Ever wonder what radiology exam to order?

[Rads Consult]

Hi. I just wanted to plug a website I created called www.radsconsult.com.

It’s the only application of its kind that is both free and comprehensive. There are no subscription plans, pop ups, or advertising on the site. It answers every question from whether or not to give IV or Oral Contrast, to when to withhold/reverse anticoagulation meds and minimum required anticoagulation parameters prior to any radiology procedure, to what imaging study to order for over 1,000 searchable diagnoses and symptoms. It also has every type of radiology exam and interventional radiology procedure you can think of with the common indications of when one would order such an exam, including all the variations of each exam with and without IV and/or Oral contrast.

It's 100% free and there's no monetization of the site.

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Members don't see this ad.

 

[thegenius]

Hi. I just wanted to plug a website I created called www.radsconsult.com.

It’s the only application of its kind that is both free and comprehensive. There are no subscription plans, pop ups, or advertising on the site. It answers every question from whether or not to give IV or Oral Contrast, to when to withhold/reverse anticoagulation meds and minimum required anticoagulation parameters prior to any radiology procedure, to what imaging study to order for over 1,000 searchable diagnoses and symptoms. It also has every type of radiology exam and interventional radiology procedure you can think of with the common indications of when one would order such an exam, including all the variations of each exam with and without IV and/or Oral contrast.

It's 100% free and there's no monetization of the site.

If it's free and no monetization, they why have people login and sign-up? Just to keep track of who is using it? (not a criticism, just wondering why.)

I actually did sign up for it. Visually looks quite appealing!

A common question / debate among my colleagues is the use of IV contrast in computed tomography of the abdomen and pelvis for a number of pathologies including renal colic. Despite me telling them that time and time again, I've never heard a radiologist say that IV contrast reduces diagnostic accuracy of obstructing ureterallithiasis (especially if the CT is timed to start < 1 min after the bolus of contrast), there are tons of ER docs that think it is the wrong study.

I like the answer your website gives...

"Rads Consult"

(that sure is a long link!!!)

One suggestion.
Maybe common FAQs for a disease process can have that specific Q&A on the disease page.
For instance, from the home page type "kidney" in the search box. I get three choices. I click on "Kidney Stone"
On the "Kidney Stone" page it just says exam type. Why not also put a FAQ question there, such as "Can I scan with IV contrast?"

The answer to that question can be found on the website, but requires more searching for it.

Thanks!

 

[Rads Consult]

If it's free and no monetization, they why have people login and sign-up? Just to keep track of who is using it? (not a criticism, just wondering why.)

I actually did sign up for it. Visually looks quite appealing!

A common question / debate among my colleagues is the use of IV contrast in computed tomography of the abdomen and pelvis for a number of pathologies including renal colic. Despite me telling them that time and time again, I've never heard a radiologist say that IV contrast reduces diagnostic accuracy of obstructing ureterallithiasis (especially if the CT is timed to start < 1 min after the bolus of contrast), there are tons of ER docs that think it is the wrong study.

I like the answer your website gives...

"Rads Consult"

(that sure is a long link!!!)

One suggestion.
Maybe common FAQs for a disease process can have that specific Q&A on the disease page.
For instance, from the home page type "kidney" in the search box. I get three choices. I click on "Kidney Stone"
On the "Kidney Stone" page it just says exam type. Why not also put a FAQ question there, such as "Can I scan with IV contrast?"

The answer to that question can be found on the website, but requires more searching for it.

Thanks!

Thank you. And yes, registration is to see who is using it but mostly to protect the content. Without a login page, the entire site is crawled by google.

And thank you so much for the feedback. I'll try to incorporate it on the next update. Any other feedback is greatly appreciated!

Also, it's built to be used on mobile so it's very mobile friendly and meant for docs on the go.

 

[Tenk]

You lost me at oral contrast.

 

[Angry Birds]

If it’s head order CT head.
If it’s chest order CT chest.
If it’s abdomen order CT abd/pelvis.

Just kidding. I’ll definitely check out the app. Thanks for making it free.

 

[shookwell]

A common question / debate among my colleagues is the use of IV contrast in computed tomography of the abdomen and pelvis for a number of pathologies including renal colic. Despite me telling them that time and time again, I've never heard a radiologist say that IV contrast reduces diagnostic accuracy of obstructing ureterallithiasis (especially if the CT is timed to start < 1 min after the bolus of contrast), there are tons of ER docs that think it is the wrong study.

