Healthcare 2018


KEYNOTE: Medical Malpractice - The Knowledge That Keeps You Calm to Image On (NI)

A. Tony Santos, JD - Lead Division Counsel, Professional and Public Liability Litigation Section, Southern California Permanente Medical Group. 


description: This discussion will explore the world of medical malpractice in diagnostic imaging. What constitutes medical malpractice, how to avoid lawsuits, and what is the future of medicine and the legal environment will be presented utilizing case examples.


1.  Understand the elements needed to bring a lawsuit.

2.  Explain the most common types of lawsuits against technologists.

3.  Discuss how to avoid finding themselves in a lawsuit.


Breakout Session A


Mara Ridane, RT (R) (M), ARRTAssistant Director, Southern California Permanente Medical Group, Los Angeles.

description: - In this presentation we will enhance your safety awareness as it pertains to all aspects of CT and MRI. In addition, the benefits and risks associated with CT and MR procedures will be discussed.


  1. Bring more awareness of CT and MRI Safety to the general public and healthcare providers.

  2. Educate healthcare professionals of the benefits of patient safety in CT and MR.

  3. Review the risks associated with CT and MR procedures.


RADIOLOGY: Radiologic Evaluation and Management of Abdominal Aortic Aneurysm: Screening, Diagnosis and Treatment

Diego Covarrubias, MD Interventional Radiologist, Southern California Permanente Medical Group, West Los Angeles.     

description: This presentation will cover abdominal aortic aneurysm, its characteristics and the corresponding imaging modalities to obtain a diagnosis. Specifically, it will address various types of treatments and management depending on the size and speed of growth of the aneurysm.


    1. list the characteristics of an abdominal aortic aneurysm

    2. Identify the causes, risk factors and subsequent imaging modalities to best obtain a diagnosis.  

    3. recognize the indications for regular monitoring by US, operative vs non-operative treatment and/or stent placement in interventional radiology.


DIGITAL/MAMMOGRAPHY: EQUIPing yourself and your team - A novel perspective on self and departmental improvement

Jason Cord, MDRadiologist, Regional Breast Imaging Chair, Southern California Permanente Medical Group, Anaheim.

description: The Enhancing Quality Using Inspection Program or EQUIP initiative marked the beginning of the 25th year since the passage of MQSA and emphasizes the need for ongoing facility review of clinical image quality. We will explore the parameters and implementation options and then consider larger societal expectations in care delivery. We will then expound on that concept and explore core skills that we can focus on to improve both our personal life and career. I hope to support you embracing EQUIP and motivate your journey of personal and career growth.



    1. explain why EQUIP is more of a mantra than a guideline and why that "bothers" us

    2. discuss how changes in our perception of care quality and delivery are changing expectations from care delivery teams

    3. describe skills that are "hard to learn" but pay off for your career and life


ULTRASOUND: Renal Transplant Doppler

Rosalie Vis, BS, RDMS, RVT - Senior Ultrasound Technologist, St. Joseph Hospital, Orange County.

description: This lecture will focus on the Doppler techniques and vascular findings of renal transplant ultrasound.  The normal and abnormal values of acceleration time and resistive indices will be discussed with examples of each.  Characteristics of various abnormal waveforms will be shown as well as post-biopsy vascular complications.  


  1. Describe the components of a renal artery waveform.

  2. Identify the normal range for resistive index and acceleration time measurements.

  3. List the conditions which can be associated with elevated intra-renal resistive indices or absent diastolic.

  4. List two possible post biopsy complications related to renal transplants.


NUCLEAR MEDICINE: Current Updates in the Technique of Technetium-Labeled Red Blood Cell Scans for Gastrointestinal Bleeding Scintigraphy (R)

Ramona Tabib, MD - Nuclear Medicine Physician, Southern California Permanente Medical Group, Woodland Hills.

description: Use of technetium-99m red blood cells as a diagnostic radiopharmaceutical in gastrointestinal bleeding scintigraphy imaging will be reviewed. A better understanding of labeling mechanisms will provide greater knowledge regarding the current techniques and interventions used when labeling and its importance to the study.


