mssmem.com

You can now upload images on a DVD/CD from any computer with a drive. Go to https://lila.mountsinai.org. From there you set up an account which took me 1 minute and then click upload. Very rapid. Once they are uploaded to Lila you click on the image and “nominate” them to PACS so that they cross over. just FYI.

With the obesity epidemic sweeping our nation (and some other countries), we are faced with caring for a patient population never before seen, in these numbers: The morbidly obese.
Sometimes we need to use CT imaging to evaluate these patients for significant/dangerous pathology. But the rumors abound about the BMI/wt limits. Thanks to our Rads Chief Resident, Serge Sicular, we’ll set the record straight, here and now.

1. The max wt we can image is 450lbs at main CT (the ED CT can only scan up to 350lbs), but with the caveat that if the machine doesn’t move or the pt doesn’t fit into the donut portion, they need to be transferred to an OSH for a scan.

2. If the tech tells us the pt is too big, we should page the rads resident to confirm the need to use the main CT scan or transfer the patient out (this is a big deal bc it costs the dept time/money and delays diagnosis and treatment time; the pt still has to be transferred back to sinai, potentially too)

3. Dr. Sicular will make sure that the rads residents are all aware of the weight limits of the machines.

4. If we do transfer a patient to Jacobi (which has a scan with a larger limit), the rads team there should interpret the images; please get a digital copy of the images for surgery, neurosurg, etc.

f you have a case that may need urgent / emergent IR involvement (and would prefer not go through the rads resident to explain your clinical decision making), the in-house pager is RADS (7237).

Luke

Hey HSC,

There is a new policy change: Starting May 22, anytime you order a contrast-enhanced CT scan, a consent form will print out (attached below for your perusal) that a patient will have to fill out themselves. You will no longer need to get the consent yourself. Please pass on to the residents in your Department.

Thanks and enjoy the extra time in your day!

Go team,
Serge Sicular

IV Contrast Consent May 2012

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Hello,
Please be aware that if appropriately shielded, parents are allowed in room with their child while they are undergoing CT scans. Occasionally techs mention some policy, which does not exist, that parents are not allowed in. According to the email below from Dr. Rosenberg, this is not true. Today I was able to complete a non contrast Head CT on a 21 month old male without sedation. This clearly would not have been possible with the mother out of the room. Be aware that there is no policy against this.
thanks,
Adam

———- Forwarded message ———-
From: Rosenberg, Henrietta
Date: Tue, Apr 3, 2012 at 9:24 PM
Subject: RE: CT
To: Adam Vella

Adam,

If the parent is appropriately shielded, there is no reason why they cannot be in the room. However, having a parent present does not ensure patient cooperation when the patient is of an age when their behavior is likely unpredictable. What age and what type of CT study are you alluding to?

Henrietta

From: Adam Vella
Sent: Tuesday, April 03, 2012 4:53 PM
To: Rosenberg, Henrietta
Subject: CT

Hello Henrietta,

I have a quick question regarding radiology policy. Frequently having a parent in the room with the patient will allow us to complete a study without sedation. If the parent is wearing lead is there some problem with this? I have had multiple radiology techs say that their policy is that parent’s can’t be in the room. Clearly this is not family centered if it is the case. Can we address this from the pediatric perspective?

Adam

After conversation with our rads colleagues, should you find yourself needing immediate radiology sonographic expertise the following is the workflow they would like us to follow.

1. Indicate “portable” on the request.

2. Since these studies should occur infrequently, attending to attending or attending to on-call resident should occur as this will ensure that the exam is expedited.

These are the numbers you can use:

Ultrasound reading room (8a-5p M-F): x45750

Body reading room (5p-11p M-F, 9a-5p S-S): x47928

Radiology resident on call (all other times): pager 1490

Godspeed and goodluck,

Luke

In case you missed this info from the Medical Board, approved September 2011-

Pregnancy screening NOT required for extremity films, chest x-ray, and some other commonly ordered studies from the ED.

>From the policy, these are the procedures that DO REQUIRE pregnancy screening:

The following is a List of Procedures that require pregnancy screening for female patients age 11-50
1. All diagnostic studies involving intravascular contrast
2. All MR studies
3. Studies employing ionizing radiation (fluoroscopy, radiography or computed tomography) that might be expected to expose the uterus to significant radiation:
a. Abdomen (all views)
b. Pelvis (all views) including
Sacro-iliac joints
c. Hips, including
Femoral heads
Fluoroscopy-guided groin catheterization
d. Segments of spine in the primary beam, including
Thoracic Spine
Lumbar Spine
Sacrum/coccyx
e. Bowel Series, including
GI Series
Small Bowel Series
Barium Enema

from smartem.org

CT Consent SMARTEM

MRI Checklist

[see attached radiology department policy. reminder courtesy of dr. chan, as it pertains to CT brain perfusion studies below]

Dear Colleagues and Residents,

Per Dr. Tuhrim, certain acute ischemic stroke patients may require emergent CT perfusion scans in addition to the non-contrast head CTs. For this particular subset of acute stroke patients, creatinine and written consents are not required before obtaining the CT perfusion scans- please see the attached radiology protocol.

