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- “ The future of radiology as a discipline will rest largely on how the profession responds to challenges in 3 broad areas:
1. advancing and leveraging technology
2. influencing the changing structure of professional imaging practice
3. inventing new economic models to support radiologic practice”
The Future of Radiology in the
New Health Care Paradigm:
The Moreton Lecture
Goldsmith, J
J Am Coll Radiol 2011;8:159-163. - “More powerful advanced imaging modalities are generating markedly greater quantities of images that must be reviewed individually by interpreting radiologists. In some modalities, such as mammography, computer assisted image recognition software already can flag specific images for more detailed review, helping focus radiologists’ time on the handful of images that contain clinically significant information. It may be that ultimately, image recognition software will be the logical “first reader” of high-technology scans in the future, narrowing and focusing scarce radiologists’ time and attention. ”
The Future of Radiology in the
New Health Care Paradigm:
The Moreton Lecture
Goldsmith, J
J Am Coll Radiol 2011;8:159-163. - “Active experimentation, not only with emerging technologies, but emerging forms of care organization and payment, will be required for radiology to extend and strengthen its professional franchise in the coming decade. There are grounds for optimism that the profession’s successful adaption will continue. ”
The Future of Radiology in the
New Health Care Paradigm:
The Moreton Lecture
Goldsmith, J
J Am Coll Radiol 2011;8:159-163.
- Pulmonary Embolism in Pregnancy: Facts
- Estimated incidence of 10.6 per 100,000
- Risk is highest in the post partum period
- Prevalence of PE in pregnant woman presenting with clinical symptoms is in the 3-6% range
- CT is a challenge in the pregnant patient due to physiologic changes including increased cardiac output and blood volume that result in decreased opacification - “ Pulmonary embolism (PE) is a leading cause of maternal mortality in the developed world. Along with appropriate prophylaxis and therapy, prevention of deaths from PE in pregnancy requires a high index of clinical suspicion followed by a timely and accurate diagnostic approach.”
American Thoracic Society Documents: An Official American Thoracic Society/Sociey of Thoracic radiology Clinical Practice Guideline-Evaluation of Suspected Pulmonary Embolism in Pregnancy
Leung AN et al.
Radiology 2012; 262:635-646 - Fetal and Maternal Doses Associated with Diagnostic Tests for PE
- Some Explanations for the Decision Process
- “ In pregnant woman with suspected PE and a normal CXR, we recommend lung scintigraphy as the next imaging test rather than CTPA.” (strong recommendation, low quality evidence)
- “ The recommendation puts a high value on minimizing radiation dose to the mother. It puts a lower value on rapidity of the diagnostic test and the possibility of alternate diagnoses afforded by CTPA.” - Some Explanations for the Decision Process
- “ In pregnant woman with suspected PE and a nondiagnostic V/Q scan we suggest further diagnostic testing rather than clinical management alone (weak recommendation, low quality evidence). In patients with a nondiagnostic V/Q scan in whom a decision is made to further investigate, we recommend CTPA rather than DSA (strong recommendation, very low quality evidence)”
- “ This recommendation puts a high value on diagnostic certainty given the potential morbid consequences if PE is undiagnosed due to a nondiagnostic V/Q scan.”
"In conclusion,in this large perspective investigation, performance of an abdominal CT in the emergency department for patients with nontraumati abdominal complaints increased the physicians diagnostic certainty and changed planned management decisions "
Abdominopelvic CT Increases Diagnostic Certainty and Guides Management Decisions: A Prospective Investigation of 584 Patients in a Large Academic Center
Abujudeh HH, Thrall JH et al
AJR 2011; 196:238-243"Given current concerns about the increased health care cost and radiation exposure related to the use of CT Technology , it is critical for physicians to be able to weigh the risk of radiation to patients and cost of the examination against the benefits of CT."
Abdominopelvic CT Increases Diagnostic Certainty and Guides Management Decisions: A Prospective Investigation of 584 Patients in a Large Academic Center
Abujudeh HH, Thrall JH et al
AJR 2011; 196:238-243"The most common diagnoses were renal colic (119/584, 20.4%) and intestinal obstruction (80/584, 13.7%). CT altered the leading diagnosis in 49% of the patients (284/584) and increased mean physician diagnostic certainty from 70.5% to 92.2%. The management plan was changed by CT in 42% (244/583). Surgery was planned for 79 patients before CT, whereas hospital discharge was planned for 25.3% of these patients (20/79) after CT."
Abdominopelvic CT Increases Diagnostic Certainty and Guides Management Decisions: A Prospective Investigation of 584 Patients in a Large Academic Center
Abujudeh HH, Thrall JH et al
AJR 2011; 196:238-243"The objective of our study was to prospectively determine how CT affects physicians diagnostic certainty and management decisions in the setting of patients with nontraumatic abdominal complaints presenting to the emergency department. In the management of patients presenting to the emergency department with nontraumatic abdominal complaints, CT changes the leading diagnosis, increases diagnostic certainty, and changes potential patient management decisions."
Abdominopelvic CT Increases Diagnostic Certainty and Guides Management Decisions: A Prospective Investigation of 584 Patients in a Large Academic Center
Abujudeh HH, Thrall JH et al
AJR 2011; 196:238-243"In the management of patients presenting to the emergency department with nontraumatic abdominal complaints, CT changes the leading diagnosis, increases diagnostic certainty, and changes potential patient management decisions."
Abdominopelvic CT Increases Diagnostic Certainty and Guides Management Decisions: A Prospective Investigation of 584 Patients in a Large Academic Center
Abujudeh HH, Thrall JH et al
AJR 2011; 196:238-243