That comes from the ACR appropriateness criteria which strongly recommends non-contrast CT over contrast CT for acute onset flank pain with suspicion for kidney stones. The recommendation for undifferentiated or non-localizing abdominal pain is generally to use IV contrast but also recognizes that the decision should be made based on history and lab findings.

https://acsearch.acr.org/docs/69467/Narrative/
https://acsearch.acr.org/docs/69362/Narrative/

I generally will defer to the appropriateness criteria when deciding which test to order unless I have a specific reason to do something different.

 

[Rads Consult]

That comes from the ACR appropriateness criteria which strongly recommends non-contrast CT over contrast CT for acute onset flank pain with suspicion for kidney stones. The recommendation for undifferentiated or non-localizing abdominal pain is generally to use IV contrast but also recognizes that the decision should be made based on history and lab findings.

https://acsearch.acr.org/docs/69467/Narrative/
https://acsearch.acr.org/docs/69362/Narrative/

I generally will defer to the appropriateness criteria when deciding which test to order unless I have a specific reason to do something different.

I think the appropriateness criteria is great, but you must admit that those pages are terrible to read through to find what you're looking for. I think most clinicians would rather guess at the right exam and have radiology figure it out than look at a 17 page .pdf when running around trying to do a million other things at once. Yes, the answer is in there somewhere but this is why we choose to read the Wikipedia page on a famous person rather than their biography.

ACR lists 10 exams you can order, half of which are definitely not appropriate and the others which are not really appropriate either but only under very certain circumstances. It should be easier than that. Maybe an attending who's been practicing for a while can figure out the ACR appropriateness pages, but can a med student or a new PA, or an new NP?

Why can't they just say Non-contrast CT for renal stones? Why do they even list Fluoroscopy and Nuclear Medicine White Blood Cell Scans for Acute abdominal pain?

These recs are crazy:

Variant 4: Acute nonlocalized abdominal pain. Not otherwise specified. Initial imaging. Procedure Appropriateness Category Relative Radiation Level CT abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢ CT abdomen and pelvis without IV contrast Usually Appropriate ☢☢☢ MRI abdomen and pelvis without and with IV contrast Usually Appropriate O US abdomen May Be Appropriate O MRI abdomen and pelvis without IV contrast May Be Appropriate O CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢ Radiography abdomen May Be Appropriate ☢☢ FDG-PET/CT skull base to mid-thigh Usually Not Appropriate ☢☢☢☢ In-111 WBC scan abdomen and pelvis Usually Not Appropriate ☢☢☢☢ Tc-99m cholescintigraphy Usually Not Appropriate ☢☢ Tc-99m WBC scan abdomen and pelvis Usually Not Appropriate ☢☢☢☢ Fluoroscopy upper GI series with small bowel follow-through Usually Not Appropriate ☢☢☢ Fluoroscopy contrast enema Usually Not Appropriate ☢☢☢

 

[Angry Birds]

Is it available as an app for iPhone?

 

[thegenius]

Those ACRs are useless...if I had to read those on shift I would throw them away. If I had to read those at home, I would crumble them up and use them to start my mini BBQ as kindling.

 

[Rads Consult]

Is it available as an app for iPhone?

It’s a progressive web application (PWA) bc native apps limit functionality and scale. If you open the website on safari on your phone, it should give you a prompt to click a button on the bottom of your browser, scroll over, and tap “Add to Homescreen” button and then it functions exactly like an app with an icon on your phone or tablet, and is available without internet access. For periodic updates to content, you need to log out and log back in though, but that only takes 2s if your passwords are saved.

Hope that helps!

 

[jjstudentdoc]

Those ACR criteria are weird. Why would they do that?

 

[bravotwozero]

anyone have any clue what the hell stealth protocol is for brain MRIs? it always asks me on Epic if I want a stealth protocol for my brain MRI. I've asked our in house radiologists and even they don't know...

 

[thumbz]

I don't post here often anymore, but I need to say thank you for this. Most common question I get from residents is "should I order this with or without contrast?"

Thank you again!

 

[gutonc]

anyone have any clue what the hell stealth protocol is for brain MRIs? it always asks me on Epic if I want a stealth protocol for my brain MRI. I've asked our in house radiologists and even they don't know...

Stealth is a neurosurgical planning/execution tool (software and hardware) that uses MRI and CT imaging to help navigate all those important fiddly bits up in the cranium.

It's something that only the neurosurgeons really use. It's not a protocol done for diagnosis, only for planning and, although the radiologists at my site read the scans (because...boat payments), they usually make sure to include a snarky comment like "unchanged from the MRI done 3 days prior, unclear indication for repeat imaging".

 

[Rads Consult]

anyone have any clue what the hell stealth protocol is for brain MRIs? it always asks me on Epic if I want a stealth protocol for my brain MRI. I've asked our in house radiologists and even they don't know...

