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