Casey Hurrell

Retroperitoneal sarcomas (RPS) are a heterogenous family of neoplasms. The Canadian Association of Radiologists Retroperitoneal Sarcoma Working Group was established to provide recommendations for the imaging evaluation and initial workup of suspected RPS in the context of the Canadian healthcare system. The recommendations, which are based on available literature and expert consensus, provide guidance on the imaging pathway, biopsy approach and surveillance for RPS.

Multiple North American and European societies now endorse a combined serological and imaging-based clinical care pathway for non-invasive risk stratification of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). A multidisciplinary group of Canadian radiologists, hepatologists, family physicians, and other health professionals have recently published consensus guidelines for identification and risk stratification of patients with suspected MASLD. Screening should be performed with the FIB-4 score, and those with an indeterminate FIB-4 (between 1.32.67) should undergo imaging-based liver stiffness evaluation either with transient elastography (FibroScan), ultrasound shear wave elastography, or magnetic resonance elastography as a second step. While the implementation of these techniques for measuring liver stiffness differ, there is no clinically significant difference in their diagnostic performance. This narrative review, intended for Family Physicians, summarizes recommendations for serological investigations and imaging modalities of liver steatosis and stiffness. Practical guidance includes an algorithm with thresholds. We discuss current challenges and future directions of risk-stratifying patients with MASLD in the community.

Focused Abbreviated Survey Technique (FAST) MRI protocols address the clinical challenges of prolonged scan times, sedation requirements, and ionizing radiation exposure in pediatric neuroimaging. These guidelines, developed by the Canadian Society of Pediatric Radiology (CanSPR), provide evidence-informed recommendations to assist practitioners in the selective application of abbreviated MRI protocols across diverse clinical scenarios. Based on comprehensive literature review and expert consensus, the working group established a framework for using FAST MRI as a targeted, CT-sparing strategy. The guideline outlines protocols and indications for the follow-up of hydrocephalus, arachnoid cysts, and syringomyelia. It also addresses its application in acute settings, including suspected stroke, first-time seizures, and accidental trauma, as well as its role in evaluating macrocrania following inconclusive ultrasound and headaches. While FAST MRI facilitates timely diagnosis and improves safety by minimizing anesthesia, it may have lower spatial resolution than conventional protocols. Consequently, these recommendations emphasize its use for targeted diagnostic questions rather than as a replacement for comprehensive MRI examinations.

These practice guidelines, developed by the Canadian Association for Interventional Radiology (CAIR) and the Canadian Association of Radiologists (CAR) with input from hematology experts, provide evidence informed, practical recommendations for managing bleeding risk during image guided procedures. Building on the 2019 Society of Interventional Radiology guideline, they streamline decision making around anticoagulation, antiplatelet therapy, laboratory testing, and transfusion thresholds for use across Canadian radiology departments. A systematic review of post 2019 evidence and expert consensus-informed updates to procedural risk stratification and clarified INR and platelet thresholds. The guidance emphasizes that most radiologic procedures carry very low bleeding risk and generally do not require routine laboratory screening or interruption of anticoagulant or antiplatelet medications, while high risk procedures warrant targeted testing and standardized transfusion thresholds, including those tailored for chronic liver disease. Special sections address lumbar puncture, arterial access, and urgent or emergent procedures. Overall, the guideline highlights individualized clinical judgment, avoidance of unnecessary delays or consultations, and careful consideration of transfusion risks, with the goal of promoting streamlined, safe, and consistent care across Canadian imaging practices.

Purpose: This study aimed to assess the experiences and challenges faced by Canadian radiologists participating in Multidisciplinary Team rounds (MDT), with a focus on demographics, meeting characteristics, preparation processes, and perceptions of workload and compensation. Methods: The Canadian Association of Radiologists constituted a working group which developed a 35-question survey that was distributed to 1958 radiologists and radiology trainees across Canada. The survey garnered 129 complete responses, for a response rate of 6.6%. Results: Respondents predominantly practiced in academic settings (65.9%) and had subspecialty training (96.1%). The majority reported that MDT rounds lasted 30 to 60 minutes and discussed 6 to 10 cases. Most radiologists (62.8%) were the sole presenters of imaging. Preparation time was often limited, with only 6.2% having dedicated time for preparation. 59.8% of respondents reported receiving additions to caseloads within the 24-hour period prior to the meetings. While 93.8% valued the opportunity for interaction with colleagues, 93.8% felt inadequately compensated for their efforts by their practices, while 92.3% felt inadequately compensated by their province. Conclusions: While most radiologists indicated adequate time for discussion and meaningful clinical engagement during rounds, many highlighted repeated challenges such as last-minute case additions, lack of protected preparation time, and technological barriers. Systemic barriers also play a role and include lack of provincial remuneration and workforce issues which in turn impact individual workload pressures.

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed nonalcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk-stratification of patients with MASLD, including a patient pathway using serological and imaging investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) programs. In Part 2 of these guidelines, the WG provides 14 recommendations for risk stratifying MASLD patients into low and high risk for advanced hepatic fibrosis ( F ≥ 3) using a combination of serological and imaging investigations. Population screening and risk stratification of MASLD patients using a clinical and serological investigation (FIB-4) followed by imaging pathway is recommended. Clinical, technical, and grading recommendations for point shear wave elastography (pSWE), 2-dimensional SWE (2D-SWE), and MRE are discussed.

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed nonalcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk stratification of patients with MASLD, including a patient pathway that applies blood-based and imaging-based investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) for disease staging. In the third part of these guidelines, the WG provides 18 recommendations for standardized implementation, remuneration, and quality assurance for SWE and MRE programs. Structured reporting templates for standardized SWE and MRE are provided. Introductory training presentations for technologists and radiologists are also provided. The goal of these guidelines is to enable standardized image-based screening and risk stratification of patients with MASLD across Canada.

The Canadian Association of Radiologists (CAR) metabolic dysfunction-associated steatotic liver disease (MASLD) Working Group (WG) is a multidisciplinary working group composed of radiologists, hepatologists, and family physicians. In this 3-part series, we provide Delphi consensus-based guidance on clinical and imaging findings for patients with known or suspected MASLD (formerly termed non-alcoholic fatty liver disease or NAFLD). Part 1 focuses on the detection and grading of hepatic steatosis on imaging; Part 2 on risk-stratification of patients with MASLD, including a patient pathway that incorporates serological and imaging investigations; and Part 3 on the implementation of practice recommendations for quality assurance using shear wave elastography (SWE) and magnetic resonance elastography (MRE) for disease staging. In the first part of these guidelines, we provide 17 guidance statements for detection, grading, and surveillance of hepatic steatosis using ultrasound (US), CT, or MRI. In addition to conventional B-mode US, we review current evidence on semi-quantitative and quantitative US techniques and provide guidance for appropriate indications and recommended technique.