1.       List the current clinical indications of TC-99m labeled Red Blood Cell Scans.

2.      Describe the current labeling methods of RBC with Tc-99m.

3.      Define the three general steps IN LABELING RBCs WITH Tc-99m.

4.      Discuss the advantages and disadvantages of currently available methods.

5.      Describe the role of each component found in products used to radiolabel red blood cells with Tc-99m.

6.      List the drug-drug interactions that interfere in the labeling process.

7.     Be aware of patient safety issues.

8.    Review image acquisition, processing, and interpretation.



Breakout Session b


RADIOLOGY: Creative Imaging - Beyond the Textbook

Elias Silva, RT - Diagnostic Imaging, Southern California Permanente Medical Group, Panorama City.

description:  Imaging patients when they cannot be positioned the way we need can be challenging. Providers may ask for views not common in our departments. Subsequently, this presentation will review routine views, the benefits of alternative views, and ways to obtain quality images while reducing movement of non-ambulatory patients.


1. Identify non-routine views that can benefit the patient and provider.

2. Apply alternative methods of obtaining necessary views.

3. Recognize how imaging patients in their wheelchair can reduce unnecessary movement of the patient.


RADIOLOGY: Quality Assurance in Radiography – from Beginning to End

Lisa Schmidt, PhD, RT(R)(M), CRT - Program Director for Pima Medical Institute (PMI) Radiologic Technology Program, Chula Vista, California.

description:  Having a robust Quality Assurance program in Radiography is essential. Ensuring technologists are familiar with evolving technology is key. Therefore, in this presentation we will be reviewing optimal projection characteristics, image evaluation criteria, and best radiation safety practices.   


  1. State the characteristics of what an optimal projection is and how radiographers should develop the ability to analyze radiographs based on a set of standards to include superimposition, adjacent structure, contrast, spatial resolution, magnification and shape distortion.

  2. Determine the amount of patient or CR adjustments that are necessary when poorly positioned projections are obtained.

  3. Discuss how images are to be properly displayed for all projections, to include proper collimation and markers.

  4. Describe the factors that affect spatial resolution (formerly called recorded detail) in a projection.

  5. Discuss universal radiation protection practices that are to be followed in order to limit patient and personnel dose.



Rachelle Casinto, R.T.(R)(M)(ARRT) – Mammographic Radiologic Technologist, Southern California Permanente Medical Group, Los Angeles.

description:  Breast imaging is a critical element in diagnostic imaging. We will evaluate 3D tomosynthesis and synthesized 2D imaging, emerging components within this modality.


1. Share some basic knowledge with the participants about 3D tomosynthesis.

2. Recognize the importance of synthesized 2D (C-View).

3. Implement tomosynthesis into your practice.


ULTRASOUND: Sonography of the Appendix

Jean Yves Sewah, RDMS, RVT - Lead Sonographer, Southern California Permanente Medical Group, West Los Angeles.

description: Sonography of the appendix is rapidly gaining ground over CT as the first line of diagnostic procedure especially in the pediatric population. Knowledge of the anatomy of the right lower quadrant is essential for the sonographer. The goal is not only to recognize an abnormal appendix which is helpful to diagnose appendicitis, but the sonographer should attempt to identify a normal appendix and demonstrate that it is normal; this will help improve the clinical management of the patient.


