When US? When CT? Fern Karlicki, MD.

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Presentation transcript:

When US? When CT? Fern Karlicki, MD

When US? When CT? After this talk, participants should: Be familiar with the strengths and weaknesses of US & CT Be familiar with how to use the ACR appropriateness criteria

US Strengths Multiplanar Real time No ionizing radiation Minimal bio-effects No IV contrast Inexpensive Portable

US Weaknesses Operator dependent Limited by: Need patient cooperation Gas - pancreas, lung, bowel Bone – ribs Obesity Metal Need patient cooperation Less sensitivity and specificity

CT Strengths Prettier pictures Better resolution Better sensitivity & specificity

CT Weaknesses Ionizing radiation Limited planes Contrast allergy, nephrotoxicity Expense IONIZING RADIATION

CT & Cancer / Leukemia 1:1000 cancer induction in children after single abdominal CT scan! Adults have same risk after 5-6 abdominal CT scans Younger women and children have highest risk

ACR Website For an excellent discussion of appropriateness of different imaging modalities in various clinical scenarios www.acr.org /ac or Google - acr appropriateness criteria

ACR - AC RLQ pain Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC RLQ pain Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC RLQ pain Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC Hematuria Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC Hematuria Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC Hematuria Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR Appropriateness Criteria Acute Onset Flank Pain Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

Last thought When US and CT have a similar appropriateness level , consider US first especially in children, young slim adults and in women of child-bearing age in order to minimize the risks of radiation in these patients.