An international survey to assess use of oral and rectal contrast in CT protocols for penetrating torso trauma.

PURPOSE: There is controversy regarding the administration of oral and rectal contrast for CT performed to detect bowel injury in the context of penetrating torso trauma. Given the lack of published societal guidelines, our goal was to survey radiologists from the American Society of Emergency Radiology membership database to determine consensus on CT protocols for penetrating trauma. METHODS: With ethics board approval, an anonymous ten-question online survey was distributed via email to 589 radiologists in the American Society of Emergency Radiology (ASER) member database. The survey was open for a 4-week period in February 2018. A commercially available website that allows subscribers to create and analyze survey results was used for analysis. RESULTS: We received 124 responses (21% response rate) with a majority from U.S. institutions (82%). Seventy-four percent of respondents indicated they do not routinely administer oral contrast in penetrating trauma, 68% do not administer rectal contrast, and 90% do not use commercially available software to assess penetrating injury trajectory. Results from U.S. and non-U.S. practices were comparable. The decision to administer intraluminal contrast is made by the referring physician at 52% of institutions. There is in-house attending level radiology coverage at 54% of institutions and when asked if trauma scans are reviewed before removing the patient from the table, 41% of respondents answered "No." CONCLUSION: Enteric contrast is used in a minority of respondents' centers for penetrating trauma cases, which is likely driven by a perceived lack of added benefit and delays in patient care.

Efficacy and Accessibility of a Novel Liver Fibrosis Evaluation Program: Limited Abdominal Ultrasound with Concurrent Transient Elastography.

RATIONALE AND OBJECTIVES: To review sustainability and fair access related to setting up a centralized transient elastography (TE) program in the radiology department and to perform a quality assessment of a novel liver fibrosis evaluation program that combines TE with limited abdominal ultrasound (US). MATERIAL AND METHODS: As part of a quality assessment, a retrospective chart review was performed on 758 patients who underwent TE immediately after limited abdominal US of the liver over a 12-month period. The elastography results and sonographic findings were documented, including the number and type of lesions identified. In terms of fair access evaluation, the indication for TE and referring service was reviewed for each case. RESULTS: Most referrals were initiated by infectious disease (52.2% [396 of 758]) or gastroenterology (46.3% [351 of 758]) for patients with viral hepatitis (29.8% [226 of 758] for HBV and 52.2% [396 of 758] for HCV) and nonalcoholic steatohepatitis (11.9% [90 of 758]). Only 3.2% (24 of 758) of indications were outside the usual indications for which standardized values of TE were available. Most studies demonstrated minimal fibrosis (66.6% [510 of 766] ≤F1) or more advanced fibrosis (21.1% [162 of 766] ≥F3). Liver nodularity was observed in 63 cases, correlating to F2 fibrosis and above in 81.0% (51 of 63). US screening detected five new cases of hepatocellular carcinoma (HCC). CONCLUSIONS: This unique program allows fair access and ensures that referrals are requested for appropriate indications. Concurrent US confers many advantages including proper TE probe placement to optimize measurement success, characterization of sonographic features that correlate with advanced fibrosis, and provides an opportunity to screen for HCC, in a population which may not otherwise have access to standardized screening.