Please do not hesitate to contact us with any questions or concerns.

Have a very happy Thanksgiving.

Yu-Feng Yvonne Chan, MD, FACEP

Radiology Policy: Contrast and Consent for IV contrast for emergent CT

Docs- please order CT’s based on the protocals listed.
if you need contrast– order the contrast by using the CT scan order set in Med Svc.

Nurses– the contrast is in the pyxis, bottles in the med room. when the pt starts drinking– print out the med order to the “ED CT MED” printer. this print out will let the CT scan BA know that the pt is drinking– they will schedule a pick up in 2 hours from the start time!

thanks for all your help with this… hopefully it will indeed reduce turnaround time for CT’s with contrast.

Kevin M. Baumlin

PROGRESS!!! There are now 6 choices for ED CT protocols, (plus “other”). If your patient fits a protocol, choose it.  You do NOT need to call the radiologist if you choose one of these protocols. Choose a protocol ONLY if your patient actually matches a protocol- do not fit everyone into a protocol just because it’s there.

There are now 6 choices for ED CT protocols, (plus “other”).  If your patient fits a protocol, choose it.  You DO NOT need to call the radiologist if you choose one of these protocols.  Choose a protocol ONLY if your patient actually matches a protocol – do not fit everyone into a protocol just because it’s there.  If you do not match one of these protocols, choose other, and call the radiologist.

Remember, DO NOT use the protocol unless your patient fits.
If your patient does not fit a protocol, choose other and call the radiologist.

Here are the protocols…

Appendicitis Protocol
Clinical indication:  acute, atraumatic right lower quadrant pain.
Scan Technique:  abdomen and pelvis with IV, oral and rectal contrast, 3 mm slice thickness with coronal reformations.

Diverticulitis Protocol:
Clinical indication: acute, atraumatic left lower quadrant pain.
Scan technique:  abdomen and pelvis with IV, oral and rectal contrast.

Pancreatitis Protocol:
Clinical indication:  clinical and biochemical evidence for acute pancreatitis.
Scan technique:    IV and oral contrast given as follows – C minus abdomen with 3mm slice thickness. C+ abdomen at 40 sec (3 mm slice thickness). C+ abdomen and pelvis at 70 sec (5 mm slice thickness).

Bowel Obstruction Protocol:
Clinical Indication:  clinical signs and radiographic evidence for either small or large bowel obstruction.
Scan technique:  abdomen and pelvis with IV and oral contrast.  One hour additional delay after oral contrast is finished. One cup of oral contrast on CT table.

Renal Stone  Protocol:
Clinical indication:  flank pain suspicious for urinary obstruction.
Scan technique:  non-contrast abdomen and pelvis with 3 mm slice thickness, patient scanned in prone position.

Pulmonary Embolism Protocol:
Clinical indication:  signs and symptoms of pulmonary embolism, positive D dimer in patients with no risk factors.
Scan technique:  chest CT with IV contrast.
Oral contrast dilution:  Gastrografin (0.8% iodine) 30 ml in 1 liter of water.

Please note that the radiologist (x 47928) or radiology resident (beeper#1490) should consulted for all complex cases, or for patients who do not strictly fit into the above clinical indications.
Scot & Kevin

Hi everyone,

Lisa and I had an interdepartmental meeting with Radiology and Surgery at Sinai today – some matters they want us to pass along.

1.  Gastrografin will not be used anymore.  Instead, for g-tube placement confirmation – we are going to use Isovue.  Isovue is the same substance as the IV contrast we use for CTs and can be obtained from almost anywhere in the Department of Radiology.  So please throw out the gastrografin you guys have hoarded in your mailboxes.

2.   When ordering radiological studies – please include your call back # on it.

3.  When ordering CT (-) for acute stroke, please include onset of symptoms.

4.  Radiology is reducing the number of CT scanners in operation from 2 to 1 at night.  ‘Night’ being 10pm – 8AM.  Radiology promises this will NOT affect the ED.  Please let me know if this becomes an issue [with specific instances, patient MR#s, etc] if it does.

5.  Radiology will still not have an u/s tech at night despite efforts by their own residents and other departments to encourage this.

6.  Lastly – per Surgery.  Patients awaiting a liver transplant AND who are on the list – in situations involving surgical issues – call Liver Transplant FIRST via.  Cirrhotic patients who are NOT on the transplant list – call SURGERY for consults.