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Emergency Radiology

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https://www.readbyqxmd.com/read/28315025/practices-and-attitudes-towards-radiation-risk-disclosure-for-computed-tomography-survey-of-emergency-medicine-residency-program-directors
#1
Jennifer R Marin, Karen E Thomas, Angela M Mills, Joshua S Broder, Kathy Boutis
PURPOSE: The purposes of this study were to evaluate the frequency with which emergency physicians involved in residency leadership disclose potential malignancy risks from computed tomography (CT), assess comfort with these discussions, and evaluate factors influencing risk disclosure. METHODS: We surveyed emergency medicine residency program directors and associate/assistant directors. Primary outcome was the proportion who "almost always" or "most of the time" discussed potential risks...
March 17, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28289906/pediatric-chest-ct-at-chest-radiograph-doses-when-is-the-ultralow-dose-chest-ct-clinically-appropriate
#2
Javier E Villanueva-Meyer, David M Naeger, Jesse L Courtier, Michael D Hope, Jack W Lambert, John D MacKenzie, Andrew S Phelps
PURPOSE: Computed tomography (CT) use in emergency departments represents a significant contribution to pediatric patients' exposure to ionizing radiation. Here, we evaluate whether ultralow-dose chest CT can be diagnostically adequate for other diagnoses and whether model-based iterative reconstruction (MBIR) can improve diagnostic adequacy compared to adaptive statistical iterative reconstruction (ASIR) at ultralow doses. METHODS: Twenty children underwent chest CTs: 10 standard-dose reconstructed with ASIR and 10 ultralow-dose reconstructed with ASIR and MBIR...
March 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28255931/scary-gas-intravascular-intracranial-and-intraspinal-ectopic-gas-part-iii
#3
Claire K Sandstrom, Sherif F Osman, Ken F Linnau
While ectopic gas can be a sign of dangerous disease requiring immediate medical or surgical intervention, it can also be an incidental and benign finding. Intravenous gas and spinal vacuum gas are common and almost always benign. Intravascular gas is most often related to instrumentation and, if intraarticular, can cause end-organ ischemia; however, treatment is usually supportive. Pneumocephalus arises from a communication with paranasal sinuses or mastoids more often than from meningeal infection and can usually be managed nonoperatively...
March 2, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28255930/scary-gas-a-spectrum-of-soft-tissue-gas-encountered-in-the-axial-body-part-ii
#4
Claire K Sandstrom, Sherif F Osman, Ken F Linnau
Ectopic gas in the mediastinum, subperitoneal abdomen, and superficial soft tissues is concerning and can be seen in the setting of trauma, iatrogenic injuries, infection, and inflammation. It can spread along different dissection pathways and may present remotely from the involved organ as described in part one. Recognition of ectopic gas on imaging and differentiating it from other causes of benign gas is very important as these conditions associated with ectopic gas can lead to rapid patient deterioration and usually require urgent surgery...
March 2, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28251366/scary-gas-pathways-in-the-axial-body-for-soft-tissue-gas-dissection-part-i
#5
Claire K Sandstrom, Sherif F Osman, Ken F Linnau
Gas is often encountered in abnormal locations in the torso, including within soft tissue compartments, vessels, and bones. The clinical significance of this gas ranges from incidental, benign, and self-limited to aggressive infection requiring immediate surgery. As a result of fascial interconnectivity and pressure differences between compartments, gas can dissect distant from its source. Gas can easily dissect between spaces of the extrapleural thorax, subperitoneal abdomen, deep cervical spaces, and subcutaneous tissues...
March 1, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28243766/every-second-counts-signs-of-a-failing-heart-on-thoracic-ct-in-the-ed
#6
David J Maldow, Abhishek Chaturvedi, Katherine Kaproth-Joslin
Impending cardiac failure is often difficult to recognize and requires a multidisciplinary approach. Upon arrival in the emergency department, patients are promptly screened for potentially life-threatening conditions through a history and physical examination. In many cases, the diagnosis is not clear until confirmatory laboratory or imaging tests are performed. Unfortunately, patients can rapidly decompensate as this diagnostic information is being obtained. Emergent CT plays a key role in identifying conditions that may result in cardiovascular collapse, including severe congestive heart failure, myocardial infarction, cardiac tamponade, and impending cardiac failure...
