INDICATIONS FOR IMAGING IN DISORDERS OF THE AXIAL SKELETON
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1 INDICATIONS FOR IMAGING IN DISORDERS OF THE AXIAL SKELETON Geert Vanderschueren, MD, PhD Department of Musculoskeletal Radiology UZ Leuven, Leuven, Belgium 1111
2 DIFFERENT TOPICS 1. MRI: PATIENT S CHECKLIST 2. MRI: TECHNICIAN S CHECKLIST MR SPINE UZ LEUVEN 6. CONSILIUM RADIOLOGICUM 7. LUMBAR SPINE METASTASIS 8. POWER
3 1. MRI: PATIENT S CHECKLIST
4 1. MRI: PATIENT S CHECKLIST
5 2. MRI: TECHNICIAN S CHECKLIST rradiologierintranet UZ LEUVEN
6 2. MRI: TECHNICIAN S CHECKLIST rradiologierintranet UZ LEUVEN
7 2. MRI: TECHNICIAN S CHECKLIST rradiologierintranet UZ LEUVEN
8 2. MRI: TECHNICIAN S CHECKLIST COCHLEAR IMPLANTS rradiologie INTRANET UZ LEUVEN
9 MRI: COCHLEAR IMPLANTS rradiologierintranet UZ LEUVEN
10 MRI: COCHLEAR IMPLANTS rradiologierintranet UZ LEUVEN
11 3.
12 3.
13 3. UNSAFE!
14 4.
15 4. ONLINE ELECTRONIC ELECTRONIC SURVEY REQUEST
16 4. ONLINE ELECTRONIC REQUEST
17 5. MR SPINE UZ LEUVEN MRI SCANNING PROTOCOL GUIDELINES
18 5. MR SPINE UZ LEUVEN INDICATIONS Trauma Infection (spondylodiscitis) Inflammation (multiple sclerosis) Tumour (metastases) Disc Herniation Post-operative
19 6. CONSILIUM RADIOLOGICUM
20 6. CONSILIUM RADIOLOGICUM 20
21 MR versus CT? DISC HERNIATION SPINAL METASTASIS
22 6. CONSILIUM RADIOLOGICUM MRI!!!! RED FLAG!
23 6. CONSILIUM RADIOLOGICUM RED FLAG! dropfoot
24 MR versus CT? DISC HERNIATION SPINAL METASTASIS
25 6. CONSILIUM RADIOLOGICUM ACUTE BACK PAIN X-RAY NOT ROUTINELY INDICATED!! (except osteporotic vertebral fracture = red flag )
26 6. CONSILIUM RADIOLOGICUM ACUTE BACK PAIN MRI PREFERRED, IF CLINICALLY INDICATED
27 CT: RADIATION DOSE Chest AP 0,02 msv x 500!!!! = 10 msv (CT pelvis)
28 6. CONSILIUM RADIOLOGICUM SUMMARY: In case of back pain < 6 weeks: 1. Imaging is mandatory for: - red flags -complicated radiculopathy (paresis) 2. Imaging is not indicated for: -non-complicated radiculopathy -non-specific (mechanical) back pain -EXCEPT: in case of planned surgery or Interventional pain treatment
29 6. CONSILIUM RADIOLOGICUM SUMMARY: -Question: Why is imaging is not routinely indicated for: -non-complicated radiculopathy -non-specific (mechanical) back pain -Answer: -imaging does not change the therapeutic approach -radiation load in case of x-rays and CT
30 6. CONSILIUM RADIOLOGICUM -Question: What does the UZ Leuven expect? -Answer: -less imaging requests for back problems < 6 weeks on behalf of GP s (general practitioners) -swifter imaging access for: 1. red flags, complicated radiculopathy and pretreatment planning (surgery, interventional pain therapy) 2. back problems > 6 weeks
31 CASE:SPONDYLODISCITIS(TBC) T1 - T1 + L5-S1 spondylodiscitis + paraspinal abscess (TBC)
32 CASE:SPONDYLODISCITIS: POTT S DISEASE (TBC) -etiology: -tuberculosis -pulmonary TB in 10% -findings: -1.spondylodiscitis -2.abscesses (paraspinal, psoas,...) -DD: brucellosis, sarcoid, T1 +
33 CASE:SPONDYLODISCITIS(TBC) ABSCESS FORMATION: psoas abscess, paraspinal T1 +
34 CASE:SPONDYLODISCITIS:TBC ABSCESS FORMATION T1 + PSOAS ABSCESS SINUS TRACT DRAINAGE/FISTULA TO SKIN
35 CASE:SPONDYLODISCITIS (L2-3) L3 L2 DISC SPACE EFFACEMENT/EROSION
36 CASE:SPONDYLODISCITIS (L2-3) 83-year-old male patient with bacterial endocarditis (Enterococcus Faecalis) and... pacemaker (no MRI)!!! L2 L3 DISC SPACE EFFACEMENT/EROSION
37 7. LUMBAR SPINE METASTASIS EMERGING ECONOMIES FELTRIN, Leonir Terezinha et al. Signs of hypervascularization at magnetic resonance imaging in bone metastases from renal cell carcinoma. Radiol Bras [online]. 2009, vol.42, n.3, pp
38 7. LUMBAR SPINE METASTASIS EMERGING MULTIMODALITY TECHNIQUES
39 PATIENT S SELF- EDUCATION 8. POWER
40 8. POWER WIKIPEDIA PATIENT S SELF- EDUCATION
41 CONCLUSION HEALTH ECONOMICS WILL PLAY AN EVEN MORE IMPORTANT ROLE IN THE FUTURE, WITH SELECTION OF PATIENTS FOR IMAGING AND TREATMENT MRI IS PREFERRED OVER CT (RADIATION DOSE), IF NO CONTRA-INDICATIONS FOR MRI EXIST X-RAYS ARE HELPFUL IN DIAGNOSING ACUTE OSTEOPOROTIC VERTEBRAL FRACTURES
42 THANKS FOR YOUR ATTENTION!
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MR imaging the post operative spine - What to expect! Poster No.: C-2334 Congress: ECR 2012 Type: Educational Exhibit Authors: A. Jain, M. Paravasthu, M. Bhojak, K. Das ; Warrington/UK, 1 1 1 2 1 2 Liverpool/UK
Actinomycosis of Thoracic Spine A Rare Case
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Pediatric CT Protocols (18 years old or less)
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Clinical Appropriateness Guidelines: Advanced Imaging
Clinical Appropriateness Guidelines: Advanced Imaging Appropriate Use Criteria: Quantitative CT (QCT) Bone Mineral Densitometry Effective Date: September 5, 2017 Proprietary Date of Origin: 05/21/2007
Radiology Codes Requiring Authorization*
70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) 70450 Computed tomography, head or brain; without contrast material 70460 Computed tomography, head or brain; with contrast material(s)
University of Jordan. Professor Freih Abuhassan -
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Imaging Patient Education. Magnetic Resonance Imaging (MRI)
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Signs of Nature in Spine Radiology
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Louisa Fleure. Advanced Prostate Cancer Clinical Nurse Specialist. Guys and St Thomas NHS Trust
Louisa Fleure Advanced Prostate Cancer Clinical Nurse Specialist Guys and St Thomas NHS Trust The classification of advanced prostate cancer The incidence of patients presenting with, or developing advanced