Cervical Spine Computed Tomography Research Articles

Establishment of local diagnostic reference levels for computed tomography with cloud-based automated dose-tracking software in Türkiye

The purpose of this study is to establish local diagnostic reference levels (LDRLs) for computed tomography (CT) procedures using cloud-based automated dose-tracking software. The study includes the dose data obtained from a total of 104,272 examinations performed on adult patients (>18 years) using 8 CT scanners over 12 months. The protocols included in our study were as follows: head CT without contrast, cervical spine CT without contrast, neck CT with contrast, chest CT without contrast, abdomen-pelvis CT without contrast, lumbar spine CT without contrast, high-resolution computed tomography (HRCT) of the chest, and coronary CT angiography (CTA). Dose data were collected using cloud-based automatic dose-tracking software. The 75th percentiles of the distributions of the median volume CT dose index (CTDIvol) and dose length product (DLP) values were used to determine the LDRLs for each protocol. The LDRLs were compared with national DRLs (NDRLs) and DRLs set in other countries. Inter-CT scanner variability, which is a measure of how well clinical practices are standardized, was determined for each protocol. Median values for each protocol were compared with the LDRLs for dose optimization in each CT scanner. The LDRLs (for DLP and CTDIvol, respectively) were 839 mGy.cm and 41.2 mGy for head CT without contrast, 530.6 mGy.cm and 19.8 mGy for cervical spine CT without contrast, 431.9 mGy.cm and 15.5 mGy for neck CT with contrast, 364.8 mGy.cm and 9.3 mGy for chest CT without contrast, 588.9 mGy. cm and 11.2 mGy for abdomen-pelvis CT without contrast, 713 mGy.cm and 24.3 mGy for lumbar spine CT without contrast, 326 mGy.cm and 9.5 mGy for HRCT, and 642.3 mGy.cm and 33.4 mGy for coronary CTA. The LDRLs were comparable to or lower than NDRLs and DRLs set in other countries for most protocols. The comparisons revealed the need for immediate initiation of an optimization process for CT protocols with higher dose distributions. Furthermore, protocols with high inter-CT scanner variability revealed the need for standardization. There is a need to update the NDRLs for CT protocols in Turkey. Until new NDRLs are established, local institutions in Turkey can initiate the optimization process by comparing their dose distributions to the LDRLs established in our study. Automated dose-tracking software can play an important role in establishing DRLs by facilitating the collection and analysis of large datasets.

Research into the anatomy of the subaxial cervical pedicle for ensuring screw insertion safety.

The study aimed to determine the optimal entry points and trajectories for posterior subaxial cervical pedicle screw (CPS) fixation. Computed tomography (CT) and Mimics software were used to evaluate the subaxial cervical pedicle in 42 cervical spine CT scans. The width of the cervical pedicle was measured and compared at medial angulations of 30°, 35°, 40°, 45°, 50°, 55°, and 60° relative to the midline sagittal plane. Based on an observational examination of the positions of all cervical 3-dimensional models and screws, the proposed entry point for C3-7 CPS was analyzed. Although the variations in C3-6 pedicle width (PW) among 45°, 50°, and 55° were not statistically significant, they were significantly larger than the differences among 30°, 35°, 40°, and 60° angles (P < .05). The differences in C7 PW between the 30°, 35°, 40°, and 45° angles were not statistically different even though the 30°, 35°, 40°, and 45° angles were significantly bigger. (P < .05). The proposed entry point for C3-7 CPS was below the junction of the lateral and lower borders of the superior articular process joint surface. The entry point for C3-7 levels was below the junction of the lateral and lower borders of the superior articular process joint surface. The optimal medial angulation for the posterior C3-6 CPS was 45°-55° and that for the posterior C7 CPS was 30°-45°. The sagittal angle of the posterior C3-7 CPS was parallel to the corresponding upper endplate.

Significance of upper cervical epidural venous engorgement on head computed tomography in the initial diagnosis of spontaneous intracranial hypotension: patient series.

