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Showing posts with label imaging. Show all posts
Showing posts with label imaging. Show all posts

Thursday, August 14, 2014

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.


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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.

Thursday, June 19, 2014

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) 


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, June 6, 2014

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.


Thursday, June 5, 2014

Child sinusitis?

Suspected child sinusitis?

Summary:    uncomplicated acute sinusitis - no imaging

                    acute with no response, recurrent or chronic - CT sinus without contrast
                    sinusitis and concern for orbital complication - CT sinus with contrast 

                    sinusitis and concern for orbital and intracranial complication - CT sinus and head with contrast  


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.


Pulsatile abdominal mass on exam, next step?

Pulsatile abdominal mass on exam, next step?

Summary:         If asymptomatic and smaller body habits = ultrasound
                         If symptomatic or large body habitus = ABD CT without contrast

                         If symptomatic and want pre-interventional planning = ABD CT with contrast


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.