Welcome to brand new Ask the Fish. Post your questions in different boards to get in touch with CTisus team & Dr. Elliot K. Fishman!
Our old Ask the Fish forum can be still viewed as an archive at https://ctisus.com/redesign-askfish/index.html.
We encourage all the users to register in this new forum to get answers to their questions since the posts in old forum will no longer be reviewed!
Thank you for visiting & looking forward to your feedback!

Recent Posts

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Q&A: Why the public should not worry about radiation contamination when bodies are cremated

Mahadevappa Mahesh, MS, PhD

When JAMA published a research letter detailing radiation contamination in a crematorium, it gained considerable attention from both the mainstream media and the general public. Hoping to ease potential concerns before things grew out of hand, the American Association of Physicists in Medicine (AAPM) and American College of Radiology (ACR) published a joint statement emphasizing that the use of radiopharmaceuticals in healthcare is routine and has been proven to be safe.

Mahadevappa Mahesh, MS, PhD, chief physicist for Johns Hopkins Hospital in Baltimore, Maryland, spoke with Radiology Business to provide additional information about this subject. Mahesh is a representative of both organizations behind the joint statement, serving as treasurer of the AAPM and chair of the ACR Commission on Medical Physics. He is also the president of the Maryland Radiological Society.

Link: https://www.radiologybusiness.com/topics/care-delivery/radiation-contamination-cremation-bodies-aapm-acr


What are your thoughts?  Comments?
Case Studies / Seeking better review
« Last post by KindHope on March 07, 2019, 02:09:10 pm »
Hello Dr. Fishman,

I received a CT scan in January after several months of abdominal pain, predominantly upper left side. The diagnosis was generally benign, except for a note regarding the the pancreas, which was listed as markedly atrophic.  An immediate EUS with possible biopsy was advised, although the Gastroenterologist  only reviewed the report and not the scan itself.

I obtained a 2nd opinion from a GI surgeon who did my Nissen Fundoplication, who at first advised me to not do anything due to the risk of creating a possible case of pancreatitis, but agreed to review the scan. I was then told that the pancreas is somewhat fatty and "feathery" which could create a challenge during any surgery. There was also mention of possible lesions. An EUS was advised.

At this point I would be so grateful if I could share my CT with you to to review. I believe your extensive experience in interpreting CT scans would aid in a successful path forward. Thank you so very much for caring about the patients and the practitioners in your field who toghether with you positively affect so very many of us.

Kind regards,


Ps:I did email this, but strongly believe it ended up in a spam filter, it happens often from gmail.
CME / NASHVILLE: Hot Topics in Body CT Scanning: What You Need to Know
« Last post by Lilly Kauffman on March 07, 2019, 10:52:24 am »
Click here to register: https://hopkinscme.cloud-cme.com/default.aspx?P=5&EID=16734

Hot Topics in Body CT Scanning: What You Need to Know

When: Friday, May 17, 2019 - Sunday, May 19, 2019
Where: Gaylord Hotel and Convention Center, Nashville, TN
Overview: The rapid evolution of multidetector CT (MDCT) has impacted all aspects of patient diagnosis from cardiac imaging to vascular imaging to hepatic imaging. The development of these new scanners requires a close look at all aspects of our CT programs ranging from our scan protocols, to contrast injection to the use of oral contrast. The new clinical applications require a better understanding of our scanners as the “room for error” has decreased with scanners routinely acquiring datasets in under 10 seconds. New applications have evolved from coronary CTA to virtual colonoscopy to dual energy imaging, to name a few. Classic applications like imaging the liver, kidneys or pancreas have changed with the role of multiphase acquisition and post processing techniques becoming more critical. This has been both a time of change and a time of excitement. This meeting will provide the attendee with an improved understanding of the role of MDCT today and will help them improve their practice skills and knowledge base. Whether it is designing new scan protocols or learning new skill sets, this meeting will be a catalyst for increasing your core competencies through a series of lectures and hands-on training over a four-day period. The goal of the meeting is to improve your ability to do the best studies possible for optimal patient care in your own practice.

