Incidence of pulmonary emboli on chest computed tomography angiography based upon referral patterns.

Pulmonary embolism (PE) is a potentially lethal condition, and the diagnosis of PE can be difficult. The purpose of this study is to evaluate the incidence of PE on chest computed tomography angiography (CTA) studies ordered in the inpatient, outpatient, and emergency department (ED) settings and further segregated based on the adult and pediatric populations, and by the ordering clinician (attending physicians, resident physicians, or physician extenders). A retrospective review of chest CTA examinations performed between July 1,2009 and June 30, 2010 was performed. Of 5848 adult CTA studies, PE was diagnosed in 594 (10.1 %). Of these positive studies, 315 (53 %) were inpatient, 234 (39.4 %) were ED patients, and 45 (7.6 %) were outpatient. Four hundred sixty-four of 4445 (10.4 %) CTA examinations ordered by attending physicians were positive for PE. Seventy-four of the 801 (9.2 %) CTA examinations ordered by resident physicians were positive for PE. Fifty-six of the 608 CTA examinations ordered by physician extenders were positive for PE. Thirty-three pediatric CTA studies for PE met criteria and none of them indicated PE. There is no significant difference in the incidence of PE in chest CTA based on setting or ordering clinician.

Ossification patterns of the atlas vertebra.

OBJECTIVE: The objective of this study was to characterize ossification patterns of the C1 (atlas) vertebra in children, to better differentiate normal variants from traumatic injury. MATERIALS AND METHODS: A retrospective review of all sinus and temporal bone CT examinations was performed for the period of 2002-2009. Patients 96 months old or younger for whom C1 level was at least partially imaged were included. Patients with a history of trauma or genetic disorder-associated spinal abnormalities were excluded. RESULTS: A total of 1270 CT examinations were reviewed. The anterior arch of C1 was completely imaged in 841 patients (66%), and the posterior arch was completely imaged in 378 patients (30%). Multiple anterior arch ossification centers were observed in 179 of 841 patients (21%), and posterior arch variants were present in nine of 378 patients (2%). At least partial ossification of the anterior arch was seen in 113 of 147 children (77%) younger than 25 months, whereas only 14 of the remaining 694 children (2%) older than 24 months failed to show any ossification. Incomplete ossification of the anterior arch was noted in 47 of 103 patients (46%) in the 85-96-month-old category. The posterior arches were at least partially ossified in all children. Incomplete fusion of the posterior synchondrosis was seen in 17 of 108 patients (16%) older than 60 months. CONCLUSION: C1 ossification patterns and timing of synchondrosis fusion are variable. Knowledge of these patterns is important to better differentiate a normal variant from traumatic injury.

Imaging of the oral cavity.

The oral cavity is a challenging area in head and neck imaging because of its complex anatomy and the numerous pathophysiologies that involve its contents. This challenge is further compounded by the ubiquitous artifacts that arise from the dental amalgam, which compromise image quality. In this article, the anatomy of the oral cavity is discussed in brief, followed by a description of the imaging technique and some common pathologic abnormalities.

Certificate of need.

Certificate of Need (CON) programs represent a patchwork of state regulatory programs across the United States that regulate the availability of selected health care services. Thirty-six states maintain laws designed to ensure access to health care services, maintain or improve quality, and control capital expenditures on health care services and facilities by limiting unnecessary health facility construction and checking the acquisition of major medical equipment. This article discusses the history of CON and explores controversies surrounding the current state of CON regulations.