February 27, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28243765/clinical-information-available-during-emergency-department-imaging-order-entry-and-radiologist-interpretation
#7
Tarek N Hanna, Saurabh Rohatgi, Haris N Shekhani, Ishaan Amit Dave, Jamlik-Omari Johnson
OBJECTIVE: The objective of this study was to evaluate the proportion of Emergency Department (ED) radiology examinations ordered or interpreted prior to a documented clinical assessment. MATERIALS AND METHODS: We collected 600 retrospective consecutive ED cases consisting equally of patients whose first ED imaging examination was computed tomography (CT), radiography (XR), or ultrasonography (US). For each patient, the following times were documented: ED arrival, ED departure, ED length of stay (LOS), imaging order entry, image availability, radiology report availability, triage note, ED provider note, and laboratory results...
February 27, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28243764/the-spectrum-of-traumatic-injuries-at-the-craniocervical-junction-a-review-of-imaging-findings-and-management
#8
Juveria Siddiqui, Patrick J Grover, Hegoda Levansri Makalanda, Thomas Campion, Jonathan Bull, Ashok Adams
The craniocervical junction is an area with unique biomechanical properties and injuries conferred often represent high-impact trauma. The vital structures traversing this region are susceptible to injury with frequent, only subtle findings identified on unenhanced CT, with MRI and CT angiography often revealing the full extent of injuries. This article reviews the osseous and ligamentous anatomy of the region and common injury patterns. Endovascular and neurosurgical management will also be discussed.
February 27, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28236025/incremental-diagnostic-quality-gain-of-cta-over-v-q-scan-in-the-assessment-of-pulmonary-embolism-by-means-of-a-wells-score-bayesian-model-results-from-the-acdc-collaboration
#9
Laila Cochon, Kaitlin McIntyre, José M Nicolás, Amado Alejandro Baez
OBJECTIVE: Our objective was to evaluate the diagnostic value of computed tomography angiography (CTA) and ventilation perfusion (V/Q) scan in the assessment of pulmonary embolism (PE) by means of a Bayesian statistical model. METHODS: Wells criteria defined pretest probability. Sensitivity and specificity of CTA and V/Q scan for PE were derived from pooled meta-analysis data. Likelihood ratios calculated for CTA and V/Q were inserted in the nomogram. Absolute (ADG) and relative diagnostic gains (RDG) were analyzed comparing post- and pretest probability...
February 24, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28181026/incidental-findings-in-blunt-trauma-patients-prevalence-follow-up-documentation-and-risk-factors
#10
Melissa K James, Michael P Francois, Gideon Yoeli, Geoffrey K Doughlin, Shi-Wen Lee
PURPOSE: The frequency of computed tomography (CT) imaging of trauma patients has given rise to an increase in the discovery of incidental findings. The purpose of this study was to evaluate the frequency and documentation of follow-up recommendations of incidental findings during the initial trauma evaluation. Secondarily, trauma patients with and without incidental findings were compared. We hypothesized that there would be a high rate of incidental findings in trauma patients and that these findings would be poorly documented...
February 9, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28168531/clinical-and-imaging-features-indicative-of-clinically-worrisome-pneumatosis-key-components-to-identifying-proper-medical-intervention
#11
Riya Goyal, Hwayoung K Lee, Meredith Akerman, Leonora W Mui
PURPOSE: The purpose of this retrospective study was to determine clinical and imaging factors on computed tomography (CT) associated with clinically worrisome pneumatosis intestinalis (PI) that may aid in the decision to provide conservative management or urgent surgical intervention. METHODS: Informed consent was waived in this IRB approved study. Imaging features assessed included the presence, location, and pattern of PI, bowel dilatation, thickening, enhancement, stranding, portal venous (PV) and mesenteric venous gas, mesenteric edema, free air, and ascites...
February 6, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28150047/evaluation-of-the-diagnostic-value-of-a-venous-phase-in-ct-angiography-of-the-extremities-in-the-setting-of-trauma-is-vein-imaging-in-vain
#12
Zachary Masi, Kathryn Gussman, Joshua P Hazelton, Ron Gefen
PURPOSE: This study examined the value of including a venous phase in addition to the initial arterial phase in the CT angiography evaluation of extremity trauma. METHODS: CT studies from 157 patients (average age 38 years, age range 18-89 years, male 83%, female 17%) were obtained for trauma to the upper or lower extremity with both arterial and venous phases and retrospectively reviewed. The detection rate and type of vascular injury were evaluated by using the arterial phase alone and compared to the detection rate when interpreting the arterial and venous phases together...
