Frequency of external iliac artery branch injury in blunt trauma: improved detection with selective external iliac angiography

PURPOSE

To assess the utility of selective external iliac artery (EIA) angiography and the frequency of injury to branches of the EIA in cases of blunt pelvic trauma.

MATERIALS AND METHODS

A retrospective review of pelvic angiograms in 66 patients with blunt pelvic trauma was conducted over a 12-month period. Pelvic and femur fracture patterns were correlated to the presence of EIA injury. Pelvic arteriography was compared versus selective EIA angiography for the detection of arterial injury.

RESULTS

Fifty-four of 66 patients (82%) exhibited pelvic arterial injury or elicited enough suspicion for injury to warrant embolization. Internal iliac artery embolization was performed in 50 of 66 (76%). EIA branch injury was identified in 11 of 66 patients (17%), and 10 were successfully embolized. EIA branch vessel injury was identified more frequently when there was ipsilateral intertrochanteric fracture (P = .07) or ipsilateral ilium fracture (P = .07). The sensitivity of nonselective pelvic angiography in the detection of EIA branch vessel injury was 45%.

CONCLUSIONS

EIA branch injury occurs in a substantial fraction of patients with blunt pelvic trauma who undergo pelvic angiography. Selective EIA angiography should be considered in all patients undergoing pelvic angiography in this situation.

Business of radiology 101: the state of radiology business practice and health care policy curricula at US radiology residency programs

PURPOSE

The aim of this study was to assess the prevalence, content, and perceptions of curricula focused on radiology business practice and health care policy at US radiology residency training programs.

METHODS

The desired survey population was trainees and faculty members of radiology residency programs in the United States. Three anonymous survey instruments were distributed, including an e-mail survey to the membership of the ACR RFS, a paper survey to ACR RFS delegates attending the 2010 AMCLC, and an e-mail survey to the membership of the Association of Program Directors in Radiology (APDR).

RESULTS

Response rates for the surveys were 12%, 25%, and 21%, respectively. Members of the APDR and RFS agreed that understanding and competency in business practice and health care policy topics are important to the future careers of residents (total favorable sentiment >86% for APDR members and >96% for RFS members). Most survey respondents' home institutions offer some form of a noninterpretive curriculum (91% of APDR respondents, 74% of RFS respondents), but the breadth of topics addressed and educational time devoted to these curricula were quite variable. Subjective effectiveness of curricula was infrequently rated as very effective by 12% of APDR respondents and 6% of RFS respondents.

CONCLUSIONS

Despite the perceived importance of radiology business practice and health care policy education, and residency training requirements in competencies related to these subjects that have been in place for more than a decade, curricula addressing these items still seem to be in a stage of acceptance and development. Further commitment to and innovation within these curricula are requisite in educating our future radiologists.

Imaging and percutaneous treatment of vascular anomalies

Vascular anomalies are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or, more often, in combination. Although mostly congenital, they can occasionally be acquired as well. They present a challenge both for workup and therapy. This article attempts to describe some of their main anomalies, their workup, and their therapies, with the goal of increasing the comfort level of endovascular therapists.

Visceral trauma: principles of management and role of embolotherapy

Interventional radiology for the treatment of traumatic visceral hemorrhage has emerged as an important adjunct to modern trauma care. This article outlines the general surgical concepts of the acute care of trauma patients as a guideline for catheter-based therapy. Specific considerations are presented for embolizing visceral injuries in the liver, spleen, and kidney. Expected outcomes and follow-up are reviewed.

Multifocal metachronous giant cell tumor in a 15-year-old boy

We report a case of multifocal metachronous giant cell tumor (GCT) that involved the fibula, tibia, and sacrum of a 15-year-old boy. Multifocal GCT of bone presenting in children is an exceedingly rare phenomenon; however, there is evidence that multifocal GCT presents, on average, at a younger age than solitary GCT. Pediatric radiologists should be aware of this when encountering a single lesion with characteristic radiographic features of GCT and when encountering multiple lytic skeletal lesions.