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Muroga K, Kitahara K. Adjustment of scan delay for bolus tracking with cardiothoracic ratio of CT scout image for hepatic artery phase of hepatic dynamic CT. Radiol Phys Technol 2024; 17:651-657. [PMID: 38758495 DOI: 10.1007/s12194-024-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/15/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
This study aimed to determine the scan delay for bolus tracking in the hepatic artery phase (HAP) of hepatic dynamic computed tomography (CT) using the cardiothoracic ratio (CTR) from CT scout images. We retrospectively studied 188 patients who underwent hepatic dynamic CT, 24 of whom had scan delays adjusted for CTR. The contrast enhancement of the abdominal aorta, portal vein, hepatic vein, and hepatic parenchyma was calculated for HAP. The adequacy of the scan timing for HAP was assessed using three classifications: early, appropriate, or late. The effect of HAP on scan timing adequacy was determined using multivariate logistic regression analysis, and the optimal cutoff value of CTR was evaluated using receiver operating characteristic analysis. The trigger times for bolus tracking (odds ratio: 1.58) and CTR (odds ratio: 1.23) were significantly affected by the appropriate scan timing of the HAP. The optimal cutoff value of CTR was 59.3%. The scan timing of HAP with a scan delay of 15 s was 14% of early and 86% of appropriate, and the proportion of early in CTR ≥ 60% (early, 52%; appropriate, 48%) was higher than that in CTR < 60% (early, 6%; appropriate, 94%). Adjusting the scan delay to 20 s in CTR ≥ 60% increased the proportion of appropriate (early, 4%; appropriate, 96%). The CTR of a CT scout image is an effective index for determining the scan delay for bolus tracking. Adjusting the scan delay by CTR can provide appropriate HAP images in more patients. Trial registration number: R-080; date of registration: 9 March 2023, retrospectively registered.
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Affiliation(s)
- Koji Muroga
- Department of Diagnostic Radiology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, 380-8582, Japan.
| | - Kanta Kitahara
- Department of Diagnostic Radiology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, 380-8582, Japan
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Weber MA. Easily missed pathologies of the musculoskeletal system in the emergency radiology setting. ROFO-FORTSCHR RONTG 2024. [PMID: 39094774 DOI: 10.1055/a-2369-8330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The musculoskeletal region is the main area in terms of easily missed pathologies in the emergency radiology setting, because the majority of diagnoses missed in the emergency setting are fractures.A review of the literature was performed by searching the PubMed and ScienceDirect databases, using the keywords ('missed injuries' or 'missed fractures') and ('emergency radiology' or 'emergency room') and ('musculoskeletal' or 'bone' or 'skeleton') for the title and abstract query. The inclusion criteria were scientific papers presented in the English and German languages. Among the 347 relevant hits between 1980 and 2024 as identified by the author of this review article, there were 114 relevant articles from the years between 2018 and 2024. Based on this literature search and the author's personal experience, this study presents useful information for reducing the number of missed pathologies in the musculoskeletal system in the emergency radiology setting.Predominant factors that make up the majority of missed fractures are 'subtle but still visible fractures' and 'radiographically imperceptible fractures'. Radiologists are able to minimize the factors contributing to fractures being missed. For example, implementing a 'four-eyes principle', i.e., two readers read the radiographs, would help to overcome the missing of 'subtle but still visible fractures' and the additional use of cross-sectional imaging would help to overcome the missing of 'radiographically imperceptible fractures'. Knowledge of what is commonly missed and evaluation of high-risk areas with utmost care also increase the diagnostic performance of radiologists. · Radiological imaging in an emergency setting increases the likelihood of radiological diagnostic errors, such as missing musculoskeletal pathologies.. · The majority of diagnoses missed in the emergency setting are fractures.. · To lessen the number of easily missed pathologies in the musculoskeletal system in the emergency radiology setting, a systematic approach is necessary.. · Adequate training of radiologists in emergency radiology and close collaboration with clinical partners are important measures to decrease the number of missed musculoskeletal injuries.. · Weber MA. Easily missed pathologies of the musculoskeletal system in the emergency radiology setting. Fortschr Röntgenstr 2024; DOI 10.1055/a-2369-8330.