Spontaneous intracranial hypotension (SIH) is a rare condition characterized by positional headache, for which contrast-enhanced magnetic resonance imaging (MRI) is the preferred diagnostic method. Although MRI reveals characteristic findings, head computed tomography (CT) is usually the first diagnostic step, but identifying features of SIH on CT is often difficult. This study was specifically designed to evaluate the utility of head CT in detecting upper cervical epidural venous engorgement as a sign of SIH. Of 24 patients with SIH diagnosed between March 2011 and May 2023, 10 did not undergo upper cervical CT. In the remaining 14 patients, engorgement of the upper cervical epidural venous plexus was observed. CT detection rates were consistent with MRI for spinal fluid accumulation or dural thickening. After treatment, in 92.9% of patients, the thickness of the epidural venous plexus decreased statistically significantly from 4.8 ± 1.3 mm to 3.6 ± 1.2 mm. This study suggests that upper cervical spine CT focused on epidural venous engorgement may be helpful in the initial diagnosis of SIH and may complement conventional MRI evaluation. Extending CT imaging to the upper cervical spine will improve the diagnostic accuracy of patients with positional headaches suspected to be SIH.

Posttraumatic Isolated Diffuse SAH Because of Atlas (C1) Fracture Involving Transverse Process without Vertebral Artery Injury: A Case Report

AbstractTraumatic subarachnoid hemorrhage (SAH) can be seen in mild, moderate, and severe head injury. Traumatic SAH is usually present in the sulci or superficial subarachnoid space (SAS) of the cortex rather than in the basal SAS. Basal SAH is usually harmful because of the injury to vascular structure resulting into vasospasm and ischemia. Here we are presenting a rare case in which patient is presented with traumatic injury to the neck followed by the isolated diffuse SAH mostly basal without injury to the brain parenchyma. Patient was presented with the raised intracranial pressure features (headache, vomiting) and seizure. On admission, he had a Glasgow Coma Scale of E3V3M5. His computed tomography (CT) of the brain was suggestive of diffuse SAH in all cisterns especially in basal cistern. He was evaluated by angiogram that was suggestive of no major vascular involvement. His CT cervical spine was suggestive of Atlas (C1) fracture involving transverse process with medial and inward displacement of bone, probably causing vascular insult in the form of venous injury leading to the SAH.

Venous pathology targeted surgical management in Hirayama disease: A comprehensive case series of nine cases exploring this potential etiology.

Hirayama disease is a rare cause of cervical myelopathy predominantly affecting young individuals. The disease is classically characterized by muscle atrophy in the distal upper limbs. While various etiopathogenesis such as dural sac dysplasia, nerve root dysplasia, structural abnormalities of the spinal ligament, and venous dysplasia have been proposed, this study explores the potential role of venous pathology and surgical management on the basis of it. This is a prospective descriptive case series of nine cases. The diagnosis was made based on the Huashan diagnostic criteria which includes clinical manifestation, imaging, and electrophysiology. In cases where magnetic resonance imaging (MRI) failed to demonstrate engorged veins, a computed tomography (CT) venogram of the cervical spine was used as an imaging tool. All patients underwent cervical laminectomy and coagulation of the posterior epidural venous plexus with or without laminoplasty. All the patients were followed up regularly; clinical improvement and neck disability index were assessed. All nine patients were male and exhibited classical clinical features, electrophysiological abnormalities, and MRI findings except, in one patient where a CT venogram helped in establishing the diagnosis as the MRI was inconclusive. Postoperatively, all patients had neurological improvement and stabilization of the disease. All patients who underwent CT venogram and cervical spine X-ray in neutral and dynamic position demonstrated no recurrence of engorged venous plexus or significant instability except one patient developing kyphosis. One patient experiencing symptoms in the other limb underwent a second surgery. This comprehensive case series strongly supports venous pathology as a potential etiology of Hirayama disease. Surgical management with laminectomy and venous coagulation with or without expansile laminoplasty has delivered consistent improvement in neurological outcomes and long-term disease stabilization without the restriction of movements and lesser complications. However, further research is warranted to elucidate the mechanism underlying cervical venous dilatation.

Factors Associated with Overutilization of Computed Tomography of the Cervical Spine.

