Accidental or intentional ingestion of toothbrushes: experience with 8 adult patients
ConclusionsIngested toothbrushes can be easily identified on radiological studies because of the radiopaque wires holding the nylon bristles. The plastic parts of it, however, are only visible on computed tomography. All cases would require endoscopic or surgical removal of the retained toothbrushes because spontaneous passage per rectum does not occur. (Source: Emergency Radiology)
Source: Emergency Radiology - January 13, 2022 Category: Emergency Medicine Source Type: research

The utility of spectral Doppler evaluation of acute appendicitis
ConclusionBy incorporating spectral Doppler criteria into routine graded compression ultrasound, the diagnostic accuracy of acute appendicitis was increased. In comparison, high PSV and RI values of the appendix with a cut-off point of 9.6  cm/s and 0.49 differ significantly between positive and negative appendectomy patients.Graphical abstract (Source: Emergency Radiology)
Source: Emergency Radiology - January 11, 2022 Category: Emergency Medicine Source Type: research

Deep learning prediction of sex on chest radiographs: a potential contributor to biased algorithms
ConclusionDCNNs trained on two large CXR datasets accurately predicted sex on internal and external test data with similar heatmap localizations across DCNN architectures and datasets. These findings support the notion that DCNNs can leverage imaging biomarkers to predict sex and potentially confound the accurate prediction of disease on CXRs and contribute to biased models. On the other hand, these DCNNs can be beneficial to emergency radiologists for forensic evaluations and identifying patient sex for patients whose identities are unknown, such as in acute trauma. (Source: Emergency Radiology)
Source: Emergency Radiology - January 10, 2022 Category: Emergency Medicine Source Type: research

Interventional radiology in renal emergencies: a pictorial essay
AbstractRenal emergencies necessitate prompt diagnosis and management to stop active bleeding and retain kidney function. Causes of renal emergencies can be classified into traumatic, atraumatic, iatrogenic, and obstructive etiologies. Interventional radiology (IR) has emerged as an acceptable alternative to surgical treatment in the management of renal emergencies due to its minimally invasive nature. With the rise of interventional procedures, there is a need for further discussion of angiographic and fluoroscopic imaging in the setting of renal emergencies. (Source: Emergency Radiology)
Source: Emergency Radiology - January 10, 2022 Category: Emergency Medicine Source Type: research

Retrospective analysis of the application of CT scan in the emergency department to screen clinically asymptomatic COVID-19 before hospital admission
ConclusionOur descriptive analysis confirms that CT scan cannot be considered a valid tool to screen clinically occult COVID-19, when the asymptomatic patients need hospitalization for other conditions. Application of personnel protections and distancing among patients remains the best strategies to limit the possibility of intrahospital cross-infections. (Source: Emergency Radiology)
Source: Emergency Radiology - January 8, 2022 Category: Emergency Medicine Source Type: research

Parenchymal echotexture changes as a predictor of viability in testicular torsion
ConclusionUltrasound finding of focal parenchymal echotexture heterogeneous changes is highly specific although not sensitive, for nonviable testis. The presence of this finding reassures non-viability in over 99%. (Source: Emergency Radiology)
Source: Emergency Radiology - January 7, 2022 Category: Emergency Medicine Source Type: research

Increased relative risk of delayed hemorrhage in patients taking anticoagulant/antiplatelet medications with concurrent aspirin therapy: implications for clinical practice based on 3-year retrospective analysis in a large health system
AbstractPurposeThe incidence of delayed posttraumatic intracranial hemorrhage (DH) in patients on anticoagulant (AC) and antiplatelet (AP) medications, especially with concurrent aspirin therapy, is not well established, with studies reporting disparate results with between 1 –10% risk of DH and 0–3% mortality. The purpose of this 3-year retrospective study is to evaluate the true risk of DH in patients on AP/AC medications with or without concurrent aspirin therapy.MethodsOne thousand forty-six patients taking AP and AC medications presenting to network emergency departments with head trauma who had repeat CT ...
Source: Emergency Radiology - January 6, 2022 Category: Emergency Medicine Source Type: research

