Emergency Radiology最新文献

Purpose: Several prior international studies have examined radiology resident reporting discrepancy rates, with a range of 1-10% quoted. Limited data exists specifically for the after-hours setting, where residents are often staffed at training institutions and report most, or all, studies. Our aims are to determine after-hours resident CT report discrepancy rates at our institution, determine the clinical significance of discrepancies, and assess factors affecting resident performance.

Methods: A retrospective review of 2000 after-hours resident CT reports (April through July 2022) was conducted. Preliminary resident reports were compared to attending radiologist finalised reports, with discrepancies categorized into 15 sub-categories; including those that were minor, major and clinically significant. Patient electronic medical records (EMR) were reviewed to assess clinical significance. Statistical analyses were performed using XLStat.

Results: The overall resident CT report discrepancy rate was 44.3% (885/2000), with most discrepancies considered minor changes (67.8%). The rate of major discrepancies was 19.9% (398/2000), while the rate of clinically significant discrepancies was 2.45% (49/2000). The most common major discrepancies included diagnostic misses (16.9%) and overcalls (5.7%). Discrepancies were highest among 2nd-year residents. Significant differences were observed when comparing 2nd- vs. 3rd-year residents (48.1% vs. 39.3%, p < 0.001), early evening vs. overnight shifts (49.5% vs. 38.5%, p < 0.001), and weekdays vs. weekends (49% vs. 38.2%, p < 0.001). No significant differences were found between major or clinically significant discrepancies.

Conclusions: Most resident after-hours CT discrepancies are minor. Our institution demonstrates a low rate of clinically significant discrepancies, which is at the lower end of rates quoted in prior studies. Our findings support high resident performance and reinforce the effectiveness of our current after-hours model in reducing the clinical impact of resident reporting errors.

Purpose: Older adult self-neglect, the inability to perform essential self-care, is an emerging public health problem. We aimed to evaluate imaging utilization and outcomes of patients with self-neglect compared to matched controls.

Methods: This IRB-approved retrospective study, conducted at two major academic medical centers, utilized the enterprise data warehouse to identify patients of > 60 years receiving a self-neglect mandate in the emergency department (ED) during 2019. Our study cohort consisted of 108 cases and 108 matched controls by age, gender, race, and time of ED presentation.

Results: During the index visit, cases had significantly higher imaging utilization (p < 0.001). Revisit and readmission rates over the 5-year study period were significantly higher among cases (526 versus 290 revisits (p < 0.001) and 254 versus 88 readmissions (p < 0.001)), with increased imaging utilization on follow-up for CT (p < 0.0001), X-ray (p < 0.0001), US (p < 0.0001), and MRI (p = 0.003). There were 44 deaths among cases versus 7 among controls. Subgroup analysis revealed that noncompliant cases had significantly higher CT use and an elevated mortality risk over the 5-year study period (both p = 0.02). Significantly higher number of cases lived alone (p < 0.001), had a higher substance use (p = 0.044), and had a higher prevalence of psychiatric illness (p < 0.001).

Conclusions: Older adult self-neglect patients experience increased ED revisits/readmissions and use more imaging services yet exhibit poorer clinical outcomes, particularly those who do not adhere to discharge recommendations. Identifying at-risk patients and implementing early interventions can mitigate healthcare burdens and improve patient outcomes.

Purpose: This study investigates how involuntary patient mis-centering affects dose distribution and image quality in computed tomography (CT), with the goal of reducing radiation exposure while preserving diagnostic performance.

Methods: Mis-centering was performed by shifting a Sun Nuclear CTDI phantom vertically and laterally, with dose recorded in specific phantom holes using a 10X6-3CT ionization chamber (Radcal). Measurements were performed on three CT scanners (Philips, FUJIFILM, Hitachi) under identical acquisition parameters. Additionally, a Philips system paired with a Catphan-503 phantom was used to assess image-quality changes. Dose ratios, calculated from absorbed dose measurements in multiple phantom holes, quantified the effect of off-center positioning.