February 2, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28144761/addition-of-the-apical-oblique-projection-increases-the-detection-of-acute-traumatic-shoulder-abnormalities-in-adults
#13
Kimberley J Ross, Grant R Tomkinson, Bonnie F McGregor, Oliver C Ayres, Diana Piscitelli
PURPOSE: Plain radiographic evaluation of acute shoulder trauma in adults requires a minimum of two projections, commonly the anteroposterior (AP) and lateral scapular projections, with additional projections taken for diagnosis. The aim of this retrospective study was to determine whether the addition of the apical oblique (AO) projection to the AP and lateral scapular projections increases the number and/or alters the types of abnormalities detected in the examination of acute shoulder trauma...
February 1, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28138836/core-curriculum-illustration-invasive-fungal-sinusitis
#14
Khanant Desai, Diego B Nunez, Christopher A Potter
This is the 27th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.erad.org/?page=CCIP_TOC .
January 30, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28124724/number-of-positive-radiographic-findings-in-pediatric-trauma-patients
#15
Thomas Ruffing, Tim Danko, Thomas Henzler, Christel Weiss, Alexander Hofmann, Markus Muhm
PURPOSE: Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically. METHODS: A transversal cohort study was conducted at a level 1 trauma center in Germany (2008-2014)...
January 26, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28116533/negative-d-dimer-testing-excludes-pulmonary-embolism-in-non-high-risk-patients-in-the-emergency-department
#16
John B Harringa, Rebecca L Bracken, Scott K Nagle, Mark L Schiebler, Michael S Pulia, James E Svenson, Michael D Repplinger
PURPOSE: The purpose of this study was to assess the ability of d-dimer testing to obviate the need for cross-sectional imaging for patients at "non-high risk" for pulmonary embolism (PE). METHODS: This is a retrospective study of emergency department patients at an academic medical center who underwent cross-sectional imaging (MRA or CTA) to evaluate for PE from 2008 to 2013. The primary outcome was the NPV of d-dimer testing when used in conjunction with clinical decision instruments (CDIs = Wells', Revised Geneva, and Simplified Revised Geneva Scores)...
January 24, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28091809/a-review-of-penetrating-brain-trauma-epidemiology-pathophysiology-imaging-assessment-complications-and-treatment
#17
REVIEW
Mona T Vakil, Ajay K Singh
Gunshot injuries are the most common cause of penetrating brain injury (PBI) and carry a high morbidity and mortality. The incidence of PBI has increased over the last decade with an estimated 35,000 civilian deaths annually. Patients that survive to reach the hospital require rapid triage and imaging evaluation. CT findings in conjunction with the Glasgow Coma Scale are typically used to determine which patients are surgical candidates. Radiologists should be familiar with the various injury patterns and imaging findings which are poor prognostic indicators, notably brainstem, bilateral hemispheric, multilobar, or transventricular injuries...
January 14, 2017: Emergency Radiology
https://www.readbyqxmd.com/read/28032258/core-curriculum-illustration-acute-pyelonephritis
#18
Muhammad Mubashir Ramzan, Claire Kalsch Sandstrom
This is the 26th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.htm .
December 28, 2016: Emergency Radiology
https://www.readbyqxmd.com/read/27572932/ct-angiography-of-the-chest-and-abdomen-in-an-emergency-patient-via-humeral-intraosseous-access
#19
Nils Markus Budach, Stefan Markus Niehues
A 69-year-old woman was taken to our emergency department after having been found unconscious. An intraosseous catheter was placed in the head of the right humerus due to inaccessible peripheral veins. With the suspected diagnosis of shock, pulmonary embolism, and mesenteric ischemia, a CT scan of the chest and abdomen was initiated. Pulmonary embolism and mesenteric arterial embolism could be ruled out at excellent image quality.
February 2017: Emergency Radiology
https://www.readbyqxmd.com/read/27519693/advanced-imaging-of-glenohumeral-instability-the-role-of-mri-and-mdct-in-providing-what-clinicians-need-to-know
#20
REVIEW
Shadpour Demehri, Nima Hafezi-Nejad, Elliot K Fishman
The inherently unstable anatomy of glenohumeral (GH) joint predisposes it to shoulder dislocation. Shoulder dislocation can occur either due to acute trauma or due to chronic microtraumas in the setting of underlying morphological abnormality. A plain radiograph is the initial imaging modality for diagnosis and management of shoulder dislocation and its associated osseous abnormalities such as Hill-Sachs deformity or osseous Bankart lesion. However, advanced imaging techniques such as multidetector CT (MDCT) with three-dimensional (3D) volume rendering and MRI can be helpful in further characterization of osseous abnormalities and detection of associated soft tissue injuries, respectively...
February 2017: Emergency Radiology
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