#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.

More about Dr. Vachon - ORAinformatics.com

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

Tweeting some more good info here! @helpfulrads

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.

More about Dr. Vachon - ORAinformatics.com

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

Tweeting some more good info here! @helpfulrads

What is appropriate medical imaging?

Having been in radiology a number of years, I know it can be difficult to decide what is the best study, if any, for each patient. Radiation? Cost? Wait time? Contrast or not? MRI vs CT scan?

The American College of Radiology teamed up with many specialist to create the Appropriateness Criteria. It has the goal of helping providers better choose which study is best for their patients.

There is terrific information in this project, however it can be intimidating to navigate.

I will summarize a few per week, with links to the source documentation, as a primer for my friends who are not necessarily radiologists.

Fellow providers, please leave comments and I will address them to the best of my ability. Patients please see below.

This is the entire Appropriateness Criteria:

http://www.acr.org/Quality-Safety/Appropriateness-Criteria

This is also accessible from here:

http://www.guideline.gov/search/search.aspx?term=acr+appropriateness



Radiologists in training may benefit from these posts as well as the ABR Core Exam asks specific question from the ACR AC.

More about Dr. Vachon - ORAinformatics.com

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

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

Tweeting some more good info here! @helpfulrads

Foot trauma? Foreign body? X-ray needed?

Acute foot trauma? - #orderwhat #footpain @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg

Meet Ottawa Rules or not neurologically intact  => Xray

Concern for Lisfranc injury => Weight bearing Xray, if able or MRI foot

Does not meet Ottawa Rules => No study indicated

X-rays negative and concern for tendon injury or dislocation => MRI foot

Penetrating trauma and concern for foreign body => X-ray, then US 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

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

Dyspnea, suspected cardiac origin?

Dyspnea of suspected cardiac origin

Summary:

Chest xray and transthoracic echocardiography (possibly followed by a stress: echo, SPECT or PET or Cardiac MRI) 

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

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

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