A Comprehensive Radiologic Review of Shoulder Girdle Trauma.

Radiologic knowledge of different fracture patterns involving the shoulder girdle is an important tool to generate clinically relevant reports, identify concomitant injuries, guide management decisions, and predict and minimize complications, such as nonunion, osteoarthritis, osteonecrosis, and hardware failure. Complex unstable injuries like scapulothoracic dissociation can also occur because of shoulder girdle trauma. Management options may vary from conservative to surgical, depending on the fracture type and patient factors. Injuries around the shoulder girdle can involve the glenohumeral articulation, scapula, superior shoulder suspensory complex, acromioclavicular joints, and scapulothoracic articulation.

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making.

Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.

How well do we represent ourselves: an analysis of musculoskeletal radiology fellowships website content in Canada and the USA.

OBJECTIVE: Radiology residents review information available on fellowship program websites for shortlisting programs and for applying for fellowships. The aim of this study was to evaluate the comprehensiveness of musculoskeletal (MSK) fellowship program websites. METHODS: The content of US and Canadian MSK fellowship program websites was evaluated using 25 distinct criteria in the following domains: application, recruitment, research, clinical, education, clinical work, benefits. Programs without websites were excluded from analysis. RESULTS: In Canada and the USA, there were 100 MSK fellowship programs, 90 of them having dedicated websites. The average score across all programs was 9.5/25 or 38%. The most comprehensive program included 18/25 items or 72%. The least comprehensive program included only 1/25 items or 4%. The median score across all programs was 9/25 or 36%.More programs included information on the application process (65.5/90, 72.8%; SD 24.7%) than in education/research (24/90, 26.7%; SD 17.3%) or incentives (12.5/90, 13.9%; SD 7.8%).Mean scores amongst US schools did not differ based on geographical distribution (p = 0.32), although they did by rank; schools ranked in the bottom tier scored lower than the unranked, middle, and top tier schools (p < 0.05). CONCLUSION: The majority of MSK fellowship program websites are not comprehensive. Areas that needed the most improvement include incentives, education/research, clinical teaching, and recruitment information. Addressing these insufficiencies can help programs in easing the application process for prospective fellows and enhance recruitment.

Postmortem CT in Trauma: An Overview.

As forensic radiology sees an exponential gain in popularity, postmortem computed tomography (PMCT) is increasingly being used in the appropriate setting, either as preautopsy guidance or as part of complementary virtual autopsy protocol. Many articles have expounded the value it adds to forensic pathology in the general setting and the appropriate technical parameters to be used for optimum benefit. We aim to put forth a concise review on the role of PMCT specifically in trauma and the pitfalls to be aware of. Reviews have shown that presumed cause of death in trauma have been proven by autopsy to be wrong in about 30% cases. Radiology applied to postmortem investigation in unnatural deaths and more specifically in trauma shares many semiotic features with emergency radiology. Therefore, in the near future, emergency radiologists might be required to integrate this type of imaging in their regular practice. Although the predominant drawbacks are time-dependent, PMCT also has some difficulty in differentiating antemortem and postmortem events. However, in many such scenarios, PMCT and autopsy play a complementary role in arriving at conclusions, and we believe understanding the benefits and role in trauma is imperative considering the expanding usage of PMCT.

An Update in Imaging of Blunt Vascular Neck Injury.

Traumatic injuries of the cervical carotid and vertebral arteries, collectively referred to as blunt cerebrovascular injury (BCVI), can result in significant patient morbidity and mortality, with one of the most feared outcomes being cerebrovascular ischemia. Systematic imaging-guided screening for BCVI aims for early detection to guide timely management. In particular, accurate detection of the severity and grade of BCVI is paramount in guiding initial management. Furthermore, follow-up imaging is required to decide the duration of antithrombotic therapy. In this article, classification of the grades of BCVI and associated imaging findings will be outlined and diagnostic pitfalls and mimickers that can confound diagnosis will be described. In addition, updates to existing screening guidelines and recent efforts of criteria modification to improve detection of BCVI cases will be reviewed. The advent of postprocessing tools applied to conventional computed tomography (CT) angiograms and new diagnostic tools in dual energy CT for improved detection will also be discussed.

