Emergency radiology: from head to toe

Celebrating the International Day of Radiology with a special article collection

Medical Imaging plays a vital role in emergency medicine, enabling problems to be diagnosed quickly and accurately so the right treatment can be delivered. From MRI scans to look for damage in the brain to CT scans that help identify blood clots in the lung, radiology saves lives. On 8 November, the International Day of Radiology is celebrating the role of radiology in the emergency room.

Now in its sixth year, the International Day of Radiology is led by the European Society of Radiology (ESR), the Radiological Society of North America (RSNA) and the American College of Radiology (ACR). It has the aim of “building greater awareness of the value that radiology contributes to safe patient care, and improving understanding of the vital role radiologists play in the healthcare continuum.”

To celebrate IDoR 2017, we have collated a special collection of articles published in Elsevier’s medical imaging journals, highlighting some of the recent work done on imaging in emergency medicine. The collection is free to access until 31 December 2017.

Article Collection:

Emergency radiology

The articles in this collection are free to access until 31 December 2017.

Introduction to Emergency Radiology Article Collection

According to the CDC, there were more than 141 million visits to the emergency room across the US in 2014. Sometimes people’s injuries are clearly visible, but it’s often necessary to look inside the body to understand the problem. Radiologists use a variety of techniques to image bone, blood vessels, soft tissue and the brain, providing a clearer picture of the injury. This is key to enabling doctors to treat the injury or illness quickly, with the highest possible success.

Imaging the brain

Stroke is a leading cause of death, accounting for 1 out of 20 deaths in the US – approximately 140,000 people a year. Stroke can be caused by the blockage, or occlusion, of a blood vessel in the brain, and it’s important for doctors to know where the blockage is in order to treat the stroke.

Radiologists typically use a technique called non-contrast computed tomography (NCCT) to take images of the brain. In their paper in Clinical Radiology, authors from the North Bristol NHS Trust in the UK suggest that hospitals that treat hyperacute stroke patients should also consider performing computed tomography (CT) angiography, a technique that uses a dye to locate the blockage and find out how big it is. This, they say, would select those individuals suitable for a thrombectomy i.e. removal of the blood clot, performed by a neuro-interventional radiologist, and would support better outcomes for the patients, ultimately saving more lives.

Imaging is also critical in diagnosing brain conditions that lead to disability, such as traumatic brain injury (TBI). More than 70 percent of cases are mild and difficult to diagnose, but TBI has a significant impact on people. What’s more, pursuing litigation for a financial payout when the patient still has symptoms can lead to even more anxiety, depression and poor outcomes.

According to a study in Magnetic Resonance Imaging, radiologists can use different imaging techniques to detect lesions in the brain and diagnose brain injuries in people with persistent symptoms, such as fatigue, loss of concentration, dizziness and irritability. The researchers compared the brain images of 180 people with symptoms who were pursuing litigation to those of people with no symptoms. They showed that people with mild TBI may have brain injuries that can be detected with MRI biomarkers using fluid-attenuated inversion recovery (FLAIR) and susceptibility-weighted imaging (SWI).

Looking lower down

An estimated 8 percent of patients go to the emergency room with abdominal pain, accounting for more than 11 million visits a year in the US. With more than 250,000 patients undergoing surgery to remove their appendix every year in the US, appendicitis is one of the most common complaints.

There are several imaging options in suspected acute appendicitis, with different costs and lengths of stay associated with them. In their study in Clinical Imaging, researchers at NYU Langone Medical Center in the US compared the outcomes of three imaging techniques: computerized tomography (CT) alone, ultrasound alone, and ultrasound followed by CT. They found that in young patients with low BMI, ultrasound alone has similar outcomes to the other options, but with a shorter stay, making it more convenient for the patient and less costly for the hospital, although CT remains the main diagnostic tool in adults.

