Radiology for
Transcript: ACR: postmeno women >50 males >50 with risk factors Mammography Soft tissue masses ACS, ACCP, ASCO, NCCN, AAFP: data less convincing or inconclusive NORMAL Medicare once every 12 months beginning at 40 35-39 can get 1 baseline exam Fluoroscopy No ionizing radiations! Repeat study on same machine! PSMC Radiology for Prevention, Diagnosis, & Intervention Imagine MAY be appropriate Roll-out TBA for PSMC CMS Coverage: (Feb 2015) 55-74 and asymptomatic 30 py smoking history current smoker or quit < 15 years Biliary leak Soft tissue mass Recommendations and Coverage skin change 20% Decrease Mortality from Lung Cancer BI-RADS 3 Duct patency Recommendations and Coverage Sonohysterograms +/- HSG DEXA Lung-RADS Acute / chronic cholecystitis Known CAD for risk stratification . . . the only method of screening for breast cancer shown to decrease mortality. ULTRASOUND ACR APPROPRIATENESS CRITERIA Cyclical, uni/bilat regardless of age Noncyclical, diffuse, uni/bilat, <40 USPSTF, ACOG: women 65 and older Nuclear Medicine Results USPSTF: 55-80, 30 py, current smoker or quit <15 yr AAST and ACR support this recommendation Feel a mass single x-ray VS chest CT for 3 years USPSTF and AAFP: 50-74 biennially; 40-49 discuss R/B ABNORMAL Liver < 30 = Ultrasound first Recommendations and Coverage Foreign body removal Breast mass Low Dose CT Lung Cancer Screening ...imaging by emission rather than transmission. Who needs a diagnostic mammo? 50,000 people, 55-74, >30 py Recommendations BONE SCAN Reporting Requirements for Reimbursement INDICATIONS Noncyclical, focal, <30 = US Noncyclical, focal, >30 = mammo + US 70-80 % of women High Risk = BRCA, >20% lifetime risk mammo and breast MRI 25-30 or 10 years before 1 degree with breast cancer per ACR and NCCN CARDIAC Arthrograms Get a Mammo HIDA Patient data Always get an X-ray! hormonal response, smoking, psychological factors, caffeine intake, large breasts, duct ectasia ACR, ACS, ACOG annually beginning at 40 OTHER TOOLS HSG Focally tender [maybe] Describe by quadrant or clock face Nipple discharge Biopsies Men Non-diagnostic routine exercise stress test Lung Kids Medicare: every 24 months for Estrogen deficient X-rays shows possible osteoporosis Prednisone or other steroids Hyperparathyroidism Efficacy of osteoporosis drug Average Risk Women Intermediate Risk = breast ca or atypia, 10-15% lifetime risk yearly mammo possibly MRI NOF: women >50 and men 50-69 with risk factors all women >65 and men >70 THE STUDY -- NLCS Trial Kidney Joint injections T-score >= -1.0 Normal Osteopenia <= -2.5 Osteoporosis Intermediate probability based on symptoms and/or risk factors 30-40 = either OK No Imaging needed > 40 = Mammo first Wellness Screening Breast Pain Male Breast Mass INDICATIONS CT-Guided Biopsies Practice parameters INDICATIONS Shin splints vs Stress Fracture Mets Bone tumor Hardware loosening vs Infection
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