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Affiliation(s)
- Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
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Milavec H, Gasser VT, Ruder TD, Deml MC, Hautz W, Exadaktylos A, Benneker LM, Albers CE. Supplementary value and diagnostic performance of computed tomography scout view in the detection of thoracolumbar spine injuries. Emerg Radiol 2024; 31:63-71. [PMID: 38194212 DOI: 10.1007/s10140-023-02196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Assessing the diagnostic performance and supplementary value of whole-body computed tomography scout view (SV) images in the detection of thoracolumbar spine injuries in early resuscitation phase and identifying frequent image quality confounders. METHODS In this retrospective database analysis at a tertiary emergency center, three blinded senior experts independently assessed SV to detect thoracolumbar spine injuries. The findings were categorized according to the AO Spine classification system. Confounders impacting SV image quality were identified. The suspected injury level and severity, along with the confidence level, were indicated. Diagnostic performance was estimated using the caret package in R programming language. RESULTS We assessed images of 199 patients, encompassing 1592 vertebrae (T10-L5), and identified 56 spinal injuries (3.5%). Among the 199 cases, 39 (19.6%) exhibited at least one injury in the thoracolumbar spine, with 12 (6.0%) of them displaying multiple spinal injuries. The pooled sensitivity, specificity, and accuracy were 47%, 99%, and 97%, respectively. All experts correctly identified the most severe injury of AO type C. The most common image confounders were medical equipment (44.6%), hand position (37.6%), and bowel gas (37.5%). CONCLUSION SV examination holds potential as a valuable supplementary tool for thoracolumbar spinal injury detection when CT reconstructions are not yet available. Our data show high specificity and accuracy but moderate sensitivity. While not sufficient for standalone screening, reviewing SV images expedites spinal screening in mass casualty incidents. Addressing modifiable factors like medical equipment or hand positioning can enhance SV image quality and assessment.
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Affiliation(s)
- Helena Milavec
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
- Department of Emergency Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
- Etzelclinic, Center for Minimally Invasive Surgery, Pfaeffikon, SZ, Switzerland.
| | - Vera T Gasser
- Department of Emergency Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas D Ruder
- Department of Diagnostic, Pediatric and Interventional Radiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Moritz C Deml
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | | | - Christoph E Albers
- Department of Orthopaedic Surgery and Traumatology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
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Barnsley H, Uzoukwu S, Hassan S, Borri M. The use of low dose CT scouts for MR safety screening: A multi-reader evaluation. Radiography (Lond) 2024; 30:168-175. [PMID: 38035429 DOI: 10.1016/j.radi.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Plain film radiographs are recommended to assist in MRI safety screening of patients with unknown medical histories, especially in an emergency setting where patients might be unable to answer a safety questionnaire. This study assesses the performance of CT scout images, which have low radiation dose and are faster and easier to acquire compared to plain film radiographs, in finding and naming a range of head and body implants. METHODS A retrospective analysis of 40 CT Head and Neck (HN) scout images and 40 CT Chest, Abdomen and Pelvis (CAP) scout images was undertaken. A subset of these were chosen to include a range of common internal implants not identifiable externally to the patient. The images were assessed by three readers with varying levels of clinical experience in MRI who were asked to find and name any implants seen. RESULTS Collectively, all readers reached a sensitivity of 85 % in finding internal implants, regardless of their clinical experience or experience in reviewing CT images, and a minimum specificity of 95 %. Implants were correctly named in 74 % of the images presented. CONCLUSION CT scout images were able to reveal most of the implants included. However, clinical experience in reviewing the images enhances a reader's ability to identify the type of implant. IMPLICATIONS FOR PRACTICE In an emergency setting, imaging can be critical in the management of patients presenting with acute illnesses. In the unconscious or unresponsive patient, the use of CT scouts, where this is the only option available, could provide valuable MRI safety information prior to a scan, improving access to the MRI scan in a timely manner.