Introduction: Despite the wide availability of clinical decision rules for imaging of the cervical spine after a traumatic injury (eg, NEXUS C-spine rule and Canadian C-spine rule), there is significant overutilization of computed tomography (CT) imaging in patients who are deemed to be at low risk for a clinically significant cervical spine injury by these clinical decision rules. The purpose of this study was to identify the major factors associated with the overuse of CT cervical spine imaging using a logistic regression model. Methods: This was a retrospective review of all adult patients who underwent CT cervical spine imaging for evaluation of a traumatic injury at a tertiary academic emergency department (ED) and three affiliate community EDs in January and February 2019. We performed multivariable logistic regression to identify factors associated with obtaining CT cervical spine imaging despite low-risk classification by the NEXUS C-spine Rule. Results: A total of 1,051 patients underwent CT cervical spine imaging for traumatic indications during the study period, and 889 patients were included in the analysis. Of these patients, 376 (42.3%) were negative by the NEXUS C-spine rule. Variables that were associated with increased likelihood of unnecessary imaging included age over 65, Emergency Severity Index (ESI) score 2 and 3, arrival as a walk-in, and anticoagulation status. Patients who presented to the tertiary academic ED had a significantly lower likelihood of unnecessary imaging. Twenty-one patients (2.4%) were found to have cervical spine fractures on imaging, two of whom were negative by the NEXUS C-spine rule, but neither had a clinically significant fracture. Conclusion: Cervical spine imaging is vastly overused in patients presenting to the ED with traumatic injuries, as adjudicated using the NEXUS C-spine rule as a reference standard. Older age, ESI level, arrival as a walk-in, and taking anticoagulation drugs were associated with overutilization of CT imaging. Conversely, presenting to the tertiary academic ED was associated with a lower likelihood of undergoing unnecessary imaging. This model can guide future interventions to optimize ED CT utilization and minimize unnecessary testing.

Reduction of Atlanto-Occipital Dislocation After Cervical Collar Removal

A 39-year-old male pedestrian-hit-by-car was transferred to our institution with atlantooccipital dislocation (AOD) on outside computed tomography (CT) imaging. On arrival he had a rigid cervical collar in place. Given the reported AOD, we placed the patient flat, removed the cervical collar, and supported the head in neutral alignment with sandbags. Due to a technical issue uploading his prior imaging to our system, the patient underwent repeat CTs at our center. Subsequently, after the outside images were uploaded, we were able to compare his cervical spine CT images before and after removing his cervical collar. On comparison, we noted a substantial reduction in AOD after collar removal. We hope this serves as a reminder of this key step in managing a rare but deadly clinical entity and a small demonstration of the efficacy of this intervention.

Intensive Care Physician-Led Clearance of the Cervical Spine: A Retrospective Review of the Utility of a Normal Cervical CT Scan for Safe Removal of Hard Collars by Critical Care Physicians.

Background: Cervical spine clearance in intubated patients due to blunt trauma remains contentious. Accumulating evidence suggests that a normal computed tomography (CT) cervical spine can be used to clear the cervical spine and remove the collar in unconscious patients presenting to the emergency department. However, whether this strategy can safely be employed by critical care physicians with intubated patients admitted to the trauma intensive care unit (TICU) with cervical collars in situ, has not been definitively studied. Methods: A retrospective review of 730 intubated victims of trauma who presented to the Level 1 Trauma center of a tertiary hospital was conducted. The rates of missed cervical injuries in patients who had their cervical collars removed by intensive care physicians based on a normal CT scan of the cervical spine, were reviewed. Secondary outcomes included rates of collar-related complications. Results: Three hundred and fifty patients had their cervical collars removed by Trauma ICU doctors based on a high-quality, radiologist-interpreted normal CT cervical spine. Seventy percent of patients were sedated and/or comatose at the time of collar removal. Fifty-one percent of patients had concomitant traumatic brain injury. The average GCS at time of collar removal was 9. The incidence of missed neurological injury discerned clinically at time of both ICU and hospital discharge was nil (negative predictive value 100%). The rate of collar-related complications was 2%. Conclusion: Cervical collar removal by intensive care physicians on TICU following normal CT cervical spine, is safe, provided certain quality conditions related to the CT scan are met. Not removing the collar early may be associated with increased complications. An algorithm is suggested to assist critical care decision-making in this patient cohort.

