The objectives of this article are to discuss the current evidence-based recommendations regarding radiation dose concerns, the use of iodinated and gadolinium-based contrast agents, and the ...comparative advantages of multimodality imaging (ultrasound, CT, and MRI) during pregnancy and lactation. We also discuss the use of imaging to evaluate pregnant trauma patients.
Maternal and fetal radiation exposure and dose are affected by gestational age, anatomic site, modality, and technique. The use of iodinated and gadolinium-based contrast agents during pregnancy and lactation has not been well studied in human subjects. Imaging should be used to evaluate pregnant trauma patients only when the benefits outweigh the risks.
The purpose of this study was to determine whether diagnostic radiologists impart variation into resource use and patient outcomes in emergency department (ED) patients undergoing CT for headache.
...This was a single-institution retrospective quality assurance cohort study of 25,596 unique adult ED patients undergoing head CT for headache from January 2012 to October 2017. CT examinations were interpreted by 55 attending radiologists (25 neuroradiologists, 30 radiologists of other specialties) who each interpreted a mean of 1469.8 ± 787.9 CT examinations. Risk adjustment for variables thought to influence outcome included baseline risk (demographics, Elixhauser comorbidity score), clinical factors (vital signs, ED triage and pain scores, laboratory data, hydrocephalus, prior intracranial hemorrhage, neurosurgical consultation within last 12 months), and system factors (time of CT, physician experience, neuroradiology training). Multivariable models were built to analyze the effect of individual radiologists on subsequent outcomes. Any
value less than 0.007 was considered significant after Bonferroni correction.
The study found 57.5% (14,718/25,596) of CT interpretations were performed by neuroradiologists, and most patients (98.1% 25,119/25,596) had no neurosurgical history. After risk adjustment, individual radiologists were not an independent predictor of hospital admission (
= 0.49), 30-day readmission (
= 0.30), 30-day mortality (
= 0.14), or neurosurgical intervention (
= 0.04) but did predict MRI use (
< 0.001; odds ratio OR range among radiologists, 0.009-38.2), neurology consultation (
< 0.001; OR range, 0.4-3.2), and neurosurgical consultation (
< 0.001; OR range, 0.1-9.9).
Radiologists with different skills, experience, and practice patterns appear interchangeable for major clinical outcomes when interpreting CT for headache in the ED, but their differences predict differential use of downstream health care resources. Resource use measures are potential quality indicators in this cohort.
Blunt pelvic trauma is associated with injuries to the musculoskeletal, lower genitourinary, and vascular systems, leading to significant morbidity and mortality. This article provides a ...comprehensive review of these injuries, reviews classification systems that are helpful in predicting prognosis, describes the most appropriate imaging tests for injury detection, and emphasizes the role that interventional radiology plays in the setting of pelvic trauma.
Blunt pelvic injuries can involve the musculoskeletal, genitourinary, and vascular systems, often concomitantly, making it imperative for radiologists to recognize injury patterns and understand implications for management. Injury classifications can be helpful in determining management and predicting prognosis. Contrast-enhanced CT is the imaging modality test of choice in evaluating pelvic trauma, and protocols should be optimized for best detection of injuries. Transcatheter arterial embolization plays a critical role in stopping acute hemorrhage and improving clinical outcomes.
Background
Pediatric traumatic abdominal wall hernias are rare but potentially devastating injuries. Although classically considered to be caused by handlebar injuries from bicycle accidents, our ...anecdotal experience suggests pediatric traumatic abdominal wall hernias are far more likely to occur following road traffic accidents and have a high association with other significant intra-abdominal injuries.
Objective
The purpose of this study was to determine the frequency, mechanisms of injury, and associated injuries of traumatic abdominal wall hernias in the pediatric population.
Materials and methods
This is a retrospective observational cohort study from two large urban level 1 trauma centers. Institutional trauma registries were queried from January 1, 2008, to December 31, 2020, for patients under 18 years of age diagnosed with traumatic abdominal wall hernias, excluding those without initial abdominopelvic CT imaging. Finalized CT reports and images were reviewed to confirm the presence of a traumatic abdominal wall hernia and document any associated secondary injuries. The medical record was reviewed to extract pertinent physical findings, interventions performed, and outcomes. Injury Severity Score (ISS) for each patient was calculated by the trauma registrar.
