Abstract
In this chapter, five cases are presented to illustrate the central role of radiologists in patient care. These cases illustrate the incredible value that the radiologists can bring to the table, and the input of radiologists in promoting evidence-based guidelines in the management of patients. Clinical algorithms in determining when an abdominopelvic CT examination is indicated for blunt abdominopelvic trauma are discussed. A case in the workup of incidentalomas shows the potential for high-value care radiologists can offer to patients, a case illustrating the radiologist ability to influence medical versus surgical management of appendicitis in the era where imaging diagnosis has arguably trumped over clinical diagnosis of appendicitis. Cases discussing the central role of radiologists in diagnosing renal colic and colonic diverticulitis, and the potential for radiologists to act as patients advocate to minimize unnecessary radiation exposure associated with CT scans, are also discussed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Andeweg CS, Wegdam JA, Groenewoud J et al (2014) Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol 49:775–784
Baghdanian AH, Baghdanian AA, Armetta A et al (2017) Effect of an institutional triaging algorithm on the use of multidetector CT for patients with blunt abdominopelvic trauma over an 8-year period. Radiology 282(1):84–91
Caoili EM, Korobkin M, Francis IR et al (2002) Adrenal masses: characterization with combined unenhanced and delayed enhanced CT. Radiology 222(3):629–633
Choi YA, Kim CK, Park BK, Kim B (2013) Evaluation of adrenal metastases from renal cell carcinoma and hepatocellular carcinoma: use of delayed contrast-enhanced CT. Radiology 266(2):514–520
Cohen MD (2015) ALARA, image gently and CT-induced cancer. Pediatr Radiol 45(4):465–470
Kaiser AM, Jiang JK, Lake JP et al (2005) The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 100:910–917
Kim HY, Park JH, Lee YJ, Lee SS, Jeon J-J, Lee KH (2017) Systematic review and meta-analysis of CT features for differentiating complicated and uncomplicated appendicitis. Radiology 287(1):104–115
Laméris W, van Randen A, Bipat S et al (2008) Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol 18(11):2498–2511
Laméris W, van Randen A, van Gulik TM et al (2010) A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum 53(6):896–904
Lau KC, Spilsbury K, Farooque Y et al (2011) Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum 54(10):1265
Livingston EH, Woodward WA, Sarosi GA, Haley RW (2007) Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Ann Surg 245(6):886–892
Mayo-Smith WW, Song JH, Boland GL et al (2017) Management of incidental adrenal masses: a white paper of the ACR incidental findings committee. J Am Coll Radiol 14(8):1038–1044
McNamara MM, Lalani T, Camacho MA, et al. (2018) ACR appropriateness criteria® left lower quadrant pain—suspected diverticulitis. American College of Radiology. https://acsearch.acr.org/docs/69356/Narrative/. Accessed 18 Sept 2018
Moreno CC, Beland MD, Goldfarb S, et al. (2018) ACR appropriateness criteria® acute onset flank pain—suspicion of stone disease (urolithiasis). American College of Radiology. https://acsearch.acr.org/docs/69362/Narrative/. Accessed 18 Sept 2018
Nicolau C, Claudon M, Derchi LE et al (2015) Imaging patients with renal colic—consider ultrasound first. Insights Imaging 6(4):441–447
Patel J, Davenport MS, Cohan RH, Caoili EM (2013) Can established CT attenuation and washout criteria for adrenal adenoma accurately exclude pheochromocytoma? Am J Roentgenol 201(1):122–127
Ripollés T, Agramunt M, Errando J, MartÃnez MJ, Coronel B, Morales M (2004) Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. Eur Radiol 14(1):129–136
Rodriguez RM, Anglin D, Langdorf MI et al (2013) NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA Surg 148(10):940–946
Sai VF, Velayos F, Neuhaus J, Westphalen AC (2012) Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review. Radiology 263(2):383–390
Salminen P, Paajanen H, Rautio T et al (2015) Antibiotic therapy vs. appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA 313(23):2340–2348
Sartelli M, Catena F, Ansaloni L et al (2016) WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg 11:37
Sharma PV, Eglinton T, Hider P, Frizelle F (2014) Systematic review and meta-analysis of the role of routine colonic evaluation after radiologically confirmed acute diverticulitis. Ann Surg 259(2):263
Smith-Bindman R, Aubin C, Bailitz J et al (2014) Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med 371(12):1100–1110
Stollman N, Smalley W, Hirano I et al (2015) American gastroenterological association institute guideline on the management of acute diverticulitis. Gastroenterology 149(7):1944–1949
Turk C, Neisius A, Petrik C, et al. (2018) Urolithiasis. European association of urology. http://uroweb.org/guideline/urolithiasis/#3. Accessed 18 Sept 2018
Wong C, Teitge B, Ross M, Young P, Robertson HL, Lang E (2018) The accuracy and prognostic value of point-of-care ultrasound for nephrolithiasis in the emergency department: a systematic review and meta-analysis. Acad Emerg Med 25(6):684–698
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lim, K.L. (2019). Value-Based Radiology in Abdominal and Pelvic Imaging. In: Silva, C., von Stackelberg, O., Kauczor, HU. (eds) Value-based Radiology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2018_204
Download citation
DOI: https://doi.org/10.1007/174_2018_204
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-31554-2
Online ISBN: 978-3-030-31555-9
eBook Packages: MedicineMedicine (R0)