CT scan

but they're not getting benefits of a soldier, okay? Because remember, the program is still secret.

So if you have any type of health insurance, you can petition to get an MRI, a CT scan, x-ray, ultrasound, and tomography scan.

Sorry, I forgot about that one.

The best one is a tomography scan.

It looks real.

Okay.

Whereas MRI, CT scans, x-rays, they look like black and white.

Yeah.

The early subchondral cysts or subtle joint space narrowing will be completely hidden from you.

So weight-bearing CT is becoming the gold standard.

Unquestionably.

A weight-bearing CT scan provides a three-dimensional, multiplanar assessment of joint congruency under actual physiological load.

You can see exactly what the cartilage space looks like when the patient is standing.

That's invaluable.

But let's take it a step further.

What if the CT shows equivocal changes, maybe just some mild sclerosis, but the patient has diffuse clinical hindfoot pain and you aren't sure if it's coming from the ankle or the subtalar joint?

So if you are listening to this, you are likely in the trenches.

Maybe you're a radiologic technology student mastering CT, MRI, X-ray or ultrasound.

Or, you know, perhaps you're a nursing student or stepping into literally any other patient facing health care role.

Right.

Were the fasting protocols followed? Has all metal been removed? Has the patient changed into the proper gown? Confirming these steps isn't just bureaucratic red tape skipping.

It's a profound safety hazard.

Well, let's talk about the nuances of those modalities, because the preparation for a CT scan versus an MRI involves entirely different physics.

Entirely different risks.

So the calcium measures your heart plaque, but before it turns hard, it's soft.

He goes, you're going to have to pick out a pocket, but I would like you to consider a CT angiogram.

And that's going to measure the soft plaque.

And for those who may have done it or haven't done it, that's when they put dye through your heart and they can measure is there anything soft.

It goes up by like two times, three times, four times, like massive, massive total cholesterol and massive LDL cholesterol.

And there's a study ongoing now for these people, again, eating these particular diets, very low carbohydrate, very high fat.

they're doing CT angiograms on all of these people and their overall plaque load of including soft plaque is extremely low and they're not doing any kind of treatment.

And it's absolutely fascinating to get the one year, the two year and eventually hopefully the five year data to see what the plaque progression is.

So there are certain articles, if you pull up, they will say every febrile, every man with a febrile UTI should at some time have some kind of imaging to assess the GU tract.

In this day and age, you know, CT with contrast, CT abdomen pelvis with contrast.

But that's not a uniform kind of practice.

I find some heterogeneity in how people approach that question.

I've done a lot of digging into phosphomycin for just simple cystitis.

And I think it's an inferior antibiotic when you compare it to nitroferantoin or trimethoprim sulfamethoxazole.

And we have RCTs to show that.

so then you take and then you try to apply that to like any other reason someone would use phosphomycin and we know it you know and then the susceptibility testing is a nightmare as you've described you know e coli maybe enterococcus faecalis but you can't really reliably test it against any other organisms you don't even know and just the whole and for prostatitis i admit i have not deep dove into this so i'm not sure but just like the pkpd standpoint of it how would this even work i have to wrap my head around it but That being said, chronic bacterial prostatitis is uncomfortable for patients.

Little housekeeping.

So if you heard my last podcast episode where I talked about the CT Tech Academy and I am transitioning that into a 12 week training program.

So I am just about done because I'm rolling out some things for the modules and things like that that will be in the Training Academy.

So what I am going to do is I am going to teach the entire process of the training program live.

If you come into the CT Tech Academy later or you happen to see it and it's past the time where I have taught the entire program live, you could just come in, dive in.

It'll be on demand and you can go ahead and just dive right in.

So what that consists of is I'm also going to do a monthly live training as well inside the school community.

Also, there is going to be monthly Q&As and I will be dropping case reviews and protocol tips and tricks and things like that.

That's correct.

And what advantages does ultrasound have in this area over CT or maybe MRI in breast ablation?

Yeah.

So, I mean, I think the breast is well suited for ultrasound guided ablation because it's a superficial organ.

And so with ultrasound-guided cryo, we can actually watch the ice ball form around the tumor and continuously monitor its relationship to the tumor, the skin, the pec muscle.

And we're not just using the ultrasound to place the probe, but to monitor the treatment as it's happening.

And then from a practical standpoint, ultrasound is just much more readily available than CT or MRI, and there's no ionizing radiation.

And so you don't need to worry about occupying those more advanced imaging suites for this procedure since it is still amenable to ultrasound guidance.

I'll drop this and let the whole world feel it.

When your patient has a test ordered, such as CT or MRI, you must call that department to coordinate a time or understand their timeline.

We're ICU nurses.

We do not sit around waiting for the phone to ring.

of which we do very seldom because there's only one physician in the city who can do somatosensory evoked potentials in a useful fashion for neurologic prognosis.

Most of the rest of our signs are associated with poor outcome but not universally hopeless outcome.

Extensor posturing, myoclonus, birth suppression on the EEG, loss of grey-white matter differentiation on the CT scan, these are all poor prognostic signs and taken in summary as independent data points may lead one to the conclusion that the prognosis is poor.

And that has to be taken in the context of the rest of the patient.