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CT Scan Protocols / Re: CT R/O STONE PROTOCOLS
« Last post by Elliot K. Fishman, MD 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
« Last post by Jpersak on May 19, 2019, 10:27:35 am »
Regarding CT r/o renal stone protocols (CT abdomen and pelvis without contrast) for initial diagnosis.

Is it advisable medical legally and/or  for coding/billing purposes to do any of the following alone or in combination.

1).  Decrease the scan coverage. e.g. cut off/not imaging the cephalad portion of liver and spleen.

2). Decrease mas/ technique. If so what amount is acceptable. What SD or noise level.

3). The need to specifically state any of the above in the report.


4). The need to Include any diagnostic disclaimer in the report if using 1 or 2 .

5). What would an example diagnostic disclaimer look like.

6). Is such disclaimer legally acceptable, coding acceptable and clinically/practically acceptable.
Case Studies / Re: Analyzing subcutaneous adipose tissue abnormalities.
« Last post by salamisamuel on May 10, 2019, 09:25:19 pm »
Done and done.

Masses palpable and numerous, only one could be visualized on ultrasound 1.6 x 1.2x 0.5cm well defined echogenic lesion 2 oclock CFN suggestive of lipoma.
Nothing from initial CT scan by radiologist.
Cross correlation mammogram suggested by radiologist, one physician consult recommended open biopsy, one said watchful waiting.

Guess the concern is that it's only "suggestive" of a lipoma and it brought a lot of buddies that aren't able to be visualized as a lipoma with it.


Case Studies / Re: Seeking better review
« Last post by Elliot K. Fishman, MD 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
« Last post by Elliot K. Fishman, MD on May 09, 2019, 01:54:26 pm »
you need a power injector
if not 3cc/sec for 120 cc and start scanning asap
General Questions / Ct orbits & Neck with contrast
« Last post by dolinger1 on May 07, 2019, 10:56:56 am »
I’m working at a place that doesn’t have a power injector.
How much ct dye do i use and when should i start scanning the patient?
I have a GE 16 slice scanner
Case Studies / Analyzing subcutaneous adipose tissue abnormalities.
« Last post by salamisamuel on May 01, 2019, 04:06:12 pm »

Trying to wrap my head around what can be felt and what can be seen on a contrast CT. A physical examination ruled out lipoma and gynecomastia as there is male breast involvement. At first blush nothing was found beneath the areola that was palpable. Palpable lumps extending from right axilla into right trunk, right breast, right pectoral.

Palpable masses are deep, vary in shape and feel appear to be multiplying and some are enlarging. When looking at the CT there are areas that look like lipoma but after a physical examination that was ruled out by the person performing the exam. Non-tender but can hurt the tissue around it when manipulated. Mobility varies.
Spontaneous appearance, 3-5 felt three weeks ago, 10+ two weeks ago, 30+ now. Varying in all sorts of shapes and sizes. There is also diastasis recti in the epigrastric region the patient was completely unaware of that does share some imaging characteristics.

If you're interested or can point in the right direction I can share the imaging privately, thank you.


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How many different combinations are there with these operators? Will any of these produce artificial intelligence?

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