Starting an Emergency Radiology Division: Scheduling and Staffing, Compensation, and Equity and Parity.

Establishing an emergency radiology division in a practice that has long-standing patterns of operational routines comes with both challenges and opportunities. In this article, considerations around scheduling and staffing, compensation, and equity and parity are provided with supporting literature references. Furthermore, a panel of experts having established, grown and managed emergency radiology divisions in North America and Europe share their experiences through a question and answer format.

Importance of clinical decision support system response time monitoring: a case report.

Clinical decision support (CDS) systems are prevalent in electronic health records and drive many safety advantages. However, CDS systems can also cause unintended consequences. Monitoring programs focused on alert firing rates are important to detect anomalies and ensure systems are working as intended.

Management of pneumothoraces detected on chest computed tomography: can anatomical location identify patients who can be managed expectantly?

Background: Pneumothorax (PTX) can be readily detected by computed tomography (CT) or ultrasound. However, management of PTX in hemodynamically stable patients remains controversial.

Study Objectives: We sought to investigate whether a distinct anatomical distribution of PTX along prespecified chest zones as detected by CT can be described in patients with or without subsequent chest tube thoracotomy (CTT), thus potentially allowing the extended focused assessment with sonography for trauma (EFAST) ultrasound examination to guide PTX management.

Implementation of speech recognition in a community-based radiology practice: effect on report turnaround times.

Purpose: Large academic practices have reported important benefits with the implementation of speech recognition software (SRS). However, the applicability of these results has been questioned in the community hospital setting because of major differences in workflow. The aim of this study was to evaluate the impact of SRS on radiology report turnaround times (TATs) at a community-based hospital practice with no radiology training program.

Diagnostic errors in the evaluation of nontraumatic aortic emergencies.

Nontraumatic aortic emergencies (NTAE) are a complex and dynamic group of serious, potentially fatal conditions affecting the aorta. These entities most often present in the emergency department setting, and include aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, as well as aortic rupture and impending rupture. The radiologist plays a critical role in prompt diagnosis and evaluation since presenting signs and symptoms are often nonspecific.

Abbreviated MRI for patients presenting to the emergency department with hip pain.

Objective: The objective of our study was to assess the diagnostic performance of two abbreviated hip MRI protocols--coronal STIR images only and coronal STIR with coronal T1-weighted images--as compared with a full hip MRI protocol in patients presenting to the emergency department (ED) with hip pain and negative radiographic findings.

Materials And Methods: The cohort included 385 patients (277 females, 108 males; mean age, 61 years; age range, 16-99 years) who underwent MRI within 1 month of negative radiographs obtained for ED evaluation of hip pain between January 2000 and March 2009. MR examinations were graded independently by two musculoskeletal fellowship-trained emergency radiologists for detection of fracture, avascular necrosis (AVN), and muscle injury in three subsets: coronal STIR images only; coronal STIR images and coronal T1-weighted images; and the full examination.

Simplified diagnostic algorithm for Lauge-Hansen classification of ankle injuries.

Ankle injuries occur in a predictable sequence, allowing a logical understanding of their classification once the injury mechanism is recognized. The Lauge-Hansen classification system was developed on the basis of the mechanism of trauma and is useful for guiding treatment. Three radiographic views of the ankle (anteroposterior, mortise, and lateral) are necessary to classify an injury with the Lauge-Hansen system.

Anatomical distribution of traumatic pneumothoraces on chest computed tomography: implications for ultrasound screening in the ED.

Objectives: We sought to assess the anatomical distribution of traumatic pneumothoraces (PTXs) on chest computed tomography (CT) to develop an optimized protocol for PTX screening with ultrasound in the emergency department (ED).

Methods: We performed a retrospective review of all chest CTs performed in one ED between January 2005 and December 2008 according to presence, location, and size of PTX. Pneumothoraces were then measured and categorized into 14 anatomical regions for each hemithorax.