1. Be familiar with the anatomy of the appendix.

2. Discuss the important clinical and lab indicators for appendicitis.

3. Recognize normal and abnormal appendix on ultrasound.


Amir Entezari, MD - Nuclear Medicine Physician, Southern California Permanente Medical Group, Panorama City.

description: Positron emission tomography (PET) used to be mainly for research applications, although in recent years, changes in reimbursement and availability have led to the rapid expansion of PET for clinical patient care. Many commonly used positron-emitting radioisotopes are based on atoms found in organic substances such as: O-15, N-13, C-11, and the F-18. Most PET scans are performed to evaluate cancer using the glucose analog fluorine-18 fluorodeoxyglucose (F-18 FDG); by using radiopharmaceuticals that target physiological parameters such as glucose metabolism, PET enables imaging and quantification of cellular function and tumor detection.


1. Review radioisotopes utilized on PET.

2. Review F-18 FDG PET protocol.

3. Recognize the normal distribution and variants of biodistribution of F-18 FDG and recognized imaging artifact.




Breakout Session C


DIGITAL/RADIATION SAFETY-FLUORO: Personnel Protection During Fluoroscopic Imaging Procedures
Art O. Alfaro, RT (R) (T), CMD, Southern California Permanente Group, Los Angeles Medical Center 

DESCRIPTION: The presentation will provide historical overview of both Analog and Digital Imaging and how its nature and characteristics of secondary stray radiation correlates to stochastic and non-stochastic biological events in personnel/patients. Similarly, methods and considerations to minimize personnel/occupational exposure during fluoroscopy will be entertained adhering to State mandated regulations.


  1. review the History of Dynamic Imaging

  2. develop an understanding of Digital Fluoroscopy.

  3. Identify the properties of stray radiation in fluoroscopic procedures.

  4. apply methods to minimize occupational and patient exposure

  5. adhere to regulatory guidelines regarding radiation exposure.


RADIOLOGY/NUCLEAR MEDICINE: Fundamentals of Cardiac CT (I)

Mark C. Hyun, CNMT, NCT, RS, R.T.(N)(R)(CT), FASNC – Nuclear Medicine, Cardiac CT & Research Specialist, Department of Imaging & Cardiac Imaging Research, Cedars-Sinai Medical Center.

DESCRIPTION:   Mastering a process requires understanding the fundamentals. In the realm of cardiac CT, these fundamentals include preparing for the exams and selecting optimal technical factors. Integrating cardiac CT with nuclear cardiology is a specific component that can aid in cardiac disease diagnosis.



  1. Recognize the complementary role between cardiac CT and Nuclear MPI.

  2. List the steps to achieve optimal Cardiac CT.

  3. Explain the basic Cardiac CT physics and scan settings.

DIGITAL/MAMMOGRAPHY:  Digital Mammography Quality Improvement

Trisha Kim, MD – Radiologist, Southern California Permanente Medical Group South Bay

description: This presentation will explore digital mammography quality improvement. The proper positioning for image quality, common pitfalls and artifacts, the importance of obtaining a complete patient history as well as interesting cases will be covered.


  1. discuss the importance of proper positioning in order to obtain a good diagnostic image.

  2. understand common pitfalls and artifacts and be able to prevent them from affecting the final image.

  3. obtain a complete patient history with all breast-relevant information and be able to apply skin markers as indicated.

ULTRASOUND: Doppler Sonography in Pregnancy

Rozina Badal Munir, RPVI, RDMS, RVT - Diagnostic Medical Sonographer, Southern California Permanente Medical Group, West Los Angeles.

description:  Doppler Ultrasound of fetal blood vessels is important in pregnancies that have the risk for IUGR (intrauterine growth restriction), preeclampsia, fetal anemia and umbilical cord abnormalities. As a result, obstetrical decision making will improve timing of delivery to prevent intrauterine death. Doppler results are therefore useful in perinatal and neonatal management of these high-risk pregnancies in order to reduce fetal mortality and morbidity.


