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The first step in medical imaging is to examine the patient and determine the possible cause of his or her problem. Only after this is done can you decide which imaging study is the most appropriate. A vast number of algorithms or guidelines have been developed, but no consensus exists on the “right” one for a given symptom or disease because a number of imaging modalities have similar sensitivities and specificities. In this text, I have chosen to give you my opinion on the initial study to order in a specific clinical setting.

What should you expect from an imaging examination?

Typically, one expects to find the exact location of a problem and hopes to make the diagnosis. Although some diseases present a very characteristic picture, most can appear in a variety of forms depending on the stage. As a result, image interpretation will yield a differential diagnosis that must be placed in the context of the clinical findings...