CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient.

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

Overnight attending radiologist coverage decreases imaging-related emergency department recalls by at least 90.

PURPOSE: Benefits of overnight attending radiologist final reports are debated, often stating low resident discrepancy rates, usually assessed retrospectively. The objective of this study was to assess the impact of overnight final reporting on the recall rates for patients in the emergency department (ED) receiving overnight imaging. METHODS: Retrospective matched cohorts of two separate years prior (prior-16 and prior-17) and 1 year after (post-18) introduction of overnight attending radiologist final reporting. Patients receiving imaging between 22:00 and 07:00 h and returned to ED within 48 h of initial visit discharge were electronically identified. String matching identified return visits possibly related to imaging completed on first visit. Identified return visit notes were scored by three observers individually. Unclear and discrepant cases were resolved by consensus meeting, using full patient charts where needed. Incidences were provided and logistic regression analysis defined if coverage model was a predictor for recall. Odds ratios were calculated. RESULTS: ED patient count with imaging completed overnight in prior-16 was 9200, in prior-17 was 9543, and in post-18 was 9992. The number of overnight imaging studies performed was respectively 13,883, 14,463, and 15,112. Imaging-related ED recalls were respectively 54, 61, and 7, a decrease with the new coverage model of 89% to true and at least 90% of expected recalls.Logistic regression demonstrated that coverage model was a significant predictor of ED recalls with chi-square of 59.86 and p < 0.001, an R2 of 0.03 (Hosmer and Lemeshow). Compared to post-18, ED patients had an odds ratio of 8.42 (prior-16) and 9.18 (prior-17) to be called back to ED. CONCLUSION: Overnight final reporting significantly decreases ED recalls for patients receiving diagnostic imaging overnight. While numbers are low even prior to rollout, the number should be minimized wherever possible to diminish patient anxiety and discomfort, reduce ED overcrowding and expedite definitive management. KEY MESSAGES/WHAT THIS PAPER ADDS: Section 1: What is already known on this subject • Radiology resident preliminary report discrepancy rates are low. • Overnight attending radiologist coverage is a model increasingly applied in academic and large non-academic centers. • Patient recalls to the ED are a burden to the patient and impact patient throughput in (over)crowded EDs. Section 2: What this study adds • First study to look at the impact of overnight attending final reports on the recall rate for ED patients with overnight imaging performed. • While absolute numbers are low, there is a significant decrease in patients returning to ED for imaging related issues after introducing overnight attending coverage. • Resident autonomy can be preserved and training enhanced while increasing patient safety and comfort.

Cinematic Rendering of Traumatic Intrathoracic Gastric Herniation.

Online supplemental material is available for this article.

Changes in Approach to Solid Organ Injury: What the Radiologist Needs to Know.

This review aims to examine the challenges facing radiologists interpreting trauma computed tomography (CT) images in this era of a changing approach to management of solid organ trauma. After reviewing the pearls and pitfalls of CT imaging protocols for detection of traumatic solid organ injuries, we describe the key changes in the 2018 American Association for the Surgery of Trauma Organ Injury Scales for liver, spleen, and kidney and their implications for management strategies. We then focus on the important imaging findings in observed in patients who undergo nonoperative management and patients who are imaged post damage control surgery.

Comparison of cardiac computed tomography angiography and transoesophageal echocardiography for device surveillance after left atrial appendage closure.

