CT scan

great.

So today we're looking to get into this like a gating debate going on in coronary CT.

And so before I click the record button, I was asking for like a little bit of clarity in language.

I was like, should I call it coronary CT or cardiac CT? You started to answer and I cut you off, but I would love to take that question again now that we're live.

Honestly, for the purposes of the debate, so to speak, in terms of non-gated versus or retrospective, that would be a coronary.

But I think it's more broadly we can just talk about cardiac CT. That's fine.

Coronary CT is a subset of cardiac CT.

And like coronary CT has been around for a while, but it seems like more recently it's really taken off in a big way.

don't miss that welcome to episode 25 of don't miss that radiology this is going to be a good one we're going to split into two which imaging tests to order this is very high yield great for step two great for imaging rotations great for life and let's just go into it very interactive this is a great one there's actually going to be no images so if this is a great one if you're driving Working out just listen to it.

I'll be explaining everything and hopefully you like this format So it'll be a scenario questions and an answer and an explanation So we will start with a 25 year old with fever productive cough and crackles pneumonia suspected What's the best test? Is it a chest x-ray CT with contrast? MRI chest or chest ultrasound And we want to start with the chest radiograph here.

Great first-line study, especially if you're worried about pneumonia.

If you remember from one of our earlier episodes, the lungs are too white.

Okay, next question.

Hemodynamically stable adult with high suspicion for pulmonary embolism.

What's the best test? CT pulmonary angiography, non-contrast chest CT, MRI chest, or chest radiograph? So remember for the last one, it was a chest radiograph, and that is not going to be a good one for this one.

We want to start with CT pulmonary angiography.

What do I want my students to become? The goal is not to memorize more CT information.

The goal is to walk into that room, understand what you're doing in that scan room and behind that console, why you're doing it, and when to ask questions when something does not make sense.

That is the purpose.

Welcome to the CAT Scan Guru podcast, where I burn down average CT training and teach you what your hospital won't.

I'm your host, Karinna Hogan, registered CT technologist with more than two decades in all aspects of CT and teaching thousands of technologists around the world.

If you're tired of memorizing protocols instead of understanding them, you're in the right place.

Every week, I break down real cases, CT concepts, contrasts, mistakes nobody talks about, and the clinical thinking that separates average technologists from the ones everyone wants working their scanner.

So grab your coffee and let's teach CT the right way.

No percentage of apportionment, no discussion of the 2017 award was given.

And also, there were significant records that the defense attorney or the employer in the 2022 CT claim failed to provide to the QME.

Now, on the defense's motion to get a supplemental report and conduct a cross-examination of the QME, they provide the QME with the prior award.

2016 and 2019 lumbar spine MRI, a 2009 radiographic X-ray image of the right shoulder, and a 2004 operative report of the left knee, which causes the QME to revise his causation analysis, and that results in the lumbar spine, 20% of the disability being caused by multilevel degenerative disc disease and facet arthropathy, documented on the 2016 mri and and and it shows that it's progressive on the 2019 study independent of work and of note that is all prior to the employment with the current employer uh as to the right shoulder it's now 40 caused by pre-existing radiographically documented type 3 acromion and rotator cuff tendinosis before uh 2009 that that's being present and unrelated to the uh current employment And then finally, the left knee is now reduced to 50% caused by the 2004 non-industrial ACL reconstruction with residual chondral effects, which the CUME opines would have produced the same disability by this stage in life regardless of employment.

And the opinion must be stated within reasonable medical probability.

In terms of speculative, watch out for that as well.

Speculative in terms of you might have a QMI, say, I give a diagnosis for a body part, say a knee, and they say there's a meniscal tear, but they haven't looked at any medical reports, any objective findings, whether it's an MRI, CT scan, or an x-ray that actually shows or talks about a meniscal tear.

I'd argue that that's speculative.

But you have to use your years of experience as a radiologist saying, no, no, that's not a fracture and overrule it.

Or if you're not quite sure, sometimes you might phone a friend or do a CT scan if there's a concern.

But overall, it's been very positive.

And I presume there's a role in terms of improving the AI so that it doesn't do that next time.

Well, development, I should say, but we have a national imaging platform in Ireland called NIMIS.

It's an integrated medical imaging system, and it's a digital system that stores images and also can be used for sharing of images.

So if I'm reporting a CT in Beaumont, I can look and see if this patient has had imaging elsewhere in Ireland.

And it can sometimes help me with my reporting.

Calcium score sounds like it's a blood test.

It's actually a CT scan of the heart and it scans the heart for calcium buildup in the heart.

Anywhere that there is plaque buildup, the body will put calcium on that plaque to try to stabilize it.

So we use it as a marker.

Make sure there's nothing that's critical.

Let's say there's something critical there.

Let's say we do something called the CT coronary angiogram, which is a very great test.

It's almost as good as heart catheterization without actually going into the heart.

So I went there a couple of days later and then essentially never left.

So they took me to A&E and then I had a CT scan first.

And I still never, ever, brain tumour did not come into my mind.

In fact, I'd left work the day before and one of my colleagues had said, oh, it's probably brain tumour.

that's

giving me goosebumps.

So then I went for the CT, still not thinking anything.

And then they said, right, it was from the CT. There's a mass on your brain.

The biblical prayer fills your mind with the Word of God, and contemplative prayer empties your mind.

And when we empty our minds, studies, CT, okay, they did a study on Zen Buddhists, MRI scans, not CT, the MRI scans of the brain.

During their meditation time, which Zen Buddhists meditate, right? Their frontal lobes were offline.

They had decreased blood flow, which means they had decreased oxygenation in that frontal lobe, and it was offline.