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Introduction to Neuroimaging
Introduction to Neuroimaging Aaron S. Field, MD, PhD Assistant Professor of Radiology Neuroradiology Section University of Wisconsin–Madison Updated 7/17/07 Neuroimaging Modalities Radiography (X-Ray) Magnetic Resonance (MR) Fluoroscopy (guided procedures) • MR Angiography/Venography (MRA/MRV) • Angiography • Diffusion and Diffusion Tensor • Diagnostic MR • Interventional • Perfusion MR • Myelography • MR Spectroscopy (MRS) Ultrasound (US) • Functional MR (fMRI) • Gray-Scale Nuclear Medicine ―Duplex‖ • Color Doppler • Single Photon Emission Computed Tomography (SPECT) Computed Tomography (CT) • Positron Emission Tomography • CT Angiography (CTA) (PET) • Perfusion CT • CT Myelography Radiography (X-Ray) Radiography (X-Ray) Primarily used for spine: • Trauma • Degenerative Dz • Post-op Fluoroscopy (Real-Time X-Ray) Fluoro-guided procedures: • Angiography • Myelography Fluoroscopy (Real-Time X-Ray) Fluoroscopy (Real-Time X-Ray) Digital Subtraction Angiography Fluoroscopy (Real-Time X-Ray) Digital Subtraction Angiography Digital Subtraction Angiography Indications: • Aneurysms, vascular malformations and fistulae • Vessel stenosis, thrombosis, dissection, pseudoaneurysm • Stenting, embolization, thrombolysis (mechanical and pharmacologic) Advantages: • Ability to intervene • Time-resolved blood flow dynamics (arterial, capillary, venous phases) • High spatial and temporal resolution Disadvantages: • Invasive, risk of vascular injury and stroke • Iodinated contrast and ionizing radiation Fluoroscopy (Real-Time X-Ray) Myelography Lumbar or -
Radiation Protection Guidance for Diagnostic X Rays
Disclaimer - For assistance accessing this document or additional information, please contact [email protected]. EPA 520/4-76-019 FEDERAL GUIDANCE REPORT NO. 9 RADIATION PROTECTION GUIDANCE FOR DIAGNOSTIC X RAYS ENVIRONMENTAL PROTECTION AGENCY INTERAGENCY WORKING GROUP ON MEDICAL RADIATION FEDERAL GUIDANCE REPORT NO. 9 RADIATION PROTECTION GUIDANCE FOR DIAGNOSTIC X RAYS Interagency Working Group on Medical Radiation U.S. Environmental Protection Agency Washington, D.C. 20460 October 1976 PREFACE The authority of the Federal Radiation Council to provide radiation protection guidance was transferred to the Environmental Protection Agency on December 2, 1970, by Reorganization Plan No. 3. Prior to this transfer, the Federal Radiation Council developed reports which provided the basis for guidance recommended to the President for use by Federal agencies in developing standards for a wide range of radiation exposure circumstances. This report, which was prepared in cooperation with an Interagency Working Group on Medical Radiation formed on July 5, 1974, constitutes a similar objective to provide the basis for recommendations to reduce unnecessary radiation exposure due to medical uses of diagnostic x rays. The Interagency Working Group developed its recommendations with the help of two subcommittees. The Subcommittee on Prescription of Exposure to X rays examined factors to eliminate clinically unproductive examinations and the Subcommittee on Technic of Exposure Prevention examined factors to assure the use of optimal technic in performing x-ray examinations. Both subcommittees also considered the importance of appropriate and properly functioning equipment in producing radiographs of the required diagnostic quality with minimal exposure. Reports by these subcommittees were made available for public comment. -
Neurological Critical Care: the Evolution of Cerebrovascular Critical Care Cherylee W
50TH ANNIVERSARY ARTICLE Neurological Critical Care: The Evolution of Cerebrovascular Critical Care Cherylee W. J. Chang, MD, FCCM, KEY WORDS: acute ischemic stroke; cerebrovascular disease; critical FACP, FNCS1 care medicine; history; intracerebral hemorrhage; neurocritical care; Jose Javier Provencio, MD, FCCM, subarachnoid hemorrhage FNCS2 Shreyansh Shah, MD1 n 1970, when 29 physicians first met in Los Angeles, California, to found the Society of Critical Care Medicine (SCCM), there was little to offer for the acute management of a patient suffering from an acute cerebrovascular Icondition except supportive care. Stroke patients were