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Arenaza Choperena G, Cuetos Fernández J, Gómez Usabiaga V, Ugarte Nuño A, Rodriguez Calvete P, Collado Jiménez J. Abdominal trauma. RADIOLOGIA 2023; 65 Suppl 1:S32-S41. [PMID: 37024229 DOI: 10.1016/j.rxeng.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/19/2022] [Indexed: 04/08/2023]
Abstract
Traumatic injuries are the leading cause of death in people aged<45 years, and abdominal trauma is a source of significant morbidity and mortality and high economic costs. Imaging has a fundamental role in abdominal trauma, where CT is a fundamental tool for rapid, accurate diagnosis that will be key for patients' clinical outcomes.
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Affiliation(s)
- G Arenaza Choperena
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain.
| | - J Cuetos Fernández
- Servicio de Radiología, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - V Gómez Usabiaga
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - A Ugarte Nuño
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - P Rodriguez Calvete
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
| | - J Collado Jiménez
- Radiología de Urgencias, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, Spain
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Chen H, Unberath M, Dreizin D. Toward automated interpretable AAST grading for blunt splenic injury. Emerg Radiol 2023; 30:41-50. [PMID: 36371579 DOI: 10.1007/s10140-022-02099-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The American Association for the Surgery of Trauma (AAST) splenic organ injury scale (OIS) is the most frequently used CT-based grading system for blunt splenic trauma. However, reported inter-rater agreement is modest, and an algorithm that objectively automates grading based on transparent and verifiable criteria could serve as a high-trust diagnostic aid. PURPOSE To pilot the development of an automated interpretable multi-stage deep learning-based system to predict AAST grade from admission trauma CT. METHODS Our pipeline includes 4 parts: (1) automated splenic localization, (2) Faster R-CNN-based detection of pseudoaneurysms (PSA) and active bleeds (AB), (3) nnU-Net segmentation and quantification of splenic parenchymal disruption (SPD), and (4) a directed graph that infers AAST grades from detection and segmentation results. Training and validation is performed on a dataset of adult patients (age ≥ 18) with voxelwise labeling, consensus AAST grading, and hemorrhage-related outcome data (n = 174). RESULTS AAST classification agreement (weighted κ) between automated and consensus AAST grades was substantial (0.79). High-grade (IV and V) injuries were predicted with accuracy, positive predictive value, and negative predictive value of 92%, 95%, and 89%. The area under the curve for predicting hemorrhage control intervention was comparable between expert consensus and automated AAST grading (0.83 vs 0.88). The mean combined inference time for the pipeline was 96.9 s. CONCLUSIONS The results of our method were rapid and verifiable, with high agreement between automated and expert consensus grades. Diagnosis of high-grade lesions and prediction of hemorrhage control intervention produced accurate results in adult patients.
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Affiliation(s)
- Haomin Chen
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Mathias Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - David Dreizin
- Emergency and Trauma Imaging, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
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Lee W, Cho E, Kim W, Choi H, Beck KS, Yoon HJ, Baek J, Choi JH. No-reference perceptual CT image quality assessment based on a self-supervised learning framework. MACHINE LEARNING: SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1088/2632-2153/aca87d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Abstract
Accurate image quality assessment (IQA) is crucial to optimize computed tomography (CT) image protocols while keeping the radiation dose as low as reasonably achievable. In the medical domain, IQA is based on how well an image provides a useful and efficient presentation necessary for physicians to make a diagnosis. Moreover, IQA results should be consistent with radiologists’ opinions on image quality, which is accepted as the gold standard for medical IQA. As such, the goals of medical IQA are greatly different from those of natural IQA. In addition, the lack of pristine reference images or radiologists’ opinions in a real-time clinical environment makes IQA challenging. Thus, no-reference IQA (NR-IQA) is more desirable in clinical settings than full-reference IQA (FR-IQA). Leveraging an innovative self-supervised training strategy for object detection models by detecting virtually inserted objects with geometrically simple forms, we propose a novel NR-IQA method, named deep detector IQA (D2IQA), that can automatically calculate the quantitative quality of CT images. Extensive experimental evaluations on clinical and anthropomorphic phantom CT images demonstrate that our D2IQA is capable of robustly computing perceptual image quality as it varies according to relative dose levels. Moreover, when considering the correlation between the evaluation results of IQA metrics and radiologists’ quality scores, our D2IQA is marginally superior to other NR-IQA metrics and even shows performance competitive with FR-IQA metrics.
