Tag Archives: radiology

CT Scan Ordering Guide Added

The new CT scan ordering guide has been added here. It can be directly viewed under Clinical -> Radiology.

CHW Ultrasound and Nuclear Medicine Change in Hours

Starting August 9th, the hours of operations for CHW Ultrasound will be as follows:

General Ultrasound

Monday-Friday 6:30 am to 7:30 pm

Saturday 7:00 am to 3:30 pm

Sunday call only

 

Monday-Friday on-call from 7:30 pm to 6:30 am

Saturday after 3:30pm to Monday morning on-call

 

 Echo Ultrasound

Monday-Friday 6:30 am to 3:00pm

Monday-Friday on-call from 3:00 pm to 6:30 am**

Saturday and Sunday on-call only**

***Cardiologist approval needed for STAT call-ins***

 

For CHW Nuclear Medicine:

Nuclear Medicine

Monday-Friday 7:00 am to 4:00 pm

 

Monday-Friday on-call from 4:00pm to 7:00 pm

Saturday and Sunday call only 7:00am to 7:00pm

 

Any emergent Nuclear Medicine after hour exams will need to be sent to CHH or CHM.

Emergency Premedication for Patients with History of Contrast Allergy

The ACR Manual on Contrast Media [1] recommends the following options for premedication in the acute setting in patients undergoing planned contrast enhanced imaging procedure (e.g. CT Pulmonary Angiogram). Options #1 or #2 should be used in all Emergency Department situations unless there is an extreme urgency.

IV steroids have not been shown to be effective when administered less than 4 to 6 hours prior to contrast injection

Emergency Premedication

In Decreasing Order of Desirability

  1. Methylprednisolone sodium succinate (Solu-Medrol®) 200 mg intravenously every 4 hours (q4h) until contrast study required plus diphenhydramine 50 mg IV 1 hour prior to contrast injection [35].
  2. Dexamethasone sodium sulfate (Decadron®) 7.5 mg or betamethasone 6.0 mg intravenously q4h until contrast study must be done in patent with known allergy to methylpred-nisolone, aspirin, or non-steroidal anti-inflammatory drugs, especially if asthmatic. Also diphenhydramine 50 mg IV 1hour prior to contrast injection.
  3. Omit steroids entirely and give diphenhydramine 50 mg IV.

Appropriate Ordering of Medical Imaging Studies in Cases of Clinically Suspected Pulmonary Embolism

Any patient with creatinine level of 2.0 mg/dL or less and/or eGFR of 30 ml/min or greater can have CTPA to evaluate for PE without undue risk of CIN

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Shortage of VQ scan tracer

We wish to inform you there is a disruption to the current Nuclear Medicine supply chain. Effective immediately, there is a stock out situation at the sole manufacturer of MAA (macro aggregated albumin), which is used to perform V/Q lung scans. The company anticipates having commercial supply available mid-October.

Fortunately, since best practice is to use CT pulmonary angiography for the vast majority of clinical situations where image evaluation for suspected pulmonary embolism is needed, we anticipate that this shortage should have limited impact.

Please feel free to contact any of the Radiologists, at 815-759-4262, to discuss clinical alternatives.

We will provide communication one we have confirmation the shortage has ended.

We appreciate your understanding during this experience.

Thank you.

Philip Gilroy, M.D. – McHenry Radiologist and Imaging Associates

John Heinrich – Director, Medical Imaging

What are the guidelines for radiocontrast allergies?

Major Recommendations

Radiocontrast Media (RCM)

  • Anaphylactoid reactions occur in approximately 1% to 3% of patients who receive ionic RCM and less than 0.5% of patients who receive nonionic RCM.(C)
  • Risk factors for anaphylactoid reactions to RCM include female sex, atopy, concomitant use of β-blocking drugs, and a history of previous reactions to RCM.(C)
  • Although asthma is associated with an increased risk of a RCM reaction, specific sensitivity to seafood (which is mediated by IgE directed to proteins) does not further increase this risk. There is no evidence that sensitivity to iodine predisposes patients to RCM reactions.(C)
  • Patients who experienced previous anaphylactoid reactions to RCM should receive nonionic, iso-osmolar agents and be treated with a premedication regimen, including systemic corticosteroids and histamine1 receptor antihistamines; this will significantly reduce, but not eliminate, the risk of anaphylactoid reaction with re-exposure to contrast material.(D)
  • Delayed reactions to RCM, defined as reactions occurring 1 hour to 1 week after administration, occur in approximately 2% [of] patients.(C) Most are mild, self-limited cutaneous eruptions that appear to be T-cell mediated, although more serious reactions, such as Stevens-Johnson syndrome, TEN, and DRESS syndrome have been described.

Rating Scheme for the Strength of the Recommendations

Strength of Recommendation

  • A Directly based on category I evidence
  • B Directly based on category II evidence or extrapolated from category I evidence
  • C Directly based on category III evidence or extrapolated from category I or II evidence
  • D Directly based on category IV evidence or extrapolated from category I, II, or III evidence
  • E Based on consensus of the Joint Task Force on Practice Parameters

References

Drug Allergy an Updates Practice Parameter: Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology, the American College of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology; ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY; VOLUME 105, OCTOBER, 2010

Medical Imaging Educational Survey

Radiology viewer in now online – Paragon

Radiology studies can now be viewed in Paragon.

Go to Results → Radiology

Then click on the camera icon next to the study under the “Img” column or if in a report the camera icon in the upper left hand corner.

Radiology iconThis should launch a viewer similar to the one below. The controls are on the left hand column. Click on the image below to see an enlarged view.

PACS viewer paragon