Repeat Head CT for Neurologically Stable Patients With Mild Traumatic Subarachnoid Hemorrhage During Interfacility Transfer and Follow-Up Does Not Alter Patient Care [Formula: see text].

PURPOSE: To evaluate the impact of repeat head computed tomography (CT) during (1) interfacility transfer and (2) inpatient and/or outpatient follow-up on management, cost-effectiveness, and radiation dose in neurologically stable patients with mild traumatic subarachnoid hemorrhage (tSAH). MATERIAL AND METHODS: This is a single-center retrospective study evaluating patients with mild tSAH presenting between January 2017 and July 2019. A total of 101 and 140 patients met the eligibility criteria for the first and second subgroups, respectively. Common inclusion criteria were isolated mild tSAH, Glasgow Coma Scale between 13 and 15, and neurological stability. Additional inclusion criteria for the first subgroup were availability of brain imaging at the outside institution prior to transfer and the second subgroup was the availability of follow-up imaging. RESULTS: In the first subgroup, 76.20% of patients had stable SAH, 18.80% had reduced SAH, while 5% had an interval increase in SAH. None required any surgical intervention. Additional per-patient mean radiation exposure was 1.77 ± 0.26 mSv. In the second subgroup, all 140 patients had complete resolution of tSAH. One patient had a new tiny subdural hemorrhage, which subsequently resolved on follow-up. The additional mean radiation exposure was 2.47 ± 1.29 mSv. A total of 256 avoidable CT scans were performed resulting in excess health care costs of about US$531 696. CONCLUSION: In neurologically stable isolated tSAH patients, repeat brain imaging during interfacility transfer and inpatient and/or outpatient follow-up do not alter patient management despite increased health care costs and radiation burden.

Advanced multimodality neuroimaging of a giant, thrombosed MCA aneurysm complicated by an acute stroke in a pediatric patient.

A 17-year-old boy presented to our quaternary hospital because of acute mental status changes following prolonged gastrointestinal illness resulting in dehydration. Neuroimaging studies with computed tomography and magnetic resonance imaging (MRI) revealed a giant thrombosed aneurysm of the left middle cerebral artery (MCA) with acute left MCA stroke. An ischemic penumbra was identified based upon the mismatch between diffusion weighted (DWI) and susceptibility weighted (SWI) MRI matching with the perfusion weighted imaging (PWI). On follow-up MRI, the core of ischemia as identified by DWI progressed into the ischemic penumbra identified by SWI. The patient had permanent moderate right hemiparesis and aphasia on last follow-up. In conclusion, thrombosis is a rare complication of a giant aneurysm in children. Advanced neuroimaging using the combination of DWI and noncontrast enhanced SWI is a valuable alternative or possibly adjunct to PWI to identify tissue at risk for progressing stroke.

Incentivizing Physician Diversity in Radiology.

In this article, the authors review the evolving state of diversity in the field of radiology. The authors discuss several early and recent historical legislative milestones that increased the equitable delivery of health care in the United States, such as Title VI of the Civil Rights Act of 1964, which ensured that funds for Medicare reimbursement would be available only to desegregated hospitals. Furthermore, the authors examine the current state of diversity and representation in radiology, in which underrepresented minorities represent 8.3% of training and practicing radiologists, and women represent 27.8% of radiologists. Finally, the authors present arguments for diversity in the current medical education system, analyze hurdles to increasing representation in radiology, and consider the future of diversity and inclusiveness in the field.