1. Provide the imaging techniques in fetal Doppler for evaluation of intrauterine growth restriction (IUGR).

2. Explain the use of color and spectral Doppler. 

3.  Recognize the pitfalls and limitations in obstetric ultrasound.


NUCLEAR MEDICINE: Review of I-131 Therapy Requirements A to Z (from America to Zambia) (T)

Jessica Clements, MS, DABR - Chief Physicist, Southern California Permanente Medical Group. Board certified to practice diagnostic and nuclear medical physics.

description: I-131 therapies are commonly performed and there are regulatory requirements associated with treatments. This presentation will include a review of thyroid cancer types and treatment options, explain how a determination for treatment location is made (inpatient versus outpatient), review regulations relating to the treatment and release of patients with radioactive material, and finally, discuss training I recently provided on I-131 procedures in Lusaka, Zambia, this summer.


1. List thyroid cancer types and treatment options.

2. Explain how a determination for treatment location is made.

3. Discuss regulations relating to the treatment and release of patients with radioactive material.



Breakout Session D


RADIOLOGY: What If…X-Rays Were Never Discovered?

Enrique Lerma, A.S., R.T.(R), BS, MS  - Diagnostic Imaging Supervisor: Kaiser Permanente Fontana/Ontario, Southern California Permanente Medical Group.

DESCRIPTION: What we do defines who we are. This explains why our job can be strongly connected to our identity. But, what if x-rays were never discovered? How would that affect us? In this presentation we will explore how Rontgen discovered the x-ray and the importance his discovery had within the medical community. We will review the significance that has been earned from the title “technologist”. And, we will contemplate the importance our emotions have within our work environment.


  1. reflect on the importance within their job responsibilities.

  2. Consider the absolute necessity of diagnostic imaging within the medical community.

  3. Realize the role emotions have in the work environment.


RADIOLOGYBattling the Bugs and Winning! Infection Prevention Techniques in Diagnostic Imaging

Judith Liu, MSN, RN - Diagnostic Imaging, Southern California Permanente Medical Group, Panorama City

DESCRIPTION:  In Diagnostic Imaging, microorganism “bugs” are everywhere. What is hiding on your x-ray cassettes? What is lurking on your ultrasound probe? How well did you disinfect after that patient with c-diff?  This presentation will review ways to “battle” against the spread of nosocomial infections and eliminate those “bugs” so you are on the “winning team”.


      1. Discuss the importance of hand hygiene in the prevention of disease transmission and regulatory requirements in the diagnostic imaging setting.
      2. Identify Standard Precautions and other types of precautions including prevention of aerosol transmissible diseases.

      1.  Apply various methods of infection prevention in the diagnostic imaging setting



      DIGITAL/MAMMOGRAPHY: History of Breast Imaging from Past to Present and the Things on the Horizon  

      Payal Jain, MD - Radiologist/Breast Imager, Southern California Permanente Medical Group, West Los Angeles.

      description:  The presentation describes the evolution of breast imaging - the practices and direction in which it is leading. It shows how MRI and Sonography significantly complement Mammography. Tomosynthesis and Breast CT are examples of modern procedures and techniques that are advancing breast imaging into a very bright future.


      1. explain how mammography started and its influence in imaging diagnosis.

      2. specify how past innovations in breast imaging have led to current practices.

      3. appreciate the progress of breast imaging since its evolution, current practices, and the direction it is leading towards.


      ULTRASOUND: Pancreaticobiliary Ultrasound: Beyond Cholecystitis

      Elon Granader, MD - Radiologist, Diagnostic Imaging, Southern California Permanente Medical Group, Downey.

      description:  This presentation will review the role of ultrasound in the evaluation of the gallbladder, biliary tree and pancreas. The sonographic appearance of normal pancreaticobiliary anatomy will be discussed. Examples of pancreaticobiliary pathology on ultrasound will be illustrated through a case based format with clinical and CT/MRI correlation.