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Traumatismo abdominal. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Steffey DC, Chishti EA, Acevedo MJ, Acosta LF, Lee JT. Single Center Retrospective Review of Post-laparotomy CT Abdomen and Pelvis Findings and Trends. FRONTIERS IN RADIOLOGY 2022; 2:850911. [PMID: 37492676 PMCID: PMC10365115 DOI: 10.3389/fradi.2022.850911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/03/2022] [Indexed: 07/27/2023]
Abstract
Purpose To identify common findings visualized on CT following damage control laparotomy, including post-surgical changes and additional injuries, and to determine change in frequency of post-laparotomy CT at our institution over time. Methods Single institution, IRB-Exempt, retrospective review of the University of Kentucky trauma registry from 1/2006 to 2/2019 for all trauma patients undergoing exploratory laparotomy initially and subsequently undergoing CT of the abdomen and pelvis within 24 hours. Operative findings from surgical operation notes and findings reported on post-laparotomy CT were recorded, including vascular and solid organ injuries, operative changes, free intraperitoneal fluid/air, and retroperitoneal findings. Next steps in management were also recorded. Results In total 1,047 patients underwent exploratory laparotomy initially at our institution between 1/2006-2/2019. Of those, only 96 had a diagnostic CT of the abdomen and pelvis within 24 h after initial surgery, first occurring in 2010. Among these 96, there were 71 blunt and 25 penetrating injuries. Most common injuries recognized during exploratory laparotomy were bowel/mesentery (55), spleen (34), and liver (26). Regarding CT findings, all patients (96/96, 100%) had residual pneumoperitoneum, 84/96 (87.5%) had residual hemoperitoneum, 36/96 (37.5%) noted post-surgical changes or additional injuries to the spleen, 36/96 (37.5%) to the bowel/mesentery, and 32/96 (33.3%) to the liver, and 34/96 (35.4%) were noted to have pelvic fractures. After CT, 31/96 (32.3%) went back to the OR for relook laparotomy and additional surgical intervention and 7/96 (7.3%) went to IR for embolization. Most common procedures during relaparotomy involved the bowel (8) and solid organs (6). Conclusions CT examination within 24 h post damage control laparotomy was exceedingly rare at our institution prior to 2012 but has steadily increased. Frequency now averages 20.5% yearly. Damage control laparotomy is an uncommon clinical scenario; however, knowledge of frequent injuries and common post-operative changes will aid in radiologist detection of additional injuries helping shape next step management and provide adequate therapy.
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Affiliation(s)
- Dylan C. Steffey
- University of Kentucky College of Medicine, Lexington, KY, United States
| | - Emad A. Chishti
- University of Kentucky College of Medicine, Lexington, KY, United States
| | - Maximo J. Acevedo
- University of Kentucky College of Medicine, Lexington, KY, United States
| | - Luis F. Acosta
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, United States
| | - James T. Lee
- Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, United States
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Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients. Updates Surg 2022; 74:343-353. [PMID: 35001252 DOI: 10.1007/s13304-021-01199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
High energy blunt trauma patients with normal vital signs are usually investigated with a Contrast Enhanced Computed Tomography (CECT) for torso injuries. CECT involves high levels of radiations, often showing no injuries in patients over-triaged to the trauma center. The aim of our study was to suggest an alternative diagnostic protocol based on Emergency Room (ER) tests (physical exam, blood tests, extended FAST, Chest and Pelvis X-ray) to avoid CECT in selected patients. A prospective cohort study was conducted from September 2018 to September 2019. Five hundred patients fulfilled the inclusion criteria. Patients received torso-CECT scan only if they had at least one positive ER test. The validity of the single component of the protocol and the global validity of the ER tests to detect torso injuries was assessed through sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, positive (+ LR) and negative (- LR) likelihood ratio. Multivariate analysis was performed to identify independent predictors of torso injuries. One hundred and seventy patients received a torso-CECT scan because of positive ER tests. ER tests showed a global sensitivity for torso injuries of 86.96% (95% CI 80.17-92.08) specificity of 83.98%(95% CI 79.79-87.60), PPV of 67.42% (95% CI 61.83-72.54), NPV of 94.41% (95% CI 91.63-96.30) + LR of 5.43 (95% CI 4.25-6.93), - LR of 0.16 (95% CI 0.10-0.24). ER tests in an experienced center seem to be able to identify more severe blunt trauma patients needing CECT. Further studies are advisable to confirm these results.
