Welcome to brand new Ask the Fish. Post your questions in different boards to get in touch with CTisus team & Dr. Elliot K. Fishman!
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Recent Posts

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How many different operators are there in mathematics? Are there only so many base operators?

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

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CT Scan Protocols / Re: ISOVUE 250 ORAL CONTRAST
« Last post by Elliot K. Fishman, MD 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
CT Scan Protocols / ISOVUE 250 ORAL CONTRAST
« Last post by dolinger1 on April 24, 2019, 12:04:01 pm »
How much Isovue 250 & water do yo mix together for your oral contrast
« Last post by SharonCed on April 23, 2019, 06:19:56 pm »
All the best to you Sir, today and everyday. May you have a wonderful, happy and safe birthday and the same is wished for you on all days.

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!! Please Read - About the Board / Coronary CTA
« Last post by Docsands on April 10, 2019, 11:55:28 pm »
Can you share a protocol for an infant with Fallot's tetralogy with suspected anomalous coronary artery anatomy. We have a 128 slice GE CT.
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
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