MSCT shows its mettle in the Magic Kingdom

I recently attended the annual Johns Hopkins CT course in Orlando, which I first caught 15 years ago when I left active duty in the Navy.

I had been stationed for two years at Pensacola Naval Hospital, which at the time had no CT scanner. My new job required that I read CT, so I went to Orlando to brush up old skills. This year's course was my fifth. I'm not sure if CT is changing rapidly or I'm just forgetting rapidly, but I learn more new things from the course every time.

We're shopping for a new CT, and, like most radiologists, I suffer from slice envy. Our neighbor has 16, we have four, the university has 16 and is looking at 64-what should we buy? Before my last trip to Orlando, I was pushing for a 64-slice scanner. But I drive a pickup with aluminum toolboxes and a ladder rack, so my partners and our administrators know that if there is a bigger, faster tool for the job, I want it. I left Orlando knowing I was right; 64-slice scanners are just better. Can you do good work with fewer slices? Sure, but if you have a choice, faster is better.

Since I have kids, the Hopkins course offers some real perks. The Disney hotel where it is held has one of the best pools I've ever seen. My family was so happy that for two mornings they preferred to stay at the pool instead of spending vast quantities of money at a theme park. I was also happy, because as a convention attendee I could buy significantly reduced park tickets after 2 p.m. When we did the park thing, we went from 2 until closing. Not only is it cheaper, but your kids are asleep before you get off the elevator. And on a family trip, there is nothing more relaxing than the sight of your children sound asleep.

Over the years, some of my least intelligent and least helpful reports have been generated by small bowel series. For some time I have suspected, and this course confirmed, that almost anything you can do with a small bowel series, you can do better with multislice CT. I love it. No more hemming and hawing about fold thickness and questionable transition points. I have been pushing the demise of the small bowel follow-through for years, and now MSCT is doing it for me. Unfortunately, every silver lining comes with its own cloud; in this case it is high-resolution chest CT.

The course featured two excellent lectures on HRCT of the lungs. Like a bad dream, I was transported back to my first year of residency. Memories of Dr. Robert Fraser (of Fraser & Pare's Diagnosis of Diseases of the Chest fame) waxing poetic about the differential diagnosis of interstitial lung disease overwhelmed me. Volume 4 of the text was 200-plus pages of just these differentials. The reason it takes more than 200 pages is simple: Every recognizable pattern includes the same 7480 diseases on its list of possible causes. The authors just rearranged the order. With MSCT, we can see the patterns of lung disease in much greater detail than on a chest x-ray. Unfortunately, most of the key players still show up on every damn list.

Obviously, I like the course. On every trip I learn ways to do body imaging better. When I mentioned that we were shopping for a CT, folks at the course asked which brand we were going to buy. My standard reply is that I don't think it matters. I trained on an EMI scanner that took seven minutes per slice. At the time, the limiting factor was the equipment. Every scanner made today does amazing studies. If I don't get the right diagnosis on a case these days, it's hard to fault the machine. I blame the technologists.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.