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Davies J, Johnson R, Kashef E, Khan M, Dick E. How to deliver an effective primary survey report for the trauma CT: A radiological and surgical perspective. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408621995144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Whole body contrast-enhanced multidetector CT (WB-CE MDCT) is integral to the assessment of the severely injured patient with stable haemodynamic parameters or in those who respond to resuscitation with blood products. WB-CE MDCT is able to identify the number and severity of injuries sustained by the patient and enable time critical intervention. In this narrative review article we discuss how communication within the trauma team, including the radiologists and appropriate clinicians is crucial in optimizing the effectiveness of WB-CE MDCT. We review the time critical imaging findings and their clinical relevance, which should be included in a succinct CT primary survey report. We also discuss the process through which the effectiveness of the trauma report may be maximised and how non technical factors including teamwork may be optimised to facilitate decision making in this high pressure environment.
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Affiliation(s)
- Joseph Davies
- Maidstone & Tunbridge Wells NHS Trust, Maidstone, UK
| | - Rowena Johnson
- Nuffield Orthopaedic Centre, Oxford NHS Foundation Trust, Oxford, UK
| | - Elika Kashef
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mansoor Khan
- Digestive Diseases Department, Brighton and Sussex University Hospitals, Brighton, UK
| | - Elizabeth Dick
- St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
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Ackermans LLGC, Volmer L, Wee L, Brecheisen R, Sánchez-González P, Seiffert AP, Gómez EJ, Dekker A, Ten Bosch JA, Olde Damink SMW, Blokhuis TJ. Deep Learning Automated Segmentation for Muscle and Adipose Tissue from Abdominal Computed Tomography in Polytrauma Patients. SENSORS 2021; 21:s21062083. [PMID: 33809710 PMCID: PMC8002279 DOI: 10.3390/s21062083] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/28/2021] [Accepted: 03/10/2021] [Indexed: 12/15/2022]
Abstract
Manual segmentation of muscle and adipose compartments from computed tomography (CT) axial images is a potential bottleneck in early rapid detection and quantification of sarcopenia. A prototype deep learning neural network was trained on a multi-center collection of 3413 abdominal cancer surgery subjects to automatically segment truncal muscle, subcutaneous adipose tissue and visceral adipose tissue at the L3 lumbar vertebral level. Segmentations were externally tested on 233 polytrauma subjects. Although after severe trauma abdominal CT scans are quickly and robustly delivered, with often motion or scatter artefacts, incomplete vertebral bodies or arms that influence image quality, the concordance was generally very good for the body composition indices of Skeletal Muscle Radiation Attenuation (SMRA) (Concordance Correlation Coefficient (CCC) = 0.92), Visceral Adipose Tissue index (VATI) (CCC = 0.99) and Subcutaneous Adipose Tissue Index (SATI) (CCC = 0.99). In conclusion, this article showed an automated and accurate segmentation system to segment the cross-sectional muscle and adipose area L3 lumbar spine level on abdominal CT. Future perspectives will include fine-tuning the algorithm and minimizing the outliers.
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Affiliation(s)
- Leanne L. G. C. Ackermans
- Department of Traumatology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (J.A.T.B.); (T.J.B.)
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (R.B.); (S.M.W.O.D.)
- Correspondence: (L.L.G.C.A.); (L.V.); Tel.: +31-433-877-489 (L.L.G.C.A.); +31-884-456-00 (L.V.)
| | - Leroy Volmer
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (L.W.); (A.D.)
- Correspondence: (L.L.G.C.A.); (L.V.); Tel.: +31-433-877-489 (L.L.G.C.A.); +31-884-456-00 (L.V.)
| | - Leonard Wee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (L.W.); (A.D.)
- Clinical Data Science, Faculty of Health Medicine and Lifesciences, Maastricht University, Paul Henri Spaaklaan 1, 6229 GT Maastricht, The Netherlands
| | - Ralph Brecheisen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (R.B.); (S.M.W.O.D.)
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (P.S.-G.); (A.P.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Alexander P. Seiffert
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (P.S.-G.); (A.P.S.); (E.J.G.)
| | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (P.S.-G.); (A.P.S.); (E.J.G.)
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Development Biology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (L.W.); (A.D.)
- Clinical Data Science, Faculty of Health Medicine and Lifesciences, Maastricht University, Paul Henri Spaaklaan 1, 6229 GT Maastricht, The Netherlands
| | - Jan A. Ten Bosch
- Department of Traumatology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (J.A.T.B.); (T.J.B.)
| | - Steven M. W. Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (R.B.); (S.M.W.O.D.)
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany
| | - Taco J. Blokhuis
- Department of Traumatology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands; (J.A.T.B.); (T.J.B.)
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Ayoob AR, Lee JT, Herr K, LeBedis CA, Jain A, Soto JA, Lim J, Joshi G, Graves J, Hoff C, Hanna TN. Pancreatic Trauma: Imaging Review and Management Update. Radiographics 2020; 41:58-74. [PMID: 33245670 DOI: 10.1148/rg.2021200077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.
