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Sunday, August 31, 2014

#Fat? So what?

I read a lot of #CT scans. People come in different shapes and sizes.

Many requests say "abdominal pain" and more than half of my reports say normal or close to it.



Two patients, similar age with no acute findings to explain their pain.

What do the blue arrows represent?

Should my report still say normal?

Should my report include: Correlate with risk factors for metabolic syndrome?

Here's what the Mayo Clinic thinks of metabolic syndrome.

As of right now, I do not include this on my report - should I?

Will it make a difference when you meet with the patient with the results of the scan?

Blue arrows are subcutaneous fat, btw.

____________________________


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.

Sunday, August 24, 2014

#Poop and #belly #pain!

Too much stool? #orderwhat  @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg


Many radiologist would not specifically comment on stool burden.  I have made it part of my practice to include "Dense stool and air filled colon, correlate with signs and symptoms of constipation" when I see a radiograph like this.

If you get a normal report and you see the colon looking like this, consider constipation.

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.

Image credit:

http://pediatriceducation.files.wordpress.com/2009/01/122704constipationaxr.jpg?w=367&h=474


Suspected Physical Abuse Child

2 years or younger? Over 2? Neurologic findings?  #NAT #orderwhat  @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg

2 years old or younger, no focal neuro symptoms => Skeletal survey

2 or younger, head trauma with no focal neuro symptoms => Skeletal survey and non con head CT

2 or younger, WITH focal neuro symptoms => Skeletal survey and non con head CT, probably brain MRI

OVER 2, WITH focal neuro symptoms => Non con head CT, probably brain MRI


Any age with obvious chest, abdomen or pelvic trauma => Skeletal survey and indicated CT 




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.

Dysphagia?

Where does it get stuck?  #oropharynx #retrosternal #orderwhat  @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg

Known cause, Oropharynx => Modified barium swallow
Un-known cause, Oropharynx => pharyngeal dynamic radiographic exam


Retro-sternal => Bi-phasic esophagram and probably endoscopy 


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.

Acute Pelvic Pain?

Acute Pelvic Pain? - #orderwhat #pain @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg

Pregnant and gyn etiology suspected?  => US pelvis 

NOT Pregnant and gyn etiology suspected? US pelvis 

Pregnant and NON-gyn etiology suspected? US abdomen and possibly pelvis 


NOT Pregnant and NON-gyn etiology suspected? => CT abdomen and pelvis 


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.

Vomiting infant - imaging needed? Bilious? X-ray or Ultrasound?

Vomiting In Infants Up To 3 Months Of Age?


Bilious vomiting in neonate up to 1 week old = abdomen radiograph and possibly upper GI or contrast enema

Bilious vomiting in infant 1 week to 3 months old = upper GI

Intermittent non-bilious vomiting since birth = possibly upper GI


New onset  projectile non-bilious vomiting = abdominal ultrasound 


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.

Friday, August 15, 2014

Osteomyelitis in diabetic foot?

Imaging of suspected osteomyelitis in diabetic foot?


Summary

Soft tissue swelling with or without neuropathic arthropathy or with or without ulcer = foot X-ray AND MRI foot without and with contrast

If imaging is indeterminate, biopsy or aspiration is warranted


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.