2018_04_06 - Concept: Radiology

Coming soon to a radiology department near you:

Hm. Angina Pectoris is a symptom and it makes very little sense that this could be revealed by Angiography, since it's a subjective complaint.
Instead I bet you are thinking of Coronary Artery Disease: https://en.wikipedia.org/wiki/Coronary_artery_disease

Dysp wrote:Hm. Angina Pectoris is a symptom and it makes very little sense that this could be revealed by Angiography, since it's a subjective complaint.
Instead I bet you are thinking of Coronary Artery Disease: https://en.wikipedia.org/wiki/Coronary_artery_disease

Hello! Thanks for pointing this one out, we're now discussing 'arterial stenosis' which could be a better name for the symptom itself. The term seems to have a pretty different meaning in English compared to Czech, which is quite interesting - but not helpful

'Arterial stenosis' would be more accurate, but I wouldn't exactly call this a 'symptom'. It's a finding.

Here is how Wikipedia describes a symptom, which I find very accurate:
A symptom is a departure from normal function or feeling which is noticed by a patient, reflecting the presence of an unusual state, or of a disease. A symptom is subjective, observed by the patient, and cannot be measured directly, whereas a sign is objectively observable by others.
[Source]

When doing tests, we are looking for 'clues' that can determine a diagnosis. We order these tests based on the symptoms that a patient describe and the clinical examination (objectively looking for signs/clues).

This is an extremely simplified work flow:

1. Subjective anamnesis
2. Objective medical examination
3. Order relevant tests
4. Test results conclude the diagnosis. If these aren't conclusive, we run more tests to be sure (and sometimes you gotta treat before having a diagnosis, eg. when suspecting meningitis)
5. Treatment based on diagnosis
6. Follow up to see whether treatment was succesful or not

Well the angiograph you mapped out here is not used as an diagnosis tool by itself, its used for the intervention and maybe before to definitely safe the diagnosis.

It is used for an PTA percutane transluminal angioplasty (https://en.wikipedia.org/wiki/Angioplasty).

All the symptoms/diseases you meantioned are diagnosed elsewhere:
pulmonary artery blockage = lung embolism (disease) - CT with contrast agent (emergency case)
angina pectoris (symptom) - Coronary artery disease (well disease) - well a lot of diagnostics, modern method: Magnetic resonance imaging; usual method: echo, ecg, cardiac stress test
portal vein blocked (disease) = portal vein thrombosis (https://en.wikipedia.org/wiki/Portal_vein_thrombosis) - I am not sure how, but it is treated elsewhere I think

As an Intervention you can use this gadget for:
PTA: Peripheral artery disease, Coronary artery disease, basically for all artery stenosis (not for vein thrombosis)
Endovascular aneurysm repair:  Aortic aneurysm (https://en.wikipedia.org/wiki/Aortic_aneurysm)
Thoracic endovascular aortic repair: Aortic dissektion (But this would usually be done by an open surgery)
Transcatheter aortic valve implantations (TAVI): aortic valve stenosis (https://en.wikipedia.org/wiki/Hybrid_cardiac_surgery)

for the diagnosis before you start the intervention you always need an MRI or an CTI

Well, technically angiography is a diagnostic process but it's usually not done unless you're almost certain you will be doing an intervention. It is rare but still possible that an angiogram would be done without intervention, ie, prinzmetal finding or diffuse disease not amenable to point correction. It's kind of semantics though

As has been said, many of the diagnoses listed are made using CT/MRI. I work in CT and specialise in Cardiac imaging. We perform TAVI and Coronary Angiography CT scans, these patients would then go to the 'cath lab' or vascular department for intervention utilising equipment such as that shown above. CT is preferred as a first-line imaging modality for these patients as it's less invasive than sending the patient straight for an interventional angiogram. As for the design of the equipment, well done it's spot on!

Too many professionals in the forum
I expect a realistic hospital game like Project Hospital seems it but not a simulator.
I think is impossible to show every aspect of medical procedures and hospital life.