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Affiliation(s)
- Andres R Ayoob
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - James T Lee
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Keith Herr
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Christina A LeBedis
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Ashwin Jain
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Jorge A Soto
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Jihoon Lim
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Gayatri Joshi
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Joseph Graves
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Carrie Hoff
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Tarek N Hanna
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
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Nasir MU, Chandy PE, Roberts J, O'Neill SB. A Guide to Mass Casualty Incidents for Radiology Residents: Strategies, Ethics, Directions. Curr Probl Diagn Radiol 2020; 50:555-559. [PMID: 32951950 PMCID: PMC7448733 DOI: 10.1067/j.cpradiol.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022]
Abstract
Mass casualty incidents, by nature of their scale and unpredictability, can rapidly overwhelm health infrastructure. Preparation is the key to managing these crises with the lowest risk to emergency and health personnel, while providing maximal life saving measures. We present an overview of the multitiered planning that should go into forming a well set out emergency response plan and one that is capable of being adapted to a wide range of mass casualty scenarios. We highlight the ethical implications that a healthcare team faces while making challenging decisions rapidly in a high-pressure environment. Radiology trainees should be aware of the response systems in place at their institutions and the role that is expected of them in mass casualty incidents.
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Affiliation(s)
- Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Poornima Elizabeth Chandy
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Roberts
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siobhán B O'Neill
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Alexander LF, Hanna TN, LeGout JD, Roda MS, Cernigliaro JG, Mittal PK, Harri PA. Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries. Radiographics 2020; 39:1183-1202. [PMID: 31283454 DOI: 10.1148/rg.2019180153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by LeBedis .
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Affiliation(s)
- Lauren F Alexander
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Tarek N Hanna
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Jordan D LeGout
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Manohar S Roda
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Joseph G Cernigliaro
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Pardeep K Mittal
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
| | - Peter A Harri
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224 (L.F.A., J.D.L., J.G.C.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (T.N.H., P.A.H.); Department of Radiology, University of Mississippi Medical Center, Jackson, Miss (M.S.R.); and Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.)
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Qamar SR, Evans D, Gibney B, Redmond CE, Nasir MU, Wong K, Nicolaou S. Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making. Can Assoc Radiol J 2020; 72:293-310. [PMID: 32268772 DOI: 10.1177/0846537120914247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.
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Affiliation(s)
- Sadia Raheez Qamar
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - David Evans
- Department of Surgery, 8167Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gibney
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciaran E Redmond
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Wong
- Department of Radiology, 71511Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
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Refining the criteria for immediate total-body CT after severe trauma. Eur Radiol 2020; 30:2955-2963. [PMID: 31974691 PMCID: PMC7160085 DOI: 10.1007/s00330-019-06503-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/08/2019] [Accepted: 10/08/2019] [Indexed: 11/29/2022]
Abstract
Objectives Initial trauma care could potentially be improved when conventional imaging and selective CT scanning is omitted and replaced by immediate total-body CT (iTBCT) scanning. Because of the potentially increased radiation exposure by this diagnostic approach, proper selection of the severely injured patients is mandatory. Methods In the REACT-2 trial, severe trauma patients were randomized to iTBCT or conventional imaging and selective CT based on predefined criteria regarding compromised vital parameters, clinical suspicion of severe injuries, or high-risk trauma mechanisms in five trauma centers. By logistic regression analysis with backward selection on the 15 study inclusion criteria, a revised set of criteria was derived and subsequently tested for prediction of severe injury and shifts in radiation exposure. Results In total, 1083 patients were enrolled with median ISS of 20 (IQR 9–29) and median GCS of 13 (IQR 3–15). Backward logistic regression resulted in a revised set consisting of nine original and one adjusted criteria. Positive predictive value improved from 76% (95% CI 74–79%) to 82% (95% CI 80–85%). Sensitivity decreased by 9% (95% CI 7–11%). The area under the receiver operating characteristics curve remained equal and was 0.80 (95% CI 0.77–0.83), original set 0.80 (95% CI 0.77–0.83). The revised set retains 8.78 mSv (95% CI 6.01–11.56) for 36% of the non-severely injured patients. Conclusions Selection criteria for iTBCT can be reduced from 15 to 10 clinically criteria. This improves the positive predictive value for severe injury and reduces radiation exposure for less severely injured patients. Key Points • Selection criteria for iTBCT can be reduced to 10 clinically useful criteria. • This reduces radiation exposure in 36% of less severely injured patients. • Overall discriminative capacity for selection of severely injured patients remained equal. Electronic supplementary material The online version of this article (10.1007/s00330-019-06503-2) contains supplementary material, which is available to authorized users.
