The 2015 Amtrak Philadelphia Train Derailment: After-Action Review of the Emergency Radiology Response at Temple University Health System.

PURPOSE: The aim of this article is to assess a large tertiary care medical center's emergency radiology response after the 2015 Amtrak Philadelphia train derailment. METHODS AND MATERIALS: A total of 55 patients with 308 total CTs and radiographs ordered within 12 hours of arrival to Temple University Health System (combining Temple University Hospital and Episcopal Hospital) emergency departments on May 12 to 13, 2015, were included in this study. A retrospective PACS and electronic medical record chart review of emergency department imaging turnaround times (TAT) during this event was completed and compared with emergency department radiology operations for the same 12-hour period throughout the preceding year. Wilcoxon's rank-sum test analysis was performed. RESULTS: A total of 308 CTs and radiographs were performed, and 91 radiologically evident injuries were observed in a total of 30 patients, with fractures (n = 51) as the most common type of injury. There were no significant differences in time from patient arrival to beginning of radiological examination (26 min; interquartile range [IQR], 11-58 min) compared with annual median (28 min; IQR, 10-131 min; P = .232). Examination completion TATs were significantly increased (35 min; IQR, 17-112 min) compared with annual median (10 min; IQR, 5-15 min; P < .001), and time required from viewing of the examination by the radiologist to the examination being marked as read was significantly decreased (17 min; IQR, 6-45 min) compared with annual median (248 min; IQR, 126-441 min; P < .001). CONCLUSIONS: The analysis highlights areas of efficiency in our response but also indicates areas for process improvement in future potential mass casualty events.

Imaging Patterns of Injuries After the 2015 Amtrak Philadelphia Train Derailment.

OBJECTIVE: The purpose of this article is to describe the injury patterns observed in the 2015 Philadelphia Amtrak train derailment. CONCLUSION: Fractures accounted for most observed injuries, but uncommon and potentially serious injuries included posterior sternoclavicular dislocation and mesenteric contusion. Imaging plays a critical role in the triage of patients during mass-casualty events, and familiarity with the injury patterns associated with high-velocity unrestrained blunt force trauma will aid diagnosis in any future similar occurrence.

Event Documentation and Transfer of Care After Severe Contrast Reactions.

PURPOSE: Radiology residencies are increasingly using clinical simulation to teach contrast reaction management. The aim of this study was to evaluate resident documentation of management and transfer of care in severe contrast reactions after a clinical simulation. METHODS: After a high-fidelity mannequin simulation of contrast-induced anaphylactic shock, residents (n = 18) were asked to document the event in a progress note and transfer care to a receiving medical team. A total of 22 prospectively determined criteria were selected, and notes were analyzed by a blinded reviewer. RESULTS: Notes contained between 12 and 21 of the prospectively determined 22 criteria (54%-95%). The median number of criteria contained in a note was 16. None of the notes fulfilled all 22 criteria. However, consistent deficiencies were found in documenting prior reaction to contrast (28%) and transfer-of-care criteria (22%-44%). CONCLUSIONS: Although standards for the documentation of advanced cardiovascular life support codes and other emergencies have been devised, no such standards exist for documentation in the management of contrast reactions. The results of this study suggest the need to develop a standardized documentation system for severe contrast-induced reactions. Education regarding transfer of care and documentation should be emphasized during clinical simulation.

Functional MRI of sensory motor cortex: comparison between finger-to-thumb and hand squeeze tasks.

BACKGROUND: An important imaging technique that has advanced decision-making for noninvasive preoperative evaluation is functional magnetic resonance imaging (fMRI). Preoperative fMRI imaging based on blood oxygenation level dependent (BOLD) fMRI is routinely used to map a variety of eloquent cortex brain functions such as language, visual, and sensory-motor regions. PURPOSE: The purpose of this study was to evaluate the regional volumes of sensory and motor cortex (SMC) activation by two widely used fMRI motor tasks: a simple hand squeeze (HS) versus a more complex finger-to-thumb (FTT) opposition. METHODS: Ten right-handed (five males; five females) subjects were studied using a block design BOLD fMRI technique at 1.5T. A region of interest analysis was performed in the right and left SMC following a HS and FTT task with the dominant right hand. RESULTS: Results show the total volume of motor and sensory activation for ipsilateral and contralateral areas for the FTT task was statistically larger than the HS task (P= .02). CONCLUSION: Due to the greater degree of activation of the SMC with the FTT task, we suggest use of this task over the HS task if a patient can adequately perform the more complex FTT task. The greater SMC activation using FTT task compared to the HS task was primarily due to an increase in activation in the post-central sensory cortex. There was less lateralization, and therefore a greater degree of bilateral SMC activation, in the FTT task compared to the HS task. These results show the importance of optimization and fMRI task selection for presurgical SMC mapping.

Correlation among on-call resident study volume, discrepancy rate, and turnaround time.

RATIONALE AND OBJECTIVES: With continued increase in imaging utilization and remote access image viewing technology, many academic radiology departments are presented with the suggestion to supplement on-call resident preliminary reports with an outsourced attending interpretation. This idea is often brought to administrative attention because of the subjective impression that outsourced studies will benefit from significantly faster interpretation times and lower discrepancy rates, especially when study volume is high. We attempt to retrospectively analyze on-call resident studies at a busy Trauma I university hospital and establish whether a statistical correlation exists among study volume, discrepancy rate, and turnaround time. MATERIALS AND METHODS: On-call computed tomography and ultrasound studies between January 2008 and June 2008 were retrospectively reviewed by blinded staff radiologists for discrepancies between preliminary and final reports. A correlation analysis between discrepancy rate and study volume per shift was performed. In addition, correlation analysis between volume per shift and interpretation time was also performed. RESULTS: A total of 1133 studies were reviewed. The major discrepancy rate is 1.85% with average turnaround time of 28.5 minutes. The correlation coefficient between major discrepancy rate and study volume is 0.35. The correlation coefficient between interpretation time and study volume is 0.29. CONCLUSION: Our large retrospective review of preliminary reports from different residents reveals no significant correlation among discrepancy rate, turnaround time, and study volume. The overall discrepancy rate is similar to that reported by other studies. Other institutions can perform this study to analyze whether their volume and resident performance warrants supplemental assistance before depriving residents of the educational benefits the independent on-call experience affords.

Diffusion tensor imaging and fiber-tracking in Marchiafava-Bignami disease.

Marchiafava-Bignami disease, a rare disorder most commonly seen in patients with a history of alcohol consumption, involves demyelination and subsequent necrosis of the corpus callosum. Diffusion tensor imaging demonstrates regional abnormalities in the corpus callosum that are not evident by conventional magnetic resonance imaging (MRI). Furthermore, fiber-tracking demonstrates significant disruption of axonal fiber bundles within the corpus callosum, most marked within the body, corresponding to the clinical finding of interhemispheric disconnection, which is characteristic of the disease.