Diagnostic yield of computed tomography after non-traumatic out-of-hospital cardiac arrest

AimDetermine the frequency with which computed tomography (CT) after out-of-hospital cardiac arrest (OHCA) identifies clinically important findings. MethodsWe included non-traumatic OHCA patients treated at a single center from February 2019 to February 2021. Clinical practice was to obtain CT head in comatose patients. Additionally, CT of the cervical spine, chest, abdomen, and pelvis were obtained if clinically indicated. We identified CT imaging obtained within 24 hours of emergency department (ED) arrival and summarized radiology findings. We used descriptive statistics to summarize population characteristics and imaging results, report their frequencies and, post hoc, compared time from ED arrival to catheterization between patients who did and did not undergo CT. ResultsWe included 597 subjects, of which 491 (82.2%) had a CT obtained. Time to CT was 4.1 hours [2.8–5.7]. Most (n = 480, 80.4%) underwent CT head, of which 36 (7.5%) had intracranial hemorrhage and 161 (33.5%) had cerebral edema. Fewer subjects (230, 38.5%) underwent a cervical spine CT, and 4 (1.7%) had acute vertebral fractures. Most subjects (410, 68.7%) underwent a chest CT, and abdomen and pelvis CT (363, 60.8%). Chest CT abnormalities included rib or sternal fractures (227, 55.4%), pneumothorax (27, 6.6%), aspiration or pneumonia (309, 75.4%), mediastinal hematoma (18, 4.4%) and pulmonary embolism (6, 3.7%). Significant abdomen and pelvis findings were bowel ischemia (24, 6.6%) and solid organ laceration (7, 1.9%). Most subjects that had CT imaging deferred were awake and had shorter time to catheterization. ConclusionsCT identifies clinically important pathology after OHCA.

Effect of Deep Learning Reconstruction on Evaluating Cervical Spinal Canal Stenosis With Computed Tomography.

Magnetic resonance imaging (MRI) is commonly used to evaluate cervical spinal canal stenosis; however, some patients are ineligible for MRI. We aimed to assess the effect of deep learning reconstruction (DLR) in evaluating cervical spinal canal stenosis using computed tomography (CT) compared with hybrid iterative reconstruction (hybrid IR). This retrospective study included 33 patients (16 male patients; mean age, 57.7 ± 18.4 years) who underwent cervical spine CT. Images were reconstructed using DLR and hybrid IR. In the quantitative analyses, noise was recorded by placing the regions of interest on the trapezius muscle. In the qualitative analyses, 2 radiologists evaluated the depiction of structures, image noise, overall image quality, and degree of cervical canal stenosis. We additionally evaluated the agreement between MRI and CT in 15 patients for whom preoperative cervical MRI was available. Image noise was less with DLR than hybrid IR in the quantitative ( P ≤ 0.0395) and subjective analyses ( P ≤ 0.0023), and the depiction of most structures was improved ( P ≤ 0.0052), which resulted in better overall quality ( P ≤ 0.0118). Interobserver agreement in the assessment of spinal canal stenosis with DLR (0.7390; 95% confidence interval [CI], 0.7189-0.7592) was superior to that with hybrid IR (0.7038; 96% CI, 0.6846-0.7229). As for the agreement between MRI and CT, significant improvement was observed for 1 reader with DLR (0.7910; 96% CI, 0.7762-0.8057) than hybrid IR (0.7536; 96% CI, 0.7383-0.7688). Deep learning reconstruction provided better quality cervical spine CT images in the evaluation of cervical spinal stenosis than hybrid IR.

A Retrospective Study on Profile of Patients with Faciomaxilary Fractures in a Tertiary Care Center.