Click here for more information: https://hopkinscme.cloud-cme.com/default.aspx?P=5&EID=16734

RSVP to the Facebook event here: https://www.facebook.com/events/537935686717390/
General Questions / Re: Does modulation for CT scan of the brain.
« Last post by Elliot K. Fishman, MD 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
Lectures & Quizzes / CT and the Pregnant Patient
« Last post by Lilly Kauffman on March 05, 2019, 02:49:11 pm »
The issues surrounding CT and the pregnant patient are often asked about and it's an important topic to be versed in for imaging.

View the lecture on the pregnant patient here: https://ctisus.com/responsive/media/2019/03/04/ct-and-the-pregnant-patient
Lectures & Quizzes / March 2019 Quiz
« Last post by Lilly Kauffman on March 05, 2019, 02:47:29 pm »
The march 2019 quiz is up!


How many did you get right?  What were the hardest/easiest questions?
Journal Club / Texture Analysis of Imaging: What Radiologists Need to Know.
« Last post by Lilly Kauffman on March 05, 2019, 12:57:47 pm »
Texture Analysis of Imaging: What Radiologists Need to Know.

AJR Am J Roentgenol. 2019 Mar;212(3):520-528. doi: 10.2214/AJR.18.20624. Epub 2019 Jan 15.
Varghese BA1, Cen SY1, Hwang DH1, Duddalwar VA1.

OBJECTIVE: Radiologic texture is the variation in image intensities within an image and is an important part of radiomics. The objective of this article is to discuss some parameters that affect the performance of texture metrics and propose recommendations that can guide both the design and evaluation of future radiomics studies.

CONCLUSION: A variety of texture-extraction techniques are used to assess clinical imaging data. Currently, no consensus exists regarding workflow, including acquisition, extraction, or reporting of variable settings leading to poor reproducibility.

DOI: https://doi.org/10.2214/AJR.18.20624


What are your thoughts?  Comments?
General Questions / Does modulation for CT scan of the brain.
« Last post by Jpersak on March 04, 2019, 03:14:11 pm »
 Dr. Fishman,

 Any experience or recommendations for Dose modulation of CT scans of the brain.   Increase mas for Improve resolution/noise  of the posterior fossa/brainstem  with decreased mas for supratentorial structures.  And overall decrease CDTI compared to standard helical imaging.

Joe Persak MD
Using a Deep Learning Network to Diagnose Congestive Heart Failure.

Long H. Ngo

Medical imaging technologies such as radiography, US, CT, and, increasingly, MRI are indispensable in the screening and diagnosis of diseases of the heart, lungs, bones, and other organs. Chest radiography to detect congestive heart failure (CHF) and related complications is one of the most common radiologic procedures performed in the United States. A positive screening result for CHF at chest radiography may be followed by serum B-type natriuretic peptide (BNP) assessment to help confirm the diagnosis. The diagnostic accuracy of BNP in the detection of CHF is excellent, with a sensitivity above 95%. However, BNP testing is not performed for all patients, the laboratory test is expensive, and the final result may be delayed if an off-site laboratory is used. In the absence of BNP data, what is the loss in diagnostic accuracy of using just the chest radiograph? Is there a data-driven solution to compensate for this loss?

DOI: https://doi.org/10.1148/radiol.2018182341


What are your thoughts?  Comments?
Journal Club / Current Update on Desmoid Fibromatosis.
« Last post by Lilly Kauffman on February 21, 2019, 02:42:46 pm »
Current Update on Desmoid Fibromatosis.

J Comput Assist Tomogr. 2019 Jan/Feb;43(1):29-38. doi: 10.1097/RCT.0000000000000790.
Ganeshan D1, Amini B2, Nikolaidis P3, Assing M4, Vikram R2.

OBJECTIVE: The purpose of this article is to review the etiopathogenesis, molecular cytogenetics, histopathology, clinical features, and multimodality imaging features of desmoid fibromatosis. Recent advances in the management of desmoid fibromatosis will also be discussed.

CONCLUSIONS: Desmoid fibromatosis is a rare soft tissue neoplasm with a high incidence of local recurrence. Imaging plays an important role in the diagnosis and management of this disease.

DOI: https://doi.org/10.1097/RCT.0000000000000790


What are your thoughts?  Comments?
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