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Messages - Elliot K. Fishman, MD

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CT Scan Protocols / Re: Oral Contrast for CT: 2 Questions
« on: August 05, 2019, 03:47:15 pm »
the era of delay is over
if u get 15-20m minutes "praise the Lord"

CT Scan Protocols / Re: Special protocol for "gallbladder cancer"?
« on: August 05, 2019, 09:56:50 am »
if I was staging GB cancer I would do dual phase to try and define liver involvement by direct extension. If only one phase I would wait 70 sec

CT Scan Protocols / Re: Oral Contrast for CT: 2 Questions
« on: August 05, 2019, 09:55:47 am »
we need oral contrast to prevent misdiagnosis.
use 500-1000 cc of Oral Omnipaue or 500-1000cc of water depending on the situation.
this is a quality of care issue

!! Please Read - About the Board / Re: Coronary CTA
« on: July 14, 2019, 08:15:46 pm »
you can see the protocol on CTISUS protocol section.
our rule with infants is to wait a bit longer and opacify all structures to prevent a misdiagnosis

!! Please Read - About the Board / Re: Rules
« on: July 14, 2019, 08:14:28 pm »
Hope the rules are helpful to all

the ACR has lots of info and resources for free.
here is a link to get started
ACR lung screening at ttps://www.acr.org/Clinical-Resources/Lung-Cancer-Screening-Resources

CT Scan Protocols / Re: 20g vs 22g for CTA work
« on: June 06, 2019, 11:53:57 am »
you should at least use the B and D catheters so that you can inject 5 cc thru a 22g
these are the Nexiva catheters

CT Scan Protocols / Re: CTPA in Abnormal Lung
« on: June 06, 2019, 11:51:40 am »
we do not and have not found this to be an issue. triggering off the main PA works fine

if you were not there you missed a great meeting

CT Scan Protocols / Re: CT R/O STONE PROTOCOLS
« on: May 19, 2019, 09:46:43 pm »
we scan for a stone protocol mid liver thru pelvis. We do not use disclaimers but if the patient has hematuria we would in the face of a negative stone study suggest that a contrast enhanced scan is needed to exclude non stone renal pathology.
as for dose we use a dose that is low but not so low that I would need a disclaimer in my report

Case Studies / Re: Seeking better review
« on: May 09, 2019, 01:57:13 pm »
unfortunately I can't read officially scans from people but if you send it via Hopkins Ambra I will take a look. Its free on the web

I would speak to your primary care physician

General Questions / Re: Ct orbits & Neck with contrast
« on: May 09, 2019, 01:54:26 pm »
you need a power injector
if not 3cc/sec for 120 cc and start scanning asap

CT Scan Protocols / Re: ISOVUE 250 ORAL CONTRAST
« on: April 24, 2019, 10:11:28 pm »
we use oral Omnipaque and not Issue. Only Omni is FDA approved for oral contrast for CT. We use either premixed bottles at 9mg or put 100 cc of Omnipaque-350 in a gallon of water

General Questions / Re: Does modulation for CT scan of the brain.
« on: March 05, 2019, 10:42:59 pm »
I asked Tony Cook from Siemens your question and he said;

 Yes, using dose modulation on routine brain imaging is very common. The mAs will adjust on its own to account for the thicker bone at the skull base and petrous bones vs. the remainder of the brain.

The default Care Dose 4D quality reference mAs values in the Siemens default head protocols are a good place to start, then the QRM can be fine tuned up/down if needed depending on the Radiologist personal preference for image quality

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