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Neuro Review
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Spleen
Stomach
Kidneys
Kidney
Pancreas
Pelvic congestion syndrome
Liver
Biliary
CT Abd Epiploic Appendagitis
Fractures Wrist
Wrist
Diffuse periosteal reaction
Signs in Uroradiology
Male breast
MRI Breast Indications
CT Head Cerebellar Mass
Biopsies
Diagnostic mammography
Screening mammography
Mammo Pearls
ACR Appropriateness Criteria Breast Cancer Screen
AVM types
CT Orbits
CT Abd NL
Chiari Malformations
Vesicoureteral Reflux (VUR)
Elbow
XRAY Abdominal Series

Abdomen
Cardio
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General
GU
Mammography
MSK
neuro
Neuroradiology
NM
Nuclear Medicine
Pediatric
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Ultrasound
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Biopsy

There are several types of breast biopsies:
  • Ultrasound guided biopsy is used when lesion is visible on ultrasound.
  • Stereotactic biopsy is used to sample suspicious calcifications or if mass cannot be seen with ultrasound.
  • If path results comes back discordant with mammographic findings, excisional biopsy will be ordered. Needle localization biopsy, however will have to be done first.

Needle localization excisional biopsy

This is a two step procedure: First the mammographer uses orthogonal views to pass a needle into the area of interest, deploys a hooked wire through the needle, than removes the needle, leaving the hook in the area of interest, with the wire passing out through the patient's skin. The surgeon then excises this area with the hook of the wire still in the specimen. A specimen radiograph is made and results called to the operating room informing the surgeon that the area of interest is or is not in the specimen. If it is not, the surgeon willl frequently remove more tissue. Advantages:
  • less sampling error as a large amount of tissue is removed
  • unlikely to need additional biopsy for diagnosis
  • can be easily done on breasts too thin for stereotactic biopsy
Disadvantages:
  • 2-3 times more expensive than core biopsy
  • requires a surgeon, a radiologist, sedation and often an Operating Room
  • leaves scar
  • may leave noticeable deficit in breast
  • patient usually in hospital for several hours, counting recovery time

Stereotactic Vacuum Assisted Core Needle Biopsy

Utilizing ultrasound guidance or a stereotactic biopsy table, a large gauge needle, usually 11G, is passed into the area of interest and multiple core samples are obtained through an aperture in the side of the needle. The vacuum pulls the core samples out of the needle onto a specimen tray. A marker is often deployed at the site should a subsequent procedure be needed.