The use of ultrasound in establishing COVID-19 infection as part of a trauma evaluation
ConclusionsEvaluation of the lung during EFAST cannot be used in the trauma setting to identify patients with active COVID-19 infection or to stratify patients as high or low risk of infection. This is likely due to differences in lung imaging technique and the presence of concomitant thoracic injury. (Source: Emergency Radiology)
Source: Emergency Radiology - January 6, 2022 Category: Emergency Medicine Source Type: research

Deep learning versus iterative image reconstruction algorithm for head CT in trauma
AbstractPurposeTo compare the image quality between a deep learning –based image reconstruction algorithm (DLIR) and an adaptive statistical iterative reconstruction algorithm (ASiR-V) in noncontrast trauma head CT.MethodsHead CT scans from 94 consecutive trauma patients were included. Images were reconstructed with ASiR-V 50% and the DLIR strengths: low (DLIR-L), medium (DLIR-M), and high (DLIR-H). The image quality was assessed quantitatively and qualitatively and compared between the different reconstruction algorithms. Inter-reader agreement was assessed by weighted kappa.ResultsDLIR-M and DLIR-H demonstrated low...
Source: Emergency Radiology - January 5, 2022 Category: Emergency Medicine Source Type: research

Correction to: Detection of acute rib fractures on CT images with convolutional neural networks: effect of location and type of fracture and reader ’s experience
(Source: Emergency Radiology)
Source: Emergency Radiology - December 15, 2021 Category: Emergency Medicine Source Type: research

Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study
ConclusionsAn abbreviated TS-MRI protocol of IRsag + T2ax is noninferior to the standard non-contrast protocol, potentially allowing for faster emergent imaging diagnosis and triage. (Source: Emergency Radiology)
Source: Emergency Radiology - December 2, 2021 Category: Emergency Medicine Source Type: research

Detection of acute rib fractures on CT images with convolutional neural networks: effect of location and type of fracture and reader ’s experience
ConclusionThe CNN specialized for the detection of acute rib fractures on CT images can improve the radiologists ’ diagnostic performance regardless of the type of fractures and reader’s experience. Further studies are needed to clarify the usefulness of the CNN for the detection of acute rib fractures on CT images in actual clinical practice. (Source: Emergency Radiology)
Source: Emergency Radiology - December 2, 2021 Category: Emergency Medicine Source Type: research

Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study
ConclusionsAn abbreviated TS-MRI protocol of IRsag + T2ax is noninferior to the standard non-contrast protocol, potentially allowing for faster emergent imaging diagnosis and triage. (Source: Emergency Radiology)
Source: Emergency Radiology - December 2, 2021 Category: Emergency Medicine Source Type: research

Detection of acute rib fractures on CT images with convolutional neural networks: effect of location and type of fracture and reader ’s experience
ConclusionThe CNN specialized for the detection of acute rib fractures on CT images can improve the radiologists ’ diagnostic performance regardless of the type of fractures and reader’s experience. Further studies are needed to clarify the usefulness of the CNN for the detection of acute rib fractures on CT images in actual clinical practice. (Source: Emergency Radiology)
Source: Emergency Radiology - December 2, 2021 Category: Emergency Medicine Source Type: research

COVID-19 pandemic revisited: lessons the radiology community has learned a year later
AbstractFor more than 1  year, COVID-19 pandemic has impacted every aspect of our lives. This paper reviews the major challenges that the radiology community faced over the past year and the impact the pandemic had on the radiology practice, radiologist-in-training education, and radiology research. The lessons learned fr om COVID-19 pandemic can help the radiology community to be prepared for future outbreaks and new pandemics, preserve good habits, enhance cancer screening programs, and adapt to the changes in radiology education and scientific meetings. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

AP pelvis radiograph is insufficient for diagnosis of U-type sacral fractures
ConclusionThe sensitivity of an AP pelvis radiograph is poor for U-type sacral fractures, whether interpreted by radiologists or orthopedic traumatologists. Pelvis CT should be considered as a screening test to rule out sacral fracture when the patient reports posterior pelvic pain, even if plain radiography demonstrates no injury or a minimally displaced pelvic ring disruption.Level of evidenceDiagnostic level III (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Problem-solving with MRI in acute abdominopelvic conditions, part 2: gynecological, obstetric, vascular, and renal diseases
AbstractThe purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high soft-tissue contrast resolution, and ability to resolve different soft tissue, MRI holds notable advantages over other imaging modalities and can be used as a problem-solving tool. Additional advantages of MRI include lack of radiation-related risks to children and pregnant women, and the ability to acquire detailed diagnostic information even without intravenous contrast which can be beneficial in patients with contrast allergy and end-stage renal d...
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Radiologist errors by modality, anatomic region, and pathology for 1.6 million exams: what we have learned
ConclusionThe addition of error-related pathology to peer review is both feasible and practical and provides a more detailed guide to targeted individual and practice-wide peer learning quality improvement efforts. Future research is needed to determine if there are measurable improvements in detection or interpretation of specific pathologies following error feedback and educational interventions. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