Results: Peripheral doses were highly sensitive to displacement: a vertical offset above the isocenter reduced the dose by up to 35% at the point above the isocenter, while an increase was observed at symmetrical points, while a lateral offset reduced it by up to 18% at points in the direction of displacement. Image-quality metrics were affected to a lesser degree, likely because modern reconstruction algorithms partially compensate for mis-centering.

Conclusion: These findings suggest that deliberate mis-centering may be considered during follow-up CT examinations to spare radiation-sensitive regions without clinically significant loss of image quality.

Purpose: The widespread and growing use of computed tomography (CT) in emergency care across Morocco has raised critical concerns about radiation safety, particularly in the absence of national Diagnostic Reference Levels (DRLs). Without DRLs tailored to specific clinical indications, it becomes difficult to identify unjustified dose variations and ensure safe practices. This study aims to establish Morocco's first national, clinical indication-based DRLs for adult head CT examinations, promoting radiation dose optimization and alignment with international safety standards.

Methods: A retrospective multicenter analysis was performed on 1,299 adult head CT examinations across 20 Moroccan hospitals. Clinical indications were categorized into seven groups: stroke, acute neurological symptoms, post-contrast imaging (tumor/abscess), CT angiography, oncology planning, sinus and temporal bone imaging. Key parameters and dose metrics were extracted and the 75th percentile (third quartile) of volumetric CT dose index (CTDIvol) and dose-length product (DLP) distribution per indication was used to propose DRLs.

Results: DLP varied significantly across protocols (highest: oncology [1794.8 ± 128.8 mGy·cm]; lowest: temporal bone [398.4 ± 20.3 mGy·cm]). Geographic disparities emerged, with Agadir (2211 mGy·cm) and Al Hoceima (2204 mGy·cm) showing the highest doses versus Dakhla (790 mGy·cm). Stroke DLPs (880.7 ± 70.5 mGy·cm) were lower than some international benchmarks, reflecting protocol and regional differences in Moroccan practice.

Conclusion: The study establishes the first set of national, indication-specific DRLs for adult head CT. These benchmarks provide a foundational tool for dose optimization, helping radiology departments evaluate current practices, reduce unnecessary exposure and promote compliance with international guidelines.

Acute enterocolitis encompasses a broad spectrum of conditions affecting the small and large bowel, frequently presenting with nonspecific symptoms such as abdominal pain, diarrhea, fever, and vomiting. Given the clinical overlap among infectious, inflammatory, immune-mediated, vascular, and miscellaneous etiologies, imaging plays a pivotal role in refining the differential diagnosis, identifying complications, and guiding timely management. Computed tomography (CT), owing to its accessibility and rapid acquisition, remains the cornerstone of imaging evaluation in acute settings. CT enables detailed assessment of bowel wall morphology, disease distribution, vascular involvement, and extraintestinal manifestations. While ancillary imaging modalities have a role in select scenarios, this review emphasizes a CT-focused approach tailored for acute care. We present a comprehensive, pattern-based review of the CT imaging features across various forms of acute enterocolitis, highlighting diagnostic hallmarks, interpretive pitfalls, and clinically relevant mimics. The included cases were encountered by the radiologists in their day-to day practice and included based on their ability to highlight the majority representative features of each pathology. Through the integration of structured tables, illustrative cases, and diagnostic tips, this article aims to enhance the radiologist's ability to recognize key imaging signatures, avoid diagnostic errors, and contribute meaningfully to multidisciplinary patient care.

Purpose: To evaluate whether admission C-reactive protein (CRP) can triage patients with suspected renal colic to low dose non contrast CT KUB or contrast enhanced CT of the abdomen and pelvis (CTAP) at first presentation.

Methods: Retrospective single centre diagnostic accuracy study in a United Kingdom emergency department. Index test was admission CRP with a prespecified cut-off of 5 mg/L (positive if CRP ≥ 5 mg/L). Reference standard was CT classified a priori as: A normal, B simple calculus, C complicated calculus, D alternative acute diagnosis. The target condition for accuracy analyses was C or D. We constructed a 2 × 2 table and calculated sensitivity, specificity, predictive values and likelihood ratios with 95% confidence intervals.

