Radiology

Radiology : 

Radiology Introduction to Clinical Medicine Francis Neuffer M.D. Asso Professor/Radiology U.S.C. School of Medicine

Radiology : 

Radiology E-mail: x-ray@med.sc.edu Radiology Website: http://radiology.med.sc.edu Radiology Department: Basement of Library 733-3295

GOALS : 

GOALS Radiologists and radiology departments Residency Ordering studies Reading reports Issues

GOALS : 

GOALS Understand exams and indications Strengths and weakness Interpretation Work-up for diseases Resources

What is Radiology? : 

What is Radiology? Supervises and interprets imaging studies Reports findings to referring physicians ANATOMY vs. PATHOLOGY LOCATION & EXTENT DIAGNOSIS & DIFFERENTIAL

RADIOLOGY TRAINING : 

RADIOLOGY TRAINING Medical School 4 years Radiology Residency 4 years (1 year clinical) Nuclear Medicine 4 years Radiation Therapy (Oncology) 4 years After Residency: Subspecialty Fellowship 1 year Research 1 year

RADIOLOGY SERVICES IN THE UNITED STATES : 

RADIOLOGY SERVICES IN THE UNITED STATES 260 - 330 million procedures 1990 400 million procedures 2005 55% performed in office 19 -20 billion dollars 1990 65-75 billion dollars 2000 85-95 billion dollars 2005 Sunshine, AJR 157, September 1990 Rothenberg JACR May 2005

DIAGNOSTIC IMAGING IN OFFICE PRACTICE : 

DIAGNOSTIC IMAGING IN OFFICE PRACTICE Frequency 4 - 4.5 times greater for self referring physician Cost 4.4 - 7.5 times higher mean imaging costs per episode of care Frequency and Cost NEJM: 323:23,1990 Hillman

DIAGNOSTIC IMAGING CENTERS PHYSICIAN ENTREPENEURSHIP : 

DIAGNOSTIC IMAGING CENTERS PHYSICIAN ENTREPENEURSHIP

DIAGNOSTIC IMAGING CENTERS PHYSICIAN ENTREPENEURSHIP : 

DIAGNOSTIC IMAGING CENTERS PHYSICIAN ENTREPENEURSHIP Frequency 47% greater for self referring physician Cost Increases cost $2.7billion Fletcher JACR May2005 WALL ST.J. May 2 2005

Mean Professional Liability Premiums per Self-Employed Physician : 

Mean Professional Liability Premiums per Self-Employed Physician 1994 1996 1998 2000 Family Practice 10.2 8.4 10.9 13.8 Internal Medicine 8.6 8.9 16.5 13.7 Surgery 22.3 21.7 22.8 23.6 Pediatrics 7.6 8.3 9.0 11.5 OB/GYN 37.4 35.2 35.8 39.2 Radiology 11.2 11.3 12.3 19.3 Psychiatry 9.4 5.2 5.4 12.9 ANNUAL PREMIUMS (in thousands of dollars) AMA, Socioeconomic Characteristic of Medical Practice 2003

RADIOLOGY PRACTICE : 

RADIOLOGY PRACTICE 1. Intellectually exciting Geographically limited 2. Good Income Little Control a. low overhead b. collectible charges 3.Limited Responsibility Clinical Perception a. reduced patient contact b. predictable hours Positive Negative

PROBLEMS WITH RADIOLOGY : 

PROBLEMS WITH RADIOLOGY Planning the diagnostic workup Too many available choices create confusion and anxiety The radiology report Disorganized and imprecise document that can rarely be taken seriously by clinicians Heilman, NEJM Vol.306, No.8, 1992d

Slide 14: 

? What next? ULTRASOUND BARIUM ANGIOGRAM NUCLEAR MEDICINE CT MRI

Slide 15: 

How to decide. . . 1. Cost Effectiveness (efficacy) Risk 4. Availability American College Radiology APPROPRIATENESS CRITERIA USC RADIOLOGY DEPT WEB PAGE

Slide 16: 

Prominent Engorged Congested Accentuated Interstitial edema Increased interstitial markings Early failure CHF THE X-RAY REPORT

RADIOLOGY TOOLS : 

RADIOLOGY TOOLS X- RAY COMPUTED TOMOGRAPHY NUCLEAR MEDICINE ULTRASOUND MAGNETIC RESONANCE

Slide 19: 

WHOLE BODY PROJECTION SECTIONAL TOMOGRAPHIC

X- RAY : 

X- RAY HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES FILM

Slide 22: 

PA & Lateral Chest X-ray

4 BASIC DENSITIES VISUALIZED : 

4 BASIC DENSITIES VISUALIZED BONE SOFT TISSUE FAT AIR

Slide 24: 

BONE SOFT TISSUE FAT AIR X- RAY

Slide 25: 

Upper GI oral barium contrast

Barium Enemarectal barium/aircontrast : 

Barium Enemarectal barium/aircontrast

Intravenous Pyelogram (IVP) : 

Intravenous Pyelogram (IVP) Intravenous Iodine contrast

Arteriogram : 

Arteriogram Intraarterial Iodine contrast

Slide 29: 

TOMOGRAPHY

COMPUTED TOMOGRAPHY : 

COMPUTED TOMOGRAPHY HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES DETECTOR DIGITAL DATA

NUCLEAR MEDICINE : 

NUCLEAR MEDICINE INJECTION OF RADIOPHARMACEUTICAL HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES DETECTOR DIGITAL DATA

EXAMPLES : 

EXAMPLES BONE HIDA RENAL

ULTRASOUND : 

ULTRASOUND SOUND WAVE NO IONIZING RADIATION REFLECTED TO DETECTOR DIGITAL DATA

EXAMPLES : 

EXAMPLES GALLBLADDER KIDNEY OB

MAGNETIC RESONANCE : 

MAGNETIC RESONANCE HYDROGEN PROTONS ALIGN IN MAGNETIC FIELD RADIO FREQUENCY SIGNAL TRANSMISSION INTENSITY OF SIGNAL RELATES TO TISSUE NO IONIZING RADIATION

MAGNETIC RESONANCE : 

MAGNETIC RESONANCE BRAIN SPINE JOINT

THE PRODUCTIONandMEDICAL USE of X-RAY : 

THE PRODUCTIONandMEDICAL USE of X-RAY

X- RAY : 

X- RAY HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES FILM

Slide 51: 

KV MAS GRID SCREEN

Slide 52: 

TISSUE OF INTEREST DETAIL REQUIRED EXPOSURE PATIENT -AGE/SEX TARGET ORGAN BENEFIT/RISK

Slide 55: 

KV MAS GRID SCREEN

Slide 56: 

SCREEN

Slide 57: 

TISSUE OF INTEREST DETAIL REQUIRED EXPOSURE PATIENT -AGE/SEX TARGET ORGAN BENEFIT/RISK

Slide 58: 

COLLIMATION

Slide 60: 

KV MAS GRID SCREEN COLLIMATION