CAT Scan
Computed tomography (CT), originally known as computed axial tomography (CAT) is a medical imaging method employing tomography where digital geometry processing is used to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation. The word "tomography" is derived from the Greek tomos (slice) and graphia (describing). CT produces a series of axial images, which can be manipulated, through a process known as windowing, in order to recreate the image in a different plane.
Principle
X-ray slice data is generated using an X-ray source that rotates around the object; X-ray sensors are positioned on the opposite side of the circle from the X-ray source. Many data scans are progressively taken as the object is gradually passed through the gantry. They are combined together by the mathematical procedure known as tomographic reconstruction.
Diagnostic Use
Since its introduction in the 1970s, CT has become an important tool in medical imaging to supplement X-rays and medical ultrasonography. Although it is still quite expensive, it is the gold standard in the diagnosis of a large number of different disease entities.
Cranial CT
Diagnosis of cerebrovascular accidents and intracranial hemorrhage is the most frequent reason for a "head CT" or "CT brain". Scanning is done without intravenous contrast agents (contrast may resemble a bleed). CT generally does not exclude infarct in the acute stage, but is useful to exclude a bleed (so anticoagulant medication can be commenced safely).
For detection of tumors, CT scanning with IV contrast is occasionally used but is less sensitive than magnetic resonance imaging (MRI). CT can also be used to detect increases in intracranial pressure, e.g. before lumbar puncture or to evaluate the functioning of a ventriculoperitoneal shunt. CT is also useful in the setting of trauma for evaluating facial and skull fractures.
In the head/neck/mouth area, CT scanning is used for surgical planning for craniofacial and dentofacial deformities, evaluation of cysts and some tumors of the jaws/sinuses/nasal cavity/orbits, and for planning of dental implant reconstruction.
Chest CT
Chest CT is excellent for detecting both acute and chronic changes in the lung parenchyma. For detection of airspace disease (such as pneumonia) or cancer, ordinary non-contrast scans are adequate. For evaluation of chronic interstitial processes (emphysema, fibrosis, and so forth), thin sections with high spatial frequency reconstructions are used. For evaluation of the mediastinum and hilar regions for lymphadenopathy, IV contrast is administered.
CT angiography of the chest (CTPA) is also becoming the primary method for detecting pulmonary embolism (PE) and aortic dissection, and requires accurately timed rapid injections of contrast and high-speed helical scanners. CT is the standard method of evaluating abnormalities seen on chest X-ray and of following findings of uncertain acute significance.
Cardiac CT
With the advent of subsecond rotation combined with multi-slice CT (up to 64 slices), high resolution and high speed can be obtained at the same time, allowing excellent imaging of the coronary arteries. Images with high temporal resolution are formed by updating a proportion of the data set used for image reconstruction as it is scanned. In this way individual frames in a cardiac CT investigation are significantly shorter than the shortest tube rotation time. It is uncertain whether this modality will replace the invasive coronary catheterization.
Dual Source CT scanners, introduced in 2005, allow higher temporal resolution when acquiring images of the heart, allowing a greater number of patients to be scanned.
Abdominal and pelvic CT
Many abdominal disease processes require CT for proper diagnosis. The most common uses include diagnosis of renal/urinary stones, appendicitis, pancreatitis, diverticulitis, abdominal aortic aneurysm, and bowel obstruction. CT is also the first line for detecting solid organ injury after trauma. Oral and/or rectal contrast is usually administered (more often iodinated contrast than barium due to the tendency of barium to cause imaging artifacts that limit evaluation of abdominal structures).
CT has limited application in the evaluation of the pelvis. For the female pelvis in particular, ultrasound is the imaging modality of choice. Nevertheless, it may be part of abdominal scanning (e.g. for tumors), and has uses in assessing fractures.
CT is also used in osteoporosis studies and research along side DXA scanning. Both CT and DXA can be used to asses bone mineral density (BMD) which is used to indicate bone strength, however CT results do not correlate exactly with DXA (the gold standard of BMD measurement), is far more expensive, and subjects patients to much higher levels of ionizing radiation, so it is used infrequently.
Extremities
CT is often used to image complex fractures, especially ones around joints, because of the ability to reconstruct the area of interest in multiple planes.
Positron Emission Tomography
Positron emission tomography (PET) is a nuclear medicine medical imaging technique, which produces a three-dimensional image or map of functional processes in the body.