Outside imaging in emergency department transfer patients: CD import reduces rates of subsequent imaging utilization.

Purpose: To test the hypothesis that among emergency department (ED) transfer patients, CD import of outside examinations into the picture archiving and communication system (PACS) decreases imaging utilization in the subsequent 24 hours.

Materials And Methods: Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent for retrospective medical records review. In 1487 consecutive ED patients, CD import to PACS was attempted between February 1 and August 31, 2009.

Current role of lateral cervical spine radiograph: a case report.

We report a case showing the classic features of a Hangman's cervical spine fracture following a motor vehicle collision. Because this injury was not diagnosed at ED presentation, this case also illustrates the select subset of trauma patients for whom the almost obsolete lateral cervical spine radiograph remains an important part of the radiographic trauma series.

Spiral head CT in the evaluation of acute intracranial pathology: a pictorial essay.

The purpose of this pictorial essay is to review the benefits of spiral head computed tomography (CT) with routine multiplanar reformations in the evaluation of acute intracranial pathology. This technique is particularly useful in trauma patients for detection of skull base or calvarial fractures, thin tentorial subdural hematomas, or for more specific characterization of intracranial hemorrhage. The benefits of multiplanar reformations have been described for a variety of other diagnoses in the chest, abdomen, extremities, and spine, and their routine use continues to grow with the widespread availability of multi-slice CT scanners.

Comparison of respiratory motion artifact from craniocaudal versus caudocranial scanning with 64-MDCT pulmonary angiography.

Objective: The purpose of this article is to compare respiratory motion artifact between craniocaudal versus caudocranial 64-MDCT acquisition for CT pulmonary angiography.

Materials And Methods: We retrospectively reviewed 100 consecutive emergency radiology CT pulmonary angiography examinations acquired on a 64-MDCT scanner between April 2007 and February 2008 for two groups of patients: caudocranial acquisition (mean age, 50.5 years; range, 16.

Nonoperative management of patients with a diagnosis of high-grade small bowel obstruction by computed tomography.

Objective: To determine the natural history and treatment of high-grade small bowel obstruction (HGSBO). Small bowel obstruction is a frequent complication of abdominal surgery. Complete and strangulating obstructions are managed operatively while partial obstructions receive a trial of nonoperative therapy.

Outside CT imaging among emergency department transfer patients.

Purpose: The aim of this study was to characterize the quantity and types of outside computed tomographic (CT) examinations submitted for reinterpretation among emergency department (ED) transfers to a tertiary care, level I trauma, academic medical center and the frequency of and reasons for repeat imaging.

Methods: Reinterpretation requests for outside CT studies accompanying ED transfer patients over a 4-month period were prospectively audited. Clinicians completed forms specifying type of CT study, outside report availability, interpretational discrepancies, repeat imaging requests, and reasons for repeat imaging.

Reduced-dose CT: effect on reader evaluation in detection of pulmonary embolism.

Objective: The purpose of this study was to evaluate the effect of reduction in radiation dose on CT detection of pulmonary embolism.

Subjects And Methods: Emergency department patients were evaluated for pulmonary embolism with standard and simulated reduced-dose CT angiography. Simulated lower-dose CT angiograms obtained at 90, 45, 22, and 10 mAs(eff) were reconstructed by mathematical addition of noise to the standard dose (180 mAs(eff)) data from the images of 18 patients with and 20 patients without pulmonary embolism.

Changes in thoracolumbar computed tomography and radiography utilization among trauma patients after deployment of multidetector computed tomography in the emergency department.

Background: Diagnostic-quality thoracolumbar spine (TLS) images, generated from routine thoracoabdominal multidetector computed tomography (MDCT) data, have been demonstrated superior to conventional radiography (CR) for TLS injury. We evaluated thoracoabdominal computed tomography (CT) and TLS utilization among trauma patients after deployment of MDCT. We hypothesized that reformatted MDCT images replaced CR for evaluation of TLS trauma among patients undergoing chest or abdominal CT, and that utilization of thoracoabdominal CT and TLS screening in trauma increased postMDCT.

