Page 130 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
13 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
A CXR is also helpful in excluding other causes of chest pain but a normal CXR does not exclude the diagnosis of aortic dissection.
Contrast enhanced spiral CT scan is the initial investigation of choice for the evaluation of suspected spontaneous aortic dissection.
Echocardiography is very rarely used as the first line imaging modality.
Abdominal Aortic Aneursym (AAA) Rupture or Leak
As indicated in the abdominal pain algorithm, a bedside ultrasound scan performed by an Emergency Physician is the best initial investigation to screen for an abdominal aneurysm.
CT may be indicated if the USS is negative and there remains diagnostic uncertainty.
Ultrasound is the first line modality for follow up of abdominal aortic aneurysms. CT angiography is used in patients with aneurysms >5 cm in diameter to guide surgery or endoluminal repair.
Arthritis, Joint Disease and Osteoporosis
The new National Community Radiology Access Criteria have very reasonable recommendations for imaging in suspected joint disease. They focus on red flags and when imaging is not typically indicated and emphasize the importance of considering whether the result will change management.
The following 10 key recommendations for imaging in rheumatoid arthritis are taken from the Ann Rheum Dis 2013;0:1–11. They were developed using the limited research-based evidence available (level of evidence shown) and expert opinion.
MRI requests in rheumatoid arthritis must be endorsed by a consultant rheumatologist.
Note that Waikato Hospital does not have a DEXA scanner. Limited funding is available for private scans. Requests are co-ordinated by the medical managers. Requests must be endorsed by a SMO.