Ordering Thoracic Imaging Studies Flashcards
2 major choices for eval of the chest
CXR and Chest CT
When is MRI helpful
Anterior mediastinum, vascular, osseous or soft tissue patho, cardiac anatomy
US helpful when
Soft tissue and subq lesions
EKG and Nuclear med
Cardiac functio nand anatomy
Ventilation and perfusion scan (pulm emboli)
AP vs. PA and lateral
AP is easier
PA and lateral better but need a compliant patient
Lateral CXR advantages
Allows triangulation of fidnings from PA
Better spine eval
Better eval of blind spots seen on PA CXR
When to do AP
Fast study in ER or patient can’t be moved
Chest pain
Pulmonary edema evaluation
Post surgical eval (instrument count off) and post line placement (want it in the vein vs. artery)
Trauma with chest pain
Pneumothorax –> chest tube
When to do a PA and lateral CXR
Pre-op
Pt has a cough and there is suspected pneumonia
CT advan and disadv
Detailed anatomy of lungs and mediastinum
More expensive
Concerns about radiation with overuse
Non contrast CT
Geared towards pulmonary parenchymal pathology
Nodules
Cancer
Airspace dz and atelectasis
Contrast CT
Pathology in mediastinum, hilum, and major thoracic vascular structures
Non contrast chest CT
Routine
Low dose
Hi rez
Pneumonia, atelectasis, possible lung mass
Lung nodules follow up to document stability
Evalutate interstitial lung dz, inspiration, exp, prone imaging
Contrast chest CT
Routine
Pulmonary angiogram
Thoracic aorta
Routine - mediastinal abnormalities
PE study
Aneurysm, dissection