Results
A total of 19 patients with TAWH met inclusion criteria, with an overall frequency of 0.095% and a mean age of 10.6 years (range 3–17). Eleven patients were male (57.9%) with a mean ISS of 18.6 (range 1–48, including 63.2% with ISS > 15). The most common mechanism of injury was motor vehicle collision (
N
= 11, 57.9%) followed by bicycle accident (
N
= 3, 15.8%). A total of 17 (89.5%) had associated injuries, including 11 (57.9%) with intestinal injuries, 5 (26.3%) with pelvic fractures, 4 (21.1%) with femur fractures, 3 (15.8%) with splenic injuries, 3 (15.8%) with kidney injuries, and 3 (15.8%) with Chance fractures of the lumbar spine. All patients required surgery for the traumatic abdominal wall hernias and associated injuries.
Conclusion
Pediatric traumatic abdominal wall hernias are more likely to be seen following motor vehicle collisions, with a majority (89.5%) having associated injuries, most frequently to the bowel (57.9%). Handlebar injuries were seen in a minority of patients (15.8%) and were less likely to be associated with additional injuries.
Clinical impact
Pediatric patients with a traumatic abdominal wall hernia on admission CT should be thoroughly evaluated for bowel injuries, especially in the setting of a motor vehicle collision.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The objectives of this article are to discuss the current evidence-based recommendations regarding the use of diagnostic imaging in the evaluation of pulmonary embolism, appendicitis, urolithiasis, ...and cholelithiasis during pregnancy.
Diagnostic imaging should be performed during pregnancy only with an understanding of the maternal and fetal risks and benefits, the comparative advantages of different modalities, and the unique anatomic and physiologic issues associated with pregnancy.
To determine retrospectively the clinical effectiveness of an unenhanced magnetic resonance (MR) imaging protocol for evaluation of equivocal appendicitis in children.
Institutional review board ...approval was obtained. Pediatric patients (≤18 years old) underwent unenhanced MR imaging and contrast material-enhanced computed tomography (CT) of the appendix between December 2013 and November 2014 and December 2012 and November 2013, respectively, within 24 hours after an abdominal ultrasonographic examination with results equivocal for appendicitis. Pertinent MR imaging and CT reports were reviewed for visibility of the appendix, presence of appendicitis and appendiceal perforation, and establishment of an alternative diagnosis. Surgical reports, pathologic reports, and 30-day follow-up medical records were used as reference standards. Diagnostic performance with MR imaging and CT was calculated with 95% confidence intervals (CIs) for diagnosis of appendicitis and appendiceal perforation. The Fisher exact test was used to compare proportions; the Student t test was used to compare means.
Diagnostic performance with MR imaging was comparable to that with CT for equivocal pediatric appendicitis. For MR imaging (n = 103), sensitivity was 94.4% (95% CI: 72.7%, 99.9%) and specificity was 100% (95% CI: 95.8%, 100%); for CT n = 58, sensitivity was 100% (95% CI: 71.5%, 100%), specificity was 97.9% (95% CI: 88.7%, 100%). Diagnostic performance with MR imaging and CT also was comparable for detection of appendiceal perforation, with MR imaging (n = 103) sensitivity of 90.0% (95% CI: 55.5%, 99.8%) and specificity of 85.7% (95% CI: 42.1%, 99.6%) and CT (n = 58) sensitivity of 75.0% (95% CI: 19.4%, 99.4%) and specificity of 85.7% (95% CI: 42.1%, 99.6%). The proportion of examinations with identifiable alternative diagnoses was similar at MR imaging to that at CT (19 of 103 18.4% vs eight of 58 13.8%, respectively; P = .52). The proportion of appendixes seen at MR imaging and at CT also was similar (77 of 103 74.8% vs 50 of 58 86.2%, respectively; P = .11).
Unenhanced MR imaging is sensitive and specific for the diagnosis of equivocal appendicitis in nonsedated pediatric patients.
Purpose
To assess the influence of time of day when a study is interpreted on discrepancy rates for common and advanced studies performed in the acute community setting.
Methods
This retrospective ...study used the databank of a U.S. teleradiology company to retrieve studies between 2012 and 2016 with a preliminary report followed by a final report by the on-site client hospital. Neuroradiology, abdominal radiology, and musculoskeletal radiology studies were included. Teleradiologists were fellowship trained in one of these subspecialty areas. Daytime, evening, and overnight times were defined. Associations between major and minor discrepancies, time of day, and whether the study was common or advanced were tested with significance set at
p
= .05.
