Computed Tomography Scan Reports Research Articles

A Study to Evaluate the Efficacy of Ultrasonography as a Diagnostic Screening Tool in Maxillofacial Fractures: A Prospective Study.

The aim of the study was to estimate the diagnostic efficacy of high-resolution ultrasonography (USG) in the diagnosis of maxillofacial fractures. A descriptive diagnostic evaluation study was carried out on 30 patients with suspected maxillofacial fractures, out of which 26 were male (86.7%) and 4 were female (13.3%). After initial management, detailed clinical examinations were carried out and significant findings were noted. Computed tomography (CT) scans were performed in fracture-suspecting patients followed by USG examination which was done in a standardized pattern on both sides of the face. The result of USG was compared with the CT scan report. Based on CT findings, 65 sites were found to be fractured, and this was considered the gold standard. Ultrasonography detected 58 fractures at these 780 sites, of which 54 were true fractures, while 4 were false-positive results. However, USG was not able to detect eleven fractures. The overall sensitivity and specificity of USG were 83.1% and 99%, respectively. The positive and negative predictive values were 93% and 98%, respectively. According to our study, it may be concluded that USG may be recommended as a diagnostic screening tool to detect superficial maxillofacial fractures. Ultrasonography provides a safe, cost-effective, reliable, non-invasive, easily available, and portable imaging modality to screen for maxillofacial fractures.

Imaging Findings in Pediatric Accessory Cranial Sutures using 3D CT Reconstruction: Fracture or Rudimentary Suture.

Objective:Although accessory sutures are considered to be relatively rare, the consequences of a missed diagnosis are profound. Distinguishing between accessory sutures and cranial fractures can be difficult, especially in cases of suspected non-accidental trauma. High-resolution imaging is the best way to discern between two- and three-dimensional computerized tomography (3D CT) is considered the preferred method for evaluation. The goal of this study was to determine the impact of 3D CT scans in distinguishing between accessory sutures and cranial fractures in suspected child abuse cases in a rural community and the importance of early detection in such cases, as well as call attention to the consequences of initial misinterpretation. Materials and methods:The researchers conducted a retrospective chart review of all pediatric patients diagnosed with cranial fractures (265 in total) at University Medical Center between May 30, 2016, and May 30, 2021. Initial computed tomography (CT) scans and subsequent 3D CT scans were evaluated for each patient that fit the inclusion criteria, 13 in total. Patients were then categorized into two groups based on the final diagnosis on the radiology report: accessory cranial suture or cranial fracture. Once these patients were identified, the etiology and structural components of each were evaluated, and the key differences were highlighted. Results:Our results showed that, of the 11 cases of suspected non-accidental trauma, six were finally diagnosed with accessory sutures with the use of 3D CT scans, and of those six, four were diagnosed with cranial fractures from the initial CT scan report due to a similar presentation and asymmetric nature. Conclusion:Discerning between fracture and accessory suture is essential in evaluating pediatric patients presenting with signs ofcranial fracture due to the increased risk of misinterpretation that can lead to severe legal consequences considering that cranial suture variants may mimic intentional injury and be mistaken for child abuse, causing significant distress for patients and their families.

Evaluation of Cancer Risk Induced by Radiation Exposure from Normal Head CT Scans

Purpose: Radiology examinations are growing significantly every year. Analysis of the CT scan reports can highlight defects and is a good way to develop safety in healthcare. This study aimed to evaluate the rate of normal head Computed Tomography (CT) scans at a hospital radiology department in Shahroud and estimate the cancer risk associated with these normal CT scans.
 Materials and Methods: In total, the data of 400 patients referred to the emergency radiology center of Imam Hossein hospital in Shahroud from November 23 to December 10, 2021, were collected. CT scan reports were categorized into three groups according to the interpretation of the radiologist. The BEIR VII model was used to estimate the radiation cancer risk.
 Results: Among the 400 patients, 248 (62%) were males and the average age of the patients was 49.05 ± 22.60 years. CT scans in 270 (67.5%) cases were reported normal. The average age of the patients with normal, and abnormal CT scans were 41.86 ± 20.27, and 63.03 ± 20.27 years, respectively and the difference was significant (p-value <0.001). The average effective dose was obtained 1.72±0.09, 1.31±0.11, and 0.87±0.09 mSv for different age groups of 1-5, 5-10, >10-year-old. The average risks of all solid cancers were 7.82 cases per 100,000 patients, while the average risk of leukemia was 0.71 cases per 100,000 patients.
 Conclusion: A large percentage of CT examinations are normal in our country which leads to many public health issues in the future years. Therefore, efforts should be made to establish predictor clinical factors to reduce unnecessary radiology examinations.

