"Learning From Disaster: What Past Events Can Teach Radiology Departments about Planning for a Mass Casualty Incident".

The increased frequency of mass shootings, terror attacks, and natural disasters in recent years have presented challenges to provision of quality medical care in both short and long-term stressful situations. While emergency departments and trauma surgeons are usually the face of the response to mass casualty incidents (MCI), other departments such as radiology are often active participants in caring for these patients but may not be as well prepared. In this article, we review nine papers describing the experiences of various radiology departments with specific MCIs and the lessons they learned from those experiences.

Update on establishing and managing an overnight emergency radiology division.

Emergency department (ED) radiology divisions that serve to provide overnight attending coverage have become an increasingly common feature of radiology departments. The purpose of this article is to review the common ED radiology coverage models, describe desirable traits of emergency radiologists, and discuss workflow in the ED radiology setting. ED radiologists may be trained as ED radiologists or may develop the necessary skills and adopt the subspecialty.

No way out: Causes of duodenal and gastric outlet obstruction.

Upper gastrointestinal obstruction (UGIO), obstruction occurring at the level of the stomach or duodenum, represents only about 5% of bowel obstructions. As with other bowel obstructions, timely diagnosis is necessary to prevent complications including ischemia and death. Because the presenting symptoms of UGIO can be vague and nonspecific, the diagnosis may not be suspected clinically.

CT of the Neck: Image Analysis and Reporting in the Emergency Setting.

Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. In the emergency department setting, CT is performed to investigate acute infectious or inflammatory symptoms and chronic processes. With few exceptions, neck CT should be performed with intravenous contrast material, which accentuates abnormally enhancing phlegmonous and neoplastic tissues and can be used to delineate any abscesses or necrotic areas.

Performing MRI on patients with MRI-conditional and non-conditional cardiac implantable electronic devices: an update for radiologists.

Pacemakers and implantable cardioverter defibrillators are commonly encountered in clinical practice, and entails special consideration when magnetic resonance imaging (MRI) is required. It is estimated that 50-75% of patients with cardiac implantable electronic devices (CIED) will have an indication for MRI during their lifetime. Radiologists may want to recommend MRI or may be consulted about the need to perform MRI in a patient with a CIED, at which point they may need to approve or at least provide guidance as to whether MRI may be performed safely.

Implantable Electronic Stimulation Devices from Head to Sacrum: Imaging Features and Functions.

Electronic stimulation devices are implanted in various locations in the body to decrease pain, modulate nerve function, or stimulate various end organs. The authors describe these devices using a craniocaudal approach, first describing deep brain stimulation (DBS) devices and ending with sacral nerve stimulation (SNS) devices. The radiology-relevant background information for each device and its imaging appearance are also described.

Intraperitoneal Urinary Bladder Perforation with Pneumoperitoneum in Association with Indwelling Foley Catheter Diagnosed in Emergency Department.

Background: Indwelling Foley catheter is a rare cause of urinary bladder perforation, a serious injury with high mortality that demands accurate and prompt diagnosis. While the gold standard for diagnosis of bladder injury is computed tomography (CT) cystography, few bladder ruptures associated with Foley catheter have been reported to be diagnosed in the emergency department (ED).

Case Report: An 83-year-old man with indwelling Foley catheter presented to the ED for hematuria and altered mental status.

Acetabular fractures: what radiologists should know and how 3D CT can aid classification.

Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures.

Computed tomographic imaging of renal and ureteral emergencies.

A variety of renal and ureteral pathologies are encountered on computed tomographic scans performed in the emergency department. Although these are often suspected based on the patient's clinical presentation, they may also be fortuitous or incidental findings. Stone disease is the most common genitourinary condition seen in the acute setting; however, other conditions such as infection, hemorrhage, acute ischemic disease, and iatrogenic and traumatic injuries may also occur.

Beyond ultrasound: CT and MRI of ectopic pregnancy.