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Affiliation(s)
- H Barnsley
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - S Uzoukwu
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - S Hassan
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - M Borri
- Neuroradiology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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Lee MH, Lubner MG, Mellnick VM, Menias CO, Bhalla S, Pickhardt PJ. The CT scout view: complementary value added to abdominal CT interpretation. Abdom Radiol (NY) 2021; 46:5021-5036. [PMID: 34075469 DOI: 10.1007/s00261-021-03135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 12/30/2022]
Abstract
Computed tomography (CT) scout images, also known as CT localizer radiographs, topograms, or scanograms, are an important, albeit often overlooked part of the CT examination. Scout images may contain important findings outside of the scanned field of view on CT examinations of the abdomen and pelvis, such as unsuspected lung cancer at the lung bases. Alternatively, scout images can provide complementary information to findings within the scanned field of view, such as characterization of retained surgical foreign bodies. Assessment of scout images adds value and provides a complementary "opportunistic" review for interpretation of abdominopelvic CT examinations. Scout image review is a useful modern application of conventional abdominal radiograph interpretation that can help establish a diagnosis or narrow a differential diagnosis. This review discusses the primary purpose and intent of the CT scout images, addresses standard of care and bias related to scout image review, and presents a general systematic approach to assessing scout images with multiple illustrative examples, including potential pitfalls in interpreting scout images.
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Affiliation(s)
- Matthew H Lee
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA.
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus, Box 8131, St. Louis, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus, Box 8131, St. Louis, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI, 53792, USA
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Yamashita S, Sato M, Yamazaki T, Yasuda S, Kato N. Identifying Cerebral Large Vessel Occlusion in Acute Ischemic Stroke by MRI Positioning Scanning. Neurol Med Chir (Tokyo) 2021; 61:521-527. [PMID: 34121049 PMCID: PMC8443971 DOI: 10.2176/nmc.oa.2021-0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Various approaches have been tried for acute ischemic stroke (AIS) treatment to shorten the time from onset to recanalization. MRI positioning scanning (PS), which must be taken before any MRI sequences, was examined whether it can detect cerebral large vessel occlusion. A total of 68 consecutive patients with AIS who underwent MRI and were treated with intravenous recombinant tissue plasminogen activator or mechanical thrombectomy at our hospital were retrospectively included in this study. Occluded vessels were identified on the axial or coronal views of PS images, and these images were compared with 3D time-of-flight MRA and digital subtraction angiogram. The sensitivities, positive predictive values (PPVs), and negative predictive values (NPVs) for internal carotid artery (ICA), the proximal M1, distal M1, and M2 segment of the middle cerebral artery occlusion were assessed, and the number of PS slices was assessed. The sensitivities of the axial slices for ICA, proximal M1, distal M1, and M2 occlusion were 62%, 21%, 35%, and 86%, respectively. The PPVs of the axial slices for ICA, proximal M1, distal M1, and M2 occlusion were 81%, 88%, 100%, and 97%, respectively, and the NPVs of the axial slices for ICA, proximal M1, distal M1, and M2 occlusion were 94%, 90%, 86%, and 100%, respectively. The detection rate for the ICA was significantly higher with three axial slices (91%) than with two slices (47%) (p <0.01). MRI PS is warranted to be referred to detect large cerebral vessel occlusion.
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Affiliation(s)
- Shota Yamashita
- Department of Neurosurgery, Mito Medical Center, Organization of National Hospital
| | - Masayuki Sato
- Department of Neurosurgery, Mito Medical Center, Organization of National Hospital
| | - Tomosato Yamazaki
- Department of Neurosurgery, Mito Medical Center, Organization of National Hospital
| | - Susumu Yasuda
- Department of Neurosurgery, Mito Medical Center, Organization of National Hospital
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center, Organization of National Hospital
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Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging. Sarcoma 2020; 2020:5105196. [PMID: 32848506 PMCID: PMC7439793 DOI: 10.1155/2020/5105196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study is to evaluate the benefit of reviewing scout CT images, obtained for routine oncologic surveillance, for the early identification of pathologic bony lesions. A retrospective review was conducted on patients who previously underwent surgical treatment by two orthopedic oncology surgeons at a tertiary care institution from 2009–2019 for pathologic lesions or fractures of the humerus or femur. Radiographic records were reviewed to identify patients in this cohort who had available scout views from CT imaging prior to official diagnosis of the bony lesion or fracture. CT scout images were assessed by two independent reviewers to identify any pathologic lesions, and radiographic reports were reviewed to identify if the lesions were noted by radiology at the time of the initial scan interpretation. One hundred and forty-four patients were identified, and thirty-nine had an available scout CT image prior to official diagnosis of the lesion. Twenty-five patients (64.1%) had lesions identified by authors on scout CT versus only 9 (23.1%) who had lesions that were documented in the initial CT radiologic report. There was a total of 29 lesions identified by the study authors on scout CT, and 19 (65.5%) were not reported in the initial radiographic interpretation with an average interval between observation by authors and official diagnosis of 202 days. Of the impending fractures, three patients (16.7%) went on to complete fracture prior to referral to orthopedics with an average interval between these missed lesions on scout CT and their presentation with fracture of 68 days. This study advocates for the careful review of all scout CT imaging as an essential part of the work up for metastatic disease and encourages all practitioners to utilize this screening tool for the identification of pathologic bony lesions which may help expedite early treatment to reduce patient morbidity.
