Radiology. Introduction to Clinical Medicine. Francis Neuffer M.D. Asso Professor/Radiology U.S.C. School of Medicine. Radiology. E-mail: x-ray@med.sc.edu Radiology Website: http://radiology.med.sc.edu Radiology Department: Basement of Library
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Radiology Introduction to Clinical Medicine FrancisNeuffer M.D. Asso Professor/Radiology U.S.C. School of Medicine
GOALS • Understand exams and indications • Strengths and weakness • Interpretation • Work-up for diseases • Resources
What is Radiology? Supervises and interprets imaging studies Reports findings to referring physicians • ANATOMY vs. PATHOLOGY • LOCATION & EXTENT • DIAGNOSIS & DIFFERENTIAL
RADIOLOGY TRAINING Medical School 4 years Radiology Residency 4 years (1 year clinical) Nuclear Medicine 4 years Radiation Therapy (Oncology) 4 years After Residency: Subspecialty Fellowship 1 year Research 1 year
RADIOLOGY SERVICES IN THE UNITED STATES 260 - 330 million procedures 1990 400 million procedures 2005 55% performed in office 19 -20 billion dollars 1990 65-75 billion dollars 2000 85-95 billion dollars 2005 Sunshine, AJR 157, September 1990 Rothenberg JACR May 2005
DIAGNOSTIC IMAGING IN OFFICE PRACTICE Frequency 4 - 4.5 times greater for self referring physician Cost 4.4 - 7.5 times higher mean imaging costs per episode of care Frequency and Cost NEJM: 323:23,1990 Hillman
Mean Professional Liability Premiums per Self-Employed Physician ANNUAL PREMIUMS (in thousands of dollars) 1994 1996 1998 2000 Family Practice 10.2 8.4 10.9 13.8 Internal Medicine 8.6 8.9 16.5 13.7 Surgery 22.3 21.7 22.8 23.6 Pediatrics 7.6 8.3 9.0 11.5 OB/GYN 37.4 35.2 35.8 39.2 Radiology 11.2 11.3 12.3 19.3 Psychiatry 9.4 5.2 5.4 12.9 AMA, Socioeconomic Characteristic of Medical Practice 2003
RADIOLOGY PRACTICE Positive Negative 1. Intellectually exciting Geographically limited 2. Good Income Little Control a. low overhead b. collectible charges 3.Limited Responsibility Clinical Perception a. reduced patient contact b. predictable hours
PROBLEMS WITH RADIOLOGY Planning the diagnostic workup Too many available choices create confusion and anxiety The radiology report Disorganized and imprecise document that can rarely be taken seriously by clinicians Heilman, NEJM Vol.306, No.8, 1992d
? NUCLEAR MEDICINE ULTRASOUND CT BARIUM MRI ANGIOGRAM What next?
How to decide. . . • 1. Cost • Effectiveness (efficacy) • Risk • 4. Availability American College Radiology APPROPRIATENESS CRITERIA USC RADIOLOGY DEPT WEB PAGE
THE X-RAY REPORT Prominent Engorged Congested Accentuated Interstitial edema Increased interstitial markings Early failure CHF
RADIOLOGY TOOLS • X- RAY • COMPUTED TOMOGRAPHY • NUCLEAR MEDICINE • ULTRASOUND • MAGNETIC RESONANCE
MAGNETIC RESONANCE • HYDROGEN PROTONS ALIGN IN MAGNETIC FIELD • RADIO FREQUENCY SIGNAL TRANSMISSION • INTENSITY OF SIGNAL RELATES TO TISSUE • NO IONIZING RADIATION
