Comparative Effectiveness Research: Alternatives to "Traditional" Computed Tomography Use in the Acute Care Setting.

Computed tomography (CT) scanning is an essential diagnostic tool and has revolutionized care of patients in the acute care setting. However, there is widespread agreement that overutilization of CT, where benefits do not exceed possible costs or harms, is occurring. The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" CT use versus alternative diagnostic strategies in the acute care setting.

Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital.

Purpose: A second opinion is a valuable resource in confirming proper medical diagnosis and treatment. This study evaluates the effectiveness of second-opinion radiology consultations to reassess the cervical spine computed tomography (CT) scans of the trauma patients referred to our hospital.

Methods: Cervical spine CT scans of 301 consecutive adult trauma patients, who were referred to our hospital from outside institutions, were analyzed.

Diagnostic emergency imaging utilization at an academic trauma center from 1996 to 2012.

Purpose: The aim of this study was to retrospectively review the growth rate in emergency radiology volume at an urban academic trauma center from 1996 to 2012.

Methods: The authors reviewed aggregated billing data, for which the requirement for institutional review board approval was waived, from 1,458,230 diagnostic radiologic examinations ordered for emergency department (ED) visits from 1996 to 2012. The growth rate was calculated as the average annual percentage change in imaging examinations per ED visits.

The role of emergency MRI in the setting of acute abdominal pain.

Abdominal pain is one of the most common reasons for patients to present to the emergency department (ED) in the USA, with an estimated seven million visits in 2007-2008, a figure which represents 8 % (±0.2 %) [2] of all ED visits and a 31.8 % increase from 1999-2000.

Coronary artery calcification is often not reported in pulmonary CT angiography in patients with suspected pulmonary embolism: an opportunity to improve diagnosis of acute coronary syndrome.

Objective: In patients with suspected pulmonary thromboembolism (PTE), coronary artery calcification (CAC) can be an incidental finding on pulmonary CT angiography. We evaluated the frequency of CAC not being reported and its association with a diagnosis of acute coronary syndrome (ACS).

Materials And Methods: Data of 469 consecutive patients who were referred to the emergency radiology department for pulmonary CT angiography of suspected PTE were reviewed.

Looking back, moving forward: 1988-2013. The first 25 years of the American Society of Emergency Radiology.

The American Society of Emergency Radiology (ASER) was founded in 1988 and is celebrating its 25th Anniversary. ASER is thriving and emergency radiology has never enjoyed greater popularity than at present. This history describes the genesis of the Society, its growth and current state of affairs.

Applications of justification and optimization in medical imaging: examples of clinical guidance for computed tomography use in emergency medicine.

Availability, reliability, and technical improvements have led to continued expansion of computed tomography (CT) imaging. During a CT scan, there is substantially more exposure to ionizing radiation than with conventional radiography. This has led to questions and critical conclusions about whether the continuous growth of CT scans should be subjected to review and potentially restraints or, at a minimum, closer investigation.

MDCT quantification is the dominant parameter in decision-making regarding chest tube drainage for stable patients with traumatic pneumothorax.

It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images.

Blunt cardiac injury in trauma patients with thoracic aortic injury.

Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center.

Diagnosing cervical spine instability: role of the post-computed tomography scan out-of-collar lateral radiograph.

Background: Cervical spine injuries may have devastating neurological consequences, which makes accurate diagnosis of injury a key part of the trauma evaluation. Imaging plays a significant role in making the diagnosis and guiding management. Current American College of Radiology Appropriateness Criteria guidelines recommend computed tomography (CT) of the cervical spine with multi-planar reformats as the highest-rated imaging examination for patients meeting clinical criteria, without subsequent need for further imaging with a negative scan in a neurologically intact and non-obtunded patient.

Abdominopelvic CT increases diagnostic certainty and guides management decisions: a prospective investigation of 584 patients in a large academic medical center.

Objective: The objective of our study was to prospectively determine how CT affects physicians' diagnostic certainty and management decisions in the setting of patients with nontraumatic abdominal complaints presenting to the emergency department.