In PET, a short-lived radioactive tracer isotope, which decays by emitting a positron, chemically incorporated into a metabolically active molecule, is injected into the living subject (usually into blood circulation). The short-lived isotope decays, emitting a positron. These are detected when they reach a scintillator material in the scanning device, creating a burst of light, which is detected by photomultiplier tubes.
PET is a valuable technique for some diseases and disorders, because it is possible to target the radio-chemicals used for particular bodily functions.
Oncology:
PET scanning with the tracer (18F) fluorodeoxyglucose (FDG, FDG-PET) is widely used in clinical oncology. This tracer is a glucose analog and is taken up by cells, phosphorylated by hexokinase (whose mitochondrial form is greatly elevated in rapidly-growing malignant tumors), and retained by tissues with high metabolic activity, such as the brain, the liver, and most types of malignant tumors. As a result FDG-PET can be used for diagnosis, staging, and monitoring treatment of cancers, particularly in Hodgkin's disease, non-Hodgkin's lymphoma, and lung cancer. However because individual scans are more expensive than conventional imaging with CT and MRI, expansion of FDG-PET in cost-constrained health services will depend on proper Health Technology Assessment. Oncology scans using FDG make up over 90% of all PET scans in current practice.
Neurology:
PET neuroimaging is based on an assumption that areas of high radioactivity are associated with brain activity. What is actually measured indirectly is the flow of blood to different parts of the brain, which is generally believed to be correlated, and usually measured using the tracer oxygen (15O). Research continues into the use of radiolabeled F-DOPA and FDDNP as more specific probes.
Cardiology:
In clinical cardiology FDG-PET can identify so-called "hibernating myocardium", but its cost-effectiveness in this role versus SPECT is unclear.
Neuropsychology / Cognitive Neuroscience:
To examine links between specific psychological processes or disorders and brain activity.
Pharmacology:
In pre-clinical trials, it is possible to radio-label a new drug and inject it into animals. The uptake of the drug, the tissues in which it concentrates, and its eventual elimination, can be monitored far more quickly and cost effectively than the older technique of killing and dissecting the animals to discover the same information. PET scanners for rats and apes are marketed for this purpose.
PET scanning is invasive, in that radioactive material is injected into the subject. However the total dose of radiation is small, usually around 7 mSv.
Friday, June 20, 2008
Thursday, June 19, 2008
Skills Required
So what all skills do one need to be a medical transcriptionist? Let me explain you in brief.
English Speaking Skills:
The most important requirement of transcription is to have good English communication skills with excellent command over English and vocabulary. This is a very significant aspect if you wish to be denoted as one of the best Medical transcriptionist (herein referred as MT.)
English Grammar:
If you are well versed with your school grammar and employ that in your daily routine, then much of your problem is solved. You can get any book on American English Grammar and evaluate yourself on the grammar front.
Computer Skills:
Knowing basics about computer use and having knowledge about computer software like Ms Word or WordPerfect will be a tremendous help. As many of us these days are glued to the computer, this should ideally not be a problem at all.
Keyboarding Skills:
This is the key for becoming a fast and accurate transcriptionist. A good transcriptionist should ideally have a typing speed of 60 to 80 words per minute. So try and evaluate your typing speed on the computer and keep on aiming higher and higher. One should make a routine of practicing 2 hours each day till the desired speed is reached. You can download a host of free typing software from the internet and practice hard till you reach the target and slowly and steadily you will beat the target with a span of few weeks.
Medical Knowledge:
That’s the most difficult aspect of transcription. Hey, but do not lose heart. With practice and reading you will start recognizing medical words, slangs and English phrases. The more you practice live dictations the better refined you become. So read the medical material carefully from our section and keep on practicing with voice files.
Practicing Voice Transcription:
Finally after having a good typing speed, knowledge about fine details on grammar usage and proficiency in medical terminology, you are ready to practice the actual live dictation. This is what that will make you a better transcriptionist. Transcribe files daily and you will see the improvement that you make in yourself at every stage.
English Speaking Skills:
The most important requirement of transcription is to have good English communication skills with excellent command over English and vocabulary. This is a very significant aspect if you wish to be denoted as one of the best Medical transcriptionist (herein referred as MT.)
English Grammar:
If you are well versed with your school grammar and employ that in your daily routine, then much of your problem is solved. You can get any book on American English Grammar and evaluate yourself on the grammar front.
Computer Skills:
Knowing basics about computer use and having knowledge about computer software like Ms Word or WordPerfect will be a tremendous help. As many of us these days are glued to the computer, this should ideally not be a problem at all.
