When US? When CT? Fern Karlicki, MD. When US? When CT? After this talk, participants should: –Be familiar with the strengths and weaknesses of US & CT.

When US? When CT?When US? When CT?

Fern Karlicki, MDFern Karlicki, MD

When US? When CT?When US? When CT?

After this talk, participants should:After this talk, participants should:– Be familiar with the strengths and Be familiar with the strengths and

weaknesses of US & CTweaknesses of US & CT

– Be familiar with how to use the ACR Be familiar with how to use the ACR appropriateness criteriaappropriateness criteria

US StrengthsUS Strengths

MultiplanarMultiplanar

Real timeReal time

No ionizing radiationNo ionizing radiation

Minimal bio-effectsMinimal bio-effects

No IV contrastNo IV contrast

InexpensiveInexpensive

PortablePortable

US WeaknessesUS Weaknesses

Operator dependentOperator dependentLimited by:Limited by:– Gas - pancreas, lung, bowelGas - pancreas, lung, bowel– Bone – ribsBone – ribs– ObesityObesity– MetalMetal

Need patient cooperationNeed patient cooperationLess sensitivity and specificityLess sensitivity and specificity

CT StrengthsCT Strengths

Prettier picturesPrettier pictures

Better resolutionBetter resolution

Better sensitivity & specificityBetter sensitivity & specificity

CT WeaknessesCT Weaknesses

Ionizing radiationIonizing radiation

Limited planesLimited planes

Contrast allergy, nephrotoxicityContrast allergy, nephrotoxicity

Ionizing radiationIonizing radiation

ExpenseExpense

IONIZING RADIATIONIONIZING RADIATION

CT & Cancer / LeukemiaCT & Cancer / Leukemia

1:1000 cancer induction in children after 1:1000 cancer induction in children after single abdominal CT scan!single abdominal CT scan!

Adults have same risk after 5-6 abdominal Adults have same risk after 5-6 abdominal CT scansCT scans

Younger women and children have highest Younger women and children have highest risk risk

ACR WebsiteACR Website

For an excellent discussion of For an excellent discussion of appropriateness of different imaging appropriateness of different imaging modalities in various clinical scenariosmodalities in various clinical scenarios

www.acr.org /ac www.acr.org /ac

oror

Google - acr appropriateness criteriaGoogle - acr appropriateness criteria

ACR - AC RLQ painACR - AC RLQ pain

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC RLQ painACR – AC RLQ pain

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC RLQ painACR – AC RLQ pain

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC HematuriaACR – AC Hematuria

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC HematuriaACR – AC Hematuria

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR – AC HematuriaACR – AC Hematuria

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

ACR Appropriateness CriteriaACR Appropriateness CriteriaAcute Onset Flank PainAcute Onset Flank Pain

Reprinted with permission of the American College of Radiology No other representation of this material is authorized without expressed, written permission from the American College of Radiology. Refer to the ACR website at www.acr.org/ac for the most current and complete version of the ACR Appropriateness Criteria..

Last thoughtLast thought

When US and CT have a similar When US and CT have a similar appropriateness level , consider US first appropriateness level , consider US first especially in especially in childrenchildren, , young slim adultsyoung slim adults and in and in women of child-bearing agewomen of child-bearing age in in order to minimize the risks of radiation in order to minimize the risks of radiation in these patients.these patients.