not often found in the ICU. Poliomyelitis, and its associated neuromuscular respiratory failure, cre- ated a natural intersection of neurology with critical care; such was not the case for stroke patients. Early textbooks describe that the primary decision in the emergency department was to ascertain whether a patient could swallow. If so, the patient was discharged with the advice that nothing could be done for the stroke. If unable to swallow, a nasogastric tube was inserted and then the patient was discharged with the same advice. In the 50 intervening years, many advances in stroke care have been made. Now, acute cerebrovascular patients are not infrequent admissions to an ICU for neurologic monitoring, observa- tion, and aggressive therapy (Fig. 1). HISTORY Over 50 years ago, stroke, previously called “apoplexy” which means “struck down with violence” or “to strike suddenly,” was a clinical diagnosis that was confirmed by autopsy as a disease of the CNS of vascular origin (1). In the 1960s, approximately 25% of stroke patients died within 24 hours and nearly half died within 2 to 3 weeks. -
Intracranial Cerebrovascular Evaluations: Transcranial Doppler
VASCULAR TECHNOLOGY PROFESSIONAL PERFORMANCE GUIDELINES Intracranial Cerebrovascular Evaluations: Transcranial Doppler Ultrasound and Transcranial Color Duplex Imaging This Guideline was prepared by the Professional Guidelines Subcommittee of the Society for Vascular Ultrasound (SVU) as a template to aid the vascular technologist/sonographer and other interested parties. It implies a consensus of those substantially concerned with its scope and provisions. The guidelines contain recommendations only and should not be used as a sole basis to make medical practice decisions. This SVU Guideline may be revised or withdrawn at any time. The procedures of SVU require that action be taken to reaffirm, revise, or withdraw this Guideline no later than three years from the date of publication. Suggestions for improvement of this guideline are welcome and should be sent to the Executive Director of the Society for Vascular Ultrasound. No part of this guideline may be reproduced in any form, in an electronic retrieval system or otherwise, without the prior written permission of the publisher. Sponsored and published by: Society for Vascular Ultrasound 4601 Presidents Drive, Suite 260 Lanham, MD 20706-4831 Tel.: 301-459-7550 Fax: 301-459-5651 E-mail: [email protected] Internet: www.svunet.org Copyright © by the Society for Vascular Ultrasound, 2019 ALL RIGHTS RESERVED. PRINTED IN THE UNITED STATES OF AMERICA. VASCULAR PROFESSIONAL PERFOMANCE GUIDELINE Updated January 2019 Intracranial Cerebrovascular Evaluation s: TCD and TCDI 01/2019 PURPOSE Transcranial Doppler ultrasound (TCD) and transcranial color duplex imaging (TCDI) studies measure blood flow velocities and direction within portions of the intracranial arteries. TCD and TCDI evaluate the anterior and posterior circulation territories to assess and manage patients with cerebrovascular disease. -
Pneumoencephalographic Planimetry in Neurological Diseaset
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.32.3.241 on 1 June 1969. Downloaded from J. Nearol. Neurosurg. Psychiat., 1969, 32, 241-248 Pneumoencephalographic planimetry in neurological diseaset H. E. BOOKER, C. G. MATTHEWS, AND W. R. WHITEHURST2 From the Epilepsy Center and Department of Neurology, University of Wisconsin, Madison, Wisconsin, U.S.A. The outline of the ventricular system on the In the present investigation planographic rather pneumoencephalogram (PEG) can be easily than linear measures of ventricular size were used. measured and lends itself to quantification. Several The subjects were not selected on the basis of a methods have been developed which utilize linear particular aetiology nor on the basis of presence or measures of the ventricles, or ratios of ventricle to absence of asymmetry of the lateral ventricles. skull size. Planographic measurements of the area of Detailed clinical and electroencephalographic data the ventricles have been employed in a few studies, were available on all subjects for purposes of but have generally been dismissed as too cumber- diagnostic classification, and, in addition, a stan- some