In many instances, the topic of ordering neuroimaging has come up in ODs on Facebook, and opinions are all over the board. Some say yes, others say refer. Some seem to order images as if on a fishing expedition. Please allow me to offer some suggestions for neuroimaging ordering.
REASONS FOR ORDERING
The indications for ordering usually fall into one of three broad presentations of clinical findings: processes affecting the afferent visual system, those affecting the efferent visual system, and those that present with anatomically identified clinical findings. Diseases affecting the afferent visual system present with visual field defects. Diseases affecting the efferent visual system usually present as motility problems. And those disease processes that present with clinically seen anatomical changes, though often overlapping with diseases affecting the afferent or the efferent system, present as proptosis, disc edema, vascular congestion, and a myriad of other suspicious findings. And there is actually a 4th presentation: those presentations that don’t fall into the above categories but that do arouse suspicion that something is going on warranting further imaging. This particular category can become fishing expeditions, and organic etiologies must be evaluated to reduce unnecessary testing.
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Cannot agree more with the key points in this feature. Clinicians must have an organized approach and several differential diagnoses before ordering scans. This information will be helpful to the radiologist as well. Great job, Jim.