be familiar with the patient diagnoses where hepatic capsular retraction may be visualized after chemotherapy
11. be familiar with the appearance of hepatic capsular retraction on CT and MR
12. be familiar with the appearance of portal vein thrombosis at imaging
13. be familiar with the pathologic process of hepatic veno-occlusive disease
14. know the patient symptoms of hepatic veno-occlusive disease
15. identify the possible method of differentiation between hepatic veno-occlusive disease and graft-versus-host disease
16. be familiar with the imaging findings of hepatic veno-occlusive disease
17. know the condition with which hepatic congestion may be associated
18. be familiar with the imaging findings of hepatic congestion
19. understand the issue of administering imatinib in conjunction with clopidogrel
20. know how splenic rupture demonstrates at CT imaging
21. be familiar with the symptoms of therapy-induced splenomegaly with which patients may present
22. know the product details of Thorotrast
23. be familiar with the appearance of pancreatitis at CT imaging
24. know the area of the bowel that is most commonly involved with enteritis
25. know how a pseudomembranous colitis diagnosis is confirmed
26. be familiar with the CT imaging findings of a delayed anastomotic leak
27. be familiar with the imaging findings of acute and chronic GVHD
28. know the conditions for which patients are receiving chemotherapeutic agents which can cause pneumatosis
29. know the sign of thromboembolism seen at CT and ultrasound imaging
30. know the clinical clues to the presence of hemorrhage
31. understand the organ tumors treated with irradiation which put the liver at risk
32. be familiar with the radiation damage progression pathway in the liver
33. be familiar with how radiation damaged liver tissue appears at imaging
34. be familiar with the presentation of chronic radiation injury to the liver
35. understand the side effects of pancreatic irradiation
36. be familiar with the secondary signs of pancreatic tumor recurrence
37. understand the effects of irradiation of the spleen
38. be familiar with the findings of acute radiation injury when irradiating the stomach and duodenum for retroperitoneal and upper abdominal tumors
39. be familiar with the CT findings in the small intestine which, in the absence of a mass, are more indicative of irradiation injury than recurrent tumor
40. know the most common location of insufficiency fractures from irradiation