d f p o a I want to thank the leadership of the American College of Surgeons for the great honor and privilege of delivering the 2011 Scudder Oration. I feel both honored and humbled, having in mind the stature and major contributions of all the previous Scudder Orators. I should like to dedicate this lecture to a lot of people, because I owe a lot to many! First, to my parents, who are now in their late 80s, still in great health, on the island of Cyprus. To my wife Elizabeth, and our children, Alexis, Stefanie, and Nicholas. To my past faculty for their major contributions—most of them currently hold leadership positions in prestigious centers across the country, and I am proud of them. To my current faculty—they are my second family. We dream, plan, and build together, and I am very proud of them. I want to single out Dr Tom DeMeester, who recruited me from Johannesburg, South Africa, in 1992, and trusted me with the leadership of the Los Angeles County and University of Southern California trauma program. For the next 17 years, he gave me his strong and unconditional support. I also want to thank the current Chairman of Surgery, Dr Vaughn Starnes, for his strong support of the trauma and Acute Care Surgery program during the last 3 years. The title of my lecture is “Blunt Thoracic Aortic Injuries: Crossing the Rubicon.” The Rubicon is a small river in Northern Italy. In 49 BC, Julius Caesar led his army across the Rubicon in violation of the law, making war inevitable. Today, crossing the Rubicon means passing the point of no return beyond which someone must continue on the current course of action because turning back is physically impossible or dangerous or prohibitively expensive. I selected the topic of blunt thoracic aortic injuries (BTAI) for my oration because, in my opinion, during the last decade no other organ injury has seen more changes in diagnosis, treatment, and outcomes than thoracic aortic trauma.