MDCTA volumetric analysis for the quantification and grading of acute non-cerebral, non-gastrointestinal hemorrhage: a feasibility study
ConclusionsMDCTA volumetric analysis for the quantification and grading of acute hemorrhage was feasible with excellent inter-observer agreement. The proposed bleeding grading system could optimize decision making and predict clinical outcomes. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Radiographic clues to the unstable knee: are findings of trochlear dysplasia on lateral knee radiographs reliable and predictive of patellar dislocation?
AbstractBackgroundTrochlear dysplasia (TD) is a key predisposing risk factor for patellar instability (PI) and lateral patellar dislocation (LPD) injuries. It is useful to understand the reliability of radiographic findings of TD and the accuracy of knee radiographs in diagnosing patients with recent LPD.PurposeThe purposes of our study are to evaluate the inter-rater reliability of specific radiographic signs of PI and staging of TD between radiologists and orthopedic surgeons, and to identify which findings are associated with recent LPD.MethodsThis retrospective study comprised 336 patients aged 8 to 18 who obtained kne...
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Comparing the first and the second waves of COVID-19 in Italy: differences in epidemiological features and CT findings using a semi-quantitative score
ConclusionsThere was no difference regarding CT pattern prevalence between the first and the second waves, confirming both the validity of the RSNA consensus and the most frequent radiological COVID-19 features. Non-typical COVID-19 features were more frequently observed in older patients, thus should not be underestimated in the elderly population. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Acute basilar artery occlusion (BAO): a pictorial review of multimodal imaging findings
AbstractAcute basilar artery occlusion (BAO) is an uncommon cause of stroke; however, it constitutes a serious medical emergency and is associated with elevated mortality rates as well as unfavorable functional outcomes. This is especially true when it is not rapidly diagnosed, and the initiation of reperfusion therapies is delayed. Its etiology is mainly embolic or atherosclerotic, and it often presents with non-specific signs and symptoms (e.g., vertigo, cephalalgia, reduced consciousness, or hemiparesis) that can simulate an anterior circulation stroke. Therefore, obtaining imaging studies that include computed tomograp...
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Problem-solving with MRI in acute abdominopelvic conditions, part 1: gastrointestinal, hepatobiliary, and pancreatic diseases
AbstractThe purpose of this article is to review the benefit and added value and advantages of magnetic resonance imaging (MRI) compared with other cross-sectional imaging in patients presenting with abdominopelvic emergencies. During the past decade, there has been increased utilization of MRI in the emergency department with widespread availability of MR scanners, improvement in rapid imaging techniques, and methods to overcome motion-related artifacts. This has benefited patients at higher risk of radiation, particularly children and pregnant women, and patients with contraindications to iodinated contrast including all...
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Diagnostic accuracy and inter-observer agreement with the CO-RADS lexicon for CT chest reporting in COVID-19
ConclusionReaders across different levels of experience could accurately identify COVID-19 positive patients using the CO-RADS lexicon with moderate inter-observer agreement and high diagnostic accuracy. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

COVID-19 infection in the cancer population: a study of emergency department imaging utilization and findings
AbstractPurposeTo analyze emergency department (ED) computerized tomography (CT) utilization in cancer patients with coronavirus disease 2019 (COVID-19).MethodsA retrospective chart review was performed to identify cancer patients who received COVID-19 diagnosis within the single healthcare system and presented to the ED within 30  days of COVID-19 positive date between May 1 and December 31, 2020.ResultsIn our 61 patients, the mean age was 72.5  years old, with 34% of patients (n = 21) on active cancer therapy and 66% (n = 40) on surveillance only. Most patients (n = 53)...
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

