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Thyroid Anatomy

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181. Clinical Appropriateness Guidelines: Radiation Oncology Brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) treatment guidelines

treatment to a higher dose, the IGRT group was noted to have similar genitourinary and gastrointestinal toxicities. Pre-treatment corrective left-right, anteroposterior and superoinferior shifts were required in 15%, 6% and 19% of cases respectively supporting the use of pre- treatment imaging. The ACR-ASTRO practice parameter for IGRT indicates that “when the target is not clearly visible and bony anatomy is not sufficient for adequate target alignment, fiducial markers may be needed.” For soft tissue (...) bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys. 2005;63(3):800-811. 31. Shah A, Aird E, Shekhdar J. Contribution to normal tissue dose from concomitant radiation for two common kV-CBCT systems and one MVCT system used in radiotherapy. Radiother Oncol. 2012;105(1):139-144. 32. Singh J, Greer PB, White MA, et. al. Treatment-related morbidity in prostate cancer: A comparison of 3-dimensional conformal radiation therapy with and without

2018 AIM Specialty Health

182. Adults With Congenital Heart Disease

are commonly excluded from clinical trials, and there are few data to guide pharmacological therapies. Although it may be tempting to extrapolate from management guidelines developed for patients without CHD (e.g., HF guidelines) (S3.17-1), treatments may not have the same benefit in the heterogeneous population of patients with ACHD and in some cases may cause harm. The evaluation of new symptoms in a patient with ACHD must be tailored to the patient’s anatomy, surgical repair, and physiology. Before (...) in patients with excellent acoustic windows; however, CMR and CTA are superior for evaluating extracardiac vascular anatomy. 2. In higher-risk patients, invasive hemodynamic assessment can be useful for direct measurement of pressures, quantification of shunt magnitude, and measurement of pulmonary arterial resistance and MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT Stout KK, et al. 2018 ACHD Guideline Page 56 responsiveness to pulmonary vasodilator therapy. Invasive hemodynamic assessment is especially

2018 American College of Cardiology

183. Exam Series: Guide to the Shoulder Exam

suggests a tear. Diagnosis is clinical, although X-rays may show narrowing of the acromiohumeral space. Ultrasound may be useful in screening for tears 9 . Calcific Tendinitis Rotator cuff pain, potentially bilateral, often at night and more common in females. Limited ROM with a painful arc and pain on palpation. X-rays may show calcium deposits. Adhesive Capsulitis “Frozen Shoulder” Primary/idiopathic (associated with diabetes, thyroid disorders, and autoimmune diseases) or secondary from shoulder (...) Successful reduction of an anterior shoulder dislocation is indicated by an improvement in anatomy, pain, and range of motion. There are several methods to reduce anterior shoulder dislocations, all of which (and more!) can be seen in : Stimson: have the patient lay prone with their dislocated arm hanging over the edge of the stretcher with a 5-15lb weight attached (or use 4 1L bags of saline in a stocking). Reduction typically occurs within 15-20 mins. Scapular Manipulation: Position the patient

2018 CandiEM

184. CRACKCast E192 – Airway

- and no backup devices (VL, EGD) available Can’t Intubate, Can’t ventilate? Time for a cric! If you are in a can’t intubate, can oxygenate situation, you have time. Call for backup and consider rescue devices. See figure 1.10. [10] How do you perform a surgical cricothyroidotomy? First—The Anatomy! Landmarks: Cricothyroid membrane is below the thyroid cartilage and above the cricoid cartilage. These 2 landmarks are palpable on most patients. Equipment : Scalpel Artery forceps Bougie Size 6 ETT Technique (...) : Extend the neck to make anatomy easier to palpate (“laryngeal handshake”) Stabilize thyroid cartilage with non-dominant hand. Hold scalpel with dominant hand, can rest on sternum for support. Make a 4cm vertical incision over cricothyroid membrane. (may extend from mandible to sternum if you can’t palpate the anatomy) Palpate the cricothyroid membrane ± blunt dissect with forceps until membrane is visible. Make a horizontal incision through the cricothyroid membrane. Dilate with a gloved little

2018 CandiEM

185. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

, ligamentum flavum hypertrophy, spondylolisthesis, or spondylosis, which may compress the epidural venous plexus within tight epidural spaces. Moreover, patients, after various spine surgeries, may develop fibrous adhesions and scar tissue, thus further compromising the capacity of the epidural space and distorting the anatomy of the epidural vessels. The risk of bleeding is further increased in pain patients taking several concomitant medications with antiplatelet effects including NSAIDs, ASA (...) the risk of bleeding and neurological injury secondary to impairment of coagulation in the setting of implantable neurostimulation devices in the spine, brain, and periphery. These recommendations are aligned with the recommendations published here. | Anatomical Considerations for Hematoma Development in Spinal and Nonspinal Areas Although most cases of a spinal hematoma have a multifactorial etiology, certain anatomical features may pose higher risks secondary to the anatomy and vascular supply