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Speelman ES, Brocx B, Wilbers JE, de Bie MJ, Ivashchenko O, Tank Y, van der Molen AJ. The influence of arm positions on abdominal image quality of whole-body computed tomography in trauma: systematic review. Emerg Radiol 2019; 27:141-150. [PMID: 31776813 PMCID: PMC7082374 DOI: 10.1007/s10140-019-01732-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Whole-body computed tomography (WBCT) is the standard diagnostic method for evaluating polytrauma patients. When patients are unable to elevate their arms, the arms are placed along the body, which affects the image quality negatively. Aim of this systematic review is to evaluate the influence of below the shoulder arm positions on image quality of WBCT. METHODS Literature in PubMed and Scopus databases was systematically searched. Results of the papers were stratified into 4 categories: arms elevated, 1 arm up 1 arm down, arms ventrally supported, arms along the body. A qualitative analysis was performed on subjective image quality and a quantitative analysis on objective quality (image noise). RESULTS Eight studies were included with 1421 participants. Various studies reported significantly higher quality scores with arms elevated, compared to arms along the body. Significant differences in objective image quality were found between the arms elevated and the arms ventrally on support group. The arms ventrally supported group had a significantly higher image quality than the arms along the body group. A statistically significant difference was found in objective image quality between the 1 arm up 1 arm down and arms along the body group. No preferential below the shoulders position could be identified. CONCLUSION Positioning the arms alongside the body results in a poor image quality. Placing the arms on a pillow ventrally to the chest improves image quality. Interestingly, asymmetrical arm positioning has potential to improve the image quality for patients that are unable to elevate the arms.
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Affiliation(s)
- E S Speelman
- Student Clinical Technology, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - B Brocx
- Student Clinical Technology, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - J E Wilbers
- Student Clinical Technology, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - M J de Bie
- Student Clinical Technology, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - O Ivashchenko
- Department of Radiology, C-2S, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Y Tank
- Department of Radiology, C-2S, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - A J van der Molen
- Department of Radiology, C-2S, Leiden University Medical Centre, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
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15
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The additional value of the arterial phase in the CT assessment of liver vascular injuries after high-energy blunt trauma. Emerg Radiol 2019; 26:647-654. [PMID: 31444680 DOI: 10.1007/s10140-019-01714-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE In the literature, no consensus exists about which CT protocol is to be adopted in patients who underwent high-energy blunt trauma. The aim of the study is to evaluate the additional value of the arterial phase in the CT assessment of vascular injuries of the liver. METHODS Admission CT examinations for patients with traumatic injury of the liver due to high-energy blunt trauma, performed between 2011 and 2017 in two major trauma centres, were retrospectively reviewed. Images were analysed for presence or absence of liver parenchymal injury, intrahepatic contained vascular injuries and active bleeding in the arterial and portal venous phase of the CT study. RESULTS Two hundred twelve patients have been identified. Parenchymal injuries were detected as isolated in 90.6% of cases, whereas they were associated with vascular injuries in 9.4% of cases: contained vascular injuries in 3.3% and active bleeding in 6.1%. Out of all parenchymal injuries detected on the CT portal venous phase, 90.5% were also detectable in the arterial phases (p < 0.0001). All of the contained vascular injuries were visible in the CT arterial phase, whereas they were detectable in 28.5% of cases also during the venous phase (p = 0.02). All 13 cases of active bleeding were detected on the CT venous phase, and 76.9% of these cases were also revealed in the arterial phase, thus confirming their arterial origin (p = 0.22). CONCLUSION The addiction of the arterial phase to the venous phase in the CT assessment of patients who underwent high-energy blunt trauma allows an accurate identification and characterization of traumatic vascular injuries, so distinguishing between patients suitable for conservative management and those requiring interventional or surgical treatment.
