Radiology Potpourri (Kujala, 3/17/2021)

Many thanks to Dr. Nick Kujala, Sutter Radiologist and mid-West Scrubs and hockey fan, who gave an entertaining and informative presentation this week, covering a range of topics in radiology: from the history of the first radiograph to the risk of radiation exposure to the invention of the CT scanner. The video recording is available HERE.

Here are a few summary points from his presentation:

1) Radiation Exposure: Many patients (and clinicians) have concerns about the risks of radiation exposure with imaging studies. It may be helpful to note that living on earth gives us daily background radiation exposure, and certain jobs/situations (e.g. working as flight attendant or pilot) increase the amount of that exposure over time. Of note,  exposure from one chest x-ray is the equivalent of  ~10 days of background radiation, whereas at CT of the chest is equivalent to ~2 years. 

Information on radiation exposure for patients is available at this website:  https://www.radiologyinfo.org/en/info.cfm?pg=safety-xray

Also, remember that MRI and ultrasound are alternative imaging modalities that offer ZERO radiation exposure.

2) Breastfeeding and contrast: Women who are breastfeeding can safely receive contrast (iodinated and gadolinium-based) for imaging studies without concern. The dose absorbed by an infant is exceedingly low. There is no need to pump and dump, but ultimately the decision should be left to the lactating mother.

3) ACR Appropriateness Criteria: The American College of Radiology (ACR) has an excellent, information-packed website to help clinicians make the correct choice about imaging studies. Everything you want to know about radiology imaging (indications, risks/benefits, radiation exposure, alternatives) can be found here: https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria

An excerpted example of these ACR criteria for abnormal uterine bleeding is pictured below.

4) MRI and Gadolinium: Gadolinium has been used as contrast in MRI for over 30 years. There is a known phenomenon of gadolinium deposition in some tissues (bone, kidney, brain); however, there has been no consistent evidence to suggest that these deposits are associated with neurotoxicity. However, as recent as 2016, some scientists have suggested a condition called Gadolinium Deposition Disease, linking these deposits with a constellation of neurological symptoms and signs.  While Dr. Kujala and the ACR  support the safety profile of gadolinium, it is not recommended during pregnancy

5) More IS Better! Give your radiologist as MUCH clinical information as possible when ordering an imaging study-- you will get more clear results back. And if you have a question, call your local radiologist sitting in his dark reading room (or at home) at x-44551.

Extras:

Roentgen's first ever radiograph of his wife's hand (1895) 

Hounsfield's invention: the CT Scanner (he shared the 1979 Nobel Prize in Medicine)

And finally, what is an Aunt Minnie? The origins of the term "Aunt Minnie" are a bit hazy, but it's believed to have been coined in the 1940s by Dr. Ben Felson, a radiologist at the University of Cincinnati. He used it to describe "a case with radiologic findings so specific and compelling that no realistic differential diagnosis exists."

Can you name the Aunt Minnie below?

Answer: Tension Pneumothorax