CT? MRI? Ultrasound? Which One and When?
CT Imaging
Earlier this week, an online radiology publication mentioned that the “demand” for computerized tomography (CT) exams is on the decline due to patients’ reluctance to have one performed. It is believed that the reason patients are refusing CT is their impressions (from media reports) that the radiation exposure is too high and, thus, too risky. In place of a CT exam, patients are demanding MRI (magnetic resonance imaging) or ultrasound for their disease condition (Freiherr 2010).
While that might sound logical and reasonable, it clearly is not in the best interest of the patient for a physician to give in to these demands. There are reasons that MRI and ultrasound are not the “workhorses” of radiology. While they have their place when imaging certain conditions or symptoms, they often are not the go-to exam to get the best answer. How is a physician to decide?
The American College of Radiology (ACR) has, thankfully, made some of that decision making easier. For a variety of disease conditions and symptoms, the ACR has put together panels of experts who have developed appropriateness criteria (ACR 2010)—criteria that lead us on a path to determining the best type of imaging exam for our patient (and the criteria also informs us of the amount of radiation exposure on a relative scale of low, medium, and high).
For instance, if you have a post-op patient with acute abdominal pain and fever (or suspected abscess), the top-rated recommended imaging exam is a CT abdomen and pelvis with contrast. The list doesn’t stop there, though; it goes on to give nine other exams that could be used, but are recommended less highly. The text with each set of data explains why.
Another example is possible appendicitis in children—ultrasound tops the recommendation list, followed closely by CT of the abdomen and pelvis (which is the recommendation for adults). And, one more, a standard chest x ray is the top recommendation for a patient with acute respiratory illness.
These criteria along with your patient’s history and current symptoms are invaluable in the choice of proper imaging exam. Make use of these criteria the next time you are deciding for your patient the exam that will yield the most information and, quite possibly, get the patient on the mend more quickly.
Steph
Claire
American College of Radiology. ACR appropriateness criteria. September 2009. Available at http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria.aspx. Accessed 24 June 2010.
Freiherr G. Dearth of data lowers the bar in debate over radiation and cancer. 21 May 2010. Available at http://www.diagnosticimaging.com/ct/content/article/113619/1573219. Accessed 24 June 2010.
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Last modified: 25 Jun 2010