You ’ll see it when you know it: granulomatous mastitis
AbstractGranulomatous mastitis (GM) is an under-recognized and under-diagnosed disease. Patients with GM often present to the emergency room with a painful breast mass, nipple retraction, and skin changes. This pictorial essay will review the clinical presentation and imaging appearance of GM, BI-RADS reporting parameters, differential diagnoses, and diagnostic challenges posed by this disease. Early and accurate diagnosis is essential, as misdiagnosis can result in repeated core biopsies, leading to fistulae and sinus tract formation. A classic history and typical sonographic appearance allow the emergency radiologist to ...
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures
ConclusionOur study supports the use of PoCUS for identifying distal radius forearm fractures and may have some value in assisting clinicians to determine post reduction success. We still advocate using standard X-ray radiographs to confirm successful or adequate cortical alignment following a manipulation. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery
ConclusionS-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

How are our residents doing on trauma tonight? The frequency of overnight resident-faculty report discrepancies in trauma patients
ConclusionMost preliminary report changes were minor and had no clinical significance. Furthermore, the few that were deemed to be major changes were of little clinical significance, particularly in the setting of the other traumatic injuries that the patient may have sustained. No negative patient safety events were caused by an error in a radiology resident preliminary report. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Uncommon acute neuroimaging findings in severe neonatal herpes simplex virus 2 and consequences of delayed diagnosis
We report a case of a three-week-old girl with herpes simplex virus type 2 (HSV-2) encephalitis with exclusive bilateral corticospinal and frontal opercular involvement, which remained undiagnosed and untreated until three months of age. Neuroimaging upon presentation to the emergency room demonstrates a highly suggestive pattern of severe neonatal CNS HSV-2 infection which followed the natural history on subsequent imaging, highlighting the importance of emergency neuroimaging as well as having a high index of suspicion for making the diagnosis. (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Correction to: Risk factors associated with intensive care unit (ICU) admission and in-hospital death among adults hospitalized with COVID-19: a two-center retrospective observational study in tertiary care hospitals
A correction to this paper has been published: https://doi.org/10.1007/s10140-021-01943-0 (Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

Correction to: Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures
(Source: Emergency Radiology)
Source: Emergency Radiology - November 15, 2021 Category: Emergency Medicine Source Type: research

COVID-19 pandemic revisited: lessons the radiology community has learned a year later
AbstractFor more than 1  year, COVID-19 pandemic has impacted every aspect of our lives. This paper reviews the major challenges that the radiology community faced over the past year and the impact the pandemic had on the radiology practice, radiologist-in-training education, and radiology research. The lessons learned fr om COVID-19 pandemic can help the radiology community to be prepared for future outbreaks and new pandemics, preserve good habits, enhance cancer screening programs, and adapt to the changes in radiology education and scientific meetings. (Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

AP pelvis radiograph is insufficient for diagnosis of U-type sacral fractures
ConclusionThe sensitivity of an AP pelvis radiograph is poor for U-type sacral fractures, whether interpreted by radiologists or orthopedic traumatologists. Pelvis CT should be considered as a screening test to rule out sacral fracture when the patient reports posterior pelvic pain, even if plain radiography demonstrates no injury or a minimally displaced pelvic ring disruption.Level of evidenceDiagnostic level III (Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Problem-solving with MRI in acute abdominopelvic conditions, part 2: gynecological, obstetric, vascular, and renal diseases
AbstractThe purpose of this article is to illustrate the benefits of magnetic resonance imaging (MRI) in the setting of abdominopelvic emergencies. Owing to intrinsically high soft-tissue contrast resolution, and ability to resolve different soft tissue, MRI holds notable advantages over other imaging modalities and can be used as a problem-solving tool. Additional advantages of MRI include lack of radiation-related risks to children and pregnant women, and the ability to acquire detailed diagnostic information even without intravenous contrast which can be beneficial in patients with contrast allergy and end-stage renal d...
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Radiologist errors by modality, anatomic region, and pathology for 1.6 million exams: what we have learned
ConclusionThe addition of error-related pathology to peer review is both feasible and practical and provides a more detailed guide to targeted individual and practice-wide peer learning quality improvement efforts. Future research is needed to determine if there are measurable improvements in detection or interpretation of specific pathologies following error feedback and educational interventions. (Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Radiographic clues to the unstable knee: are findings of trochlear dysplasia on lateral knee radiographs reliable and predictive of patellar dislocation?
AbstractBackgroundTrochlear dysplasia (TD) is a key predisposing risk factor for patellar instability (PI) and lateral patellar dislocation (LPD) injuries. It is useful to understand the reliability of radiographic findings of TD and the accuracy of knee radiographs in diagnosing patients with recent LPD.PurposeThe purposes of our study are to evaluate the inter-rater reliability of specific radiographic signs of PI and staging of TD between radiologists and orthopedic surgeons, and to identify which findings are associated with recent LPD.MethodsThis retrospective study comprised 336 patients aged 8 to 18 who obtained kne...
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Comparing the first and the second waves of COVID-19 in Italy: differences in epidemiological features and CT findings using a semi-quantitative score
ConclusionsThere was no difference regarding CT pattern prevalence between the first and the second waves, confirming both the validity of the RSNA consensus and the most frequent radiological COVID-19 features. Non-typical COVID-19 features were more frequently observed in older patients, thus should not be underestimated in the elderly population. (Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Diagnostic accuracy and inter-observer agreement with the CO-RADS lexicon for CT chest reporting in COVID-19
ConclusionReaders across different levels of experience could accurately identify COVID-19 positive patients using the CO-RADS lexicon with moderate inter-observer agreement and high diagnostic accuracy. (Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