Maxillofacial injuries in general occur quite commonly following trauma and these injuries if not properly managed can negatively influence both the psychosocial and functional activities of the patient. This is as a result of the centrality of the facial region as a key factor in human identity, aesthetics, and general well-being. Fractures involving the facial skeleton may be isolated or complex. High velocity trauma is usually seen in urban and semi-urban areas while low velocity trauma is the common setting in rural areas. The pattern of faciomaxillary fractures vary with geographical area, socioeconomic condition, enforcements of law and order of a country. Trauma to the faciomaxillary region mandates special attention as important sensory systems are contained within the face (e.g. vision, auditory, somatic sensation, gustatory, olfaction and vestibular), also, vital structures in the head and neck region are intimately associated (airway, blood vessels, nerves and gastrointestinal tracts. It should be noted that the treatment outcome of maxillofacial fractures is mainly dependent among other things on the degree of injury, type of fracture, the expertise of the surgeon, and available technology. The aim of this study is to find out the incidence of faciomaxillary injuries resulting from various etiological factor Classification of facial bone fractures; Diagnosis and different treatment modalities. This is a prospective cross sectional study comprising of 75 patients who were having different faciomaxillary fractures and visited to L.G. hospital from December 2020 to April 2022. Patients were evaluated thoroughly by history taking, proper examination and routine investigations. In general examination consciousness, orientation to time, place and person, neck movements, and general mobility of the patients were checked. In local examination- facial oedema, facial asymmetry, skin lacerations, deep cuts, decreased mouth opening, improper teeth occlusion, teeth loss, nasal bleeding, black eye, eyeball movements and redness of eyes were checked. In specialized radiological investigations x- rays, 2D & 3D Computed Tomography (CT) of Facial bones were done in all cases. CT Brain and CT Cervical spine were done in patients if needed. From our study, it seems reasonable to assume that road traffic accident remains the leading cause of faciomaxillary fractures and is closely followed by fall especially among men in their productive years. It is necessary to diagnose faciomaxillary fracture at the earliest to prevent the complications of fractures such as infection and malocclusion, for that thorough clinical examination and radiological investigations are very important. 3D CT face is the gold standard investigation in case of different faciomaxillary fractures. In isolated fractures nasal bone fractures remains the most affected bone of the facial skeleton followed by mandible. Among the different sites of mandibular fractures body of the mandible is the most common site for mandibular fractures.

Thoracic Inlet in Cervical Spine CT of Blunt Trauma Patients: Prevalence of Pathologies and Importance of CT Interpretation.

The thoracic inlet of blunt trauma patients may have pathologies that can be diagnosed on cervical spine computed tomography (CT) but that are not evident on concurrent portable chest radiography (pCXR). This retrospective investigation aimed to identify the prevalence of thoracic inlet pathologies on cervical spine CT and their importance by measuring the diagnostic performance of pCXR and the predictive factors of such abnormalities. This investigation was performed at a level-1 trauma center and included CT and concurrent pCXR of 385 consecutive adult patients (280 men, mean age of 47.6 years) who presented with suspected cervical spine injury. CT and pCXR findings were independently re-reviewed, and CT was considered the reference standard. Traumatic, significant nontraumatic and nonsignificant pathologies were present at 23.4%, 23.6% and 58.2%, respectively. The most common traumatic diagnoses were pneumothorax (12.7%) and pulmonary contusion (10.4%). The most common significant nontraumatic findings were pulmonary nodules (8.1%), micronodules (6.8%) and septal thickening (4.2%). The prevalence of active tuberculosis was 3.4%. The sensitivity and positive predictive value of pCXR was 56.67% and 49.51% in diagnosing traumatic and 8.89% and 50% in significant nontraumatic pathologies. No demographic or pre-admission clinical factors could predict these abnormalities. Several significant pathologies of the thoracic inlet were visualized on trauma cervical spine CT. Since a concurrent pCXR was not sensitive and no demographic or clinical factors could predict these abnormalities, a liberal use of chest CT is suggested, particularly among those experiencing high-energy trauma with significant injuries of the thoracic inlet. If chest CT is not available, a meticulous evaluation of the thoracic inlet in the cervical spine CT of blunt trauma patients is important.

Usefulness of digital tomosynthesis in diagnosing cervical ossification of the posterior longitudinal ligament: a comparative study with other imaging modalities.