Keyboarding Skills:
This is the key for becoming a fast and accurate transcriptionist. A good transcriptionist should ideally have a typing speed of 60 to 80 words per minute. So try and evaluate your typing speed on the computer and keep on aiming higher and higher. One should make a routine of practicing 2 hours each day till the desired speed is reached. You can download a host of free typing software from the internet and practice hard till you reach the target and slowly and steadily you will beat the target with a span of few weeks.
Medical Knowledge:
That’s the most difficult aspect of transcription. Hey, but do not lose heart. With practice and reading you will start recognizing medical words, slangs and English phrases. The more you practice live dictations the better refined you become. So read the medical material carefully from our section and keep on practicing with voice files.
Practicing Voice Transcription:
Finally after having a good typing speed, knowledge about fine details on grammar usage and proficiency in medical terminology, you are ready to practice the actual live dictation. This is what that will make you a better transcriptionist. Transcribe files daily and you will see the improvement that you make in yourself at every stage.
Medical Transcription Rules
SPACING WITH PUNCTUATION MARKS
Do Not Type a Space -
before or after a hyphen
before or after a slash
before or after a dash
between a number and percent sign
between parentheses and the enclosed material
between any word and the punctuation following it.
between the number and the colon used to indicate a dilute solution or ratio, e.g. 1:4
on either side of the colon when expressing the time of day
before an apostrophe
before or after a comma used within numbers
before or after an ampersand in abbreviations, e.g., C&S
on either side of the colon when expressing ratios e.g. 1:1
after the closing parenthesis if another mark of punctuation follows
when using the word “times” as x – e.g., x3
Type One Space...
between words
after a comma
after a semicolon
after a period following an initial
after the closing parenthesis
on each side of the x in an expression of dimension, e.g. 4 x 4 type 2 spaces...
after punctuation at the end of a sentence
after a colon except when expressing time or a dilution ratio
NUMBERS
Spell out WHOLE numbers zero through nine, use numerals for 10 and above (this may change in the near future as the AAMT is trying to standardize using numerals only.
Use numerals when numbers are directly used with symbols.
Use numerals when expressing ages.
If it is an approximate age, spell it out.
Use numerals to express size and measurements.
Use numerals for everything metric. Centimeters, millimeters, liters, etc.
Use numerals in all expressions pertaining to drugs - this includes strength, dosage and directions. Z-PAK 2 daily on day 1, then 1 daily on days 2-5.
Spell out and hyphenate fractions standing alone. He drank one-half a gallon of apple juice.
Use numerals to express mixed fractions. 1 1/2 years.
Use commas only if there are 5 or more digits when expressing numbers. e.g. 10,000, 4000.
Use numerals when expressing vital statistics including height, weight, blood pressure, pulse and respiration.
Substitute a hyphen for the word "to". He is to take 1-2 tablets of Tylenol every 4-6 hours p.r.n.
Leave a space between numerals and measurements unless they form a compound modifier. It is 6 cm below the ...... It is 1200 mL....... A 4-cm nevus....... A 2 x 2-mm lesion.......
Always use 0 in front of the decimal point if the number is not a whole number. 0.75 mg
Use decimal fractions with metric measurements. 1.5 cm
Use mixed fractions with English system measurements. 1 1/2 inch
Use numerals for: Ages, units of measure, vital statistics, lab values and in other instances where it is important to communicate clearly the number referenced. Examples: 4 inches, 3-year-old. She has three dogs who have eight fleas each. A total of 7 basal cell carcinomas removed from his left arm. (7 for clarity)
Do not start a sentence using a number. Spell out the number or recast the sentence.
Dictated as: 10 milligrams of Reglan was administered stat. Transcribe as: Reglan 10 mg was administered stat.
Exception - It is acceptable to begin a sentence with a date. Example - 2004 is going to be a prosperous year.
Plurals - do not use an apostrophe to form plural numbers.
4 x 4s
She was in her 20s or twenties (this is acceptable because it is not a definite number).
She was born in the 1970s.
Series of numbers - Use numerals if at least one is greater than nine or if there is a mixed or decimal fraction.
Example - Jeff has 1 job, 1 place of employment and 18 hours a day to do the work.
Cranial nerves - Preferred: Roman numerals I-XII
Diabetes type 1 and type 2, not Roman numerals I and II - this was recently standardized by the American Diabetes Association.