Results
A total of 5,883,980 studies were analyzed. There were 8444 major discrepancies (0.14%) and 17,208 minor discrepancies (0.29%). For common studies, daytime (0.13%) and evening (0.13%) had lower major discrepancy rates compared to overnight (0.14%) (daytime to overnight, RR = 0.57, 95%CI: 0.45, 0.72,
p
< 0.01 and evening to overnight, RR = 0.57, 95%CI: 0.49,0.67,
p
< 0.01). Minor discrepancy rates for common studies were decreased for evening (0.29%) compared to overnight (0.30%) (RR = 0.89, 95%CI: 0.80,0.99,
p
= 0.029). For advanced studies, daytime (.15%) had lower major discrepancy rates compared to evening (0.20%) and overnight (.23%) (daytime to evening, RR = 0.77, 95%CI: 0.61, 0.97,
p
= 0.028 and daytime to overnight, RR = 0.66, 95%CI: 0.50, 0.87,
p
≤ 0.01).
Conclusion
Significantly higher major discrepancy rates for studies interpreted overnight suggest the need for radiologists to exercise greater caution when interpreting studies overnight and may require practice management strategies to help optimize overnight work conditions. The lower major discrepancy rates on advanced studies interpreted during the daytime suggest the need for reserving advanced studies for interpretation during the day when possible.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The purpose of this study was to determine whether individual radiologists are predictive of important relevant health outcomes among emergency department (ED) patients undergoing abdominopelvic CT ...for right lower quadrant pain.
This single-institution retrospective cohort study included 2169 patients undergoing abdominopelvic CT for right lower quadrant pain in the ED from February 1, 2012, through August 31, 2016. CT examinations were interpreted by 15 radiologists (four emergency, 11 abdominal) who each reported on more than 70 CT examinations in the cohort. After risk adjustment for covariates thought to influence outcome, including baseline risk (demographics, 30 Elixhauser comorbidities, number of previous ED visits), clinical factors (vital signs, triage and pain scores, laboratory data), and system factors (time of CT, resident involvement, attending physician experience), multivariable models were built to analyze the effect of individual radiologists on four important health outcomes: hospital admission (primary outcome), readmission within 30 days, abdominal surgery, and image-guided percutaneous aspiration or drainage.
Radiologists had a mean experience of 14 years (range, 2-36 years) and read a mean of 145 CT examinations in the study cohort (range, 73-253 examinations). Unadjusted event rates across the 15 radiologists were 38-55% (admission), 11-21% (readmission), 10-26% (surgery), and 0-3% (aspiration or drainage). After risk adjustment, individual radiologists were not a significant multivariable predictor of hospital admission, readmission within 30 days, abdominal surgery, or image-guided abdominal percutaneous aspiration or drainage (all p > 0.05).
Individual radiologists were indistinguishable both within group and between group by emergency and abdominal specialization for the prediction of major patient outcomes after abdominopelvic CT performed for right lower quadrant pain in the ED.
Purpose To identify computed tomographic (CT) findings that are predictive of recurrence of colonic diverticulitis. Materials and Methods Institutional review board approval was obtained for this ...HIPAA-compliant, retrospective cohort study. Six abdominal fellowship-trained radiologists reviewed the CT studies of 440 consecutive subjects diagnosed with acute colonic diverticulitis between January 2004 and May 2008 to determine the involved segments, maximum wall thickness in the inflamed segment, severity of diverticulosis, presence of complications (abscess, fistula, stricture, or perforation), and severity of the inflammation. Electronic medical records were reviewed for a 5-year period after the patients' first CT study to determine clinical outcomes. Predictors of diverticulitis recurrence were assessed with univariate and multiple Cox proportional hazard regression models. Results Colonic diverticulitis most commonly involved the rectosigmoid (70%, 309 of 440) and descending (30%, 133 of 440) colon segments. Complicated diverticulitis was present in 22% (98 of 440) of patients. On the basis of the results of univariate analysis, significant predictors of diverticulitis recurrence were determined to be maximum colonic wall thickness in the inflamed segment (hazard ratio HR, 1.07 per every millimeter of increase in wall thickness; P < .001), presence of a complication (HR, 1.75; P = .002), and subjective severity of inflammation (HR, 1.36 for every increase in severity category; P value for linear trend = .003). The difference in maximum wall thickness in the inflamed segment (HR, 1.05 per millimeter; P = .016) and subjective inflammation severity (HR, 1.29 per category; P = .018)remained statistically significant in a Cox multiple regression model. Conclusion Maximum colonic wall thickness and subjective severity of acute diverticulitis allow prediction of recurrent diverticulitis and may be useful for stratifying patients according to the need for elective partial colectomy.
RSNA, 2017 Online supplemental material is available for this article.
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