The diagnosis and classification of ossification of the posterior longitudinal ligament (OPLL) can be difficult with radiography alone; therefore, computed tomography (CT) is also usually performed. There are many reports on the usefulness of digital tomosynthesis (DTS) for image analysis in orthopedics. This study aimed to compare the accuracy of DTS with radiography and CT for the diagnosis and classification of cervical OPLL (C-OPLL). We included 31 patients with OPLL and 30 with cervical spondylotic myelopathy. The patients' cervical spine radiography, DTS, and CT images were each evaluated twice by three specialists and three residents. In the intra-observer reliability study, there was one observer with a fair level of kappa values for radiography and DTS among three residents. The kappa values for CT were the best for all observers. In the inter-observer reliability study, the interclass correlation coefficient (ICC) values were high for both diagnosis and classification by specialists at the almost perfect level for all three imaging modalities. On the other hand, the ICC values for both diagnosis and classification for radiography by the residents were lower than those for DTS and CT. This study revealed that DTS may be an alternative to CT for the diagnosis and classification of C-OPLL by specialists. Caution should be exercised in diagnosing and classifying C-OPLL using radiography and DTS by residents, and the use of CT is recommended.

Factors associated with the increased risk of atlantoaxial osteoarthritis: a retrospective study.

Purpose Atlantodens osteoarthritis and atlantoaxial osteoarthritis cause neck pain and suboccipital headaches. Currently, knowledge on the risk factors for atlantoaxial osteoarthritis is lacking. This study aimed to investigate the factors related to the increased risk of atlantoaxial osteoarthritis. Methods We analyzed computed tomography (CT) images of the upper cervical spine of 1266 adult trauma patients for whom upper cervical spine CT was performed at our hospital between 2014 and 2019. The degree of atlantoaxial osteoarthritis was quantified as none-to-mild (not having osteoarthritis) or moderate-to-severe (having osteoarthritis). Risk factors associated with atlantoaxial osteoarthritis were identified using univariate and multivariable logistic regression analyses. Results The study group included 69.4% men, and the overall average age of the study population was 54.9 ± 20.4years. The following factors were independently and significantly associated with atlantoaxial osteoarthritis in the multivariable logistic regression analysis: age in the sixth decade or older (odds ratio [OR], 20.5; 95% confidence interval [CI], 6.2‒67.2, p < 0.001), having calcific synovitis (OR, 4.9; 95% CI, 2.4‒9.9, p < 0.001), women sex (OR, 3.3; 95% CI, 1.9‒5.7, p = 0.002), and not having atlantodens osteoarthritis (OR, 2.1; 95% CI, 1.2‒3.8, p = 0.014). Conclusion In the multivariable logistic regression analysis, age in the sixth decade or older, calcification of the transverse ligament, being women, and not having atlantodens osteoarthritis were found to be significantly associated with atlantoaxial osteoarthritis. Delayed diagnosis and treatment can be avoided by focusing on these risk factors.

Pharynx volume derived from three-dimensional computed tomography is associated with difficult intubation in spinal deformity surgery: A retrospective cohort study.

Spinal abnormality surgery, including surgery for ankylosing spondylitis and idiopathic scoliosis, can present significant challenges to anesthesiologists because of the potential difficult airway. The bedside screening tests routinely used to detect difficult airways are highly variable. Pharynx volume calculated using three-dimensional (3D) computed tomography (CT) may play a role in predicting difficult airways.We conducted a retrospective cohort study on patients (aged ≥14 years) who received orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis under general anesthesia. Volume of the pharynx air space was calculated through volume rendering technique by 3D reconstruction of patients’ cervical spine CT. Patients were divided into 2 groups according to their pharynx volume, pharyngeal volume lower than 16 mL (n = 11) and equal or higher than 16 mL (n = 13).Pharynx volume in low volume group was 10.4 ± 3.6 mL (n = 11), and the counterpart in high volume group was 20.8 ± 5.5 mL (n = 13). The incidence of difficult intubation was significantly higher in low pharynx volume group than in high pharynx volume group (54.5% (6/11) vs 7.6% (1/13), P = .023). Bedside screening tests including modified Mallampati test, inter-incisor gap and thyromental distance, or radiological variables such as anterior neck soft tissue thickness to vocal cords were not different between the 2 groups.Smaller pharynx volume played an important role in difficult airways for patients undergoing orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis.

