Health Management Solutions, The Woodlands, TX, 2003, $39.95
This is a concise, pocket-sized reference that describes the risks and benefits associated with a variety of imaging studies. The book is intended as a reference for primary care physicians, nurse practitioners, and physician assistants.
The first section discusses disease processes affecting individual organ systems in the adult, with special consideration given to psychiatric disorders, cancer, and trauma. A section on pediatric organ-based disease processes follows.
Under each disease process, the appropriate imaging studies, for further evaluation and work up, are listed, such as CT, MRI, plain-film, angiography, and nuclear medicine studies.
Using an easy to read and interpret table format, each procedure is evaluated by radiation dose in chest x-ray equivalents (based on PA view of the chest) and cost (based on Medicare reimbursement). The modalities are also assigned a score (0-5) for overall risk and overall benefit. This information is often followed by an explanation of an imaging exam’s particular utility, risk, or benefit.
The appendix provides a host of valuable references and offers direction for further evaluation. To compliment the chest x-ray equivalents in the main portion of the text, the appendix includes cigarette equivalents organized by anatomic area and modality. Multiple tables and graphs illustrate radiation doses.
This book will prove useful to radiologists when discussing alternative imaging exams with referring physicians. It also will have value for the referring physician when ordering exams, giving him or her some idea about limiting the number of imaging studies ordered, or the direct the evaluation of a specific disease process. Hopefully, this will decrease the risk of a patient enduring unnecessary tests, expedite diagnosis, and treatment and reduce cost.
Some statistics in this book that I’m skeptical of relate to the chances of developing a fatal malignancy after undergoing a single CT scan (1:2,000 for an adult; 1:1,200 for a child under age 15). This would equate to nearly one fatal malignancy being caused each month at our institution alone. I discussed this issue with our radiation physicist and the radiation physicist for radiation oncology. They agreed that Orrison’s figures are overstated.
Of course, there is some risk associated with radiation exposure, and imaging professionals recognize this with the principle of ALARA ("as low as reasonably achievable"). This principle must be communicated to our non-radiology colleagues in order to curb unnecessary imaging exams.
Medical Imaging Consultant is an accessible text that serves to educate other medical staff about the pros and cons of various modalities. It is everyone’s responsibility to protect the patient from avoidable adverse outcomes.
This book can also be used to acquire 1 credit of category 1 CME credit for a small fee.
By Dr. David DanielsonAuntMinnie.com contributing writer
October 20, 2003
Dr. Danielson is the chief resident in radiology at Madigan Army Medical Center, Fort Lewis, WA.
The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of Defense.
The opinions expressed in this review are those of the author, and do not necessarily reflect the views of AuntMinnie.com
Copyright © 2003 AuntMinnie.com
