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Radiology

Radiology. Introduction to Clinical Medicine. Francis Neuffer M.D. Asso Professor/Radiology U.S.C. School of Medicine. Radiology. E-mail: x-ray@med.sc.edu Radiology Website: http://radiology.med.sc.edu Radiology Department: Basement of Library

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Radiology

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

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

  3. GOALS • Radiologists and radiology departments • Residency • Ordering studies • Reading reports • Issues

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

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

  6. 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

  7. 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

  8. 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

  9. DIAGNOSTIC IMAGING CENTERS PHYSICIAN ENTREPENEURSHIP

  10. 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

  11. Mean Professional Liability Premiums per Self-Employed Physician ANNUAL PREMIUMS (in thousands of dollars) 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 AMA, Socioeconomic Characteristic of Medical Practice 2003

  12. RADIOLOGY PRACTICE Positive Negative 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

  13. 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

  14. ? NUCLEAR MEDICINE ULTRASOUND CT BARIUM MRI ANGIOGRAM What next?

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

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

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

  18. WHOLE BODY PROJECTION SECTIONAL TOMOGRAPHIC

  19. X- RAY HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES FILM

  20. PA & Lateral Chest X-ray

  21. 4 BASIC DENSITIES VISUALIZED BONE SOFT TISSUE FAT AIR

  22. X- RAY • BONE • SOFT TISSUE • FAT • AIR

  23. Upper GI oral barium contrast

  24. Barium Enemarectal barium/aircontrast

  25. Intravenous Pyelogram (IVP) Intravenous Iodine contrast

  26. Arteriogram Intraarterial Iodine contrast

  27. TOMOGRAPHY

  28. COMPUTED TOMOGRAPHY HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES DETECTOR DIGITAL DATA

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

  30. EXAMPLES • BONE • HIDA • RENAL

  31. ULTRASOUND • SOUND WAVE • NO IONIZING RADIATION • REFLECTED TO DETECTOR • DIGITAL DATA

  32. EXAMPLES • GALLBLADDER • KIDNEY • OB

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

  34. MAGNETIC RESONANCE • BRAIN • SPINE • JOINT

  35. THE PRODUCTIONandMEDICAL USE of X-RAY

  36. X- RAY HIGH ENERGY PHOTON IONIZING RADIATION EXPOSES FILM

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