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Radiological Tests: Which One is Most Appropriate for My Patient?
Objectives • Discuss tools to aid in the ordering of Radiology examinations • Radiologist • ACR appropriateness criteria® • Review case vignettes of common situations
Choosing the Correct Imaging Protocol • Complete information often available for the radiologist • Patient presenting to acute care or ED • 45-year-old male CT without contrast using • Training for a marathon Renal • Acute onset of Stone left flankProtocol pain • History of calcium oxalate renal calculi • Afebrile • Microscopic hematuria
Choosing the Correct Imaging Protocol • Complete information often available for the radiologist • Patient presenting to acute care or ED • 45-year-old male Belly Pain • Training for a marathon • Acute onset of left flank pain • History of calcium oxalate renal calculi • Afebrile • Microscopic hematuria
ACR Appropriateness Criteria® • Evidence based guidelines • Assist referring physicians in making the most appropriate imaging or treatment decision • Many topics addressed • Multiple variants of many diseases
Case 3 • 64-year-old male • No meds • Positive family history of CAD (Father MI @ 63) • No history of angina • No congestive heart failure • No cardiac rhythm disturbance
Case 4 • 72-year-old female • Emergency department • Black stools • Some orthostatic hypotension • Anemia • Negative colonoscopy 1 year ago • Negative upper endoscopy at local ED
Case 5 • 46-year-old female • Executive health physical • Family history of breast cancer • Dense breast on mammography • Breast MRI • Partially imaged liver lesion • US • Indeterminate > 1cm lesion right hepatic lobe
Case 6 • Upper extremities, -1 weakness on the Mayo scale (4/5 on the MRC scale) involving the deltoid, triceps, finger extensors on the right side • Subjective cape-like-distribution numbness that extends from the base of his neck down to about the upper thoracic level • Negative C-Spine x-ray
Summary • Radiology imaging is increasingly useful • Increasingly complex to know where to start • Radiologists can be a useful tool • Knowledge of which exam is best starting point • Know strengths of particular practice • ACR Appropriateness criteria • Imaging choice • When imaging not necessary