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  • Topnotch Radiology For Moonlighters - Sept 2019

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    Cara Marrero Iguid
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    This document provides an overview of practical imaging pearls for new physicians. It covers common scenarios and goals in imaging of the head, chest, abdomen, and musculoskeletal system. For head imaging in stroke, the goals are to exclude hemorrhage and check the location and extent of infarction. A plain head CT scan is most cost-effective for unknown onset, while plain MRI is best for known late onset. In chest imaging, the document outlines how to distinguish conditions like pneumonia from pulmonary tuberculosis or edema and evaluates trauma cases and tube placements. For abdominal imaging, it recommends ultrasound for right upper quadrant pain and next steps for jaundice or known peptic ulcer disease. In musculoskeletal imaging, it stresses getting multiple views for fractures and

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    This document provides an overview of practical imaging pearls for new physicians. It covers common scenarios and goals in imaging of the head, chest, abdomen, and musculoskeletal system. For head imaging in stroke, the goals are to exclude hemorrhage and check the location and extent of infarction. A plain head CT scan is most cost-effective for unknown onset, while plain MRI is best for known late onset. In chest imaging, the document outlines how to distinguish conditions like pneumonia from pulmonary tuberculosis or edema and evaluates trauma cases and tube placements. For abdominal imaging, it recommends ultrasound for right upper quadrant pain and next steps for jaundice or known peptic ulcer disease. In musculoskeletal imaging, it stresses getting multiple views for fractures and

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    162 views72 pages

    Topnotch Radiology For Moonlighters - Sept 2019

    Uploaded by

    Cara Marrero Iguid
    This document provides an overview of practical imaging pearls for new physicians. It covers common scenarios and goals in imaging of the head, chest, abdomen, and musculoskeletal system. For head imaging in stroke, the goals are to exclude hemorrhage and check the location and extent of infarction. A plain head CT scan is most cost-effective for unknown onset, while plain MRI is best for known late onset. In chest imaging, the document outlines how to distinguish conditions like pneumonia from pulmonary tuberculosis or edema and evaluates trauma cases and tube placements. For abdominal imaging, it recommends ultrasound for right upper quadrant pain and next steps for jaundice or known peptic ulcer disease. In musculoskeletal imaging, it stresses getting multiple views for fractures and

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    of 72

    PRACTICAL IMAGING

    PEARLS FOR THE NEW


    PHYSICIAN

    Michael Rico B. Mesina, MD, FPCR, FCTMRISP, FUSP


    Practicing Radiologist
    Assistant Professor IV of Radiology
    I. HEAD
    COMMON SCENARIO: ACUTE CVA.
    BLEED OR INFARCT?
    1. ACUTE CVA. BLEED OR INFARCT?
    GOALS OF BRAIN IMAGING
    IN STROKE

    1. TO EXCLUDE HEMORRHAGE

    2. TO CHECK THE LOCATION AND EXTENT OF


    INFARCTION, IF ANY
    WHAT TO REQUEST?
    • Most cost-effective: Plain head CT scan
    • No idea when the symptoms started: Plain
    MRI of the head
    • MRI stroke protocol?
    WHAT AM I LOOKING AT?
    DENSITIES IN CT SCAN - QUALITATIVE
    ASSESSMENT
    B.P.I.I. (BLEED PUTI, INFARCT ITIM)
    1. INFARCTION
    a. Location of Infarctions
    b. Timing of Infarctions
    Acute Infarction: Ill-defined hypodensities.
    Loss of the gray-white matter interface.
    Acute Infarction: Hyperdense Artery Sign
    Subacute Infarction
    Chronic Infarction
    2. Hemorrhages
    a. Location of Hemorrhages
    Intraparenchymal
    • Usually seen in
    HPN

    • Basal ganglia –
    most common
    (putamen)

    • Critical volume
    Subdural
    • Crescent-shaped

    • Tearing of dural
    veins

    • Crosses sutures

    • Fluid-hematocrit
    level
    Epidural • Lentiform

    • Torn meningeal
    arteries

    • Commonly associated
    with trauma (80%).

    • Best imaging study


    for head trauma?

    • Does not cross


    sutures
    Subarachnoid
    b. Timing of Hemorrhages
    STROKE IN MRI: BASICS
    Hyperacute/Acute Infarction: DWI and
    the ADC Map
    Hemorrhage: GRE or SWI
    II. CHEST
    1. Pneumonia or PTB?
    PTB: IS IT ACTIVE?
    • Check for:
    – Cavity
    – Hazy densities
    Confirming Suspicious Densities in the
    Lung Apices: Apicolordotic View
    2. Pulmonary Edema or Pneumonia?
    3. Simple Cardiomegaly or
    Pericardial Effusion?
    Confirmation: 2D-Echo
    4. Pleural Effusion or
    Atelectasis?
    For Confirmation: Ultrasound
    Another Option: Lateral
    Decubitus X-ray
    5. CA patient. Impression?
    6. Patients with chronic cough
    and weight loss. Next step?
    Answer: Chest CT scan with
    Contrast (NOT MRI)
    7. Trauma Case.
    8. Tube Placements
    Endotracheal Tube: In place?
    III. ABDOMEN
    1. Right upper quadrant /
    Epigastric pain: Ultrasound
    2. Right upper quadrant pain and
    Jaundice: Ultrasound. What next?
    CT Scan or MRCP
    3. Abdominal Pain
    4. Known case of PUD. Sudden
    severe abdominal pain.
    5. Case of Abdominal
    Enlargement.
    6. Right lower quadrant pain.
    What to do next?
    Ultrasound or CT Scan?
    7. Hematuria and pelvic pain.
    IV. MSK
    1. On fractures: Request at
    least 2 views.
    2. Knee pain.
    3. Pain and swelling at the big toe.
    4. Basketball injury. Pain and
    weakness at the knee.
    5. Bilateral hip pain.
    Before we end..
    RADIOLOGY AS A PROFESSION
    • Steadily increasing number of doctors going to radiology as a specialty
     Not really super benign
     Still have contact with patients
     Radiation exposure

    • Work-life balance
     Flexibility in setting up a practice
     Hospital or clinic based
     Modality based
     Teleradiology

    • Relatively “easier” to establish/start a practice


    • Need for additional radiologists (Uneven distribution)
    • Increasing number of modalities
    EXIT QUIZ
    1. Infarction or Hemorrhage?
    2. What the is blood supply compromised
    in this study? Left ACA, MCA or PCA?
    3. What sign is exhibited?
    4. What is the location of the acute
    hemorrhage?
    5. MRI. Infarct or Hemorrhage?
    6. Diagnosis?
    7. Effusion or Atelectasis?
    8. Diagnosis?
    9. Diagnosis?
    10. Diagnosis?
    THANK YOU!

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