Keeping it real and using science to explain

Radiology part 1

radiology part 1

Radiology part one: Interview with Dr. Ty Vachon, MD (click link to listen to the show)

We have over 205,000  Nurse Practitioners licensed in the U.S with many in the primary care role. Most all are ordering diagnostic testing. The information in this podcast is provided to educate the nurse practitioner and nursing student on diagnostic imaging.

  Dr. Cynthia Jaffe interviews radiologist, Dr. Ty Vachon.  A thank you to Dr. Rachel Danford and the Nurse Practitioner Show for allowing Dr. Jaffe the opportunity to guest host this episode.

I am very excited to be here hosting The Nurse Practitioner show because we have a very special guest, Dr .Ty Vachon, a leading Diagnostic radiologist at the Naval Medical Center in San Diego and an imaging informaticist. As an informaticist Dr. Vachon helps other primary care providers determine exactly which diagnostic test are needed for their patient.

What I would like to talk with you about today are a few controversial but important topics in radiology and then delve into a few specific radiology tests for the thyroid and kidney. The show notes and your recommendations are posted on The Nurse Practitioner Show’s blog at, so don’t worry about taking any notes and instead you can just sit back and listen and enjoy the show.

Talking points:

Patient engagement. Getting involved in our own health and wellness.

Access to the patient online health care portal

Knowledge gap between medical providers and radiologists

Should medical reports be ‘softened’ for patients who can access their report via the online patient health care portal?

Should the nurse practitioner add clinical context on an imaging requisition to assist the radiologist?

How can the radiologist add more now and what next value to the imaging report?

How should the nurse practitioner interpret the radiologist’s comment, “Clinical correlation recommended”?

What three important issues should you worry about when imaging a thyroid nodule?

American Thyroid Association guidelines-Mostly a cyst or solid? Any calcifications?

What size thyroid nodule should you be concerned with?

What if the nodule is mostly a cyst less than 1.5cm? Is there anything more to do?

Nodule is a mixed solid with some cysts and 1.5 cm or greater. Are we worried there is a risk for malignancy?

Is the size of the nodule and risk of malignancy age related? What if there is a history of risk factors?

In addition to imaging characteristics correlate nodule with Thyroid hormone values. Will thyroid hormone be abnormal when there is a nodule present?

Is there ever an indication to x-ray the thyroid?

Can ultrasound of the thyroid show micro-calcifications?

What do you expect in a thyroid nuclear scan if TSH is low and T3 is high, meaning the thyroid tissue is working too hard. Will you see nodules that are hotter than rest of the thyroid?

What imaging study is best for a thyroid nodule? Ultrasound, MRI, Doppler Ultrasound?

Who is a candidate for a thyroid nuclear scan? Does pregnancy contraindicate a thyroid nuclear scan?

What’s the nurse practitioner’s first line test for imaging the kidney for acute renal colic? CT or Ultrasound?

What if the patient has flank pain with hematuria? What is the cornerstone of imaging?

When ordering a CT scan for the kidney is that with or without contrast? What can contrast obscure?

Why is CT with contrast better if the stone gets stuck and there is pus buildup behind a kidney stone?

What is the indication for a KUB (kidney, ureter, bladder)?

If the calcific density of a kidney stone is in the 5-6 cm range can we see it on the KUB. Does it help to track the stone as it goes down? Is the KUB ordered often?

How much radiation do you get with CT vs X-ray?

If you have a clinical question that is important to answer, should we let our decision to use CT be effected by the amount of radiation the patient will receive? Is it better to choose a test with no radiation such as ultrasound?

6 yr old with stomach pain radiating and not eaten in 3-4 days-CT or Ultrasound?

How does radiation effect children? People under 30 or over 30 years old?

What is the difference between diagnostic ultrasound and treatment ultrasound in pregnancy? Is treatment ultrasound safe during pregnancy?


You can find more show notes and additional listening links for Apple, Android, and Stitcher radio at Accessible Health Institute








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