AIMS: Device surveillance after left atrial appendage (LAA) closure (LAAC) is important to assess device positioning, peri-device leak (PDL) and device-related thrombus (DRT). There are limited data on the role of cardiac CT angiography (CCTA) after LAAC. We therefore sought to compare CCTA to transoesophageal echocardiography (TEE) in patients who successfully underwent LAAC. METHODS AND RESULTS: We report our consecutive series of non-valvular atrial fibrillation patients who underwent LAAC and had CCTA and TEE post LAAC. Prospective cardiac-gated CCTA was performed with the Toshiba 320-detector or Siemens second-generation 128-slice dual-source scanner, and post-processing was performed with IMPAX 3D reformats. Glomerular filtration rate <30 mL/min/1.73 m² was an exclusion for CCTA. Device positioning, PDL or fabric leak, ratio of left atrial (LA) to LAA linear attenuation coefficient, and DRT were analysed. One hundred and two patients underwent LAAC (79 WATCHMAN, 17 Amulet, 6 ACP). Mean age was 76.4±7.5 years, CHADS2 score 3.0±1.3, and CHADS-VASc score 4.6±1.6. CCTA was performed at a mean of 105.2±54.8 days, and TEE at a mean of 124.9±100.3 days post LAAC. LAA patency was observed in 52/100 (52%), with 45 (86.5%) via PDL and seven (13.5%) through fabric leak. Linear attenuation coefficient <100 HU and LA:LAA ratio <0.25 were seen in occluded devices. PDL was only observed in 35/102 (34.3%) on TEE. Mean device compression was greater with sealed devices (11.3±4.3% versus 8.2±4.0%, p<0.001). There was only one DRT, which was observed on both TEE and CCTA. CONCLUSIONS: CCTA is a suitable alternative to TEE for device surveillance post LAAC. CCTA was more sensitive than TEE for assessing PDL and can delineate the cause of residual LAA contrast patency.

Imaging of Cardiac Trauma.

Cardiac trauma carries high mortality rates and should be considered in all patients presenting with chest trauma. These patients can have a wide range of clinical presentations, from being asymptomatic to being in hemodynamic collapse. Currently, multidetector computed tomography is the gold-standard diagnostic imaging modality for all patients with abnormal electrocardiogram and/or Troponin I levels following chest trauma. In this article, we discuss pathophysiology of cardiac trauma, review the role of medical imaging, and present the spectrum of abnormal findings in traumatic cardiac injuries.

Gender Differences in Leadership Positions Among Academic Nuclear Medicine Specialists in Canada and the United States.

OBJECTIVE: Despite equal representation of genders among medical students, women continue to be underrepresented in the field of academic diagnostic radiology. These differences are manifest across subspecialties in academic medicine and even in diagnostic radiology. There are limited data available addressing diversity among nuclear medicine specialists. Thus, our primary objective was to compare gender representation in academic and leadership positions among faculty members in nuclear medicine in Canada and the United States. Our secondary objective was to study the influences to account for the existing disparity in academic nuclear medicine. MATERIALS AND METHODS: Using the Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS), we created a database of faculty members in nuclear medicine. For assessment of academic performance, the h-index, number of publications, number of citations, and years of active research were extracted using Scopus. RESULTS: The academic ranks of 237 faculty members were used for analysis; of this group, 16.95% of associate professors were female. Women were less frequently represented in higher academic ranks, and women were also less frequently represented in leadership ranks (13.6% female vs 86.4% male). The h-index was comparable across genders. CONCLUSION: Female nuclear medicine specialists are underrepresented in academic and leadership positions compared with their male counterparts. This difference in numbers is unlikely to be because of academic performance given that both genders had comparable academic performance metrics in our study. The results show the need for devising strategies to promote diversity in academic and leadership positions across nuclear medicine specialists.

Influences for Gender Disparity in the Radiology Societies in North America.