2018 American Society of Regional Anesthesia and Pain Medicine

187. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency

endocrinologists and urologist during this transition. 6.2 In adolescent females with congenital adrenal hyperplasia, we suggest a gynecological history and examination to ensure functional female anatomy without vaginal stenosis or abnormalities in menstruation. (2|⊕⊕○○) Genetic counseling 6.3 In children with congenital adrenal hyperplasia, adolescents transitioning to adult care, adults with nonclassic congenital adrenal hyperplasia upon diagnosis, and partners of patients with congenital adrenal (...) |⊕⊕○○) Technical remark: Clinicians should use their own judgment for the above procedures. Restoring functional anatomy by surgery in individuals with congenital adrenal hyperplasia 7.1 In all pediatric patients with congenital adrenal hyperplasia, particularly minimally virilized girls, we advise that parents be informed about surgical options, including delaying surgery and/or observation until the child is older. (Ungraded Good Practice Statement) Technical remark: Surgeries should be performed only

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2018 The Endocrine Society

188. Management of Pregnancy

) ? Initiate low dose aspirin therapy for women at risk of preeclampsia ( ) Recommendation 17 ? Offer evaluation of MSAFP for pregnant women who did not have serum aneuploidy screening or who had non-invasive prenatal screening ( ) Recommendation 14 ? Offer antenatal progesterone therapy in consultation with an advanced prenatal care provider (e.g., obstetrician or maternal-fetal medicine) for women at high risk for recurrent preterm delivery ( ) Recommendation 18 ? Complete fetal anatomy ultrasound

2018 VA/DoD Clinical Practice Guidelines

189. ACR/SIR/SPR Practice Parameter for Specifications and Performance of Image-Guided Percutaneous Drainage/Aspiration of Abscesses and Fluid Collections (PDAFC)

Breast Interventional Procedures [20,21]. The procedures may be performed with ionizing radiation for image guidance, including fluoroscopy, computed tomography (CT), or with nonionizing radiation modalities, including ultrasound or magnetic resonance imaging (MRI). Optimal performance of PDAFC, and choice of imaging modality, requires knowledge of anatomy and pathophysiology, familiarity with percutaneous techniques (eg, needle, guidewire, and drainage catheter use), and knowledge of the advantages (...) of the benefits, alternatives, and risks of the procedures. The physician must have a thorough understanding of imaging anatomy (including congenital and developmental variants), the imaging equipment to be used during the procedures, radiation safety considerations, and physiologic monitoring equipment. The physician must also have access to adequate supplies and personnel to perform the procedure safely. PDAFC procedures must be performed by a physician who has the following qualifications. The physician’s

2018 Society of Interventional Radiology

190. ACR/SIR/SPR Practice Parameter for the Performance of Image-Guided Percutaneous Needle Biopsy (PNB)

be clinically informed and understand the specific clinical questions to be answered and goals to be accomplished by PNB prior to the procedure in order to plan and perform the procedure safely and effectively. The physician performing PNB must have knowledge of the benefits, alternatives, and risks of the procedure. The physician must have an understanding of imaging anatomy, imaging equipment, radiation safety considerations, physiologic monitoring equipment, and have access to adequate supplies (...) , pharmacology of contrast agents and recognition and treatment of potential adverse reactions. g. Percutaneous needle introduction techniques. h. Technical aspects of performing the procedure, including the use of various biopsy devices. i. Anatomy, physiology, and pathophysiology of the structures being considered for PNB. The written substantiation should come from the chief of interventional radiology, the director or chief of body PRACTICE PARAMETER 4 PNB imaging or ultrasound, or the chair

2018 Society of Interventional Radiology

191. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association

arterial dilatation, single coronary ostium, coronary arteries originating from the thoracic aorta, and coronary artery–to–pulmonary artery fistulas. , , Whether coronary arterial malformations increase mortality risk is unknown. The majority of the encountered coronary arterial anomalies in TS are benign or noninterarterial; however, it is important for the cardiothoracic surgeon to be aware of unusual coronary anatomy because it may necessitate modifications of the operative approach. Suggestions (...) for Clinical Practice Diagnosis If TS is highly suspected or has been confirmed prenatally, a fetal echocardiogram should be performed. If congenital heart disease is confirmed, then follow-up care by a pediatric cardiologist is recommended to provide counseling on the anatomy and physiology of the specific defect, recommended site and mode of delivery, and postnatal multidisciplinary management plan. Diagnosis of a BAV or a left-sided obstructive lesion, whether prenatally or postnatally, in a female

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2018 American Heart Association

192. Shoulder Pain - Atraumatic

, demonstrating accuracies in the detection of rotator cuff and adjacent soft-tissue abnormalities equivalent to MRI [6]. US is usually well tolerated and, as with MRI, involves no ionizing radiation. Imaging in real time allows direct functional assessment of the shoulder during provocative maneuvers (ie, impingement) as well as providing guidance for a variety of interventions. As in other modalities, the upper extremity must be positioned to optimally visualize the anatomy of interest. Discussion (...) of osseous, cartilaginous, and labroligamentous injuries [21,45]. Although CT arthrography aids in the evaluation of underlying soft tissues, the injected contrast may limit evaluation of the underlying osseous structures and cortical fragments as the injected contrast solution often has similar attenuation to cortical bone [37]. Other limitations include the need for an invasive arthrography procedure, ionizing radiation with close proximity to the thyroid and breast, poor assessment of bone marrow

