Acute hip pain, suspect fracture?

Imaging of acute hip pain, suspect fracture?

Summary:

First study middle aged or elderly = Xray hip, AP and cross table lateral and Xray pelvis, AP view BOTH

Negative or indeterminate radiograph, then = MRI hip/pelvis or CT hips

(Note if fracture and minimal trauma, eval bone density with DEXA scan)

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Imaging of solitary pulmonary nodule?

Imaging of solitary pulmonary nodule?

Summary:

Nodule discovered on chest radiograph, **greater** than 1 cm and low, moderate or high clinical suspicion for cancer = CT chest without contrast,  if CT indeterminate then PET CT whole body and biopsy if PET avid or enhances.

Nodule discovered on chest radiograph, less than 1 cm and low clinical suspicion for cancer = watchful waiting with CT follow up or CT chest without contrast (Note: Fleischner Criteria not addressed in this publication)

Nodule discovered on chest radiograph, less than 1 cm and moderate to hight clinical suspicion for cancer = CT Chest and possible biopsy or follow up CT chest.

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Acute chest pain, suspect pulmonary embolism?

Acute chest pain, suspect pulmonary embolism?

summary:

adult = chest X-ray and CTA chest, both

pregnant patient = chest X-ray, US lower extremity with doppler and possibly CTA chest or VQ scan  

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Jaundiced patient?

Imaging for jaundiced patient?

Summary: 

Abdominal pain with 1 of the following: fever, history of biliary surgery or known cholelithiasis = US abdomen (then CT ABD/PEL with contrast or MR Abdomen with contrast with MRCP)

Painless with 1 of the following: weight loss, fatigue, anorexia or symptoms greater than 3 months =  CT ABD/PEL with arterial and portal venous contrast, US abdomen or MR Abdomen with contrast with MRCP)

Clinical and lab exam makes obstruction unlikely = US abdomen (then MR Abdomen with contrast with MRCP, if needed) 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

LLQ pain suspected diverticulitis?

LLQ pain suspected diverticulitis?

Summary:

Diverticulitis, suspect complication or atypical presentation = CT ABD PEL with IV and Oral and/or colonic 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Headache in a child?

Headache in a child?

Summary:

Recurrent, including migraine, without permanent neurologic deficit or signs of increased intracranial pressure = probably nothing

Headache with permanent neurologic deficit or signs of increased intracranial pressure = MRI without (and maybe with contrast), CT, if MRI not available.

Abrupt onset, thunderclap, concern for vascular rupture = CT head without contrast (if subarachnoid, add CTA and maybe catheter angiography if available) 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon

Incidentally discovered adrenal mass?

Incidentally discovered adrenal mass?

Summary:

No history of malignancy, 1-4 cm, initial evaluation = CT ABD/PEL without contrast (then with if needed) or MRI abdomen and pelvis without contrast

No history of malignancy, 1-4 cm, follow up evaluation, if indeterminate on first scan = CT or MRI abdomen and pelvis without contrast (Asses change in 12 months)

No history of malignancy, Larger than 4 cm = CT or MRI abdomen and pelvis with contrast, pre-surgical evaluation

History of malignancy, Less than 4 cm, initial evaluation = discuss with rads (Either CT without contrast, CT with, MRI without or PET).

History of malignancy, Larger than 4 cm, initial evaluation = biopsy or PET. 

As always, please refer to the source Appropriateness Criteria created by the American College of Radiology, here.

Educational purposes for licensed providers.

Note to Patients:

Radiology is a very large and ever changing field and this post is to help your provider.  When combined with a thorough history and physical exam, this information can be very useful.  Your provider is best suited to answer specific questions regarding this post.

A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.

Of course, this is not a substitute for medical care.

More about Dr. Vachon - ORAinformatics.com

Please Link In! www.linkedin.com/in/tyvachon