Objective: Although ultrasound is the primary modality used in the diagnosis of ectopic pregnancy, various forms of this condition and their complications may occasionally be further evaluated with MRI or may be incidentally detected on CT or MRI when an alternative diagnosis is suspected.

Conclusion: Various types of ectopic pregnancy have characteristic imaging features. Radiologists should be familiar with these features and should always consider the possibility of ectopic pregnancy in the setting of hemoperitoneum or a pelvic mass in a woman of child-bearing age.

Renal stones on portal venous phase contrast-enhanced CT: does intravenous contrast interfere with detection?

Purpose: To determine the sensitivity of portal venous phase contrast-enhanced CT for the detection of renal stones.

Methods: This retrospective study included 97 CT examinations of the abdomen without and with intravenous contrast, including 85 (87.6%) examinations with at least one renal stone on the "gold standard" noncontrast images, as scored by a single radiologist.

Gallbladder torsion resulting in gangrenous cholecystitis within a parastomal hernia: findings on unenhanced CT.

Gallbladder torsion is a rare cause of acute gangrenous cholecystitis; its occurrence within an abdominal hernia has not been previously reported. We present such a case occurring within a parastomal hernia and imaged with unenhanced CT.

Appropriateness of imaging studies ordered by emergency medicine residents: results of an online survey.

Objective: The purpose of this study is to determine the proficiency of emergency medicine residents in selecting appropriate radiologic examinations for specific clinical scenarios and to ascertain whether their training improves competency in this area over the course of their residency.

Materials And Methods: An online multiple-choice questionnaire was created. It included 10 clinical scenarios excerpted from the American College of Radiology Appropriateness Criteria guidelines and instructed residents to select the most appropriate initial imaging study.

MR imaging of renal collecting system with gadoxetate disodium: feasibility for MR urography.

Purpose: To determine the feasibility of using gadoxetate disodium for MR urography.

Materials And Methods: We retrospectively reviewed 50 consecutive gadoxetate disodium-enhanced abdominal MRI examinations meeting inclusion criteria. For each examination, 30 min postcontrast hepatobiliary phase sequences were reviewed to assess bilateral collecting system segments, including upper pole, interpolar, and lower pole calyces; renal pelvis; and proximal one-third of ureter.

Teeth: what radiologists should know.

Disease of the teeth and their support structures is common and frequently seen at imaging of the head and neck. Recognition of dental disease by the interpreting radiologist has the potential to alter the course of patient care, such as when periapical disease is identified as the cause of sinusitis or pericoronitis is identified as the cause of deep neck infection. Furthermore, incidental recognition of carious lesions in both children and adults who are undergoing CT for other reasons may alert the patient and care team of the need for a dental consultation.

Imaging of the paranasal sinuses.

Evaluation of the paranasal sinuses is often performed in a purely clinical fashion, without the need for imaging. However, in certain instances imaging may be deemed valuable or even necessary in helping to solve a diagnostic dilemma, confirm a suspected diagnosis, evaluate the extent of a known condition, or assess for an underlying cause of the condition. Computed tomography (CT) and magnetic resonance imaging (MRI) can be useful in confirming a suspected diagnosis or providing additional information regarding causes or complications.

Is functional MR imaging assessment of hemispheric language dominance as good as the Wada test?: a meta-analysis.

Purpose: To perform a systematic review and meta-analysis to quantitatively assess functional magnetic resonance (MR) imaging lateralization of language function in comparison with the Wada test.

Materials And Methods: This study was determined to be exempt from review by the institutional review board. A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

A new method for aggressive management of deep vein thrombosis: retrospective study of the power pulse technique.

Failure to treat deep vein thrombosis (DVT) is associated with significant morbidity and mortality. Anticoagulation, although effective at preventing clot progression, is not able to prevent postthrombotic syndrome. Catheter-directed thrombolysis is a more aggressive alternative, with some small studies suggesting a better long-term outcome, but the associated risks are significant, and the treatment can require 2-3 days in a monitored setting.