for use (Bruijn, 1959). dardized battery of neuropsychological tests pro- While a number of previous investigators have viding quantitative measurement of intellectual and Protected by copyright. related quantitative PEG findings to clinical motor-sensory status was administered to the neurological and psychometric data, most studies majority of the subjects. PEG data on a group of have suffered from one or more limitations. Studies subjects without clinical, neurological, or electro- reporting measurements on a large number of PEGs encephalographic evidence of neurological disease have usually been limited in amount and specificity were also included for comparison purposes. -
2Nd Quarter 2001 Medicare Part a Bulletin
In This Issue... From the Intermediary Medical Director Medical Review Progressive Corrective Action ......................................................................... 3 General Information Medical Review Process Revision to Medical Record Requests ................................................ 5 General Coverage New CLIA Waived Tests ............................................................................................................. 8 Outpatient Hospital Services Correction to the Outpatient Services Fee Schedule ................................................................. 9 Skilled Nursing Facility Services Fee Schedule and Consolidated Billing for Skilled Nursing Facility (SNF) Services ............. 12 Fraud and Abuse Justice Recovers Record $1.5 Billion in Fraud Payments - Highest Ever for One Year Period ........................................................................................... 20 Bulletin Medical Policies Use of the American Medical Association’s (AMA’s) Current Procedural Terminology (CPT) Codes on Contractors’ Web Sites ................................................................................. 21 Outpatient Prospective Payment System January 2001 Update: Coding Information for Hospital Outpatient Prospective Payment System (OPPS) ......................................................................................................................... 93 he Medicare A Bulletin Providers Will Be Asked to Register Tshould be shared with all to Receive Medicare Bulletins and health care -
Esotropia: Unusual Complication of Myelography and Pneumoencephalography
278 Esotropia: Unusual Complication of Myelography and Pneumoencephalography Harris Newmark 111,1 Norman Levin,2 Richard K. APV and Jack D. Wax2 Myelography and pneumoencephalography are invasive years later showed occasional diplopia on left gaze. The patient procedures with many complications. We report two cases was asymptomatic 10 years later. of esotropia that developed 8 and 7 days after a Pantopaque myelogram and a pneumoencephalogram, respectively. For Discussion tunately, the esotropia was temporary in both cases. This rare complication, of which very few radiologists are aware, These cases are interesting in that they illustrate that was presumably secondary to the lumbar puncture per esotropia can be a complication of myelography and pneu formed for the procedure. moencephalography, although it is extremely rare. It has been reported to be a complication in 0.25%-1.00% of lumbar punctures [1 , 2], but we believe it is much rarer Case Reports since none of us, or any of our colleagues, could recall a Case 1 similar episode. The probable pathogenesis is that cerebrospinal fluid A 27-year-old man had a lumbar myelogram for a suspected leaks through the dura at the puncture site. The cerebro herniated nucleus pulposus at L5-S1 which caused right-sided leg spinal fluid pressure is less in the lumbar region than in the pain . The lumbar puncture was performed with ease on the first attempt with an 18 gauge spinal needle. The cerebrospinal fluid intracranial area after this procedure. Subsequently the was clear and the laboratory test results were normal except for a brain stem shifts caudally and the cranial nerves are slightly slight elevation of protein. -
A-Scan Echoencephalography in Measurement of the Cerebral Ventricles