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Kadom N, Palasis S, Pruthi S, Biffl WL, Booth TN, Desai NK, Falcone RA, Jones JY, Joseph MM, Kulkarni AV, Marin JR, Milla SS, Mirsky DM, Myseros JS, Reitman C, Robertson RL, Ryan ME, Saigal G, Schulz J, Soares BP, Tekes A, Trout AT, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Suspected Spine Trauma-Child. J Am Coll Radiol 2019; 16:S286-S299. [DOI: 10.1016/j.jacr.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 12/29/2022]
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Awwad A, Dhillon PS, Ramjas G, Habib SB, Al-Obaydi W. Trans-arterial embolisation (TAE) in haemorrhagic pelvic injury: review of management and mid-term outcome of a major trauma centre. CVIR Endovasc 2018; 1:32. [PMID: 30652163 PMCID: PMC6319536 DOI: 10.1186/s42155-018-0031-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/01/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Management of pelvic fracture associated haemorrhage is often complex with high morbidity and mortality rates. Different treatment options are used to control bleeding with an on-going discussion in the trauma community regarding the best management algorithm. MAIN BODY Recent studies have shown trans-arterial embolisation (TAE) to be a safe and effective technique to control pelvic fracture associated haemorrhage. Computed tomography (CT) evidence of active bleeding, haemodynamic instability, and pelvic fracture patterns are amongst important indicators for TAE. CONCLUSION Herein, we aim to provide a comprehensive literature review of the effectiveness of TAE in controlling haemorrhage secondary to pelvic fracture according to the indications, technique and embolic agents, and outcomes, whilst incorporating our Level 1 major trauma centre's (MTC) results between 2014-2017.
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Affiliation(s)
- Amir Awwad
- NIHR Nottingham Biomedical Research Centre, Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, NG72UH UK
- Radiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE UK
| | - Permesh Singh Dhillon
- Interventional Radiology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
- NIHR Nottingham Biomedical Research Centre, Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, NG72UH UK
| | - Greg Ramjas
- Interventional Radiology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| | - Said B. Habib
- Interventional Radiology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| | - Waleed Al-Obaydi
- Interventional Radiology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
- Interventional Radiology, Royal Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE UK
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Abstract
PURPOSE OF REVIEW To provide an update on the relevant and recent studies on whole-body computed tomography (WBCT) imaging of severely injured patients. RECENT FINDINGS The advantages of WBCT in time saving, diagnostic accuracy and even in survival have been proven in numerous studies. WBCT can also be beneficial in haemodynamically unstable major trauma patients. The CT scanner should be located close to the emergency department or even in the trauma room. The issue of radiation is still quite important, however, iterative as well as split-bolus protocols can nowadays reduce radiation significantly. The question: which trauma patient should receive WBCT and which not is not yet solved sufficiently. Postmortem WBCT has a promising potential to promptly define the definitive cause of death of trauma victims comparably to traditional autopsy. SUMMARY On account of the recent advances, whole-body CT has become a crucial part of the initial in-hospital assessment of severely injured patients. It is recommended as the standard radiological tool for the emergency diagnostic work-up in major trauma patients.
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Imaging and Endovascular Treatment of Bleeding Pelvic Fractures: Review Article. Cardiovasc Intervent Radiol 2018; 42:10-18. [PMID: 30225676 PMCID: PMC6267662 DOI: 10.1007/s00270-018-2071-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/30/2018] [Indexed: 11/27/2022]
Abstract
Pelvic fractures are potentially life-threatening injuries with high mortality rates, mainly due to intractable pelvic arterial bleeding. However, concomitant injuries are frequent and may also be the cause of significant blood loss. As treatment varies depending on location and type of hemorrhage, timely imaging is of critical importance. Contrast-enhanced CT offers fast and detailed information on location and type of bleeding. Angiography with embolization for pelvic fracture hemorrhage, particularly when performed early, has shown high success rates as well as low complication rates and is currently accepted as the first method of bleeding control in pelvic fracture-related arterial hemorrhage. In the current review imaging workup, patient selection, technique, results and complications of pelvic embolization are described.
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Godt JC, Eken T, Schulz A, Johansen CK, Aarsnes A, Dormagen JB. Triple-split-bolus versus single-bolus CT in abdominal trauma patients: a comparative study. Acta Radiol 2018; 59:1038-1044. [PMID: 29350048 DOI: 10.1177/0284185117752522] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Split-bolus computed tomography (CT) is a recent development in trauma imaging. Instead of multiple scans in different contrast phases after a single contrast bolus, split-bolus protocols consist of one single scan of the thorax and abdomen after two or three contrast injections at different points of time. Purpose To evaluate and compare image quality and injury findings of a new triple-split-bolus CT (TS-CT) protocol of thorax and abdomen with those of a portal venous phase CT (PV-CT) in the same patient group. Material and Methods Trauma patients in 2009-2012 who underwent both the TS-CT initially and a PV-CT during the next six weeks were included. The TS-CT examination was performed as one CT run after application of three contrast boluses (total 175 mL) to enhance renal pelvis and urinary tract, the abdominal organs, and the large arterial vessels. The PV-CT had a fixed delay of 85 s. We measured attenuation in Hounsfield units (HU), evaluated possible organ injury and assessed image quality on a 5-point scale. Results Thirty-five patients were included. Attenuation measurements of major abdominal vessels, organs, and renal pelvis were significantly higher with the TS-CT protocol. Performance in organ injury diagnosis and image quality was equal in both protocols. Conclusion The overall performance of the TS-CT protocol is similar to the standard PV-CT. Excellent visualization of the arterial tree and the collecting system may eliminate the need for separate scans.
