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Trauma: Technique Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ Trauma ❯ Technique

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  • Purpose: To determine the rate and nature of significant discordances between community and subspecialist emergency radiologists’ interpretations of cross-sectional exams performed on patients transferred to our trauma center.
    Methods: Outside hospital CT and MRI exams performed on transfer trauma patients are routinely overread by subspecialist emergency radiologists, specifying either concordance or discordance with the interpretation by the community radiologist. We evaluated the discordant reports for clinical significance, defined as an additional finding or difference in interpretation which was likely to affect patient management. The total rate of significant discordances, rate by modality, rate by body region, and rate per patient transferred were calculated. The most common errors were identified, and the distribution of errors among individual community radiologists was examined.  
    Transfer patient imaging: discordances between community and subspecialist emergency radiologists  
    Michael G. Flowers et al.
    Emergency Radiology (2022) 29:395–401 
  • Purpose: To determine the rate and nature of significant discordances between community and subspecialist emergency radiologists’ interpretations of cross-sectional exams performed on patients transferred to our trauma center.
    Conclusion: There is frequent discordance between community and emergency radiologists’ interpretations of CT and MRI exams, leading to a change in transferred patient management. Thus, trauma center radiologists provide added value over- reading these patients’ exams. It is difficult to predict which patients or exams will contain discordances, justifying routine overreading of all such exams.
    Transfer patient imaging: discordances between community and subspecialist emergency radiologists  
    Michael G. Flowers et al.
    Emergency Radiology (2022) 29:395–401 
  • Results: 9175 exams were reviewed. Significant discordances were encountered in 4.1% of exams: 3.9% for CT and 6.7% for MRI; 5.1% for head and neck exams, 3.3% for spine, 3.8% for torso, and 2.9% for extremities. The discordance rate per patient transferred was 7.7%. The most common discordances involved missing injuries to the cranio-cervical junction, missing or misinterpreting vascular injuries in the neck, and incompletely characterizing facial fractures. Discordances were evenly spread among 220 community radiologists.  
    Conclusion: There is frequent discordance between community and emergency radiologists’ interpretations of CT and MRI exams, leading to a change in transferred patient management. Thus, trauma center radiologists provide added value over- reading these patients’ exams. It is difficult to predict which patients or exams will contain discordances, justifying routine overreading of all such exams.  
    Transfer patient imaging: discordances between community and subspecialist emergency radiologists  
    Michael G. Flowers et al.
    Emergency Radiology (2022) 29:395–401 
  • “Allowing for a subjective definition of clinical significance as determined by radiologists, and understanding that our patient population is highly selective, we have identified a relatively frequent rate of discordance between community and subspecialty-trained emergency radiologists when it comes to interpreting cross-sectional exams of trauma patients. Slightly more errors are made on MRI than CT, and while the most common errors involved the head, neck, and spine, errors were distributed throughout the body. Errors were made by a wide number of community radiologists, as opposed to a small number of outliers. These findings suggest that trauma center radiologists provide added value overreading these patients’ exams. It is difficult to predict which patients or exams will contain discordances, justifying routine overreading of all such exams.”
    Transfer patient imaging: discordances between community and subspecialist emergency radiologists  
    Michael G. Flowers et al.
    Emergency Radiology (2022) 29:395–401 
  • “ For CT examination of blunt splenic injury, arterial phase is superior to portal venous phase imaging for pseudoaneurysm but inferior for active bleeding and parenchymal disruption; dual-phase CT provides optimal overall performance.”
    Optimizing Trauma Multidetector CT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans
    Boscak AR et al.
    Radiology 2013; 208:79-88
  • “ Dual (arterial and portal venous) phase CT has better overall diagnostic performance than single (arterial or portal venous) phase CT for detection of splenic injuries after blunt trauma.”
    Optimizing Trauma Multidetector CT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans
    Boscak AR et al.
    Radiology 2013; 208:79-88
  • “ With a single continuous acquisition, whole body CT angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis”
    Blunt Polytrauma: Evaluation with 64-Section Whole-Body CT Angiography
    Dreizin D, Munera F
    RadioGraphics 2012; 32:609-631
  • “ In this article, we discuss potential indications for whole body CT angiography, the importance of the use of trauma scoring, the value of whole body CT angiography in detecting important, not to miss injuries at each anatomic level, the benefit of reviewing multiplanar reformation (MPR) and three dimensional (3D) images for timely and accurate interpretation; and potential pitfalls that should be avoided, as well as ongoing controversies and future trends.”
    Blunt Polytrauma: Evaluation with 64-Section Whole-Body CT Angiography
    Dreizin D, Munera F
    RadioGraphics 2012; 32:609-631
  • “ In this article, we discuss potential indications for whole body CT angiography, the benefit of reviewing multiplanar reformation (MPR) and three dimensional (3D) images for timely and accurate interpretation.”
    Blunt Polytrauma: Evaluation with 64-Section Whole-Body CT Angiography
    Dreizin D, Munera F
    RadioGraphics 2012; 32:609-631
  • Multiorgan Trauma Protocol for 64 MDCT and Beyond
    1. Unenhanced brain CT
    2. Enhanced scan from circle of Willis to the symphysis pubis
    - 120 kVp
    - 0.7 pitch
    - 0.5 sec rotation time
    - 0.6 mm collimation
    - Images reconstructed at 3.0 (for radiologist) and 1.5 mm (for MPR and 3D)
  • Multiorgan Trauma Protocol for 64 MDCT and Beyond
    - Scan delay is fixed at 20 seconds for patients under age 55 and 25 seconds for patients over 55 years of age
    - Biphasic injection 100 ml bolus, 350 mg/ml non-ionic contrast at 4.0 cc/sec for 15 seconds, then 3.0 cc/sec for 13 seconds and then 30 ml of saline injected at 4 cc/sec
    - No oral contrast
    - Delayed scans are optional depending on the early images or clinical history
    - Scan with arms above the head in all cases

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