Radiology is also used to gather more information about flesh wounds. Writing in Clinical Radiology, doctors at Royal London Hospital in the UK explained:

“Buttock stab wounds are a surprisingly common and increasing source of presentations to emergency departments. These injuries can have a significant impact on quality of life, and there are a number of often subtle, but significant, injuries that the radiologist must be alert to when interpreting computed tomography examinations in these patients.”

In their review, the authors look at the reasons for the rise in buttock stab wounds and explore imaging techniques radiologists can use. Patients can suffer from injury to the urethra, sciatic nerve or the colon, and the authors say it is important for radiologists to look out for these injuries and alert the trauma surgeon before the patients are treated.

Injuries can often lead to further problems. A case study in Radiology Case Reports describes a traumatic leg injury that led to a blood vessel being blocked with fat this being diagnosed on CT which demonstrated fat in one of the vessels, diagnosed as fat embolus. This is common in trauma patients, but the fat is rarely seen before it travels to the lungs and causes respiratory symptoms. The authors highlight the importance of imaging the blood vessels at the site of the first injury.

You can find out about these studies and more in our special collection to mark the International Day of Radiology 2017.

Special collection: Emergency Radiology

The articles in this collection are free to access until 31 December 2017.

MR imaging findings in mild traumatic brain injury with persistent neurological impairment
Magnetic Resonance Imaging

The spectrum of injuries in buttock stab wounds
Clinical Radiology

The emerging age of endovascular treatment of acute ischaemic stroke and the role of CT angiography in patient work-up: a guide for the radiologist
Clinical Radiology

Repeated CT scans in trauma transfers: An analysis of indications, radiation dose exposure, and costs
European Journal of Radiology

A randomised clinical trial of routine versus selective CT imaging in acute abdomen: Impact of patient age on treatment costs and hospital resource use
European Journal of Radiology

Value of ultra-low-dose chest CT with iterative reconstruction for selected emergency room patients with acute dyspnea
European Journal of Radiology

Could musculo-skeletal radiograph interpretation by radiographers be a source of support to Australian medical interns: A quantitative evaluation

The impact of installing an MR scanner in the emergency department for patients presenting with acute stroke-like symptoms
Clinical Imaging

Evaluation for suspected acute appendicitis in the emergency department setting: a comparison of outcomes among three imaging pathways
Clinical Imaging

Using the Analytic Hierarchy Process for Prioritizing Imaging Tests in Diagnosis of Suspected Appendicitis
Academic Radiology

Elective and Emergency Renal Angiomyolipoma Embolization with Ethylene Vinyl Alcohol Copolymer: Feasibility and Initial Experience
Journal of Vascular and Interventional Radiology

Rapid Endovascular Treatment of Acute Ischemic Stroke: What a General Radiologist Should Know
Canadian Association of Radiologists Journal

Emergency Trauma Radiology: A Rapidly Expanding and Increasingly Important Branch of Diagnostic Imaging
Canadian Association of Radiologists Journal

Past, Present, and Future of Emergency Radiology
Canadian Association of Radiologists Journal

What to Expect When They are Expecting: Magnetic Resonance Imaging of the Acute Abdomen and Pelvis in Pregnancy
Current Problems in Diagnostic Radiology

Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond
Current Problems in Diagnostic Radiology

Rare imaging of a known entity: fat embolism seen on CT in lower extremity vein after trauma
Radiology Case Reports

Role of Imaging for Acute Chest Pain Syndromes
Seminars in Nuclear Medicine

Pediatric Nuclear Medicine in Acute Care
Seminars in Nuclear Medicine

Quantifying the Impact of Noninterpretive Tasks on Radiology Report Turn-Around Times
JACR – Journal of the American College of Radiology

Emergency Radiology Practice Patterns: Shifts, Schedules, and Job Satisfaction
JACR – Journal of the American College of Radiology

The Effect of International Teleradiology Attending Radiologist Coverage on Radiology Residents’ Perceptions of Night Call
JACR – Journal of the American College of Radiology