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Affiliation(s)
- Johannes Clemens Godt
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torsten Eken
- Department of Anesthesiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anselm Schulz
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Cathrine K Johansen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Anette Aarsnes
- Department of Diagnostic Physics, The Intervention Centre, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Johann Baptist Dormagen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
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A review of split-bolus single-pass CT in the assessment of trauma patients. Emerg Radiol 2018; 25:367-374. [DOI: 10.1007/s10140-018-1591-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/14/2018] [Indexed: 11/25/2022]
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Early experience with a split-bolus single-pass CT protocol in paediatric trauma. Clin Radiol 2017; 72:497-501. [DOI: 10.1016/j.crad.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/22/2016] [Accepted: 01/11/2017] [Indexed: 11/23/2022]
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Graves JA, Hanna TN, Herr KD. Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know. Emerg Radiol 2017; 24:557-568. [DOI: 10.1007/s10140-017-1515-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/05/2017] [Indexed: 12/26/2022]
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Treskes K, Bos SA, Beenen LFM, Sierink JC, Edwards MJR, Beuker BJA, Muradin GSR, Hohmann J, Luitse JSK, Hollmann MW, Dijkgraaf MGW, Goslings JC. High rates of clinically relevant incidental findings by total-body CT scanning in trauma patients; results of the REACT-2 trial. Eur Radiol 2016; 27:2451-2462. [PMID: 27709280 PMCID: PMC5408082 DOI: 10.1007/s00330-016-4598-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/21/2016] [Accepted: 09/05/2016] [Indexed: 12/21/2022]
Abstract
Objectives To determine whether there is a difference in frequency and clinical relevance of incidental findings detected by total-body computed tomography scanning (TBCT) compared to those by the standard work-up (STWU) with selective computed tomography (CT) scanning. Methods Trauma patients from five trauma centres were randomized between April 2011 and January 2014 to TBCT imaging or STWU consisting of conventional imaging with selective CT scanning. Incidental findings were divided into three categories: 1) major finding, may cause mortality; 2) moderate finding, may cause morbidity; and 3) minor finding, hardly relevant. Generalized estimating equations were applied to assess differences in incidental findings. Results In total, 1083 patients were enrolled, of which 541 patients (49.9 %) were randomized for TBCT and 542 patients (50.1 %) for STWU. Major findings were detected in 23 patients (4.3 %) in the TBCT group compared to 9 patients (1.7 %) in the STWU group (adjusted rate ratio 2.851; 95%CI 1.337–6.077; p < 0.007). Findings of moderate relevance were detected in 120 patients (22.2 %) in the TBCT group compared to 86 patients (15.9 %) in the STWU group (adjusted rate ratio 1.421; 95%CI 1.088–1.854; p < 0.010). Conclusions Compared to selective CT scanning, more patients with clinically relevant incidental findings can be expected by TBCT scanning. Key points • Total-body CT scanning in trauma results in 1.5 times more incidental findings. • Evaluation by TBCT in trauma results in more patients with incidental findings. • In every category of clinical relevance, TBCT detects more incidental findings.
