Astavalence

PathoSchema by Astavalence · Hepatobiliary Imaging Decision Simulator

Decision rule Start with the clinical question. Pick the test that answers it with the lowest avoidable risk.

Current scenario

RUQ pain and suspected gallstones

Localise the problem first. Gallbladder, duct, liver parenchyma, vessel, tumour, trauma or post procedure leak.

Safety modifiers

Safety checks can change the next test without changing the clinical question.

Decision pathway

Question

First test

Escalate

Avoid first

What each modality means here

Pattern recognition

Clinical reasoning prompts

Modality quick guide

Evidence anchors

Suspected gallstone disease: liver blood tests plus ultrasound first. MRCP if duct stones remain suspected after ultrasound.
RUQ pain: ultrasound, CT, MRI with MRCP or HIDA may be appropriate depending on the suspected cause and whether ultrasound is equivocal.
Jaundice: ultrasound, contrast CT or MRI with MRCP are core first line options when the cause is not established.
HCC in at risk liver: surveillance uses ultrasound based pathways. Diagnosis relies on multiphase CT or MRI features such as arterial enhancement and washout.

Rule: never order imaging until the clinical question is explicit.

Decision rule Start with the clinical question, not the machine. Select the safest test that can answer that question now.

Current case

Imaging starts with the question

Choose a clinical scenario. The map will highlight the first-line investigation, escalation route and safety checks.

Diagnostic pattern selector

Decision pathway

Safety screen

Modality atlas

Clinical reasoning prompts

Use / avoid

UseA test that answers the immediate clinical question and changes management.

AvoidImaging without a question, duplicate scans, or high-radiation tests when a safer test answers the same question.

Evidence anchors

Built around: appropriateness criteria, iRefer-style referral reasoning, radiation justification, contrast safety, pregnancy/children caution, and modality-specific strengths. Always follow local policy and senior/radiology advice.

Back To Main Menu