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Albano S, Ramnot A, Siddiqi J, Mahato D. Medical and Legal Implications of MRI Scout Imaging in a Surgical Patient with Case Presentation. Cureus 2020; 12:e6833. [PMID: 32181076 PMCID: PMC7051123 DOI: 10.7759/cureus.6833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Spinal epidural angiolipoma is an uncommon finding; this case is presented to display the medical and legal implications of MRI scout imaging. In this case, a preceding period of ambiguous and non-focal symptoms led to an MRI of the lumbar spine without contrast with a scout image that captured a thoracic lesion. Review of the scout film led to a subsequent MRI of the thoracic spine with and without contrast that aided clinical decision making leading to surgical resection of the identified lesion and resolution of symptoms for this patient. The use of scout imaging has been described in the literature, but no concise agreement among physicians or professional medical societies exists regarding what utility, if any, may be obtained from the review of scout imaging. A discussion of medical legal implications of MRI scout imaging follows.
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Affiliation(s)
- Stephen Albano
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Ajay Ramnot
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Javed Siddiqi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
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Hiding in the Hedges: Tips to Minimize Your Malpractice Risks as a Radiologist. AJR Am J Roentgenol 2019; 213:1037-1041. [DOI: 10.2214/ajr.19.21428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Saltybaeva N, Krauss A, Alkadhi H. Technical Note: Radiation dose reduction from computed tomography localizer radiographs using a tin spectral shaping filter. Med Phys 2019; 46:544-549. [DOI: 10.1002/mp.13353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Natalia Saltybaeva
- Institute for Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland
| | - Andreas Krauss
- Computed Tomography Division Siemens Healthineers Forchheim Germany
| | - Hatem Alkadhi
- Institute for Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland
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Awais M, Salam B, Nadeem N, Rehman A, Baloch NU. Diagnostic Accuracy of Computed Tomography Scout Film and Chest X-ray for Detection of Rib Fractures in Patients with Chest Trauma: A Cross-sectional Study. Cureus 2019; 11:e3875. [PMID: 30899626 PMCID: PMC6420333 DOI: 10.7759/cureus.3875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Rib fractures are a major source of morbidity in patients with chest trauma. Computed tomography (CT) scout film is a low-dose image that is obtained prior to a complete chest CT study for all patients undergoing a CT scan. In this study, we evaluated the diagnostic performance of CT scout film vis-à-vis that of chest X-ray for detection of rib fractures using chest CT scan as the reference standard. METHODS A cross-sectional study was performed at the radiology department of Aga Khan University Hospital (Karachi, Pakistan) from October 1, 2013 to September 31, 2014. Patients who underwent CT chest for evaluation of thoracic trauma were included in the study. Sensitivity and specificity of chest X-ray and CT scout film were calculated. RESULTS A total of 207 patients were included in the study (193 were male). Penetrating and blunt thoracic injuries affected 104 (50.2%) and 103 (49.8%) patients respectively. On CT chest, 75 (36.2%) patients had evidence of rib fractures. Sensitivity and specificity of CT scout film for detection of rib fractures were 56% and 87.9%, while those of chest X-ray were 61.3% and 98.5% respectively. The overall accuracy of CT scout film and chest X-ray for detection of rib fractures were 76.3% and 85% respectively. CONCLUSION Diagnostic performance of CT scout film for detection of rib fractures was comparable to that of the plain chest radiograph. CT scout film does not provide any additional information or advantage over a plain chest radiograph. In patients with severe thoracic trauma, CT chest remains the modality of choice for accurate delineation of rib fractures and associated internal injuries.