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.31.3.245 on 1 June 1968. Downloaded from J. Neurol. Neurosurg. Psychiat., 1968, 31, 245-249 A-scan echoencephalography in measurement of the cerebral ventricles ANAND G. GARG AND ALEX. R. TAYLOR From the Department ofNeurological Surgery, Royal Victoria Hospital, Belfast, Northern Ireland The first attempts at ultrasonic visualization of the METHOD cerebral ventricles were made by Dussik (1948), The ventricular measurements obtained at echoen- Ballantine, Ludwig, Bolt, and Hueter (1950), and cephalography were compared with the x-ray measure- Hueter and Bolt (1951), using the transmission ments made at pneumoencephalography. method. The possible use of the pulse-echo method ANATOMICAL CONSIDERATIONS The third and lateral (echoencephalography) for the diagnosis of hy- ventricles are supratentorial structures. The third ventricle lies between the two thalmi, communicating drocephalus was suggested by Leksell (1956). Later in front with the lateral ventricles through the inter- Kikuchi, Uchida, Tanaka, and Wagai (1957) and de ventricular foramina and behind with the aqueduct of Vlieger and Ridder (1959) recorded echoes from the the midbrain. The septum lucidum and the third ventricle walls of the lateral ventricles. According to Gordon lie in the central plane of the brain. Protected by copyright. (1959), and de Vlieger and Ridder (1959), the width The lateral ventricle is a C-shaped cavity lying within of the third ventricle can also be measured. ter the cerebral hemisphere. It consists of a central body and Braak, Crezde, Grandia, and de Vleger (1961) used three horns-anterior, posterior, and temporal-running pneumoencephalography to study the origin of into the frontal, occipital, and temporal lobes respec- ventricular echoes. -
Neuroradiology Back to the Future: Brain Imaging
Published December 8, 2011 as 10.3174/ajnr.A2936 50TH ANNIVERSARY PERSPECTIVES Neuroradiology Back to the Future: Brain Imaging E.G. Hoeffner SUMMARY: The beginning of neuroradiology can be traced to the early 1900s with the use of skull S.K. Mukherji radiographs. Ventriculography and pneumoencephalography were introduced in 1918 and 1919, re- spectively, and carotid angiography, in 1927. Technical advances were made in these procedures A. Srinivasan during the next 40 years that lead to improved diagnosis of intracranial pathology. Yet, they remained D.J. Quint invasive procedures that were often uncomfortable and associated with significant morbidity. The introduction of CT in 1971 revolutionized neuroradiology. Ventriculography and pneumoencephalogra- phy were rendered obsolete. The imaging revolution continued with the advent of MR imaging in the early 1980s. Noninvasive angiographic techniques have curtailed the use of conventional angiography, and physiologic imaging gives us a window into the function of the brain. In this historical review, we will trace the origin and evolution of the advances that have led to the quicker, less invasive diagnosis and resulted in more rapid therapy and improved outcomes. ABBREVIATIONS: CPA ϭ cerebellopontine angle; EDH ϭ epidural hematoma; LP ϭ lumbar punc- ture; NMR ϭ nuclear magnetic resonance; SDH ϭ subdural hematoma fforts to image the CNS began with skull radiographs duced by trauma, surgery, or infection.3 Skull radiographs Eshortly after Roentgen’s discovery of x-rays.1-3 In the early were also used to diagnose fractures and foreign bodies.9 20th century, contrast studies of the brain, by using air for Obtaining a single skull radiograph took minutes, with the contrast, were developed with the introduction of ventriculog- radiograph being produced on a glass plate with a slowly re- raphy and pneumoencephalography.4,5 Shortly thereafter, ce- sponding photographic emulsion. -
June-July 2000 Part a Bulletin
