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    Emergency Imaging Course 1

    Uploaded by

    Alex Danciu
    This document provides information about a radiology course on imaging in medical and surgical emergencies. It includes: - An outline of course content covering various imaging techniques, body regions, and integrative algorithms. - Information about course instructors, schedule (Wednesdays 6-8pm over 7 weeks), assessment involving a written test, attendance requirements, and dress code. - References including textbooks on radiology, imaging, and emergency diagnostic imaging. - An invitation for questions and the topic of the first course - techniques used for emergency imaging, their rationale, advantages, drawbacks, and when each would be appropriate in trauma versus non-trauma situations.

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

    Emergency Imaging Course 1

    Uploaded by

    Alex Danciu
    50 views66 pages
    This document provides information about a radiology course on imaging in medical and surgical emergencies. It includes: - An outline of course content covering various imaging techniques, body regions, and integrative algorithms. - Information about course instructors, schedule (Wednesdays 6-8pm over 7 weeks), assessment involving a written test, attendance requirements, and dress code. - References including textbooks on radiology, imaging, and emergency diagnostic imaging. - An invitation for questions and the topic of the first course - techniques used for emergency imaging, their rationale, advantages, drawbacks, and when each would be appropriate in trauma versus non-trauma situations.

    Original Description:

    radiology Xray CT MRI emergency course

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    This document provides information about a radiology course on imaging in medical and surgical emergencies. It includes: - An outline of course content covering various imaging techniques, body regions, and integrative algorithms. - Information about course instructors, schedule (Wednesdays 6-8pm over 7 weeks), assessment involving a written test, attendance requirements, and dress code. - References including textbooks on radiology, imaging, and emergency diagnostic imaging. - An invitation for questions and the topic of the first course - techniques used for emergency imaging, their rationale, advantages, drawbacks, and when each would be appropriate in trauma versus non-trauma situations.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    50 views66 pages

    Emergency Imaging Course 1

    Uploaded by

    Alex Danciu
    This document provides information about a radiology course on imaging in medical and surgical emergencies. It includes: - An outline of course content covering various imaging techniques, body regions, and integrative algorithms. - Information about course instructors, schedule (Wednesdays 6-8pm over 7 weeks), assessment involving a written test, attendance requirements, and dress code. - References including textbooks on radiology, imaging, and emergency diagnostic imaging. - An invitation for questions and the topic of the first course - techniques used for emergency imaging, their rationale, advantages, drawbacks, and when each would be appropriate in trauma versus non-trauma situations.

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    You are on page 1of 66

    Sorin M.

    Dudea MD, PhD

    R A D IO LO G Y A N D IM A G IN G
    IN M ED IC A L & S U R G IC A L
    EM ER G EN C Y

    G eneralcourse content
    Techniques, rationale
    Head & neck
    Spine, musculoskeletal, peripheral

    vessels
    Chest & heart
    Digestive system
    Urinary tract, retroperitoneum, pelvis
    Integrative algorithms

    G eneralinform ation
    Course masters:
    Assoc. Prof. Anca Ciurea
    Prof. Sorin Dudea

    Layout: lectures
    Date / time:
    every Wednesday
    6,00 8,00 p.m.
    Physiology auditorium
    Start: Feb. 26th end: Apr. 9th (7 weeks)

    G eneralinform ation
    Final assessment:
    written test, last lecture (no test no mark!)

    Presence:
    mandatory, Radiology style

    Prerequisites: none
    Dress / behavior code:
    Smart casual or formal / academic

    References
    Sutton D Textbook of Radiology and

    Imaging 7th Ed Churchill


    Livingstone, Elsevier, Edinburgh,
    2003
    Brooke Jeffery R et al Diagnostic

    Imaging, Emergency Amirsys, Salt


    Lake City, 2007

    Q uestions?

    Course 1.

    TEC H N IQ U ES

    U S ED FO R EM ER G EN C Y

    IM A G IN G

    R ATIO N A LE
    EM ER G EN C Y PATIEN T

    TO A P P R O A C H TH E

    Teaching O bjectives
    Review the techniques used for

    imaging:
    Advantages
    Drawbacks
    Pifalls

    Rationale to approach the patient


    In an emergency setting
    By means of imaging

    Em ergency
    Trauma
    Non-trauma
    Surgical
    Medical

    W here does im aging fi


    t in?
    Traum a or N on-traum a

    TRAUMA
    ATLS
    Adjuncts to primary
    survey & resuscitation
    AP - CXR, AP pelvis,
    C-spine
    US FAST