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Affiliation(s)
| | - Basit Salam
- Radiology, The Aga Khan University, Karachi, PAK
| | - Naila Nadeem
- Radiology, The Aga Khan University, Karachi, PAK
| | - Abdul Rehman
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
| | - Noor U Baloch
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
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12
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Mezrich JL. Sometimes less is more – Data acquisition and its impact on liability. Clin Imaging 2019; 53:v-vi. [DOI: 10.1016/j.clinimag.2018.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
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Abstract
Cross-sectional spinal imaging is common, and extraspinal findings are often incidentally identified during interpretation. Although some of these findings may cause symptoms that mimic a spinal disorder, the majority are entirely asymptomatic and incidental. It is essential that the radiologist not only identify those abnormalities that may have clinical significance but also recognize those that are clinically irrelevant and thereby prevent patients from being subjected to further unnecessary, expensive and potentially harmful interventions. This article focuses on those abnormalities that are commonly encountered and provides practical guidance for follow-up and management based on current recommendations.
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Affiliation(s)
- Prashant Raghavan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St, Baltimore, MD 21201, USA.
| | - Jessica Record
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St, Baltimore, MD 21201, USA
| | - Lorenna Vidal
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St, Baltimore, MD 21201, USA
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Affiliation(s)
- Leonard Berlin
- From the Department of Radiology, Skokie Hospital, 9600 Gross Point Rd, Skokie, IL 60076; Department of Radiology, Rush University, Chicago, Ill; and Department of Radiology, University of Illinois at Chicago, Chicago, Ill
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15
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The need to be all inclusive: Chest CT scans should include imaged breast parenchyma. Clin Imaging 2018; 50:243-245. [DOI: 10.1016/j.clinimag.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/21/2022]
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Mück F, Wirth K, Muggenthaler M, Kanz KG, Kreimeier U, Maxien D, Linsenmeier U, Mutschler W, Wirth S. [Pretreatment mass casualty incident workflow analysis : Comparison of two level 1 trauma centers]. Unfallchirurg 2017; 119:632-41. [PMID: 27351989 DOI: 10.1007/s00113-016-0200-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mass casualty incidents (MCI) have particularly high demands on patient care processes but occur rather rarely in daily hospital routine. Therefore, it is common to use simulations to train staff and to optimize institutional processes. OBJECTIVES Aim of study was to compare the pre-therapeutic in-house workflow of two differently structured level 1 trauma sites in the case of a simulated mass casualty incident (MCI). MATERIALS AND METHODS A MCI of 70 patients was simulated by actors in a manner that was as realistic as possible. The on-site triage assigned 7 cases to trauma site A with relatively long in-house distances and 4 patients to an independent trauma site B in which these distances were relatively short. During in-house treatment, time intervals for reaching milestones were measured and compared using the Mann-Whitney U test. RESULTS As no simultaneous patient arrival occurred, the Patient Distribution Matrix proved to be effective. Site A needed more time (minutes) from admission to endpoints (A: 31.85 ± 7.99; B: 21.62 ± 4.76; p = 0.059). In detail, the time intervals were particularly longer for both patient stay in trauma room (A: 8.46 ± 3.02; B: 2.73 ± 0.78, p < 0.01) and transfer time to the CT room (A: 1.81 ± 0.62; B: 0.06 ± 0.03, p < 0.01). A shorter stay in the CT room did not compensate these effects (A: 8.86 ± 1.84; B: 10.40 ± 2.89, p = 0.571). For both sites, image calculation and distribution were relatively time consuming (17.36 ± 3.05). CONCLUSIONS Although short in-house distances accelerated pretherapeutic treatment processes significantly, both sites remained clearly within the "golden hour". The strongest potential bottleneck was the time interval until images were available at the endpoints.
