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Appropriateness criteria headache-UPR
1.
Headaches: An Evidence
Based Imaging Approach Jorge A Vidal, MD Adjunct Professor of Radiology Edgar Colon Negron, MD Director Diagnostic Radiology UPR-RCM
2.
3.
Magnetic Resonance Imaging
(MRI)
4.
Digital Substraction Angiography
(DSA)
5.
Positron Emission Tomography
(PET)
6.
Single Positron Emission
Computed Tomography (SPECT)
7.
Ultrasound (US)
8.
Radiographs
9.
10.
Magnetic Resonance Imaging
(MRI)
11.
Digital Substraction Angiography
(DSA)
12.
Positron Emission Tomography
(PET)
13.
Single Positron Emission
Computed Tomography (SPECT)
14.
Ultrasound (US)
15.
Radiographs
16.
17.
18.
Space-occupying lesions
19.
MDCT can do
angiography
20.
21.
HIGH RADIATION DOSE
22.
Costly $$, but
lower than MRI
23.
Subdural Hematoma
24.
25.
26.
Infections, inflammatory processes
27.
Physiologic information (Spectroscopy)
28.
29.
Costly $$$
30.
Long imaging time
31.
Aneurysms
32.
MR Spectroscopy
33.
34.
35.
36.
37.
High radiation dose
38.
39.
40.
Epilepsy studies
41.
Cancer and other
tumors
42.
HIGH RADIATION DOSE
43.
44.
Radiographs There is
NO appropriate reason for the use of skull films for the evaluation of headaches!
45.
46.
47.
Pregnant?
48.
History of cancer,
rapid weight loss?
49.
Neurological deficits or
new symptoms?
50.
Recent travel destinations?
51.
52.
53.
“ Worst headache
of my life”
54.
In some studies
up to 47% had a Subarachnoid hemorrhage.
55.
56.
Subarachnoid Hemorrhage
57.
Aneurysm
58.
59.
60.
61.
62.
CTA and MRA
63.
64.
New-onset headache in
temple region
65.
Tender superficial temporal
artery
66.
67.
Temporal Arteritis Copyright
© 2007 by the American Roentgen Ray Society Bley, T. A. et al. Am. J. Roentgenol. 2005;184:283-287
68.
69.
Assess for neurological
symptoms
70.
71.
Hydrocephalus
72.
73.
Extra-axial Mass
74.
Extra-axial Mass
75.
Sellar Mass
76.
77.
Lymphoma
78.
Lymphoma
79.
80.
Toxoplasmosis
81.
82.
83.
84.
85.
Pregnant patients
86.
Retina
87.
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