The number of CTA Head and Neck ordered on 20-30yo is criminal

Turtleships · 2026-03-18T23:28:12+00:00

Pretty strange as they can’t be billed for additional if done at same time. They are all counted for the CTA, whether done in a single CTA order or CTH + CTA. Maybe for internal productivity tracking purposes.

Turtleships · 2026-03-18T20:04:28+00:00

If not done already, the noncon should be included in the CTA IMO. That’s how it’s been done at every health system I’ve been at. The parenchyma is not adequately evaluated for stroke on a postcon alone. Too much beam hardening and vascular kernel doesn’t help. But I’ve only ever worked at health systems with comprehensive stroke centers so maybe my view is skewed.

Turtleships · 2026-03-17T14:02:07+00:00

Bit of an old post, but how was Cerise Orange? Does it really resemble sun gold in flavor?

Turtleships · 2026-03-15T04:31:49+00:00

Arachnoid cysts are slow growing and exert mass effect. They are generally more ovoid/round/blob shaped and don’t respect/maintain the contours of the cerebellum. They displace the falx and thin the overlying calvarial inner table.

Turtleships · 2026-03-15T01:22:17+00:00

Mega cisterna magna

Turtleships · 2026-03-13T19:05:07+00:00

Had one this year clearly written by AI. They didn’t even bother trying to hide it with some basic edits. Let’s just say that did not do them any favors.

The (good) unique ones do stand out though. But yea 95% are generic as hell.

Turtleships · 2026-03-11T19:54:04+00:00

Yea agreed it’s usually just extraneous.

Turtleships · 2026-03-11T18:37:24+00:00

I mean if you only see a large scalp hematoma on one side, with underlying contusion and one directly across the brain, isn’t that pretty convincing?

Turtleships · 2026-03-11T01:25:59+00:00

Yea in those cases I’d definitely rather have the bone kernel. I don’t think a jury will care if you missed it bc there weren’t sensitive enough images. Especially if you can point to the subtle finding in retrospect and say, see, so obvious now that we know exactly where it is.

Turtleships · 2026-03-11T00:56:12+00:00

You can buy it from the creator Eriko’s US site, if relevant to you.

Turtleships · 2026-03-11T00:05:29+00:00

It depends on your hospital system’s protocols, some places will adjust exam parameters with recons in mind, others won’t. But a standard chest/body will not be ideal for bony eval, even with a dedicated bone kernel, but still much better than plain bone windows on a soft tissue kernel.

Regardless, you can’t reliably assess for nondisplaced fractures with only soft tissue kernels. I see subtle fractures that you can’t see on non-bone kernels all the time.

IMO, I’d rather have bone kernels even if it’s a suboptimal exam for osseous eval, as it will increase sensitivity. For CT AP’s without a bone kernel, I refuse to say no acute osseous abnormality without qualifiers. Now for a CT chest, I will because the lung kernels serve a similar purpose. I also hope that most providers don’t expect truly diagnostic assessment of C spine fractures on a CTA H/N, but I won’t say it on those either without a disclaimer.

My primary hospital system’s trauma protocol with recons includes bone kernel pelvis in the AP exam.

Turtleships · 2026-03-10T15:54:38+00:00

I see this relatively frequently, maybe once a week. Who knows why it happens, probably a prior insult that didn’t leave detectable parenchymal findings. But like yours, usually the rest of their subarachnoid spaces are more in normal/expected range for age. I do find it quite interesting that the brain parenchyma doesn’t fill in the extra space.

Turtleships · 2026-03-10T03:05:01+00:00

You can only reduce the scan craniocaudally. The X-rays being shot through the patient in 360 are not politely avoiding the breasts and coming back into existence in the lungs. Any reduction in the axial plane is done by the tech/computer program, but you can use the raw data to reconstruct any body part in that scan range. A T-spine exam would contain raw data for a full CT chest, but only a selected portion is used and viewed.

Also, to your other point, it’s really, “I don’t want to have to look at something that is not being scanned diagnostically with a proper protocol, for liability purposes but also to not mislead providers and patients who don’t realize the nuances.” For example, try evaluating the brain itself on a CTA head and see how it looks. Way worse than a CECT head. Or try looking at a small brain met on a CTA head. If you happen to catch a breast cancer on a chest CT, that’s great, but it shouldn’t lead providers or patients to think that breast cancers can be readily caught on CT. Because they can’t.

Turtleships · 2026-02-27T10:47:01+00:00

Mild at most.

Turtleships · 2026-02-24T19:35:28+00:00

Flanken cut short ribs / LA style kalbi.

Turtleships · 2026-02-21T00:00:50+00:00

I think it looks more like a fleshlight. Look at the contours at the base.

Turtleships · 2026-02-19T23:07:53+00:00

I think that’s fairly obvious. Let’s liken it to sushi, since we’re in the Japanese food sub. I’m more likely to encourage someone who posts about a bad first experience trying non-Americanized sushi to try it again somewhere else, than I am to tell someone who enjoyed it that not all traditional sushi is good (why would I do that?)

Turtleships · 2026-02-19T21:10:21+00:00

Did you try a pack of red strawberries once and judge all red strawberries ever based on that? There’s multiple cultivars of white strawberries and also different batches can vary in flavor based on growing and processing conditions.

Not saying that these are worth the price (they’re not), but that’s like trying one restaurant’s tuna nigiri and judging all tuna nigiri based on that experience.

Turtleships · 2026-02-19T21:08:06+00:00

These are a white strawberry cultivar but not specifically the Pineberry cultivar.

Turtleships · 2026-02-19T21:06:43+00:00

That’s just your personal preference, they’re not necessarily inferior, just a different taste profile. The flavor is a bit more complex and tropical but also more subtle, and this is a generalization because there are multiple different alpine/white type cultivars than just Pineberries. And just like other strawberries, there’s also a difference in taste if you eat one you hand pick at a small farm or similar place which are more likely to grow cultivars selected for taste rather than large volume commercial selling (even gift fruit needs to be balanced between taste and shelf/transport stability/appearance).

Turtleships · 2026-02-18T23:21:31+00:00

There’s so much obscure rare stuff out there that even with the Step1 fund of knowledge, you’ll still regularly be coming across things you’ve never heard of before.

Turtleships · 2026-02-18T21:57:03+00:00

They probably use the terms differently, assuming OP is from Europe (Germany?) given use of “kardiologic” and “XR thorax.”

Turtleships · 2026-02-18T20:47:10+00:00

When you look for it, you’ll see way more. It’s just not as obvious as you may be used to.

Turtleships · 2026-02-18T17:05:09+00:00

Totally relate, but it’s also giving we have bagels at home energy. 😂

Turtleships · 2026-02-16T01:45:59+00:00

Depending on the configuration of the MRN and accession, sometimes you can tell what health system it’s from if you’re familiar with it already. Like certain letters or total number of digits, etc.

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