Apgar scores - Use numerals for ratings and spell out numbers relating to minutes. Rationale - to draw attention to the scores. Example: The Apgar scores were 6 and 9 at one and five minutes. Apgar is not an acronym.
Time Examples
8:30 a.m. - morning
8:30 p.m. - evening
noon, not 12:00 noon
midnight, not 12:00 midnight or 12 'o'clock or 12:00 p.m.
MEASUREMENTS
Spell out all nonmetric measurements. Feet, inches, pounds, ounces, yards, grain, dram, etc.
Exceptions:
Use tsp for teaspoon
Use tbsp for tablespoon
Abbreviate all metric measurements.
Use F for Fahrenheit IF accompanied by the symbol for degree. 98.6°F
Spell out Fahrenheit IF degree is spelled out. 98.6 degrees Fahrenheit.
Use C for Celsius IF accompanied by the symbol for degree. 36°C
Spell out Celsius IF degree is spelled out. 36 degrees Celsius.
In tables and technical documents:
Use ft or ' for feet
Use " for inches
Use yd for yard
Use pt for pint
Use oz for ounce
Use fl oz for fluid ounce
Abbreviate most unusual units of measure when accompanied by numerals Dictated as Transcribed as:
0.8 centimeters squared 0.8 sq cm
22 milligram of mercury 22 mmHg
3.0 liters per minute 3.0 L/min
40 millimeters per hour 40 mm/h
8 grams percent 8 gm%
SYMBOLS
Spell out a symbol when used alone (with no number).
Use symbols when they are used with numbers
Common Symbols
Dictated as Transcribed as
Four to five 4-5
Number 3 0 #3-0
Twenty-twenty vision 20/20
BP 120 over 80 120/80
Grade two over six 2/6
A positive A+
Three point five
Do Not Type a Space -
before or after a hyphen
before or after a slash
before or after a dash
between a number and percent sign
between parentheses and the enclosed material
between any word and the punctuation following it.
between the number and the colon used to indicate a dilute solution or ratio, e.g. 1:4
on either side of the colon when expressing the time of day
before an apostrophe
before or after a comma used within numbers
before or after an ampersand in abbreviations, e.g., C&S
on either side of the colon when expressing ratios e.g. 1:1
after the closing parenthesis if another mark of punctuation follows
when using the word “times” as x – e.g., x3
Type One Space...
between words
after a comma
after a semicolon
after a period following an initial
after the closing parenthesis
on each side of the x in an expression of dimension, e.g. 4 x 4 type 2 spaces...
after punctuation at the end of a sentence
after a colon except when expressing time or a dilution ratio
NUMBERS
Spell out WHOLE numbers zero through nine, use numerals for 10 and above (this may change in the near future as the AAMT is trying to standardize using numerals only.
Use numerals when numbers are directly used with symbols.
Use numerals when expressing ages.
If it is an approximate age, spell it out.
Use numerals to express size and measurements.
Use numerals for everything metric. Centimeters, millimeters, liters, etc.
Use numerals in all expressions pertaining to drugs - this includes strength, dosage and directions. Z-PAK 2 daily on day 1, then 1 daily on days 2-5.
Spell out and hyphenate fractions standing alone. He drank one-half a gallon of apple juice.
Use numerals to express mixed fractions. 1 1/2 years.
Use commas only if there are 5 or more digits when expressing numbers. e.g. 10,000, 4000.
Use numerals when expressing vital statistics including height, weight, blood pressure, pulse and respiration.
Substitute a hyphen for the word "to". He is to take 1-2 tablets of Tylenol every 4-6 hours p.r.n.
Leave a space between numerals and measurements unless they form a compound modifier. It is 6 cm below the ...... It is 1200 mL....... A 4-cm nevus....... A 2 x 2-mm lesion.......
Always use 0 in front of the decimal point if the number is not a whole number. 0.75 mg
Use decimal fractions with metric measurements. 1.5 cm
Use mixed fractions with English system measurements. 1 1/2 inch
Use numerals for: Ages, units of measure, vital statistics, lab values and in other instances where it is important to communicate clearly the number referenced. Examples: 4 inches, 3-year-old. She has three dogs who have eight fleas each. A total of 7 basal cell carcinomas removed from his left arm. (7 for clarity)
Do not start a sentence using a number. Spell out the number or recast the sentence.
Dictated as: 10 milligrams of Reglan was administered stat. Transcribe as: Reglan 10 mg was administered stat.
Exception - It is acceptable to begin a sentence with a date. Example - 2004 is going to be a prosperous year.