Yield and utility of radiographic "shunt series" in the evaluation of ventriculo-peritoneal shunt malfunction in adult emergency patients.

We examined the yield and utility of shunt series (SS) performed for suspected shunt malfunction and whether an abnormal SS lead to shunt revision when head computed tomography (CT) was normal or unchanged. We reviewed medical records for all adult emergency patients over a 34-month period with suspected shunt malfunction imaged with both SS and head CT to determine whether a shunt revision was performed contemporaneous with imaging. Nine (3.

Recombinant human anti-transforming growth factor beta1 antibody therapy in systemic sclerosis: a multicenter, randomized, placebo-controlled phase I/II trial of CAT-192.

Objective: To evaluate CAT-192, a recombinant human antibody that neutralizes transforming growth factor beta1 (TGFbeta1), in the treatment of early-stage diffuse cutaneous systemic sclerosis (dcSSc).

Methods: Patients with SSc duration of <18 months were randomly assigned to the placebo group or to 1 of 3 CAT-192 treatment groups: 10 mg/kg, 5 mg/kg, 0.5 mg/kg.

Renal venous diversion: an unusual treatment for renal vein thrombosis.

Renal venous thrombosis most commonly occurs in the setting of nephrotic syndrome, hypercoagulability, or dehydration. This can usually be treated with systemic anticoagulation, and the diversion is via natural draining tributaries, eg, adrenal, lumbar, or gonadal veins. Occasionally, renal venous thrombosis results from extension of a thrombotic process, such as a large renal cell carcinoma with tumor thrombus extension into the infrahepatic inferior vena cava resulting in thrombosis of the inferior vena cava and contralateral renal vein.

Lowering the thyroid dose in screening examinations of the cervical spine.

The first objective of this study was to test the hypothesis that a lower-dose (14.1 mGy thyroid dose) protocol for helical computed tomography (CT) of the entire cervical spine demonstrates equivalent technical adequacy and diagnostic accuracy as the standard-dose protocol (26.0 mGy thyroid dose) used at our institution.

An ovary with a twist: a case of interesting sonographic findings of ovarian torsion.

An otherwise healthy young woman presented to the Emergency Department with abdominal pain. Multiple diagnoses were considered, as must be in cases of women with lower quadrant abdominal pain. Rapid identification of an abnormally enlarged ovary in close proximity to the opposite ovary on pelvic ultrasonography suggested the diagnosis of ovarian torsion.

Atlantoaxial instability associated with an orthotopic os odontoideum: a multimodality imaging assessment.

Radiography, computed tomography (CT), and magnetic resonance imaging exams of the cervical spine were performed in a 29-year-old man who was ultimately diagnosed with an orthotopic os odontoideum during admission for injuries sustained in a motor vehicle collision. Initial radiography suggested either os odontoideum or an acute fracture of the dens. Further imaging with CT and flexion and extension radiographs confirmed os odontoideum and excluded a dens fracture.

Quantification of clinical consultations in academic emergency radiology.

Rationale And Objectives: The purpose of this study is to quantify the impact of clinical consultation on the workload of an academic emergency radiology section.

Materials And Methods: Data from a 7-day audit (24 h/d) of the number and length of clinical consultations was expressed as the mean number of consultations per 24 hours and consultation minutes per 24 hours. Consultations performed on images acquired from outside institutions were noted.

Primary epiploic appendagitis.

The clinical presentation of primary epiploic appendagitis can mimic diverticulitis or appendicitis. Review of the pathologically confirmed cases in the English literature shows the majority of cases to arise from the sigmoid colon. Pathognomonic findings by computed tomography impact patient management, and it is thus important to recognize these in patients imaged in the emergency setting.