OBJECTIVE: The objective of our study was to outline the gender distribution in leadership positions in the North American radiology societies. MATERIALS AND METHODS: A review of North American radiology societies was conducted to identify committee members and those holding leadership positions. The Scopus database was queried for research productivity metrics of these individuals. Gender, university affiliation, and academic rank were identified from departmental websites. The chi-square test was used to assess for differences in gender distribution, and nonparametric analyses were applied to determine gender differences in continuous variables. RESULTS: Of 2826 radiology society committee members, men outnumbered women 67.4% (n = 1906) to 32.6% (n = 920). There were 696 society leadership positions, of which men held 501 (72.0%) and women held 195 (28.0%) (p < 0.003). Additionally, 26.3% of all men held leadership positions compared with 21.2% of all women (p = 0.0032). Overall, men had a higher median h-index (14 [range, 0-113] vs 11 [range, 0-73]), number of publications (52 [range, 2-1264] vs 35 [range, 2-428]), and number of citations (880 [range, 0-54,813] vs 483.5 [range, 0-17,332]) than women (p < 0.001). Across university academic ranks of assistant and associate professor, research productivity metrics were similar between genders, but interestingly, female representation decreased with increasing academic rank. A higher proportion of men held a university rank of professor than women (39.5% vs 33.4%; p = 0.0017) with parity at the levels of assistant and associate professors. CONCLUSION: Gender disparity exists in the leadership positions in North American radiology societies. We have attempted to study the relationship between gender, academic rank, and h-index with leadership roles in these societies.

Academic musculoskeletal radiology: influences for gender disparity.

INTRODUCTION: Research productivity is one of the few quintessential gauges that North American academic radiology departments implement to determine career progression. The rationale of this study is to quantify the relationship of gender, research productivity, and academic advancements in the musculoskeletal (MSK) radiology to account for emerging trends in workforce diversity. METHODS: Radiology residency programs enlisted in the Fellowship and Residency Electronic Interactive Database (FREIDA), Canadian Resident Matching Service (CaRMS) and International Skeletal Society (ISS) were searched for academic faculty to generate the database for gender and academic profiles of MSK radiologists. Bibliometric data was collected using Elsevier's SCOPUS archives, and analyzed using Stata version 14.2. RESULTS: Among 274 MSK radiologists in North America, 190 (69.34%) were men and 84 (30.66%) were women, indicating a statistically significant difference (χ2 = 6.34; p value = 0.042). The available number of female assistant professors (n = 50) was more than half of the male assistant professors (n = 88), this ratio however, plummeted at higher academic ranks, with only one-fourth of women (n = 11) professors compared to men (n = 45). The male MSK radiologist had 1.31 times the odds of having a higher h-index, keeping all other variables constant. CONCLUSIONS: The trend of gender disparity exists in MSK radiology with significant underrepresentation of women in top tiers of academic hierarchy. Even with comparable h-indices, at the lower academic ranks, a lesser number of women are promoted relative to their male colleagues. Further studies are needed to investigate the degree of influence research productivity has, in determining academic advancement of MSK radiologists.

Pediatric foreign body ingestion and esophageal impaction.

[No Abstract Available].

Paddlewheel multi-slice helical computed tomography reformation in the detection of pulmonary embolism. An initial experience.

OBJECTIVE: To assess the value of paddlewheel multi-slice helical CT techniques in the detection of pulmonary embolism (PE). METHODS: A prospective study was conducted from December 2011 to February 2013 at the Radiology Department, Dallah Hospital, Riyadh, Kingdom of Saudi Arabia. The CT scans of 71 patients presented for CT pulmonary angiography were selected and interpreted by 2 radiologists using reformatted paddlewheel technique besides coronal multiplanar volume reconstruction (MPVR). Paddlewheel reconstruction was carried out using inbuilt software on sagittal and axial images, setting 5 and 2 mm slab thickness with 5 and 2 degree angle rotation. Reference standard was overall interpretation of coronal MPVR and paddlewheel reformatted images by both radiologists. RESULTS: In 71 patients (44 were females and 27 were male) with suspected PE, 43 were found to be positive, and 28 were found to be negative. The youngest patient was 15 years old, and the oldest was 99 years of age. Paddlewheel reformatted images display significantly high sensitivity and specificity in eliciting total number of pulmonary emboli compared to coronal MPVR by detecting 51 additional emboli. Decreasing slab thickness and rotation angle enhanced sensitivity of paddlewheel reformatted images by detecting another 11 emboli. CONCLUSION: The paddlewheel CT angiography technique with fine slice thickness and less rotational angle enhances PE imaging.