Good answer by @bravotwozero. Also, CT Simulation is a similar concept if you ever see that pop up in your EMR

 

[Rads Consult]

That comes from the ACR appropriateness criteria which strongly recommends non-contrast CT over contrast CT for acute onset flank pain with suspicion for kidney stones. The recommendation for undifferentiated or non-localizing abdominal pain is generally to use IV contrast but also recognizes that the decision should be made based on history and lab findings.

https://acsearch.acr.org/docs/69467/Narrative/
https://acsearch.acr.org/docs/69362/Narrative/

I generally will defer to the appropriateness criteria when deciding which test to order unless I have a specific reason to do something different.

The site has recently been updated with more content and all applicable American College of Radiology (ACR) Appropriate Use Criteria (AUC) is linked to each diagnosis, when available, if you want a reference for the recommendation. Of course, [WEBSITE REMOVED] has many more diagnoses and imaging work ups than there are AUCs available. The rest of the recommendations come from fellowship trained radiologists from each section. I hope you find this helpful. Thanks.

 

[enalli]

Thank you for making this. Two (unimportant) questions:
1. What's the story behind the logo?
2. Are you maintaining this with your personal money? If you are in academics I'm sure you could get some institutional support.

 

[Rads Consult]

Thank you for making this. Two (unimportant) questions:
1. What's the story behind the logo?
2. Are you maintaining this with your personal money? If you are in academics I'm sure you could get some institutional support.

Thanks for using it. It's something med ed is extremely deficient in and it causes a lot of issues down the road.

1. No story. I made it and thought it looked cool. Half brain and half electric circuit.

2. Yea, it's all personal investment and time. And it will continue to be FREE forever. My current job has flexible hours and gives me a good amount of down time. I wouldn't make this if I was in academics because most academic programs and many private practices have contract clauses that they own anything you do while you work for them even if you don't use any of their resources or time. Pretty ridiculous that even exists and that it's so routine everywhere.

I'd be happy to work with an institution, but many of them want their stamp on it and I'd rather just build a quality product and focus on the end user rather than try to please hospital administration, which is why I posted here. That's where I think other radiology decision support systems have gone awry - trying to comply with hospital, EMR, and CMS infrastructure and policies. I'd love to share it with the FP and IM boards, but that's not allowed...

 

[namethatsmell]

the radiologists at my site read the scans (because...boat payments), they usually make sure to include a snarky comment like "unchanged from the MRI done 3 days prior, unclear indication for repeat imaging".

Experientially, I've found people who put crap like this in the patient's chart strongly trend towards douche bag.

Don't these fools realize they're a) biting the hand that feeds them (and said boat payments) and b) inviting an insurance utilization reviewer to deny payment?

And in the event of some sort of bad outcome this stuff becomes radioactive in the hands of an attorney.

 

[Rads Consult]

Experientially, I've found people who put crap like this in the patient's chart strongly trend towards douche bag.

Don't these fools realize they're a) biting the hand that feeds them (and said boat payments) and b) inviting an insurance utilization reviewer to deny payment?

And in the event of some sort of bad outcome this stuff becomes radioactive in the hands of an attorney.

I agree. I think "chart wars" are a no win situation for both sides and fodder for lawyers.

But, I also think that crappy attitude stems from a frustration with the amount of overutillization of resources. You have to admit that if you read 30 CTs for gastroenteritis, you'd probably be like wtf are we doing here and what am I doing with my life? It's complicated for sure. And yes, I have read easily 1,000 diarrhea belly CTs, PE studies on 18yr olds with no risk factors, or Head CTs on drunk guys who fall over. It's frustrating to have no control and ask yourself "This is what I trained for?"

Defensive medicine - I've had ER docs tell me "listen, i know this person doesn't have cauda equina, but i'm not willing to risk my medical license for it. call in the overnight MRI tech."

Malaligned incentives - hospitals want to be full and want us to admit everything, ER docs favor throughput and dispo over full work up, medicine docs not wanting admits until full work up is complete even though that's not really the job of the ER, and patients not having "emergencies" coming to the ER for various reasons.

Those are just my top 2. I think every physician burns out or loses it from time to tome, but the problem is that every mistake a radiologist makes is documented and saved forever including those childish outbursts of "No change and study is the same as the 10 priors, consider not scanning next time." Let's focus on the root cause instead of symptom of the doc who (inappropriately) lashes out in frustration to a system that is seriously flawed. I mean just the fact an ER doc has to "sell" an admit is a testament to how messed up it is out there.

There's actually good people on both sides this time