CT imaging in idiopathic out-of-hospital cardiac arrest: An assessment of current practice and diagnostic utility

Idiopathic Out-Of-Hospital Cardiac Arrest (OHCA) requires urgent treatment. Early Computed Tomography (CT) imaging may be useful to aid diagnosis. We aimed to determine current CT imaging practice, safety, and diagnostic value in this patient population. This study was a single-centre, retrospective cohort study of patients presenting to the Emergency Department (ED) of the Royal Infirmary of Edinburgh with idiopathic non-traumatic OHCA and Return Of Spontaneous Circulation (ROSC). Between 1st January 2016 and 31st December 2019, 140 of 156 (90%) eligible patients underwent 195 CT scans identifying the cause of OHCA in 6 (4%). CT head diagnosed one ischaemic and three haemorrhagic strokes, and CT pulmonary angiogram diagnosed one acute coronary syndrome and one pulmonary embolism. CT head (134), CT pulmonary angiogram (25) and CT cervical spine (16) were the commonest scans. 68 of 195 (35%) CT scans showed important pathology, mostly secondary to OHCA. CT imaging was safe with no cases of contrast nephropathy, allergic reaction, or other complications. The diagnostic value of CT imaging in this patient population was limited. However, imaging was a valuable method of identifying other important secondary pathology.

Interpretation of computed tomography of the cervical spine by non-radiologists: a systematic review and meta-analysis.

After trauma, clearance of the cervical spine refers to the exclusion of underlying serious injuries. Accurate assessment of computed tomography (CT) is commonly required prior to clearance of the cervical spine. Delays to clearance can lead to prolonged immobilization with associated patient discomfort and adverse effects. This systematic review aimed to determine performance of non-radiologists to evaluate cervical spine CT. MEDLINE, EMBASE, Cochrane library with sources of grey literature and reference lists of selected articles were appraised from inception to April 2021. We included manuscripts that reported discordance in CT cervical spine interpretation between non-radiologists and radiologists. The Newcastle-Ottawa scale (NOS) was used to assess quality of included studies and statistical heterogeneity was assessed using the I2 statistic. There were 43 studies identified for eligibility and 4 manuscripts included in the final analysis. There were two studies that reported on the performance of radiology residents, one study on the performance of surgical residents and one on emergency physicians. The pooled discordance was 0.25 (95%CI 0.21-0.28) but was lower for radiology residents (range 0.007-0.05). There was significant statistical heterogeneity (I2 = 99.6%, P< 0.001) among studies. There is a paucity of evidence documenting the ability of non-radiologists in accurately interpreting CT of the cervical spine. A number of discordant findings suggest that studies with larger sample sizes are indicated to accurately ascertain the ability of non-radiologists in this area.

Comparison of the Safety and Efficacy of Three-Dimensional Guiding Templates and Free Hand Technique for Cervical Pedicle Screw Fixation: A Retrospective Study

Aim. To compare the safety and efficacy of computed tomography (CT)-assisted three-dimensional guiding templates (3DGTs) and free-hand (FH) technique for posterior cervical pedicle screw fixation in cervical spondylotic myelopathy (CSM) treatment. Methods. Thirty-five patients (216 screws) with CSM and developmental cervical stenosis were randomly divided into groups A (FH) and B (3DGTs). All patients underwent modified posterior surgery with cervical pedicle screw insertion (C1-7). Preoperative, postoperative, and intergroup comparisons of efficacy were evaluated using the visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Short Form 12 (SF-12) scores and JOA score improvement rate. Incidence of intra- and postoperative complications was analyzed. Postoperative cervical spine CT was performed to evaluate (i) the pedicle screws' deviation angle from the optimal path (sagittal deviation, α; coronal deviation angle, β), screw insertion point's deviation distance (d), and screw accuracy and (ii) the deviation angle and distance of screw entrance point of pedicle screws from the optimal channel. Results. All patients successfully completed the procedures. Groups A and B did not significantly differ in age, sex ratio, body mass index, operative time, or intraoperative blood loss amount. Postoperative VAS, JOA, and SF-12 scores improved in both groups. VAS, JOA, or SF-12 scores did not significantly differ between the 2 groups. The α, β, and d scores were lower in group B, but accuracy was higher in group B. Conclusions. 3DGTs and FH technique show comparable outcomes with respect to neurological improvement and safety.