2018 American College of Radiology

193. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency

of pediatric, reproductive, and adult endocrinologists and urologist during this transition. 6.2 In adolescent females with congenital adrenal hyperplasia, we suggest a gynecological history and examination to ensure functional female anatomy without vaginal stenosis or abnormalities in menstruation. (2|⊕⊕○○) Genetic counseling 6.3 In children with congenital adrenal hyperplasia, adolescents transitioning to adult care, adults with nonclassic congenital adrenal hyperplasia upon diagnosis, and partners (...) population. (1|⊕⊕○○) Technical remark: Clinicians should use their own judgment for the above procedures. Restoring functional anatomy by surgery in individuals with congenital adrenal hyperplasia 7.1 In all pediatric patients with congenital adrenal hyperplasia, particularly minimally virilized girls, we advise that parents be informed about surgical options, including delaying surgery and/or observation until the child is older. (Ungraded Good Practice Statement) Technical remark: Surgeries should

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2018 Pediatric Endocrine Society

194. European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

determining potential side effects, an experienced radiation oncologist is required ( ). For SRS, the tumour target should be at least 3–5 mm distant from the optic chiasm and less than 3 cm in diameter. Otherwise, fractionated EBRT may be the only option. Furthermore, EBRT should be preferred for tumours with irregular anatomy, including diffuse local infiltration and suprasellar or brainstem extension, to avoid high dose radiation of healthy tissue ( ). SRS may be more convenient for the patient

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2018 European Society of Endocrinology

196. Transcatheter aortic valve implantation (TAVI) in patients at intermediate surgical risk

of a bioprosthesis in the aortic valve using a catheter. In contrast to traditional open-heart surgery (i.e. surgical aortic valve replacement, SAVR), the procedure is minimally invasive when performed through transfemoral access and can be performed with light sedation and without cardiopulmonary bypass. The diseased valve is not excised, and there is no need for suturing to deploy the valve. The choice of the access route depends on the shape of the arteries and the anatomy of the patient. The most common

2018 EUnetHTA

197. 2017 Comprehensive Update of the CCS Guidelines for the Management of Heart Failure

failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; HTN, hypertension; Hx, history; LV, left ventricle; LVEF, left ventricular ejection fraction; LVH, left ventricular hypertrophy; NP, natriuretic peptide; PPCM, peripartum cardiomyopathy; Rx, prescription; TSH, thyroid-stimulating hormone. Figure 3 Algorithm for the use of natriuretic peptides in different heart failure (HF)-related clinical scenarios. Clinical evaluation and the risks and benefits (...) when coronary anatomy is not optimal. † If imaging indicates features of high risk, progression to coronary angiography is expected. ‡ Noninvasive imaging might be performed in certain centres for risk stratification or diagnosis. Figure 7 Decision regarding coronary revascularization in patients with heart failure. It is recommended that surgical and interventional cardiology consultation be considered early in this process. ∗ Coronary anatomy suitable for CABG includes: multivessel disease > 70

2017 Canadian Cardiovascular Society

198. Lymphoma

that increase risk of non-Hodgkin lymphoma are poorly understood but may include occupational exposures to pesticides, herbicides, and dioxins, as well as chronic immune stimulation associated with autoimmune disorders (e.g. thyroiditis, Sjogren’s Syndrome, SLE) or infections (e.g. Helicobacter pylori gastritis, hepatitis C virus). 2 In 2015, it is estimated that 8200 new cases of non-Hodgkin lymphoma will be diagnosed in Canada, and 2650 deaths will occur, making non-Hodgkin lymphoma the sixth most common

2016 CPG Infobase

199. BSR guideline Management of Adults with Primary Sjögren's Syndrome

infiltration of exocrine glands [ ]. Patients characteristically complain of drying of the eyes and mucosal surfaces along with fatigue and arthralgia. There is an association with autoimmune thyroid disease, coeliac disease and primary biliary cirrhosis. Systemic features include inflammatory arthritis, scLE, immune thrombocytopenia (ITP), vasculitis with purpura, salivary gland inflammation, neuropathies, interstitial lung disease (ILD) and a 5–10% lifetime risk of B cell lymphoma [ , ]. NICE has

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2017 British Society for Rheumatology

200. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

suspected or has been confirmed prenatally, a fetal echocardiogram should be performed (⨁⨁◯◯). R 4.11. We recommend that diagnosis of a bicuspid aortic valve or a left-sided obstructive lesion in a female fetus or child should prompt a genetic evaluation for TS (⨁⨁◯◯). R 4.12. We recommend referral to a pediatric cardiologist when congenital heart disease is detected prenatally in a fetus with TS to provide counseling regarding the anatomy and physiology of the specific defect, recommended site and mode

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2016 European Society of Human Reproduction and Embryology

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