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Affiliation(s)
- F Mück
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
| | - K Wirth
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - M Muggenthaler
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - K G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - U Kreimeier
- Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - D Maxien
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - U Linsenmeier
- Institut für Interventionelle und Diagnostische Radiologie, HELIOS Klinikum München West, Steinerweg 5, 81241, München, Deutschland
| | - W Mutschler
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - S Wirth
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
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Morgan B, Stephenson JA, Griffin Y. Minimising the impact of errors in the interpretation of CT images for surveillance and evaluation of therapy in cancer. Clin Radiol 2016; 71:1083-94. [PMID: 27522436 DOI: 10.1016/j.crad.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022]
Abstract
Radiological error is inevitable and usually multifactorial. Error can be secondary to radiologist-specific causes, including cognitive and perceptive errors or ambiguity of report, or system-related causes, including inadequate, misleading, or incorrect clinical information, poor imaging technique, excessive workload, and poor working conditions. In this paper, we discuss a systematic approach to reduce errors in oncological radiology reporting, thus reducing risk to the patient. Rather than attempt to discuss all types of error, we concentrate on the most important and commonly occurring errors that we have encountered over 20 years of practice, based on weekly discrepancy reviews of our practice and independent reviews of clinical and research imaging from other institutions. This review focuses on computed tomography (CT) reporting for staging, surveillance, and response assessment of cancer patients, but the messages apply to all imaging methods.
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Affiliation(s)
- B Morgan
- University of Leicester Imaging Department, Department of Radiology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - J A Stephenson
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
| | - Y Griffin
- Department of Radiology, University Hospitals of Leicester, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK
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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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Pinto A, Reginelli A, Pinto F, Lo Re G, Midiri F, Muzj C, Romano L, Brunese L. Errors in imaging patients in the emergency setting. Br J Radiol 2016; 89:20150914. [PMID: 26838955 PMCID: PMC4985468 DOI: 10.1259/bjr.20150914] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/30/2015] [Accepted: 01/12/2016] [Indexed: 01/19/2023] Open
Abstract
Emergency and trauma care produces a "perfect storm" for radiological errors: uncooperative patients, inadequate histories, time-critical decisions, concurrent tasks and often junior personnel working after hours in busy emergency departments. The main cause of diagnostic errors in the emergency department is the failure to correctly interpret radiographs, and the majority of diagnoses missed on radiographs are fractures. Missed diagnoses potentially have important consequences for patients, clinicians and radiologists. Radiologists play a pivotal role in the diagnostic assessment of polytrauma patients and of patients with non-traumatic craniothoracoabdominal emergencies, and key elements to reduce errors in the emergency setting are knowledge, experience and the correct application of imaging protocols. This article aims to highlight the definition and classification of errors in radiology, the causes of errors in emergency radiology and the spectrum of diagnostic errors in radiography, ultrasonography and CT in the emergency setting.