Plurals - do not use an apostrophe to form plural numbers.
4 x 4s
She was in her 20s or twenties (this is acceptable because it is not a definite number).
She was born in the 1970s.
Series of numbers - Use numerals if at least one is greater than nine or if there is a mixed or decimal fraction.
Example - Jeff has 1 job, 1 place of employment and 18 hours a day to do the work.
Cranial nerves - Preferred: Roman numerals I-XII
Diabetes type 1 and type 2, not Roman numerals I and II - this was recently standardized by the American Diabetes Association.
Apgar scores - Use numerals for ratings and spell out numbers relating to minutes. Rationale - to draw attention to the scores. Example: The Apgar scores were 6 and 9 at one and five minutes. Apgar is not an acronym.
Time Examples
8:30 a.m. - morning
8:30 p.m. - evening
noon, not 12:00 noon
midnight, not 12:00 midnight or 12 'o'clock or 12:00 p.m.
MEASUREMENTS
Spell out all nonmetric measurements. Feet, inches, pounds, ounces, yards, grain, dram, etc.
Exceptions:
Use tsp for teaspoon
Use tbsp for tablespoon
Abbreviate all metric measurements.
Use F for Fahrenheit IF accompanied by the symbol for degree. 98.6°F
Spell out Fahrenheit IF degree is spelled out. 98.6 degrees Fahrenheit.
Use C for Celsius IF accompanied by the symbol for degree. 36°C
Spell out Celsius IF degree is spelled out. 36 degrees Celsius.
In tables and technical documents:
Use ft or ' for feet
Use " for inches
Use yd for yard
Use pt for pint
Use oz for ounce
Use fl oz for fluid ounce
Abbreviate most unusual units of measure when accompanied by numerals Dictated as Transcribed as:
0.8 centimeters squared 0.8 sq cm
22 milligram of mercury 22 mmHg
3.0 liters per minute 3.0 L/min
40 millimeters per hour 40 mm/h
8 grams percent 8 gm%
SYMBOLS
Spell out a symbol when used alone (with no number).
Use symbols when they are used with numbers
Common Symbols
Dictated as Transcribed as
Four to five 4-5
Number 3 0 #3-0
Twenty-twenty vision 20/20
BP 120 over 80 120/80
Grade two over six 2/6
A positive A+
Three point five
centimeters 3.5 cm
Point five centimeters 0.5 cm
CAPITALIZATION
Capitalize...
Abbreviations when the words they represent are capitalized
The first word following a colon if it begins a complete sentence or is part of an outline entry
Most abbreviations of English words
The first letter of chemical elements
The names of the days of the week, months, holidays, historic events and religious festivals
The names of specific departments or sections in the institution only when the institution name is included
The names of diseases that include proper nouns, eponyms or genus names
The trade or brand names of drugs
A quote when it is a complete sentence
The names of races, peoples, religions and languages. Black, as a race designation would be capitalized, however client preferences may differ.
Do Not Capitalize...
The spelled out names of the chemical elements
The seasons of the year
The common names of diseases
The names of viruses unless they include a proper noun
Generic drug names
The common noun following the brand name. Example - Tylenol tablets
The names of medical or surgical specialties
Designations based on skin color, like "a tall white man."
HYPHENATION
These prefixes do not require the use of a connecting hyphen in compound terms:
ante intra semi
anti micro sub
bi mid super
co non supra
contra over trans
Point five centimeters 0.5 cm
CAPITALIZATION
Capitalize...
Abbreviations when the words they represent are capitalized
The first word following a colon if it begins a complete sentence or is part of an outline entry
Most abbreviations of English words
The first letter of chemical elements
The names of the days of the week, months, holidays, historic events and religious festivals
The names of specific departments or sections in the institution only when the institution name is included
The names of diseases that include proper nouns, eponyms or genus names
The trade or brand names of drugs
A quote when it is a complete sentence
The names of races, peoples, religions and languages. Black, as a race designation would be capitalized, however client preferences may differ.
Do Not Capitalize...
The spelled out names of the chemical elements
The seasons of the year
The common names of diseases
The names of viruses unless they include a proper noun
Generic drug names
The common noun following the brand name. Example - Tylenol tablets
The names of medical or surgical specialties
Designations based on skin color, like "a tall white man."
HYPHENATION
These prefixes do not require the use of a connecting hyphen in compound terms:
ante intra semi
anti micro sub
bi mid super
co non supra
contra over trans
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