      1. Discuss the role of ultrasound in the evaluation of the gallbladder, biliary tree and pancreas.

      2. Review pancreaticobiliary anatomy with an emphasis on normal sonographic appearances.

      3. Identify pancreaticobiliary pathology on ultrasound images with clinical and CT/MRI correlation.


      NUCLEAR MEDICINE: DaTscan: New Imaging Modality in Diagnosis of Parkinsonian Syndrome (I)

      Oneil Lee, MD – Radiologist, board certified in Radiology and Nuclear Medicine, Southern California Permanente Medical Group, Orange County.

      description: Parkinsonian Syndrome is a group of neurodegenerative disorders that can be sometimes difficult to diagnose clinically. DaTscan is a relatively new imaging modality that has been helpful in distinguishing Parkinsonian Syndrome from other disorders such as essential tremor or drug-induced Parkinsonism. Come learn more about this new promising imaging modality.


      1. Discuss the epidemiology and pathophysiology of Parkinsonian Syndrome (PS).

      2. Discuss the diagnostic challenge of PS and currently available diagnostic imaging modalities.

      3. Discuss the role and limitation of DaT scan in diagnosing Parkinsonian Syndrome.



      Breakout Session E


      RADIOLOGY: MR Enterography of Inflammatory Bowel Disease with Radiologic Correlations

      Ryan Downey, MD - Radiologist, Diagnostic Imaging, Southern California Permanente Medical Group, Downey.

      description: Inflammatory bowel disease affects millions of people across the world. This is a presentation geared toward radiologic technologists discussing the radiologic findings of inflammatory bowel disease with specific emphasis on MR enterography.


      1. Provide an overview of inflammatory bowel disease and its radiologic manifestations.

      2. Discuss the advantages and disadvantages of various imaging modalities available to diagnose and monitor inflammatory bowel disease.

      3. Review MR enterography technique and describe MR features of inflammatory bowel disease.


      DIGITAL/RADIATION SAFETY-FLUORO: Radiologic Safety in the IR Suite Related to Surveys by Regulatory/Accrediting Agencies

      Robert McDermott, MS, DABR, CRT, CNMT – Adjunct Professor, Radiologic Technology Program, Cypress College, Cypress.

      description:  An inspection can be a stressful situation, but it doesn’t have to be. At the core of every inspection is safety. When it comes to interventional radiology, safety translates to a successful procedure for our valued patient while minimizing radiation exposure. To have a successful procedure radiation knowledge, dose monitoring, and the use of protective devices are paramount. Additionally, having procedural routines readily available for staff further ensures a successful procedure. During an inspection, these components are the elements the surveyor will observe.


          1. Define typical radiation exposure levels.

          2. Describe components of a radiation safety program.

          3. Implement approaches to minimize exposure to staff and patients.


      DIGITAL/MAMMOGRAPHY & ULTRASOUND: Mammography Basics with Ultrasound Correlation

      Pia Luedtke, MD – Radiologist, Southern California Permanente Medical Group, West Los Angeles.

      description: Mammography and sonography have both advantages and limitations in evaluating breast masses. However, proper correlations between these two modalities are essential for proper work-up of breast masses. The goal is to identify malignant masses that require further work-up, the hallmark for better patient management. 


      1. Describe features of benign vs malignant masses on US.

      2. Describe optimization of breast US technique.

      3. Describe work-up of mammographic asymmetries.



      NUCLEAR MEDICINE: I-131 Therapy, Nuclear Medicine Basics (T)

      Raynold Ho, CNMT, ARRT(N) – Nuclear Medicine Technologist, Southern California Permanente Medical Group, Fontana.

      description: Iodine 131 is one of the most common therapies that nuclear medicine offers. All too often, we are confronted with questions that we may be unprepared to answer. Here, we can re-familiarize ourselves with the basics of I-131 therapy as well as the changes/updates that have been made in recent years.


        1. Review the anatomy and physiology of the thyroid gland.

        2. List pharmaceutical and diet restrictions.

        3. Describe diagnostic and therapeutic abilities of I-131.

        4. Recognize advances to I-131 therapy.
          I-131 Therapy