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Asrani, Ashwin; Johnson, Jamlik-Omari; Novelline, Robert
doi: 10.1007/s10140-010-0893-8pmid: 20680653
To determine the benefit of a short-term follow-up abdominopelvic computed tomography (APCT) examination among emergency department (ED) patients with persistent abdominal pain and an initially negative CT. During a 5-year period from January 2004 to December 2008, our institution’s radiology department performed approximately 56,000 APCTs examinations in the ED. Sixty-eight percent of the APCT examinations used intravenous contrast. Nine hundred fifty-seven patients received two APCTs within 1 week for non-traumatic abdominal pain in the ED. Sixty-four patients with initially negative APCTs presented to the ED within 1 week with persistent abdominal pain and received follow-up APCT imaging. The mean follow-up period was 2.6 days. The mean interval period in which the second APCT yielded a positive result was 2.0 days. Seventy-five percent of follow-up examinations were performed with intravenous contrast. Twenty-three percent of patients had positive findings on the follow-up examination. Seventy-three percent of the follow-up positive findings were referable to bowel pathology. The cause of abdominal pain remained elusive at 1 week in 23% of patients. Short-term follow-up APCT examinations in patients with persistent, unexplained abdominal pain may be of benefit if the second APCT is performed with intravenous contrast in patients suspected of having bowel pathology.
Yaghmai, Vahid; Aghaei-Lasboo, Anahita; Brandwein, Warren; Tochetto, Sandra; Mafi, John; Miller, Frank; Nikolaidis, Paul
doi: 10.1007/s10140-010-0894-7pmid: 20683631
We compared the effect of low-density barium sulfate neutral oral contrast agent on the diameter of normal appendix and its luminal content versus that of water on multidetector-row CT. CT scans of 24 patients who had been imaged on two separate occasions for the evaluation of pancreatic pathology, once with water and subsequently with low-density barium sulfate as the neutral oral contrast agent were evaluated (total of 48 scans). Studies were randomized and reviewed in consensus on a workstation in the stack mode by two radiologists blinded to the type of oral contrast. The appendix was measured at baseline and 10 days later to obtain an average diameter. Results of the water and low-density barium sulfate groups were compared using paired t test. Contents of the appendiceal lumen were also noted (gas, fluid, mixed, and collapsed appendix). The average diameter of the appendix for scans obtained with water and low-density barium sulfate was 4.09 ± 0.87 mm (median, 4.22 mm; range, 2.50–5.65 mm) and 4.13 ± 0.93 mm (median, 4 mm, range, 2.2–5.65 mm), respectively. This difference was not statistically significant (P = 0.69). There was no statistically significant difference in the appendiceal content when water or low-density barium sulfate were used as oral contrast (χ 2 = 4.25, P = 0.89). Low-density barium sulfate does not affect appendiceal content or diameter and, therefore, should not adversely affect evaluation of the appendix on multidetector row CT.
Börjesson, Joakim; Latifi, Ali; Friman, Ola; Beckman, Mats; Oldner, Anders; Labruto, Fausto
doi: 10.1007/s10140-010-0895-6pmid: 20694568
In this prospective study, we set out to determine the accuracy of low-dose computerized tomography (LDCT) of the chest in intensive care patients. Fifteen adult intensive care patients were examined with a standard-dose CT protocol (average radiation dose = 6.7 mSv), chosen as the reference standard, followed by a non-contrast-enhanced LDCT protocol (average radiation dose = 0.59 mSv). Each examination was then read by two separate groups of radiologists blinded to both the purpose and the protocol of the study. In the small group examined, the results showed 100% accuracy in the diagnosis of pneumomediastinum, pericardial effusion, and pleural effusion, and 90% accuracy in the diagnosis of pneumothorax and consolidation. There were no false-positive findings, and the few false-negative findings were unlikely to lead to any clinical interventions. Our examination protocol, while providing a tenfold reduction of the radiation dose, nevertheless remained accurate enough for resolving certain clinical questions common in the intensive care patient. Thus, we suggest that protocols aimed at reducing the radiation dose in chest CT could be applied to the intensive care patient for resolving some specific questions, without compromising the diagnostic yield of the examinations.