Results: Of 1,096 CT examinations during the study window, 233 were for suspected renal colic; 58 patients met eligibility and had admission CRP available (29 with CRP < 5 mg/L and 29 with CRP ≥ 5 mg/L). The target condition was present in 26/58 (44.8%). Using CRP ≥ 5 mg/L, sensitivity was 0.73 (95% CI 0.54-0.86), specificity 0.69 (0.51-0.82), positive predictive value 0.66 (0.47-0.80), negative predictive value 0.76 (0.58-0.88), likelihood ratio positive 2.34 (1.16-4.70) and likelihood ratio negative 0.39 (0.20-0.77).

Conclusion: CRP provided modest but clinically interpretable probability shifts for complicated stones or alternative acute pathology. A CRP first approach may support initial imaging selection between CTAP and CT KUB. Prospective multicentre validation is required.

Objective: To compare the diagnostic performance of radiology residents and attending radiologists in detecting retained surgical items (RSIs) on intraoperative radiographs.

Methods: In this pilot study, 100 de-identified intraoperative radiographic cases (18 positive for RSIs, 82 negative) were reviewed. For each case, upper-level radiology resident (PGY-3 to PGY-5) and attending radiologist participants recorded the presence or absence of an RSI, their confidence on a three-point scale, and their decision time. We compared accuracy, sensitivity, specificity, confidence, and interpretation time between the two groups. We fit a multivariable logistic regression (fixed-effects GLM) to identify predictors of a correct interpretation, followed by a mixed-effects logistic regression (GLMM) with random intercepts for reader and case to account for clustering.

Results: A total of 1,178 interpretations were analyzed (619 from residents, 559 from attendings). There was no significant difference in diagnostic accuracy between residents (94.2%) and attendings (94.3%) (Fisher's exact p = 0.84 for accuracy, 0.82 for sensitivity, and 0.74 for specificity). Attendings were slightly faster (median time 16.4s vs. 18.8s; p = 0.0038) and reported higher confidence (mean 2.65 vs. 2.52; p < 0.001). In the fixed-effects GLM, participant type was not associated with accuracy (resident vs. attending AOR 0.92, 95% CI 0.52-1.59, p = 0.76). Compared with 'unsure,' being 'somewhat confident' (AOR 9.75, 95% CI 4.72-20.4) and 'very confident' (AOR 20.9, 95% CI 9.71-46.4) markedly increased the odds of a correct interpretation (both p < 0.001). Longer response times were associated with lower odds of correctness (AOR 0.66, 95% CI 0.46-0.94, p = 0.020). Aside from non-significant associations with response time and foreign-body type, findings were otherwise consistent in the mixed-effects model.

Conclusion: Upper-level radiology residents demonstrate diagnostic accuracy for detecting retained surgical items that is statistically indistinguishable from that of attending radiologists. These preliminary findings suggest that a resident-led preliminary interpretation model for RSI studies at the point of service is a feasible and potentially efficient approach that would not compromise patient safety.

Background/purpose: Isolated oculomotor nerve palsy (ONP) following mild traumatic brain injury (TBI) is rare and often presents diagnostic challenges. Typically associated with diffuse axonal injury and poor prognosis, ONP lacks comprehensive radiological documentation when no skull base fractures along the course of the 3rd Nerve or brainstem injuries are evident. This study explores the diagnostic utility of contrast-enhanced magnetic resonance imaging (CEMRI) in identifying ONP cases in mild TBI patients.

Methods: A retrospective analysis was conducted on six patients diagnosed with isolated ONP after mild TBI, with no evident skull base fractures along the course of the 3rd Nerve or brainstem findings. All patients underwent CE-MRI to identify structural or vascular anomalies along the course of the third cranial nerve. Clinical presentations, imaging findings, and outcomes were meticulously documented and reviewed by a neuroradiologist.