The Role of Emergency Radiology in COVID-19: From Preparedness to Diagnosis [Formula: see text].

Emergency trauma radiology, although a relatively new subspecialty of radiology, plays a critical role in both the diagnosis/triage of acutely ill patients, but even more important in providing leadership and taking the lead in the preparedness of imaging departments in dealing with novel highly infectious communicable diseases and mass casualties. This has become even more apparent in dealing with COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, first emerged in late 2019. We review the symptoms, epidemiology, and testing for this disease. We discuss characteristic imaging findings of COVID-19 in relation to other modern coronavirus diseases including SARS and MERS. We discuss roles that community radiology clinics, outpatient radiology departments, and emergency radiology departments can play in the diagnosis of this disease. We review practical methods to reduce spread of infections within radiology departments.

Clinical Applications of Dual-Energy CT.

Dual-energy CT (DECT) provides insights into the material properties of tissues and can differentiate between tissues with similar attenuation on conventional single-energy imaging. In the conventional CT scanner, differences in the X-ray attenuation between adjacent structures are dependent on the atomic number of the materials involved, whereas in DECT, the difference in the attenuation is dependent on both the atomic number and electron density. The basic principle of DECT is to obtain two datasets with different X-ray energy levels from the same anatomic region and material decomposition based on attenuation differences at different energy levels. In this article, we discuss the clinical applications of DECT and its potential robust improvements in performance and postprocessing capabilities.

A Guide to Mass Casualty Incidents for Radiology Residents: Strategies, Ethics, Directions.

Mass casualty incidents, by nature of their scale and unpredictability, can rapidly overwhelm health infrastructure. Preparation is the key to managing these crises with the lowest risk to emergency and health personnel, while providing maximal life saving measures. We present an overview of the multitiered planning that should go into forming a well set out emergency response plan and one that is capable of being adapted to a wide range of mass casualty scenarios. We highlight the ethical implications that a healthcare team faces while making challenging decisions rapidly in a high-pressure environment. Radiology trainees should be aware of the response systems in place at their institutions and the role that is expected of them in mass casualty incidents.

Advertise Right by Addressing the Concerns: An Evaluation of Women's/Breast Imaging Radiology Fellowship Website Content for Prospective Fellows.

PURPOSE: Fellowship is an important part of postgraduate medical training as it facilitates advanced training in a subspecialty of interest. Internet is the most readily available and frequently used tool for acquiring information about the fellowship programs by residents worldwide. The aim of this study was to analyze the content of the websites of American and Canadian breast/women's imaging fellowship programs. METHODS: The content of active Canadian and American breast/women's imaging fellowship websites was collected and analyzed in August 2019 using 27 different criteria in the categories of application process, recruitment, education, research, clinical work, and incentives. The fellowship program without a webpage were excluded from the study. RESULTS: Out of 76 active breast/women's imaging Radiology fellowship programs in the US and Canada, 75 had dedicated fellowship websites available for analysis. One program was excluded due to lack of a dedicated website. On average, websites showcased 11 of the 27 criteria (40.0%). The category with the least prevalent information was incentives especially career placement after completion of the fellowship (1/75, 1.3%). Majority of the programs around 80.0% (60/75) had adequate information about the application process and requirements. The mean number of schools satisfying the different groups of criteria differed (P< 0.01); more schools satisfied the application criteria (60.5/75; 79.6% ± 20.3%) than the incentives (12.8/75; 16.8% ± 8.2%) and recruitment (24.5/75; 32.2% ± 29.7%) criteria. CONCLUSION: Majority of the breast and women's imaging fellowship websites lack important information. Providing comprehensive online information about the program and application process may help the applicants to choose the best suited program for their academic needs and career progression.

