LAC-USC Radiology

1. Stu Schroff, MD (PGY 3) • Robert Lieberman, MD, MBA (PGY4) • Aaron Schein, MD (PGY5, Chief Resident) • Andrew Kim, MD (PGY5, Chief Resident) • Sebastian Sugay, MD (PGY5, Chief Resident) LAC-USC Radiology

2. Topics The Department of Radiology Radiology as a Consult Service Risks of Radiation/ALARA Optimal Imaging Strategy LAC-USC Radiology

3. Topics The Department of Radiology Radiology as a Consult Service Risks of Radiation/ALARA Optimal Imaging Strategy LAC-USC Radiology

4. “Radiology is a medical specialty that employs the use of imagingto both diagnose and treat disease visualized within the human body.” - wikipedia The field of radiology • Radiograph of the Left hand of Anna Roentgen (wife of Wilhelm Roentgen) on November 8, 1895 in Wurzburg, Germany.

5. This is an enormously busy hospital • 28 percent of trauma victims in the region • 39,000 inpatient discharges/year • 150,000 emergency department visits/year • 1 million ambulatory care visits/year • LAC+USC Medical Center Final Budget FY 2011-2012: $1.189 billion Department of Radiology

6. 2010-2011 Statistics • 60,015 CTs • 12,227 MRIs • 18,751 Interventional Procedures • 20,281 Nuclear Medicine Studies • 71,244 Ultrasounds • 239,807 Radiographs LAC+USC Department of Radiology

7. DOR Divisions • We are a subspecialized department • Body imaging (abdomen and pelvis) • CT, US, MRI, and Plain film/fluoroscopy (barium studies) are separate reading areas • Cardiothoracic imaging (CXR, CT chest, cardiac MRI)

8. DOR Divisions • Neuroradiology (Brain, spine, ENT, angiography) • Musculoskeletal imaging (X-ray, MRI, CT, arthrograms and biopsies) • Nuclear medicine (PET/CT, cardiac SPECT, bone scans, V/Q scans…)

9. DOR Divisions • Pediatric imaging • Women’s imaging (breast imaging, pelvic US and MRI) • Vascular and Interventional Radiology (angiography, liver/biliary interventions, neprhostomies) • CT and US guided procedures are handled by the pertinent division, not IR

10. LAC+USC Department of RadiologyMain Floor

11. LAC+USC Department of RadiologyED Radiology

12. LAC+USC Department of RadiologyNuclear Medicine

13. LAC+USC Department of Radiology Hours of Operation, Mon-Fri: 8AM-4PM (Normal workday— All staff/fellows/residents in house) 4PM-10PM (On call resident and staff/fellow in house) 10PM-8AM (On call resident in house; staff/fellow at home)

14. LAC+USC Department of Radiology • Hours of Operation, Weekends and Holidays: • 8AM-8PM (On call resident and staff/fellow in house) • 8PM-8AM (On call resident on call in house; • staff/fellow at home)

15. www.trojanimaging.com

16. LAC+USC Radiology Directory

17. Radread.usc.edu

18. Radread.usc.edu

19. Protocoling studies: Protocol resident Scheduling studies: Radiology tech Interpretation: Reading room radread.usc.edu www.trojanimaging.com www.amion.com pw: usc rad, dofusc, usc Who to call:

20. Staging CTs “Need a prelim before morning rounds”—There must be an urgent clinical concern to justify an overnight prelim Old studies Didactic Non-Emergent Interpretations

21. Uploading/Exporting Studies Mon-Fri 7am-3:30 pm Tony or Kenny 323-409-7253 3F102 (the “bowling alley”)

22. Uploading/Exporting Studies

23. Topics The Department of Radiology Radiology as a Consult Service Risks of Radiation/ALARA Optimal Imaging Strategy LAC-USC Radiology

24. The more useful information you provide – the more valuable information you will get out of an imaging study. Radiology Consult

25. The more useful information you provide – the more valuable information you will get out of an imaging study. Symptom location and duration Radiology Consult

26. The more useful information you provide – the more valuable information you will get out of an imaging study. Symptom location and duration Sidedness!! Radiology Consult

27. The more useful information you provide – the more valuable information you will get out of an imaging study. Symptom location and duration Sidedness!! Prior pertinent interventions Radiology Consult

28. The more useful information you provide – the more valuable information you will get out of an imaging study. Symptom location and duration Sidedness!! Prior pertinent interventions Possible ddx Radiology Consult

29. The more useful information you provide – the more valuable information you will get out of an imaging study. Symptom location and duration Sidedness!! Prior pertinent interventions Possible ddx CONTACT Info Radiology Consult

30. Radiology Consult For example… Ordering Dx: 34yo M h/o Crohn’s s/p partial SB resxn new RLQ abd pain x 1day Chief Complaint: Abscess, SBO, perf. Physican #: Reliable physician #, team VOIP preferred

31. Radiology Consult

32. Radiology Consult Actual history: 19yo M organ donor s/p organ harvesting with abnormal counts in the OR looking for foreign body per protocol

33. Radiology Consult

34. Topics The Department of Radiology Radiology as a Consult Service Risks of Radiation/ALARA Optimal Imaging Strategy LAC-USC Radiology

35. First, a note on radiation. Radiation Computed Tomography – An Increasing Source of Radiation Exposure. The New England Journal of Medicine. 2007; 357;2277-84.

36. Radiation

37. Radiation

38. Radiation Schaal B. National Academy of the Sciences – What we’ve learned about the Atomic Bomb survivors. 12/8/2010.

39. What Are the Risks Associated with Radiation Exposure: Radiation

40. What Are the Risks Associated with Radiation Exposure: • Acute Radiation Syndrome Radiation -Sorenson 2000

41. What Are the Risks Associated with Radiation Exposure: • Acute Radiation Syndrome • Cancer Radiation

42. What is ALARA? ALARA

43. Q:What is a safe dose of radiation? ALARA

44. Q:What is a safe dose of radiation? A: There is no such thing as a safe dose of radiation. ALARA

45. ALARA DECREASED Morbidity/Mortaliy INCREASED Morbidity/Mortality www.acr.org

46. ALARA DECREASED Morbidity/Mortaliy INCREASED Morbidity/Mortality www.acr.org

47. ALARA DECREASED Morbidity/Mortaliy INCREASED Morbidity/Mortality ALARA: As LowAs ReasonablyAcceptable www.acr.org

48. Why should you care about radiation dosages? ALARA

49. Why should you care about radiation dosages? ALARA Patient Safety – preventing unnecessary morbidity/mortality

50. Why should you care about radiation dosages? ALARA Patient Safety – preventing unnecessary morbidity/mortality Public Perception