Radiology and MS3

Transition Clerkship 2013

Dr. Claire B. Wilcox
UNC Department of Radiology
Radiology and You
Where is the Radiology department?
What is your job?
How do you contact us?
Ordering studies
Learn to use Impax - PACS
UNC Health Care Hospitals
NC Memorial, Womens, and Childrens
NC Childrens, NeuroSci/ED & NC Cancer Hospital
We have Radiology sections in all the hospitals,
some in the basements
UNC Imaging and Spine Center on Hwy 54
And also in off-campus locations such as...
Outpatients check-in first in
Womens Hospital Lobby, then
take elevators to Basement.
Then adult outpatients
check-in at Womens
Hospital basement.
You could find us that
way too.
Or find us by following
hallway signs.
Childrens Radiology Reception is in
Basement of Childrens Hospital

Take halls or Childrens Hosp elevators
Check-in at NC Cancer Hospital Basement for
PET-CT Scan, Mammography and some CT scans.
Check-in at 2
nd
floor,
NC Memorial Hospital
Vascular Interventional Radiology (VIR) and
Neuro Interventional Radiology (NIR):
Inpatients can be brought to our department.
And you might accompany them!
VIR rooms are
like ORs.

Scrubs or
bunny suits
needed.
We have holding areas for observing
patients after procedures, biopsies.
Standard x-ray rooms
& Fluoroscopy rooms
with tilt-tables
There are many lead
aprons available, so
come on down!!
Or you can
protect yourself
by standing
behind the leaded panels or
leaded windows.
Patients come
in all ages
and
patients
come in all
sizes.
We strive for
excellent
images on
all patients.

Here CXR in
PA
projection.
Our techs and
nurses are
essential to your
patients care.
We have friendly residents and faculty
who are happy to assist you.
MS3 -What is YOUR job?
Learn where Radiology dept is.

Know how to find phone numbers
you need.

Call us with any questions.





The numbers to call?

Look in the online directory.
http://directory.unch.unc.edu/webdirectory/

Basic Search: Type Radiology in Last Name field.

On Call Schedule: Type Radiology (day)

After Hours: 6-8850 to talk to Resident On Call
We will be glad to answer your questions.
Refresh your knowledge of
anatomy. Go Online!

Think Anatomy Radiology
MS3 -What is YOUR job?
Review the
anatomy you
have studied.
Knowing the
Anatomy is crucial
when looking at
studies.
Trauma patient with markedly elevated
Stomach from ruptured left hemidiaphragm
Compare with Normal other patient
Coronal CT slices
S
S
Child after Car
Accident
CXR shows air
lucency in right
pleural space and
collapsed right
lung.
(Also Left lung contusion.)

Large Right
Pneumothorax
separates visceral
and parietal
pleura.
Radiology Education Tools
http://www.radiologyeducation.com/
Links to many sites, tutorials, etc.


http://eradiology.bidmc.harvard.edu/
Excellent tutorials and teaching files


www.med-ed.virginia.edu/courses/rad/
Terrific tutorials and exercises






MS3 -What is YOUR job?
Understand why Rad study is needed.
Find the correct test:
Call us or look at
American College of Radiology
Appropriateness Criteria
http://www.acr.org/Quality-
Safety/Appropriateness-Criteria
What - Why - How
Large Right Pleural Effusion
No Left Pleural Effusion
Not sure?
Change Positions - Go Decubitus!
Right Lateral Decubitus
R Dec
MR Scans can show us anatomy and movement by
linking images into video sequences.
Bicuspid stenotic aortic valve
MS3 -What is YOUR job?
Learn what Radiology needs to know:

Question to be answered by study

Pertinent history

Creatinine level if contrast is needed

Is Prep needed? NPO?


NPO for Ultrasound of GB
Pneumoperitoneum Post-op
Metastatic Breast Cancer
THINK: What information might
be useful for selecting and
interpreting the study?
Previous surgery / lobectomy / radiation?
Complications?

Other medical conditions: HIV, DM, etc?

Current symptoms or signs?

Call us with any questions!
Patient with
HIV/AIDS

Now short of
breath
Hazy
opacities in
both lungs
Chest CT Scan to better evaluate the lungs
and to plan bronchoscopy.
Ground-glass opacities
bilaterally.

