I.
Clinical Approach to Imaging Studies as an O.D.
A.
Remember – an imaging study is just another tool to help in your suspected
diagnosis based on the patient presentation
B.
Based on the presentation and possible patient physical limitations select the
appropriate study
C.
Now that you have the scan make sure it’s the right scan – patient, date, study
requested
D.
Always review any study that you have ordered - correct scan, orientation, enough
cuts in the area of interest, quality
E.
Identify normal reference structures and abnormal findings, use right/left
comparisons if possible
F.
Make your differential diagnosis based on scan results and correlate to the clinical
findings, refer for additional management or consultation if indicated
II.
Where is the plain old plain film x-ray still useful?
A. Uveitis indications
1. Chronic/recurrent
2. Granulomatous
3. Bilateral
4. Systemic complaints
B.
Trauma
C.
Foreign body
D.
How to order
E.
Contraindications
F.
Radiation dose of different cuts
G. How’s backscatter imaging related and potential dosage issues?
III.
Where are CT’s (Computed Tomography) still indicated?
A. Trauma
B.
Uveitis
C.
Orbital
1.
Thyroid Eye Disease (TED)
a) EOM’s, optic nerve compression
b) Myositis vs. TED
c) When should you not use CT for TED
D.
2.
Mass lesions
3.
Foreign body
Intracranial
When should you use a CT vs. a MRI?
E.
Importance of CT for acute cranial bleeds
F.
Spiral CT technology and it’s indication in vascular disease
1.
Spiral CT angiography (SCTA or CTA)
a) Neuro-eye indications for ordering CTA
b) How CTA compares to MRA imaging and traditional angiography
c. Video walk through of CTA in patient with intracranial aneurysm
G. How to order
H. Contraindications
IV.
I.
What are the Radiation Risks from CT scanning
J.
Clinical cases
MRI (magnetic resonance imaging)...our mainstay today.
A. Open vs. closed, why the image is worse with open.
B.
T1 vs T2 vs proton density, and when to order contrast
C.
Orbital indications
D.
Neuro-eye indications
1.
Facial/lid disorders
2.
Ocular motor / diplopia disorders
3.
Optic nerve disorders (pale vs. swollen)
E. Intracranial
F. Magnetic resonance angiography (MRA)
1. Advantages and disadvantages over CTA and standard IV angiography
2. When to consider and clinical case
G. Magnetic resonance venography (MRV)
1. Clinical indications for MRV
2. The great debate of when to order MRV in patients with idiopathic intracranial
hypertension
H. How to order
1. Orbital vs brain scanning parameters
2. Specific requirements for suspected MS patients
V.
I.
General contraindications
J.
What must you always check before ordering contrast with the MRI
K.
Clinical cases
Color Doppler...from the neck and above.
A. Carotid disease indications
B.
Retinal vascular disease and orbital disease indications
C.
What is the weakness of color Doppler studies?
D.
How to order
E.
Clinical cases and patient Doppler videos
VI.
PET scans, not your old “CAT” scan.
A. Positron Emission Tomography
B.
Rationale for this scan
C.
When should you consider this scan
D.
Other functional brain scanning technology
1. Single photon emission computed tomography (SPECT)
2. Functional Magnetic Resonance Imaging (FMRI)
E.
VII.
Use of these scans in cancer detection and monitoring
Need more information?
A. Best single reference text:
Imaging of Orbital and Visual Pathway Pathology. A.L. Baert and K. Sartor:
Springer 2005
B. Web Links
1. http://www.radiologyassistant.nl
2. http://www.mypacs.net
3. http://rad.usuhs.edu/medpix
4. http://www.radiologyeducation.com/