Subjects And Methods: We included 584 patients presenting with nontraumatic abdominal complaints to the emergency department from November 2006 through February 2008. Emergency department clinicians were prospectively surveyed both before abdominal CT (pre-CT) and after abdominal CT (post-CT) to determine the leading diagnosis, the diagnostic certainty, and the management decisions.

Usefulness of comprehensive cardiothoracic computed tomography in the evaluation of acute undifferentiated chest discomfort in the emergency department (CAPTURE).

Newer cardiac computed tomographic (CT) technology has permitted comprehensive cardiothoracic evaluations for coronary artery disease, pulmonary embolism, and aortic dissection within a single breath hold, independent of the heart rate. We conducted a randomized diagnostic trial to compare the efficiency of a comprehensive cardiothoracic CT examination in the evaluation of patients presenting to the emergency department with undifferentiated acute chest discomfort or dyspnea. We randomized the emergency department patients clinically scheduled to undergo a dedicated CT protocol to assess coronary artery disease, pulmonary embolism, or aortic dissection to either the planned dedicated CT protocol or a comprehensive cardiothoracic CT protocol.

Multidetector and three-dimensional CT evaluation of the patient with maxillofacial injury.

Interpretation of images associated with the traumatically injured face is challenging. The complexity of facial anatomy, coupled with the superimposition of numerous bony structures on plain radiographs, poses specific obstacles to accurate interpretation of facial injury. Although plain radiographs can be helpful in cases of isolated injuries, CT is the most useful modality for evaluating facial injury.

Seizure-induced lumbar burst fracture associated with conus medullaris-cauda equina compression.

A 36-year-old male developed a burst fracture of the L1 vertebra following a seizure. The patient experienced conus-cauda equina compression resulting in urinary retention and patchy sensory loss. An MRI of the spine revealed short tau inversion recovery (STIR) hyperintensity at L1 with 70% loss of vertebral body height, 8-mm posterior bony retropulsion into the spinal canal and T2-weighted hyperintensity in the cord, which is consistent with cord edema.

Benefit of follow-up CT in emergency department patients with persistent non-traumatic abdominal pain.

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.

Diagnosis of necrotizing soft tissue infections by computed tomography.

Hypothesis: In contrast to previous beliefs, we hypothesize that computed tomography (CT) scanning is sensitive and specific for the diagnosis of necrotizing soft tissue infections (NSTIs).

Design: Retrospective and prospective case series.

Setting: Academic medical center.

Are cervical spine radiograph examinations useful in patients with low clinical suspicion of cervical spine fracture? An experience with 254 cases.

Trauma patients with low clinical suspicion of cervical spine fracture are often examined with a plain X-ray cervical spine series rather than with cervical spine computed tomography (CT). The authors have been concerned by the absence of fractures in the group of patients examined with plain X-ray. The objective of this investigation was to determine the usefulness of plain X-ray examinations in suspected cases of cervical spine fracture compared to CT.

MDCT for automated detection and measurement of pneumothoraces in trauma patients.

Objective: The size of a pneumothorax is an important index to guide the emergency treatment of trauma patients--chest tube drainage. The purpose of this study was to develop and validate an automated computer-aided volumetry scheme for detection and measurement of pneumothoraces for trauma patients imaged with MDCT.

Materials And Methods: Three pigs and 68 trauma patients with at least one diagnosed occult pneumothorax (23 women and 45 men; age range, 14-89 years; mean age, 41 +/- 19 years) were selected for the development and validation of our computer-aided volumetry scheme for pneumothorax.

Multidetector CT of carpal injuries: anatomy, fractures, and fracture-dislocations.

Fractures and dislocations of the carpal bones are more common in young active patients. These injuries can lead to pain, dysfunction, and loss of productivity. Conventional radiography remains the primary imaging modality for evaluation of suspected carpal fractures and dislocations.

Multidetector CT of blunt thoracic trauma.

Thoracic injuries are significant causes of morbidity and mortality in trauma patients. These injuries account for approximately 25% of trauma-related deaths in the United States, second only to head injuries. Radiologic imaging plays an important role in the diagnosis and management of blunt chest trauma.