You ’ll see it when you know it: granulomatous mastitis
AbstractGranulomatous mastitis (GM) is an under-recognized and under-diagnosed disease. Patients with GM often present to the emergency room with a painful breast mass, nipple retraction, and skin changes. This pictorial essay will review the clinical presentation and imaging appearance of GM, BI-RADS reporting parameters, differential diagnoses, and diagnostic challenges posed by this disease. Early and accurate diagnosis is essential, as misdiagnosis can result in repeated core biopsies, leading to fistulae and sinus tract formation. A classic history and typical sonographic appearance allow the emergency radiologist to ...
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Efficacy of superselective transcatheter arterial embolization for intractable postpartum hemorrhage due to genital tract trauma after vaginal delivery
ConclusionS-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE. (Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Correction to: Ultrasound in forearm fractures: a pragmatic study assessing the utility of Point of Care Ultrasound (PoCUS) in identifying and managing distal radius fractures
(Source: Emergency Radiology)
Source: Emergency Radiology - November 9, 2021 Category: Emergency Medicine Source Type: research

Correction to: COVID ‑19 ARDS: a review of imaging features and overview of mechanical ventilation and its complications
(Source: Emergency Radiology)
Source: Emergency Radiology - November 6, 2021 Category: Emergency Medicine Source Type: research

Emergency pediatric radiology imaging trends for non-COVID-19-related illnesses through different stages of the pandemic
AbstractPurposeTo evaluate how the COVID-19 pandemic affected the imaging utilization patterns for non-COVID-19-related illness in a pediatric emergency department (ED).MethodsWe retrospectively reviewed radiology reports for ultrasound, CT, MRI, and fluoroscopy studies performed at a pediatric ED in April from 2017 to 2021, excluding studies for respiratory symptoms and trauma. Radiology reports and medical records were reviewed to determine if patients had a positive radiology diagnosis, the type of diagnosis, and whether it required hospital admission. Results from during the pandemic were compared to predicted rates ba...
Source: Emergency Radiology - November 2, 2021 Category: Emergency Medicine Source Type: research

Revisiting racial disparities in ED CT utilization during the Affordable Care Act era: 2009 –2018 data from the NHAMCS
ConclusionDespite increased insurance coverage over the sample period, racial disparities between non-Hispanic Black and non-Hispanic White patients persist in CT utilization, though no disparity was seen for Hispanic or Asian/other patients. The source of this disparity remains unclear and is likely multifactorial. (Source: Emergency Radiology)
Source: Emergency Radiology - October 28, 2021 Category: Emergency Medicine Source Type: research

Interobserver agreement of interstitial lung fibrosis Reporting and Data System (ILF-RADS) at high-resolution CT
ConclusionILF-RADS is a reliable reporting system which can be routinely performed for standard interpretation of ILD. (Source: Emergency Radiology)
Source: Emergency Radiology - October 27, 2021 Category: Emergency Medicine Source Type: research