Chapter 23: Imaging Studies

INTRODUCTION

RADIOLOGY WORKFLOW

1. Provider orders an imaging study for the patient to support or disprove his or her working clinical diagnosis. The clinician should provide a brief description of the patient’s symptoms and the indication for the study, considering any preparations the patient may need (such as bowel prep).

2. The study is performed by the radiology department according to standardized and specialized protocols. The images are uploaded into PACS (picture archiving and communication system) on a computer where they will be visible to anyone with access, as well as placed into a work queue for the radiologists to interpret and issue reports.

3. A radiologist then interprets the findings in the study with attention to the indication and dictates a report, which is uploaded into the PACS system. In general, if there are any critical or urgent findings the radiologist calls the ordering physician directly.

READING RADIOLOGY REPORTS

Radiology reports are written with a specific language with terms to accurately convey the findings in the imaging studies and to interpret their meaning in the clinical context. For instance, the term “hyperdensity” on a CT image appears bright on a monitor, reflecting the fact that it corresponds to increased atomic density in the region on the image. Below is a brief selection of some of these key terms:

Artifact: A visual finding in the image that does not reflect actual anatomy or anatomic abnormality, but rather an artificial process generated by the computer, for example, from reconstruction algorithms (streak artifact in CT imaging), issues with technique (such as heart appearing larger in AP vs. PA views), motion artifact from breathing in any technique, or shadowing from bowel gas obscuring structures on ultrasound.

Air–fluid level: A pattern in which fluid rests in a gravity dependent position with overlying air/gas (“fluid sinks, air rises”).

Enhancement: When intravenous contrast administration causes an organ or region of tissues to be “brighter” or have more contrast with surrounding structures, implying increased blood flow to the area (Table 23-1).

COMMON RADIOGRAPHIC STUDIES: NONCONTRAST