In This Issue... Disclosure of Itemized Statement Providers Must Furnish an Itemmized Statement when Requested in Writing by the Beneficiary .................................................................................................... 6 Prospective Payment System The Outpatient Code Editor Software Has Been Modified in Preparation for the Implementation of Outpatient Prospective Payment System ........................... 8 Reclassification of Certain Urban Hospitals Certain Urban Hospitals in the State of Florida May Be Permitted to Be Reclassified as Rural Hospitals................................................................................ 13 ulletin Final Medical Review Policies 33216, 53850, 70541, 82108, 83735, 87621, 93303, 94010, 95004, A0320, J0207, J2430, J2792, J3240, J7190, and J9999 .......................................... 15 B Payment of Skilled Nursing Facility Claims Involving a Terminating Medicare+Choice Plan Payment of Skilled Nursing Facility Care for Beneficiaries Involuntarily Disenrolling from M+C plans Who Have Not Met the 3-Day Stay Requirement ........................................................................................... 67 Features From the Medical Director 3 Administrative 4 lease share the Medicare A roviders PBulletin with appropriate General Information 5 members of your organization. Outpatient Prospective Payment System 7 Routing Suggestions: General Coverage 12 o Medicare Manager Hospital Services 13 o Reimbursement Director Local and Focused Medical Policies 15 o Chief Financial -
Cranial Or Head Ultrasound
Cranial Ultrasound/Head Ultrasound Ultrasound imaging of the head uses sound waves to produce pictures of the brain and cerebrospinal fluid. It is most commonly performed on infants, whose skulls have not completely formed. A transcranial Doppler ultrasound evaluates blood flow in the brain's major arteries. Ultrasound is safe, noninvasive, and does not use ionizing radiation. This procedure requires little to no special preparation. Your doctor will instruct you on how to prepare, including whether adults undergoing the exam should refrain from using nicotine-based products that may cause blood vessels to constrict. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown. What is cranial ultrasound? Head and transcranial Doppler are two types of cranial ultrasound exams used to evaluate brain tissue and the flow of blood to the brain, respectively. Head Ultrasound A head ultrasound examination produces images of the brain and the cerebrospinal fluid that flows and is contained within its ventricles, the fluid filled cavities located in the deep portion of the brain. Since ultrasound waves do not pass through bone easily, this exam is most commonly performed on infants, whose skulls have not completely formed. The gaps between those skull bones provide a "window," allowing the ultrasound beam to freely pass into and back from the brain. The ultrasound probe and some gel are placed on the outside of the head in one of those regions without bone. Transcranial Doppler A transcranial Doppler (TCD) ultrasound evaluates both the direction and velocity of the blood flow in the major cerebral arteries of the brain. -
TCD CPT and ICD 10 Codes
TCD CPT Codes /ICD-10 Codes 2021 CPT Codes / ICD-10 Codes CPT codes covered if selection criteria are met: 93886 Transcranial Doppler study of the intracranial arteries; complete study 93888 limited study 93890 vasoreactivity study 93892 emboli detection without intravenous microbubble injection 93893 emboli detection with intravenous microbubble injection Other CPT codes related to the CPB: 61635 Transcatheter placement of intravascular stent(s), intracranial (eg, atherosclerotic stenosis), including balloon angioplasty, if performed REIMBURSEMENT INFORMATION: A complete transcranial Doppler evaluation includes ultrasound examination of the right and left anterior circulation and the posterior circulation, including the vertebral arteries and basilar artery. A limited transcranial Doppler evaluation includes two or less of the below mentioned areas. Excludes hand-held Dopplers that do not provide a hard copy or vascular flow bidirectional analysis. Includes complete transcranial Doppler (TCD) study. Includes patient care required to perform/supervise studies and interpret results. Includes ultrasound evaluation of right/left anterior circulation territories and posterior circulation territory. DWL USA, Inc. 30320 Rancho Viejo Road, Suite 105 San Juan Capistrano, CA 92675 www.dwl.us TCD CPT Codes /ICD-10 Codes 2021 ICD-10 Diagnosis Codes That Support Medical Necessity: D57.00 – D57.02 Hb-SS disease with crisis D57.1 Sickle-cell disease without crisis D57.20 Sickle-cell/Hb-C disease without crisis D57.211 – D57.219 Sickle-cell/Hb-C disease