Good sources for learning how to interpret CTAs

[AutumnLeaves]

I have recently changed jobs and am trying to learn how to interpret vascular CTAs, as in abdomen,pelvic,neck and head. I actually have found several sites on YouTube but still feel overwhelmed, so if anyone has a good one, I would appreciate it.

[TuxnadoDO]

Yes. But I learned to read CXRs in my residency program, and I am responsible for making decisions regarding immediately life threatening conditions that could be evidenced on a CXR. It’s within my scope of practice as established by my formal training program, and tested on both written and oral board exams. Even though I order CT angiography studies daily and look at them all myself, sometimes alerting vascular or neuro-interventional to my findings, I am not an expert in reading those and could not hope to be so.

[AutumnLeaves, MSN, RN, NP]

On 6/17/2019 at 2:06 PM, TuxnadoDO said:

This is great advice for someone who wants to be be able to look at the scans and have an idea of what he or she sees prior to the radiologist's report. I wouldn't recommend that the OP relies on her own read to ultimately make patient care decisions, however.

I am not relying on just my read to make clinical decisions. Both the vascular surgeon and the radiologist read them too. My surgeon wants me to be able to give HIM my read, and then we often look at them again.

[AutumnLeaves, MSN, RN, NP]

Sorry, left this out. I do work in an academic center and we don't have radiologists 24/7. It is often necessary for me, as the on call provider, to look at CTAs, know if there is a critical finding and report that to my surgeon. We work together then to address the problem.

[Neuro Guy NP, DNP, PhD, APRN]

On 8/28/2019 at 6:33 PM, TuxnadoDO said:

Yes. But I learned to read CXRs in my residency program, and I am responsible for making decisions regarding immediately life threatening conditions that could be evidenced on a CXR. It’s within my scope of practice as established by my formal training program, and tested on both written and oral board exams. Even though I order CT angiography studies daily and look at them all myself, sometimes alerting vascular or neuro-interventional to my findings, I am not an expert in reading those and could not hope to be so.

For the CXR example, just because an NP doesn't have residency doesn't mean he or she can't make clinical decisions off a CXR. An NP can learn to read CXR quite well. To wait for radiology is ridiculous. So I don't believe your argument holds true. It's not out of the scope for an NP to do this.

It all comes down to one knowing ones limitations rather than making hard and fast rules about what one can and cannot do. I did a post graduate fellowship in vascular neurology and neurocritical care for two years and became very proficient in various modalities of neuroimaging and we're expected to do this on the job. All the NPs and PAs are expected to look at scans, understand any critical findings. But quite naturally we do collaborate with our radiology colleagues plenty of times.

There's a balance to be struck and saying that reading scans is completely out of scope for an NP is inaccurate when all is done with the right framework.

On 8/29/2019 at 6:04 AM, AutumnLeaves said:

Sorry, left this out. I do work in an academic center and we don't have radiologists 24/7. It is often necessary for me, as the on call provider, to look at CTAs, know if there is a critical finding and report that to my surgeon. We work together then to address the problem.

Exactly THIS.

[TuxnadoDO]

4 hours ago, Neuro Guy NP said:

For the CXR example, just because an NP doesn't have residency doesn't mean he or she can't make clinical decisions off a CXR. An NP can learn to read CXR quite well. To wait for radiology is ridiculous. So I don't believe your argument holds true. It's not out of the scope for an NP to do this.

It all comes down to one knowing ones limitations rather than making hard and fast rules about what one can and cannot do. I did a post graduate fellowship in vascular neurology and neurocritical care for two years and became very proficient in various modalities of neuroimaging and we're expected to do this on the job. All the NPs and PAs are expected to look at scans, understand any critical findings. But quite naturally we do collaborate with our radiology colleagues plenty of times.

There's a balance to be struck and saying that reading scans is completely out of scope for an NP is inaccurate when all is done with the right framework.

Exactly THIS.

Jesus, you are talking in circles. I didn’t say NPs can’t or shouldn’t make decisions on a chest x-ray. You brought up the chest x-ray as an example of how other physicians, not radiologists, sometimes read radiology studies. I was pointing out the difference between me reading a chest x-ray and an NP with no formal training in vascular studies reading a CTA. If you can’t see the difference, I don’t know what else to tell you.

[Corey Narry, MSN, RN, NP]

On 8/29/2019 at 3:04 AM, AutumnLeaves said:

Sorry, left this out. I do work in an academic center and we don't have radiologists 24/7. It is often necessary for me, as the on call provider, to look at CTAs, know if there is a critical finding and report that to my surgeon. We work together then to address the problem.

An academic center without 24/7 Radiologists? that doesn't sound safe.

[Neuro Guy NP, DNP, PhD, APRN]

On 8/30/2019 at 9:15 PM, TuxnadoDO said:

Jesus, you are talking in circles. I didn’t say NPs can’t or shouldn’t make decisions on a chest x-ray. You brought up the chest x-ray as an example of how other physicians, not radiologists, sometimes read radiology studies. I was pointing out the difference between me reading a chest x-ray and an NP with no formal training in vascular studies reading a CTA. If you can’t see the difference, I don’t know what else to tell you.

This isn't worth the energy to continue back and forth with you. I was trying to be collegial, but you didn't seem to want to reciprocate. To be honest, if you're a DO I'm not sure what you get out of interacting on this site, but I digress. I'm done here.