    Adjuncts to secondary
    survey
    Add. XR,
    CT
    others

    NON TRAUMA
    Based on
    Clinical presentation
    Guidelines / protocols

    Im aging techniques
    Radiography + fluoroscopy
    Ultrasound
    CT
    MR
    Interventional
    Nuclear Medicine & PET-CT

    Radiography & fl
    uoroscopy
    PLUS
    Quick
    Very good for chest & skeleton (fractures)
    Low - dose, cost
    Easy - recognizable anatomy,
    interpretation
    Guidance (fluoro)

    Marincek et al Emergency Radiology,


    2007

    Radiography & fl
    uoroscopy
    Minus
    Limited value in the abdomen & soft
    tissues
    No solid fluid differentiation
    No information on the brain status
    Ionizing radiation

    Pitfalls
    Superposition
    Missed lesions

    Radiography & fl
    uoroscopy
    WHEN?
    TRAUMA, SOME SURGICAL

    EMERGENCIES
    adjunct to primary survey in ATLS
    Adjunct to secondary survey in ATLS

    WHAT?
    Bone
    Air

    U ltrasonography
    PLUS
    No radiation
    Quick, bedside, portable
    Low cost
    Ease of use
    Very good solid fluid differentiation
    Good abdomen & soft tissue assessment
    No-contrast flow assessment
    May be performed on hemodyn. unstable
    pts.
    Real-time guidance

    U ltrasonography
    MINUS
    Operator dependant
    Impossible behind gas & bone
    Very difficult in obese pts.
    Limited FOV & penetration

    Pitfalls
    Due to improper adjustment & poor
    technique

    U ltrasonography
    WHEN?
    TRAUMA, MEDICAL & SURGICAL

    EMERGENCIES
    adjunct to primary survey in ATLS
    Adjunct to secondary survey in ATLS

    WHAT?
    Fluid
    Status of solid organs
    Flow

    Com puter Tom ography (CT)


    PLUS
    Large volume acquisition in short time
    Multiplanar reconstruction
    Excellent soft tissue + bone + airways resolution
    Quick
    Wide FOV
    Easy understood & reproducible
    Very sensitive to bleeding (extravascular blood)
    Excellent for stones & fractures
    CM when needed
    Guidance

    Marincek et al Emergency Radiology,


    2007

    CT
    MINUS
    High radiation dose
    Beware pregnancy & children !

    More difficult access


    Only for hemodyn. stable patients
    Higher cost
    Nonspecific

    Pitfalls
    Poor technique

    CT
    WHEN & WHAT
    in the hemodynamically stable patient
    EVERYTHING !!

    The gold tool for emergency imaging

    M agnetic Resonance Im aging


    (M R)
    Plus
    Good soft tissue resolution, including spine
    Numerous sequences
    CM

    MR
    Minus
    Difficult access
    No ferromagnetic metal allowed
    No life support
    Long + expensive
    Claustrophobia

    Pitfalls
    Technical + artifacts

    MR -

    is N O T an em ergency tool

    WHEN?
    Vertebromedullary trauma with suspicion
    of cord lesion
    Peculiar cases, special indications
    Eg. Stroke + pregnancy

    What?
    Peculiar, focused aspects (eg. Cord
    homogeneity & integrity)

    N uclear M edicine + PET-CT


    Not used in emergency

    Interventionalradiology
    Applications
    Treat conditions diagnosed by the other
    techniques
    NOT diagnostic in emergency but
    THERAPEUTIC

    Rationale
    for approaching the emergency patient

    1.The requested investigation


    should be useful
    What is a useful investigation ?
    Result (+ or -) will influence the clinical
    course of the patient
    Diagnosis (establish / confidence)
    Treatment / Management

    Q uestions to be asked (and answ ered)


    BEFO RE requesting an exam
    (iRefer RCR,London,2012)

    1. Has is been done already ?


    2. Do I need it?
    3. Do I need it now?
    4. Is this the best investigation?
    5. Have I explained the problem?

    H as it been done already?


    Recent exams that may explain
    Obtain history, previous reports &

    images
    Avoid repeating unnecessarily
    Especially exams using XRay

    D o Ineed it?
    Dont request exams
    just to be covered
    When results are unlikely to change the
    management
    to do this exam as well overinvestigation
    When the anticipated positive finding is:
    irrelevant
    Unlikely

    To be reassured (although you already have


    the diagnosis)

    D o Ineed it now ?
    Too early, before
    Known onset of morphologic changes
    There is any chance of progression /
    resolution
    The result may influence management

    Always consider appropriate timing

    Is this the best investigation?


    D o Ineed this ?
    Best is the one

    that is:
    Quick
    Accurate
    Available
    Least irradiating
    Easy to perform
    Inexpensive

    Is this the best investigation?


