Introduction_to_Radiology_____PART_2

INTRODUCTION TO MSK IMAGING

Medical Radiologist

• Medical doctors specializing in diagnosing and treating injuries and diseases using medical imaging procedures such as X-rays, CT, MRI, nuclear medicine, PET, and ultrasound.

• Learn about Radiology from ACR

Training and Certification

• Radiologists undergo at least 13 years of training:

  • Medical school

  • Four-year residency

  • 1-2 year fellowship in a specialized field (e.g., radiation oncology, pediatric radiology, interventional radiology)

• Certification by the American Board of Radiology includes ongoing continuing medical education.

Types of Radiologists

• Diagnostic Radiologist: Focuses on imaging interpretation.

• Interventional Radiologist: Performs minimally invasive procedures guided by imaging.

• Radiation Oncologists: Treat cancer using radiation therapy.

Chiropractic Radiologist

• In the USA, requires a minimum of 3 years residency after obtaining a Doctor of Chiropractic degree, focusing on musculoskeletal (MSK) radiology.

• Some may pursue an additional 1-year fellowship; fewer than 400 certified diplomates exist.

• Learn about Chiropractic Radiology training

Pathway for Chiropractic Radiology

1. Obtain Chiropractic degree.

2. Complete 300-400 contact hours in radiology coursework:

   • Topics include medical physics and skeletal imaging with an emphasis on the MSK system.

3. Complete PGY 1-3 in radiology training; PGY 4 for optional subspecialty fellowship on cross-sectional MSK imaging (ultrasound and MRI).

Board Certification

• The American Chiropractic Board of Radiology requires:

  • Core written exam

  • Certifying practical exam

• More about Board certification

Radiographer/Technician

• Individuals with a degree in radiologic technology from an accredited institute.

• Certified by the American Registry of Radiologic Technologists (ARRT) to perform diagnostic imaging and ensure patient safety during radiation exposure.

• More on Radiologic Technologists

X-Ray Machine Operators

• Minimally trained operators meeting training requirements of the Consumer-Patient Radiation Health and Safety Act of 1981.

• Focus on specific body sites or standard procedures, including dental staff trained in radiographs.

American College of Radiology (ACR)

• Represents nearly 41,000 radiologists, radiation oncologists, interventional radiologists, and medical physicists.

  • Advocates for quality and safety in radiology.

  • Strives to improve patient care through innovation and the advancement of radiological practices.

  • ACR Fact Sheet

Core Purpose and Values of ACR

• Core Purpose: Empower members to improve practice and science in radiological care.

• Core Values: Integrity, Visionary, Excellence, Leadership, Transparency, Member-Driven.

PART 2: DIAGNOSTIC IMAGING REQUISITION FORM

• Appointment scheduling and essential patient information are required:

  • Patient name, DOB, sex, diagnosis, and reason for examination must clearly establish medical necessity.

  • EXAM REQUESTED: An extensive list covers multiple imaging studies.

  • Physician's signature is mandatory.

PATIENT CHECKLIST

• Inform technologist if pregnant or may be pregnant.

• Bring the prescription form and previous outside CD images for comparison.

• Check with insurance for referrals and authorizations before the appointment.

• Review exam preparation instructions for specific imaging types.

JUSTIFICATION FOR DIAGNOSTIC IMAGING

• Clinical justification of imaging must be met to confirm or exclude conditions such as neoplasms, fractures, infections, etc.

• Criteria include:

  1. Increased information about the patient's complaint

  2. Alteration in prognosis or management of care

  3. Benefits of imaging outweigh radiation hazards

  4. Utility of imaging over less invasive procedures

PATIENT HISTORY & EXAMINATION

• Baseline evaluations and assessment of response to treatments influence the decision to proceed with imaging tests.

DIAGNOSTIC TEST METRICS

• Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) form core metrics evaluating diagnostic testing efficacy.

• Definitions of outcomes:

  • True Positive (TP): Test is positive; disease is present.

  • True Negative (TN): Test is negative; disease is absent.

  • False Positive (FP): Test is positive; disease is absent.

  • False Negative (FN): Test is negative; disease is present.

MEDICAL IMAGING

• Encompasses various technologies for diagnosing, monitoring, and treating medical conditions, providing critical insights into pathologies within the body.

• Medical Radiography involves internal visualization using X-ray methods.

• Advanced Imaging involves MRI, CT, and nuclear medicine, allowing for multi-planar views similar to slicing a loaf of bread for detailed analysis.

SAFETY IN MEDICAL RADIATION

• Adhere to the ALARA principle (As Low As Reasonably Achievable) to minimize exposure through time, distance, and shielding.

THE DIAGNOSTIC IMAGING REPORT

• Essential components include demographics, relevant clinical information, findings, impressions, and recommendations.