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Affiliation(s)
- K Treskes
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - S A Bos
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J C Sierink
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M J R Edwards
- Department of Trauma and emergency surgery, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - B J A Beuker
- Trauma Unit, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - G S R Muradin
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J Hohmann
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031, Basel, Switzerland
| | - J S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M W Hollmann
- Department of Anaesthesiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Sierink JC, Treskes K, Edwards MJR, Beuker BJA, den Hartog D, Hohmann J, Dijkgraaf MGW, Luitse JSK, Beenen LFM, Hollmann MW, Goslings JC. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet 2016; 388:673-83. [PMID: 27371185 DOI: 10.1016/s0140-6736(16)30932-1] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Published work suggests a survival benefit for patients with trauma who undergo total-body CT scanning during the initial trauma assessment; however, level 1 evidence is absent. We aimed to assess the effect of total-body CT scanning compared with the standard work-up on in-hospital mortality in patients with trauma. METHODS We undertook an international, multicentre, randomised controlled trial at four hospitals in the Netherlands and one in Switzerland. Patients aged 18 years or older with trauma with compromised vital parameters, clinical suspicion of life-threatening injuries, or severe injury were randomly assigned (1:1) by ALEA randomisation to immediate total-body CT scanning or to a standard work-up with conventional imaging supplemented with selective CT scanning. Neither doctors nor patients were masked to treatment allocation. The primary endpoint was in-hospital mortality, analysed in the intention-to-treat population and in subgroups of patients with polytrauma and those with traumatic brain injury. The χ(2) test was used to assess differences in mortality. This trial is registered with ClinicalTrials.gov, number NCT01523626. FINDINGS Between April 22, 2011, and Jan 1, 2014, 5475 patients were assessed for eligibility, 1403 of whom were randomly assigned: 702 to immediate total-body CT scanning and 701 to the standard work-up. 541 patients in the immediate total-body CT scanning group and 542 in the standard work-up group were included in the primary analysis. In-hospital mortality did not differ between groups (total-body CT 86 [16%] of 541 vs standard work-up 85 [16%] of 542; p=0.92). In-hospital mortality also did not differ between groups in subgroup analyses in patients with polytrauma (total-body CT 81 [22%] of 362 vs standard work-up 82 [25%] of 331; p=0.46) and traumatic brain injury (68 [38%] of 178 vs 66 [44%] of 151; p=0.31). Three serious adverse events were reported in patients in the total-body CT group (1%), one in the standard work-up group (<1%), and one in a patient who was excluded after random allocation. All five patients died. INTERPRETATION Diagnosing patients with an immediate total-body CT scan does not reduce in-hospital mortality compared with the standard radiological work-up. Because of the increased radiation dose, future research should focus on the selection of patients who will benefit from immediate total-body CT. FUNDING ZonMw, the Netherlands Organisation for Health Research and Development.
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Affiliation(s)
- Joanne C Sierink
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Kaij Treskes
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Michael J R Edwards
- Trauma Unit, Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Benn J A Beuker
- Trauma Unit, Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Joachim Hohmann
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | | | - Jan S K Luitse
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Academic Medical Center, Amsterdam, Netherlands
| | - J Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, Netherlands.
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27
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Berger FH, Körner M, Bernstein MP, Sodickson AD, Beenen LF, McLaughlin PD, Kool DR, Bilow RM. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan. Br J Radiol 2016; 89:20150984. [PMID: 26781837 DOI: 10.1259/bjr.20150984] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the setting of mass casualty incidents (MCIs), hospitals need to divert from normal routine to delivering the best possible care to the largest number of victims. This should be accomplished by activating an established hospital disaster management plan (DMP) known to all staff through prior training drills. Over the recent decades, imaging has increasingly been used to evaluate critically ill patients. It can also be used to increase the accuracy of triaging MCI victims, since overtriage (falsely higher triage category) and undertriage (falsely lower triage category) can severely impact resource availability and mortality rates, respectively. This article emphasizes the importance of including the radiology department in hospital preparations for a MCI and highlights factors expected to influence performance during hospital DMP activation including issues pertinent to effective simulation, such as establishing proper learning objectives. After-action reviews including performance evaluation and debriefing on issues are invaluable following simulation drills and DMP activation, in order to improve subsequent preparedness. Historically, most hospital DMPs have not adequately included radiology department operations, and they have not or to a little extent been integrated in the DMP activation simulation. This article aims to increase awareness of the need for radiology department engagement in order to increase radiology department preparedness for DMP activation after a MCI occurs.
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Affiliation(s)
- Ferco H Berger
- 1 Department of Radiology and Nuclear Medicine, VU University Medical Center, Free University, Amsterdam, Netherlands
| | | | - Mark P Bernstein
- 3 Trauma & Emergency Radiology, Bellevue Hospital & NYU Langone Medical Center, New York, NY, USA
| | - Aaron D Sodickson
- 4 Emergency Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ludo F Beenen
- 5 Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick D McLaughlin
- 6 Emergency Radiology Division, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Digna R Kool
- 7 Department of Radiology, Bernhoven Hospital, Uden, Netherlands
| | - Ronald M Bilow
- 8 Diagnostic and Interventional Imaging, University of Texas Medical School, Houston, TX, USA
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28
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Beenen LFM, Goslings JC. Response to "Single-pass split-bolus CT protocol in polytrauma: reproducibility and diagnostic efficacy". Acta Radiol 2015; 56:NP49-50. [PMID: 26582939 DOI: 10.1177/0284185115613899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ludo FM Beenen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - JC Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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29
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Scialpi M, Schiavone R. Single-pass split-bolus CT protocol in polytrauma: reproducibility and diagnostic efficacy. Acta Radiol 2015; 56:NP47-8. [PMID: 26582938 DOI: 10.1177/0284185115610936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Michele Scialpi
- Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, Perugia, Italy
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