Agrawal, Anjali; Agrawal, Anurag; Pandit, Meenakshi; Kalyanpur, Arjun
doi: 10.1007/s10140-010-0899-2pmid: 20737281
International teleradiology services (ITS) to the United States are based on the principle of deploying American board-certified radiologists across global time zones to optimally distribute the workload. While errors may be reduced by circumventing the traditional night call, there is limited evidence on the actual error rates of teleradiology groups. We have a comprehensive quality assurance (QA) process in our practice, which includes a review of discrepancies between preliminary reports and the final reports by the on-site radiologists. We analyzed the discrepancy QA data to determine the error rates. Archived QA data for 126,449 cases over a period of 1 year (2008) were analyzed for the discrepancy rate, nature of errors, and possible contributory factors. The scores ranged from 0 (no error) to 5 (clinically significant in the acute setting) based on the level of clinical significance. A novel modified Lorenz plot was used to estimate the degree of underreporting and to estimate the true error rate. An internal review of 200 cases was performed to validate the findings. Of the total, there was a total of 227 confirmed errors (0.18%, 95% CI, 0.16 to 0.20). Of these, the majority were levels 2 and 3 (minor error and error of long-term significance but not in the acute setting). Even after correction for underreporting, error rates were less than 1% for clinically significant errors. ITS is associated with very low rates of clinically significant errors. Due to limited feedback, particularly for minor errors, an internal review is important.
Kokabi, Nima; Raper, Daniel; Xing, Minzhi; Giuffre, Bruno
doi: 10.1007/s10140-010-0901-zpmid: 20809342
Safe and efficient clearance of cervical spine injury in blunt trauma patients has been a controversial topic among health professionals. The increased availability of CT scanners in major trauma centers seems to be a factor that has led to increased number of unnecessary cervical spine imaging using this imaging modality. The objective of this study was to investigate the applicability and efficacy of a pre-test clinical criterion in order to stratify post-blunt trauma victims based on their risk of sustaining cervical spine injury and in turn recommend an appropriate imaging modality accordingly. Goergen's criteria (Australas Radiol 48(3):287, 2004), a pre-investigation diagnostic algorithm was retrospectively applied to 106 blunt trauma victims who presented to a level 1 trauma center in Sydney, Australia, and had a CT scan of cervical spine as part of their initial management. Overall, nine (8.5%) of patients sustained a significant cervical spine injury. All nine patients would be classified as high-risk victims according to the algorithm investigated in this study, warranting CT scanning. No patients with low-risk injuries were demonstrated to have a significant cervical spine injury. There was a statistically significant greater proportion of acute cervical spine injuries detected in the high-risk group (p value = 0.0024). Hence, using Goergen's diagnostic algorithm could reduce the number of unnecessary cervical spine CT scans ordered, while not compromising the quality of care in post-blunt trauma victims.
Chittiboina, Prashant; Cuellar, Hugo; Ballenilla, Federico; Nanda, Anil
doi: 10.1007/s10140-010-0900-0pmid: 20809343
We present two cases of hematoma contralateral to the aneurysm. Case 1 is a 62-year-old woman presenting with a large left frontal intraparenchymal hematoma (IPH) and a right posterior communicating artery (PCoA) aneurysm. This is the first reported case of a contralateral frontal IPH from PCoA aneurysm rupture. Case 2 is a 58-year-old male with right PCoA aneurysm and left sylvian SAH. Both patients underwent coil embolization of offending lesions, with repeat angiograms revealing no other vascular anomalies.
Adil, Eelam; Choudhary, Arabinda; Moser, Kevin; Ghossaini, Soha
doi: 10.1007/s10140-010-0902-ypmid: 20827498
We present an interesting and relatively uncommon case of vestibular pneumolabyrinth in a young child post-trauma. His initial clinical exam and imaging studies of the head and cervical spine were negative. He subsequently developed nystagmus and a dedicated temporal bone study demonstrated a subtle fracture and vestibular pneumolabyrinth. Temporal bone fractures can be difficult to appreciate, and therefore, associated findings of fluid in the middle ear, stapes dislocation, or vestibular pneumolabyrinth must be carefully evaluated. Temporal bone computed tomography is a high resolution study, utilizing dynamic focal spot mode which leads to increased sampling and resolution, thereby reducing aliasing artifacts but a longer scan time and increased radiation dose. CT head and cervical spine normally obtained without using this technique leads to aliasing artifacts where even the normal endolymph in the inner ear structures appear hypodense mimicking pneumolabyrinth, thereby obscuring true pneumolabyrinth. It is important to be aware of this finding and technique-related artifact, if a temporal bone injury is suspected, to ensure an earlier diagnosis and optimum management.
Yuen, Chi; Chung, Tong; Mok, Ka; Kan, Pui; Wong, Yau
doi: 10.1007/s10140-010-0906-7pmid: 20848151
Acute posterior shoulder dislocation is rare, and its early diagnosis remains a challenge to the emergency physician. This report describes two cases of acute posterior shoulder dislocation confirmed by bedside ultrasound scan performed by the emergency physician. Bedside ultrasound for diagnosis of posterior shoulder dislocation is accurate, noninvasive, repeatable, convenient, and without ionizing radiation. Dynamic ultrasound sign of posterior shoulder dislocation and using bedside ultrasound for verification of successful reduction of posterior shoulder dislocation are described.
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