Challenges in Diagnostic Imaging

2. 60 is the new 40

3. 70 is the new 50

4. 80
is
the
new
60

5. CHALLENGES IN
DIAGNOSTIC
IMAGING OF THE
G60 PATIENT
Phillip Moeser, MD
Medical Diagnostic Imaging Group
Medical Director of Radiology QA
John C. Lincoln Medical Center

6. OBJECTIVES
• Review imaging modalities most likely to
definitively diagnose specific acute injuries
(spine, hip)
• Demonstrate complexities that
comorbidities/incidental findings pose in
imaging evaluation
• Demonstrate value of communication among
providers

7. TOOLS OF DIAGNOSITIC
AND INTERVENTIONAL
IMAGING
• X-RAY
• FLUOROSCOPY
• NM
• U/S
• CT
• MRI
• IMAGING GUIDED RX/DX
• 3D WORKSTATIONS

8. THE DIAGNOSTIC
IMAGING ‘TEAM’
1. Technologists
2. Nurses
3. Support personnel (IT/PACS/etc)
4. Radiologists

9. 1972

11. CORTONA, ITALY JUNE 2005

12. CT PROTOCOLS
• HEAD/CSPINE
• Non contrast
• 1mm acquisition, displayed thicker
• Coronal, sagittal reformats
• CHEST/ABD/PELVIS/TSP/LSP
• IV contrast
• 1mm acquisition, displayed thicker
• Systemic arterial phase chest/upper abd
• Portal venous phase abd/pelvis
• Delayed phase upper abd
• Coronal, sagittal reformats

16. NON-CONTRAST

23. C-SPINE IMAGING
ALGORITHM
• CT
• MRI (depending upon Hx, PE, CT
findings)
• FLEX/EXT imaging (x-ray or CT
depending on CT/MRI findings and clinical
presentation)

26. 1 2 3 4
WHICH PATIENT HAS ACUTE FX WITH SUBSEQUENT FUSION?

27. 3

30. T6 T6
L2

34. HIP FRACTURES

40. INCIDENTAL
FINDINGS &
COMORBIDITIES

52. COMMUNICATION

60. MTTCBVCBF

61. ‘TEAM’ INVOLVED
1. Pre-hospital personnel
2. Intake personnel
3. Trauma surgeon
4. ER physician
5. ER/trauma nursing
6. Lab
7. Radiology/CT technologists
8. Radiologists
9. Neurointensivist
10. Receiving hospital neurosurgeon

63. IT’S MAGIC

64. EXCEPTIONS

65. BUT OFFICER,
I THOUGHT 80
IS THE NEW 60

66. 60
Is
The
New
80

67. THANK YOU