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Affiliation(s)
- Antonio Pinto
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Alfonso Reginelli
- Department of Clinical and Experimental Medicine and Surgery F Magrassi—A. Lanzara, Second University of Naples, Naples, Italy
| | - Fabio Pinto
- Department of Diagnostic Imaging, Marcianise Hospital, ASL Caserta (CE), Caserta, Italy
| | - Giuseppe Lo Re
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Federico Midiri
- Section of Radiological Sciences, DIBIMED, University of Palermo, Palermo, Italy
| | - Carlo Muzj
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Luigia Romano
- Department of Radiology, Cardarelli Hospital, Naples, Italy
| | - Luca Brunese
- Department of Health Science, University of Molise, Campobasso, Italy
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Mueck FG, Wirth K, Muggenthaler M, Kreimeier U, Geyer L, Kanz KG, Linsenmaier U, Wirth S. Radiological mass casualty incident (MCI) workflow analysis: single-centre data of a mid-scale exercise. Br J Radiol 2016; 89:20150918. [PMID: 26694107 DOI: 10.1259/bjr.20150918] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of the study was to analyse and interpret radiological mass casualty incident workflow data. METHODS In a mid-scale mass casualty incident exercise, the on-site triage assigned 12 cases to the investigated institution (11 included in the study). Two out of five institutional multislice-CT-scanners were used and the whole CT workflow and radiological service process chain were simulated as close to realistic as possible. The respective time intervals for reaching defined milestones were measured. RESULTS The average CT in-room time, i.e. from entering to leaving the CT room was 9.43 min [(standard deviation) SD: 2.27 min; 95% (confidence interval) CI: 7.90-10.95 min]. Time spent on CT table was 6.75 min (SD: 1.67; CI: 5.63-7.87), and the pure scan time was 4.22 min (SD: 0.64; CI: 3.79-4.65). The first images after entering the CT room were available at a dedicated CT workstation after 5.85 min (SD: 2.20; CI: 4.37-7.32) and institution wide via picture archiving system (PACS) after 7.85 min (SD: 1.27; CI: 7.00-8.71). However, the PACS archiving process, that is, transfer of standard reconstruction set of CT images into the PACS was finished after 20.85 min (SD: 2.97; CI: 18.85-22.84). CONCLUSION Up to six patients may be served per hour and per CT scanner by using a standard whole body CT polytrauma protocol. Dedicated CT triage protocols may even increase this number. The time portion until images were available at end points was relatively long. A solution has to be developed in order to avoid scenarios of patients being faster at end points than their images.
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Affiliation(s)
- Fabian G Mueck
- 1 Department of Clinical Radiology, LMU Hospital of the University of Munich, Munich, Germany
| | - Kathrin Wirth
- 1 Department of Clinical Radiology, LMU Hospital of the University of Munich, Munich, Germany
| | - Maximilian Muggenthaler
- 1 Department of Clinical Radiology, LMU Hospital of the University of Munich, Munich, Germany
| | - Uwe Kreimeier
- 2 Department of Anesthesiology, LMU Hospital of the University of Munich, Munich, Germany
| | - Lucas Geyer
- 1 Department of Clinical Radiology, LMU Hospital of the University of Munich, Munich, Germany
| | - Karl-Georg Kanz
- 3 Department of Trauma Surgery, Hospital of the Technical University Munich, Munich, Germany
| | - Ulrich Linsenmaier
- 4 Department of diagnostic and interventional radiology, HELIOS Clinic Munich East, Munich, Germany
| | - Stefan Wirth
- 1 Department of Clinical Radiology, LMU Hospital of the University of Munich, Munich, Germany
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Abstract
OBJECTIVE The purpose of this article is to share the views of an experienced expert witness in medical malpractice cases on the use of CT scout images. CONCLUSION The medical literature has resurrected issues regarding viewing of CT scout images. Scout images are an integral part of any CT examination and should be carefully reviewed for findings that may or may not be included in the FOV of the study.
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Precision and Accuracy of Measurements on CT Scout View. J Med Imaging Radiat Sci 2015; 46:309-316. [PMID: 31052138 DOI: 10.1016/j.jmir.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/12/2015] [Accepted: 06/19/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purposes of this study were to (1) investigate the limits of measurements on scout view in three computed tomography axes, x, y and z and (2) develop a model to provide better understanding of measurement accuracy. METHODS For the first objective, anteroposterior and lateral scout views of a Catphan phantom 200 mm in diameter and length were acquired with a GE scanner at 21 different table heights. Phantom measurements on scout view were performed by two experienced readers. The comparison of their measures provided estimation of precision. The accuracy was assessed by determining the bias, calculated as the difference between the values measured on scout view and the real phantom size. Second, a model was developed investigating the relationship between the dimensions of the object, its image, and the table height. This relationship was tested on our data. RESULTS Scout view measurements were precise, with less than 0.53% difference between readers. In addition, small biases of about 1 mm were detected in the z-axis, whatever the table height. In the other axes, serious biases from -13 to +73 mm were measured. Furthermore, at isocentre, overestimations up to 7 mm were shown. The results also indicated that biases in scout view measurements are because of the geometrical projection related to the object-detector distance. CONCLUSIONS Measurements in the table movement axis are precise and accurate, conferring to scout views an added value for preoperative planning in orthopedic surgery.
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