In this case, opportunistic
pneumonia from
Pneumocystis Carinii, PCP.
Some recent reasons given for CXR.
Preop
Research
Fell on 14
th
Street
682.7
Sudden onset chest pain
Gored by bull
Pt in lobby
Fever, cough

N
201442
Short of breath
New
Routine
Swallowed spoons
Hemoptysis
707.14

Which reasons are genuinely helpful?
Ordering Radiology Studies



In Radiology
department

or..



Some patients cannot be
transported, so studies must
be done Portably
in patients room.
..at the bedside?
Portable Machines can
go all over the hospital
and into the OR too.
Ordering Radiology Studies

Routine: Performed same day

Expedite: Within 45 minutes
Urgent

STAT: Within 15 minutes
Life-threatening med emergency
MS3 -What is YOUR job?
Once the study is done:


Review study on PACS (Impax)
Or on WebCis

Read the radiologists report.

Call or come ask for help if needed.


Come on in to the Reading Rooms and talk to us!
We love
meeting you
and getting
more info
about your
patients
Especially about
complicated
patients.
PET-CT scan
combines images
to locate areas
of high metabolism
such as tumors
or infections.
Left lung mass
and multiple other
metastases
are identified.

Bladder
M
M
Many conferences
are held in our Main
Radiology Conference
room, WH Basement
We will see
you there!
We read everything on computers now
So you need to
learn to use
Impax!
PACS is our Picture Archiving Computer System.
On the patient floors.
Computers are
everywhere.
There are many icons,
And some look like the right
One..BUT
DONT USE THIS ONE!
Find the CSG icon
to access the Citrix Portal
Double click the icon.

https://csg.unch.unc.edu

(Or in Internet Explorer
address line, Type
To get to the Citrix Portal)
You will see this: Citrix Portal Page
Login: User Name: your AD ID (e.g.: cwilcox)

Password: 00 plus your 9 digit PID (makes 11 characters)

ISD Help Desk phone is 6-5647.
Then you see your Main Citrix Folders
Click on Impax folder
The PACS folder icon should change to this:
Double click on the Impax icon.
You will see this window (eventually):
Some helpful phone numbers there.
Pay attention to the Domain name.
It must be UNCH for you.
If not, change it with the drop-down arrow..
Then type in your same User ID and Password.
Call 6-7227 (6-PACS) or ISD 6-5647
if you need help.
To start a Search,
you put in the information to find a study.
Start with
Study Date.
Using the drop-down menu is convenient.
Selecting Any study date can prolong the search.
Then add MRN* or Patient Last, First Name.
* MRN can be with or without the Check-Digit.
Then click Search on the right.
The study list will appear.
Highlight what you want to see.
Right Click and select Cycle.
Patient Name
Med Rec #
Age

Patient Name
Date
Time
Patient Name
Patient Name
Med Rec #
Age



Patient Name
Hit Text to see list
of all studies on the
patient, and to see
report.
Study List
Report
You can click Exit
when you are done
to return to the Search
page.
Logout when you are done always!
Todays Date here
Please try it!
Youll like it.
https://csg.unch.unc.edu

Remember

6-PACS
6-7227

For help
Call em!
MS3 -What is YOUR job?
Learn where Radiology dept is.

Know how to find phone numbers
you need.

Call us with any questions.





Refresh your knowledge of anatomy.
Go Online or back to the books!

Understand why Rad study is
needed.

Understand the question being
asked.




MS3 -What is YOUR job?
MS3 -What is YOUR job?
Once the study is done:


Review study on PACS (Impax)


Read the radiologists report.

Call or come ask for help if needed.


Ask for help. We all do!
Thanks for
Your
Attention!
Good
Luck!
Radiology Education Tools
http://www.radiologyeducation.com/
Links to many sites, tutorials, etc.

http://eradiology.bidmc.harvard.edu/
Excellent tutorials and teaching files

www.med-ed.virginia.edu/courses/rad/
Terrific tutorials and exercises

http://www.acr.org/Quality-Safety/Appropriateness-Criteria
What study When and Why