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CORE Case 1 Workshop

Join Dr. Petra Lewis from Geisel School of Medicine as she guides participants through vital concepts in diagnosing pneumonia using silhouette and sign signs. This workshop emphasizes the distinct appearances of viral pneumonias, pleural effusions, and variations in imaging views, including CT scans. Participants will learn to navigate the risks associated with medical radiation exposure, calculating risk for real patients, and understanding factors that affect radiation dosage. This session is essential for healthcare professionals seeking to enhance their radiological skills and patient safety protocols.

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CORE Case 1 Workshop

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  1. Petra Lewis MD Professor of Radiology and OBGYN Geisel School of Medicine at Dartmouth CORE Case 1 Workshop

  2. Learning objectives • Understand the meaning of the silhouette and sign signs • Understand how these concepts can be applied in the diagnosis and localization of pneumonias • See how viral pneumonias differ in appearance • Describe how pleural effusions appear on chest radiographs on different views • Understand how the appearance of effusions varies in empyema and hydropneumothorax • Understand the factors affecting the risks of medical radiation and how they can be reduced. • Calculate the risks to a real patient from his medical radiation exposure during a single clinical episode

  3. What questions/difficulties did you have arising from the case

  4. Pneumonias

  5. Silhouette sign

  6. RLL pneumonia

  7. Pleural effusions

  8. Pleural Effusions • How much fluid do you need to see on • A PA CXR? • A lat CXR? • A supine CXR? • A CT scan? • How else can you visualize pleural fluid? • Characteristics of fluid vs consolidation?

  9. Small effusions

  10. Small effusions

  11. Decubitus views

  12. Supine pleural effusions

  13. Radiation Risk

  14. Radiation risk • What factors affect how much risk patients are at from medical radiation?

  15. Relative risks of exams

  16. Radiation Equivalents Average background = 3mSv Metter et al. 2008, 248, 254-263.

  17. Case study HT abdominal CT27 year old with complicated pancreatitis

  18. HT Radiology Studies 12/7/06-2/6/07

  19. What is his increased risk of dying of a malignancy due to his radiation exposure during this hospital stay?

  20. How much radiation did HT receive?

  21. So our patient received an estimated dose of ? mSv

  22. Cancer induction rates • 8% fatal cancers per Sv (1000 mSv) • = % fatal cancers risk for HT • Fractionation reduces risk by 50% • = % fatal cancers risk for HT • Younger patient (<40) doubles risk • (much higher for young children) • = % fatal cancers risk for HT

  23. Cancer induction rates • Lifetime risk of fatal cancer • 24% males, 20% females • = /24 x 100% increased risk of dying of a cancer from his hospital exposure • = • Note – his risk of developing any type of cancer is about twice this (fatal and non-fatal)

  24. How can we reduce risk?

  25. Appendix

  26. Learning Objectives from CORE 1 • Review CXR anatomy including the location of the lobes of the lung and their relationship to fissures • Be introduced to the American College of Radiology (ACR) appropriateness criteria for imaging • Learn the indications for chest imaging in patients presenting with upper respiratory tract infection symptoms. • Learn the radiographic presentations of typical alveolar pneumonias in different lobes of the lung. • Understand the concepts of “silhouette sign” and “spine sign” and how they can be used to localize abnormalities on chest radiographs. • Understand the term “air bronchograms” and the significance of this sign. • Learn how some tumors can appear similar on imaging to pneumonia. • Be introduced to the typical radiographic appearance of PCP pneumonia, and other opportunistic and atypical pneumonias and how they differ radiographically from typical bacterial and lobar pneumonias • Understand the meaning and appearance of “ground glass” opacities on chest radiographs and CT scans. • Understand the use and limitations of portable radiographs in the ICU. • Learn the imaging features of ARDS • Acquire a basic understanding of patient radiation doses from common examinations and how we can try to limit them. • Learn the common imaging features of various types of pleural effusion including simple, hydropneumothorax, empyema and loculated pleural fluid collections (“pseudotumors”). • Understand how pleural fluid appears differently on erect and supine radiographs. • Learn when image guidance can help in the drainage of pleural fluid.

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