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during this marvelous evening. The finale of the wine tasting event found us all on Marika and Sviatoslaw Makarenko’s deck, which overlooks the Hudson River, watching a spectacular fireworks display. To this day, although Sviatoslaw refuses to admit it, we believe he had a hand in scheduling the fireworks show especially for us. Hopefully, this year will bring similar social events as well as new members to help us continue to make our Branch productive and successful. RADIOLOGICAL TESTS: WHICH SHOULD YOU GET? by Ihor Magun, M.D., F.A.C.P. Over the last few decades, medical technol ogy for diagnostic purposes has evolved dramatical ly and one aspect of this evolution includes various types of radiological tests. Each of the radiological tests presented below has a specific purpose and it is important to understand which test is appropriate, as well as the benefits, costs, and risks involved. Patients presenting with rheumatologic or orthopedic issues, for the most part, require radio logical testing to clinch a diagnosis. With an ex panded availability of radiological imaging forms, getting the correct type of study is of paramount importance. If the possibility of a bone fracture exists, a simple x-ray is all you need. It is cost-effective, easy, and available everywhere. X-rays are also helpful for patients with early rheumatoid arthritis of hands and wrists. They can serve as a baseline for future treatment options. It is important to note that some hairline fractures may not be evident with an initial x-ray taken immediately after an injury and a follow-up x-ray, taken several days later, may be needed. MRIs are used primarily in case where damage to soft tissue elements is suspected. This generally includes and potential damage to the men- iscal cartilage of the knee, ligament issues, diseases of the spine, costochondritis, disc herniation, soft tissue disease like infections or malignancy, or in flammation of the bone. CAT scans are useful in imaging defects in the spine, especially in patients with rheumatoid arthritis with atlantoaxial subluxation in the neck. They are also utilized in evaluating cartilage loss in the pelvis. An ultrasound is used to evaluate cysts, which may be present behind the knee. It is also frequently utilized to evaluate fluid proliferation in the knees, ankles, wrists, elbows, and fingers. Although the accessibility to these tests is universally available, keep in mind that x-rays and CAT scans pose a risk for radiation exposure. MRIs cannot be performed on patients with loose metal hardware or with pacemakers. Caution should be exercised in patients with new cardiac stents; a minimum of a six month time lapse from the date of the stent procedure is required. As noted above, simple x-rays are cost- effective. The other procedures may be quite expensive, even though costs have gone down in the last few years. Moreover, most insurance companies require special pre-authorization before approving coverage. Most films today are digital, and the days of wet-developing are long gone. These digital images are instant and can be stored on discs. Most facili ties gladly furnish copies at minimal cost. It is pru dent to archive all radiological images for your records, especially for comparison to any images taken in the future. H A P P Y T H A N K S G I V I N G
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