The Effectiveness of Image Augmentation in Deep Learning Networks for Detecting COVID-19: A Geometric Transformation Perspective.

Chest X-ray imaging technology used for the early detection and screening of COVID-19 pneumonia is both accessible worldwide and affordable compared to other non-invasive technologies. Additionally, deep learning methods have recently shown remarkable results in detecting COVID-19 on chest X-rays, making it a promising screening technology for COVID-19. Deep learning relies on a large amount of data to avoid overfitting. While overfitting can result in perfect modeling on the original training dataset, on a new testing dataset it can fail to achieve high accuracy. In the image processing field, an image augmentation step (i.e., adding more training data) is often used to reduce overfitting on the training dataset, and improve prediction accuracy on the testing dataset. In this paper, we examined the impact of geometric augmentations as implemented in several recent publications for detecting COVID-19. We compared the performance of 17 deep learning algorithms with and without different geometric augmentations. We empirically examined the influence of augmentation with respect to detection accuracy, dataset diversity, augmentation methodology, and network size. Contrary to expectation, our results show that the removal of recently used geometrical augmentation steps actually improved the Matthews correlation coefficient (MCC) of 17 models. The MCC without augmentation (MCC = 0.51) outperformed four recent geometrical augmentations (MCC = 0.47 for Data Augmentation 1, MCC = 0.44 for Data Augmentation 2, MCC = 0.48 for Data Augmentation 3, and MCC = 0.49 for Data Augmentation 4). When we retrained a recently published deep learning without augmentation on the same dataset, the detection accuracy significantly increased, with a χ McNema r ' s statistic 2 = 163 . 2 and a p-value of 2.23 × 10-37. This is an interesting finding that may improve current deep learning algorithms using geometrical augmentations for detecting COVID-19. We also provide clinical perspectives on geometric augmentation to consider regarding the development of a robust COVID-19 X-ray-based detector.

The Performance of Deep Neural Networks in Differentiating Chest X-Rays of COVID-19 Patients From Other Bacterial and Viral Pneumonias.

Chest radiography is a critical tool in the early detection, management planning, and follow-up evaluation of COVID-19 pneumonia; however, in smaller clinics around the world, there is a shortage of radiologists to analyze large number of examinations especially performed during a pandemic. Limited availability of high-resolution computed tomography and real-time polymerase chain reaction in developing countries and regions of high patient turnover also emphasizes the importance of chest radiography as both a screening and diagnostic tool. In this paper, we compare the performance of 17 available deep learning algorithms to help identify imaging features of COVID19 pneumonia. We utilize an existing diagnostic technology (chest radiography) and preexisting neural networks (DarkNet-19) to detect imaging features of COVID-19 pneumonia. Our approach eliminates the extra time and resources needed to develop new technology and associated algorithms, thus aiding the front-line healthcare workers in the race against the COVID-19 pandemic. Our results show that DarkNet-19 is the optimal pre-trained neural network for the detection of radiographic features of COVID-19 pneumonia, scoring an overall accuracy of 94.28% over 5,854 X-ray images. We also present a custom visualization of the results that can be used to highlight important visual biomarkers of the disease and disease progression.

Interventional radiology and COVID-19: evidence-based measures to limit transmission.

As we face an explosion of COVID-19 cases and deal with an unprecedented set of circumstances all over the world, healthcare personnel are at the forefront, dealing with this emerging scenario. Certain subspecialties like interventional radiology entails a greater risk of acquiring and transmitting infection due to the close patient contact and invasive patient care the service provides. This makes it imperative to develop and set guidelines in place to limit transmission and utilize resources in an optimal fashion. A multi-tiered approach needs to be devised and monitored at the administrative level, taking into account the various staff and patient contact points. Based on these factors, work site and health force rearrangements need to be in place while enforcing segregation and disinfection parameters. We are putting forth an all-encompassing review of infection control measures that cover the dynamics of patient care and staff protocols that such a situation demands of an interventional department.