Results: CE-MRI findings revealed consistent abnormalities in all cases. Thickening, blooming, and post-contrast enhancement of the cisternal portion of the third cranial nerve were observed, with two cases demonstrating extension into orbital segments. Despite the absence of fractures or direct injuries, partial recovery was noted in most cases, facilitated by targeted steroid therapy in some instances. These imaging patterns suggest indirect mechanisms such as traction, vascular compromise, or intraneural hemorrhage as potential causes of ONP.

Conclusions: High-resolution CE-MRI proves instrumental in diagnosing isolated ONP in mild TBI patients, even without conventional radiological indicators. Early imaging and intervention may improve recovery outcomes. This study underscores the significance of including CE-MRI in evaluation protocols for ONP. It highlights the importance of further research to unravel the underlying pathophysiology and optimize therapeutic approaches for these patients.

Purpose: Meniscal injuries are a common cause of knee dysfunction and healthcare utilization, with magnetic resonance imaging (MRI) being the diagnostic gold standard. However, MRI's cost, limited accessibility, and contraindications of MRI have prompted interest in ultrasound (US) as a more affordable, portable, and radiation-free alternative. This review aimed to synthesize the current evidence on the diagnostic accuracy of US for meniscal tears and to define its role alongside MRI and arthroscopy in clinical practice.

Methods: We conducted a systematic review following the PRISMA guidelines, searching PubMed from January 2020 to March 2025 for English-language studies of adult patients (>18 years) undergoing US assessment of suspected meniscal injuries. Eligible studies used MRI or surgical (arthroscopic or open) findings as reference standards. Two reviewers independently screened the titles, abstracts, and full texts, extracted the study characteristics and diagnostic metrics, and tabulated the results.

Results: Six studies comprising 499 participants met the inclusion criteria. US sensitivity for detecting meniscal tears ranged from 63% to 92.9%, and specificity from 63.6% to100%, with higher performance for medial than for lateral tears. Point-of-care US in emergency settings demonstrated sensitivities up to 92.9% and specificities up to 88.9%. Community-based US yielded specificity ≥97% for medial tears.

Conclusion: US exhibits clinically acceptable diagnostic accuracy for meniscal injury, particularly when high-frequency probes and experienced operators are used. However, future research should focus on large-scale standardized trials to refine scanning protocols, quantify learning curves, and develop guidelines for integrating US into meniscal injury trajectories.

Purpose: To assess the prognostic value of automated quantitative chest CT metrics in predicting in-hospital mortality among patients with COVID-19 pneumonia admitted through the emergency department in a resource-limited setting in Gaza.

Methods: This retrospective study included 300 adult patients with RT-PCR-confirmed COVID-19 pneumonia who underwent non-contrast chest CT upon hospital admission. Automated quantitative lung metrics were derived using LungCTAnalyzer, an open-source 3D Slicer extension. Metrics included functional lung volume, affected lung volume, and the COVID-Q index (affected-to-functional lung ratio). Patients were stratified by survival status, and outcomes were analyzed using ROC curves, Kaplan-Meier survival analysis, and log-rank testing.

Results: Among the cohort, 112 patients (37.3%) died during hospitalization. Non-survivors were older and more likely to require advanced respiratory support (p < 0.001). Quantitative CT analysis revealed significantly reduced functional lung volume (47.2% vs. 73.9%) and increased affected lung volume (52.8% vs. 26.1%) in non-survivors (p < 0.001). The COVID-Q index was markedly higher in the deceased group. ROC analysis showed good predictive performance for total affected lung volume (AUC = 0.756; 95% CI: 0.696-0.815), with an optimal threshold of approximately 42%. Right lung involvement was associated with the poorest survival outcomes (log-rank = 67.6, p < 0.001).

Conclusion: Automated quantitative chest CT provides objective, reproducible metrics for early mortality risk stratification in COVID-19 pneumonia. The use of open-source tools like LungCTAnalyzer may assist emergency radiologists in prioritizing care in resource-constrained and conflict-affected healthcare systems.