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Radiology Review Abstract: Optometrists are becoming increasingly more comfortable ordering and interpreting imaging studies of the orbits and brain. This course goes beyond the visual system to present cutting edge technology in all areas of radiologic examinations. Clinical correlates for optometry are discussed using case examples. Outline I. Introduction A. About Radiology 1. How are radiological images produced? a) The various types of radiological procedures may be grouped by the means in which their images are produced: (1) Transmission imaging (2) Reflection imaging (3) Emission imaging 2. Glossary of terminology a) Angiography b) Barium c) Brachytherapy d) Computed tomography (CT) e) Fluoroscopy f) Gamma camera g) Magnetic resonance imaging (MRI) h) Mammogram i) Nuclear medicine j) Positron emission tomography (PET) k) Radiopaque/radiolucent l) Tomography m) Ultrasound n) X-ray 3. 4. 5. B. II. A brief history of radiology Safety issues, contraindications What to expect from an imaging exam (1) Localization of problem (2) Diagnostic value A Clinical Approach to Image Interpretation 1. Examine the patient 2. Determine possible cause of the problem 3. Select appropriate type of imaging study 4. Examine the image, noting type of scan, orientation, and limitations. I.e. "This is a coronal CT scan of the head done with IV contrast." 5. Note name and age on film to avoid mix-up 6. Identify and describe abnormal findings on image 7. Review common causes of abnormal findings, then prioritize differential diagnoses 8. Combine radiology findings with other clinical data to establish diagnosis Types of Radiological Examinations A. B. C. D. E. F. G. III. Angiography Mammography Computed Tomography (CT) Magnetic Resonance Imaging (MRI) Nuclear medicine Ultrasound X-rays (Diagnostic) Systems-specific Imaging Strategies A. B. C. D. Central Nervous System Cardiovascular System Genitourinary System Gastrointestinal System E. F. G. H. I. IV. Respiratory System Musculoskeletal System Ear, Nose, and Throat Breast Abdomen Clinical Correlates in Optometry: Case Examples A. Carotid Occlusive Disease 1. Angiography 2. Non-invasive vascular studies 3. Hollenhorst plaque 4. Ocular Ischemic Syndrome 5. Differential diagnosis of amaurosis fugax B. Sarcoidosis 1. Chest X-ray 2. CT of chest and abdomen a) Anterior/Posterior uveitis workup C. Thyroid Disease 1. Ultrasound techniques 2. Thyroid scan and Iodine uptake 3. EOM anatomy and actions 4. Thyroid ophthalmopathy a) Euthyroid Graves’ Disease D. Metastatic Disease 1. Ultrasound a) CT scan 2. Mammography 3. Metastatic disease to the orbit/lacrimal gland 4. Metastatic disease to the choroid E. Intracranial Hypertension 1. MRI of brain, orbits, sella a) Papilledema b) Pseudotumor Cerebri c) d) e) F. Arteriovenous malformation Compression Other causes Cerebral Hemisphere Lesions 1. CT of brain, visual pathway a) Space-occupying lesions b) Stroke c) Trauma d) Maldevelopment 2. MRI of brain, visual pathway a) Foster-Kennedy Syndrome b) Compression c) Other lesions 3. Demyelinating disease (Multiple Sclerosis) (1) INO/BINO (2) Optic neuropathy (3) Typical MRI findings (4) Atypical MRI findings Key Words Optic disc/nerve, Systemic Disease, Neurologic disease