Appropriate Imaging for Geriatric Trauma.

Trauma is the leading cause of preventable death in the United States. Early detection of life-threatening injuries leads to improved survival. Computed tomography (CT) scanning has become the modality of choice for early detection of injuries in the stable patient. Some studies have associated selective imaging (Selective-CT) with equivalent outcomes compared to whole body imaging (Pan-CT) with lower costs and radiation exposure. Within the geriatric population, however, the utility of Pan-CT remains controversial. Therefore, the aim of this study was to determine if a difference exists between Selective-CT and Pan-CT imaging in the geriatric trauma patient. A retrospective analysis of Level 3 (G60) trauma activations presenting to our urban Level I trauma center between June 2016 and June 2019 was performed. Pan-CT was defined by ICD-10 codes indicating a head, cervical spine, chest, abdomen, and pelvis CT series. Patients with missing images and those who were transferred from other institutions were excluded. Logistic regression controlling for age, gender, injury type, severity, and Glasgow Coma Score was performed. A total of 1014 patients met inclusion criteria. Of these, 30.9% underwent Pan-CT (n = 314), 48.9% had Selective-CT (n = 497), and 20.2% received no CT imaging (n = 203). After logistic regression, no clinically significant variations in emergency department length of stay (LOS), hospital LOS, ICU LOS, ventilator days, discharge disposition, missed injury rate, or mortality rate were observed between imaging strategies. Pan-CT provides no clinically significant advantage over Selective-CT in the geriatric trauma patient.

Is It Possible to Replace Conventional Radiography (CR) with a Dose Neutral Computed Tomography (CT) of the Cervical Spine in Emergency Radiology-An Experimental Cadaver Study.

The purpose of this experimental study on recently deceased human cadavers was to investigate whether (I) the radiation exposure of the cervical spine CT can be reduced comparable to a dose level of conventional radiography (CR); and (II) whether and which human body parameters can be predictive for higher dose reduction potential (in this context). Materials and Methods: Seventy serial CT scans of the cervical spine of 10 human cadavers undergoing postmortem virtual autopsy were taken using stepwise decreasing upper limits of the tube current (300 mAs, 150 mAs, 110 mAs, 80 mAs, 60 mAs, 40 mAs, and 20 mAs) at 120 kVp. An additional scan acquired at a fixed tube current of 300 mAs served as a reference. Images were reconstructed with filtered back projection and the upper (C1-4) and lower (C4-7) cervical spine were evaluated by three blinded readers for image quality, regarding diagnostic value and resolution of anatomical structures according to a semiquantitative three-point-scale. Dose values and individual physical parameters were recorded. The relationship of diagnostic IQ, dose reduction level, and patients’ physical parameters were investigated. The high-contrast resolution of the applied CT protocols was tested in an additional phantom study. Results: The IQ of the upper cervical spine was diagnostic at 1.69 ± 0.58 mGy (CTDI) corresponding to 0.20 ± 0.07 mSv (effective dose) in all cadavers. IQ of the lower cervical spine was diagnostic at 4.77 ± 1.86 mGy corresponding to 0.560 ± 0.21 mSv (effective dose) in seven cadavers and at 2.60 ± 0.93 mGy corresponding to 0.31 ± 0.11 mSv in four cadavers. Significant correlation was detected for BMI (0.8366; p = 0.002548) and the anteroposterior (a.p.) chest diameter (0.8363; p = 0.002566), shoulder positioning (0.79799; p = 0.00995), and radiation exposure. Conclusions: Conventional radiography can be replaced with a nearly dose-neutral CT scan of the cervical spine.