    D o Ineed this ?
    Best is the one

    Best is not the one

    that is:

    that is:

    Quick
    Accurate

    Most sophisticated
    Highest in demand

    Available
    Least irradiating

    Fanciest
    Most expensive

    Easy to perform
    Inexpensive

    Requiring the

    greatest skill for


    operation

    Is this the best investigation?


    D o Ineed this ?
    Best is the one

    Best is not the one

    that is:

    that is:

    Quick
    Accurate

    Most sophisticated
    Highest in demand

    Available
    Least irradiating

    Fanciest
    Most expensive

    Easy to perform
    Inexpensive

    Requiring the

    greatest skill for


    operation

    Usefulness should always be checked against the suspected


    diagnosis and the clinical problem addressed.

    H ave Iexplained the problem ?


    Provide to the radiologist:
    Appropriate clinical information
    Questions that imaging should answer

    Ask for a clinically relevant answer (dont

    tell the radiologist what and, especially,


    how to do)
    OR FACE:
    Wrong technique
    Wrong focus of the report

    2.The requested investigation should


    be perform ed at the proper tim e
    Too early (see above)
    Too late (result will no longer

    influence management)

    3.The investigations should be


    perform ed in the proper sequence
    Whenever possible, comply with

    guidelines, protocols or strategies.


    If not certain, discuss with the
    radiologist.

    4.Risk /benefi
    t should alw ays favor
    the patient
    Use the less irradiating technique

    (ALARA) that provides appropriate


    information
    Dont hesitate to use irradiating

    techniques if mandatory.

    Irradiation
    (iRefer,RCR,London,2012)

    Examination
    Limbs / joints

    Eq. no.
    chest XR

    Eq. period of natural


    Bg. irrad.

    <1

    <2 days

    2,5 days

    Lumbar spine

    40

    3 months

    Mammography (2
    view)

    35

    3 months

    Abdomen

    30

    2 months

    140

    11,5 months

    90

    7,5 months

    CT chest /
    abdomen+pelvis

    450

    3 years

    CT chest + abdomen
    + pelvis

    670

    4,5 years

    1200

    8,1 years

    Chest (single PA)

    IVP
    CT head

    PET-CT body (F-18

    Irradiation & CT

    Mettler FA & al Radiology, 253, 2009

    Irradiation & CT

    Mettler FA & al Radiology, 253, 2009

    Clinicalquizzes
    A GP requests a

    chest x-ray for a


    63-year-old woman
    who has recently
    joined his practice.
    She is
    asymptomatic

    A Guide to Justification for Clinical Radiologists RCR, 2000

    Clinicalquizzes
    A GP requests a

    chest x-ray for a


    63-year-old woman
    who has recently
    joined his practice.
    She is
    asymptomatic

    The practitioner (a

    clinical radiologist)
    determines that
    the clinical details
    do not justify the
    exposure and
    returns the request
    to the GP with an
    A Guide to Justification for Clinical Radiologistsexplanatory
    RCR, 2000
    letter.

    Clinicalquizzes
    A 24-year-old

    woman presents
    with right iliac
    fossa pain. The
    pregnancy test is
    negative, and the
    referrer (the
    Accident &
    Emergency
    specialist) requests
    abdominal CT for

    A Guide to Justification for Clinical Radiologists RCR, 2000

    The clinical

    Clinicalquizzes
    A 24-year-old

    radiologist (the
    practitioner)
    recommends
    ultrasound
    (including
    transvaginal and
    graded
    compression
    studies) as an
    effective
    alternative
    technique which
    does not involve
    ionising radiation.

    woman presents
    with right iliac
    fossa pain. The
    pregnancy test is
    negative, and the
    referrer (the
    Accident &
    Emergency
    specialist) requests
    abdominal
    CT
    forRadiologists RCR, 2000
    A Guide
    to Justification for
    Clinical

    Clinicalquizzes
    A 35-year-old

    woman presents
    with a breast lump.
    The surgeon
    requests a
    mammogram.

    A Guide to Justification for Clinical Radiologists RCR, 2000

    Clinicalquizzes
    A 35-year-old

    The radiographer

    (operator) does not


    authorise the mammogram
    as it falls outwith
    departmental guidelines.
    The clinical radiologist
    (practitioner) determines
    that the risk to benefit ratio
    in a patient of this age
    would not justify an
    exposure and an
    ultrasound is performed
    which confirms features of
    A Guide to Justification for Clinical Radiologists
    RCR, 2000
    a benign
    fibroadenoma.

    woman presents
    with a breast lump.
    The surgeon
    requests a
    mammogram.

    Thank you !

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