Imaging Strategies

Editor Ashley Davidoff MD

copyright 2006 

Imaging technology is rapidly evolving, and  closely following the accelerated progress  unfolding in the digital world.   As the technology changes the clinical application of the technology changes.  What was therefore appropriate in the past may not be optimal today.   It is difficult for radiologists to keep up with breadth and depth of changes.  It is even more difficult for clinicians to keep up with the advances.   Ignorance of how to best use the technology is rife and waste of precious and expensive resources  is also rife.

The abdomen is a complex structure consisting of multiple spaces and compartments filled with variety of heterogeneous organs and structures.   The spaces and organs have been compartmentalized, divided and reclassified throughout the course of medical history according to the purposes of the specific group.  For the clinician, dividing the abdomen into quadrants makes clinical sense.  Right upper quadrant symptoms, for example bring certain differential considerations and these are completely different from left lower quadrant symptoms.  For the clinician who thinks embryologically, foregut, midgut and hindgut division makes intuitive sense. For the surgeon who has to decide about an incisional approach, division of the abdomen relates to upper or lower, and right midline or left.  The imaging approach mostly depends on the clinical presentation and can be divided into a focused approach or a global approach.  A focused approach to right upper quadrant pain, or abnormal LFTs, would warrant an ultrasound examination, while the patient with non specific abdominal pain would be best served with the global strengths of a CT scan.  In the latter instance the abdomen and pelvis should be examind together since a peritoneal transudate from an upper abdominal structure may have no obvious structural change in the upper abdomen, but clues that support the existence of significant disease may only be suspected by the presence of the free fluid in the cul de sac in the pelvis.