S1643 Risk Factors for Malignancy in Patients With Gastric Wall Thickening

Introduction: Gastric wall thickening (GWT) can be due to an amalgam of reasons, including, but not limited to gastrointestinal (GI) malignancy, infection, ischemia or inflammation. Current data suggests that focal, irregular and asymmetrical thickening of the GI tract can indicate malignancy. The aim of our project was to identify predisposing risk factors in patients with GWT, predictive for GI malignancy. Methods: Extensive electronic medical record review was performed to identify patients 18 years of age or older with computed tomography scan reports including the word, “thickening”. A follow up endoscopy report with biopsy results was necessary for inclusion. Data, including patient demographics such as age, gender, race, body mass index (BMI) and lab results were collected. Pathology reports of biopsy specimens were also reviewed and recorded. P-values were then calculated using Wilcoxon rank sum test for comparison of medians and chi-squared test for categorical values. Results: Overall, 99 patients, 39 males and 60 females, with a history of GWT were identified and included in our study (Table). Eighty-four patients (85%) were African American (A.A.), 6 were White (6%) and 5 (5%) were Hispanic. Thirteen patients with GWT had pathology consistent with malignancy, of which, 8 had gastric adenocarcinoma, 3 had mesenchymal or stromal tumors, one had lymphoma and one had metastatic disease. Race was found to be the sole statistically significant risk factor associated with a higher risk of malignancy (P-value < .03). Of the 13 patients with malignancy, 9 were A.A. (69%) and 2 (15%) were of Hispanic origin. None of our White or Asian cohort had evidence of malignancy. Gender, BMI, and lab work including hemoglobin, White cell count, metabolic panel, liver enzymes, coagulation factors and thyroid function were not found to be statistically significant. Conclusion: Currently, data regarding risk factors associated with GWT leading to malignancy is scarce. Our research highlights that African Americans made up the highest percentage of patients in both the malignancy and non-malignancy cohort. There was also a higher percentage of Hispanic patients in the malignancy group compared to the non-malignancy group. There were no White or Asian patients with evidence of malignancy in our study. Differences in BMI and blood work were not found to be statistically significant. Further research is necessary to determine other possible risk factors for malignancy which may exist but were not noted during the course of this study. Table 1. - Demographics of patients with GWT including sex, race and BMI Patients without Malignancy (n=86) Patients with Malignancy (n=13) Sex Number (n) % Sex Number (n) % P-value Male 32 37.21% Male 7 53.85 .253 Female 54 62.79% Female 6 46.15 Race Number (n) % Race Number (n) % P-value African American 75 87.21 African American 9 69.23 .03 White 6 6.98 White 0 0 Hispanic 3 3.49 Hispanic 2 15.38 Asian 1 1.16 Asian 0 0 Others 0 0 Others 1 7.69 Unknown 1 1.16 Unknown 1 7.69 BMI Number (n) % BMI Number (n) % P-value Underweight 5 5.81 Underweight 2 15.38 .072 Normal 27 31.4 Normal 5 38.46 Overweight 21 24.4 Overweight 5 38.46 Obese 33 38.3 Obese 1 7.69

Homoeopathic Management of Sub-acute Appendicitis—A Case Report

AbstractSub-acute appendicitis is a condition where some episodes of acute appendicitis apparently subside spontaneously before they reach the acute stage. A 29-year-old man presented with pain in the right iliac fossa for the last 1 week with periumbilical radiation of pain associated with continual nausea, occasional bouts of vomiting, chill and rigours. Computed tomography scan report suggested a case of sub-acute appendicitis. On the basis of presenting features, the patient was treated with Belladonna and Calcarea carbonica in 30c and 200c (centesimal) potencies, respectively, with repetitions. The patient was under treatment for nearly 6 months with favourable improvement of the generalities along with the underlying pathology. The case was indicative of further studies with adequate sample size in such pathological condition to come to any decisive conclusion.

Impact of a Structured Report Template on the Quality of Multislice Spiral Computed Tomography Scan Reports for Small Bowel Diseases: A Preliminary Study

Background: The application of multislice spiral computed tomography (MSCT) scan has improved the diagnosis of small bowel diseases (SBDs). Objectives: This study aimed to develop a structured report (SR) template for SBDs based on MSCT scans and to compare its value with free-text reports (FTRs) by radiologists with different levels of seniority in radiology. Patients and Methods: A total of 120 SBD cases were confirmed based on the clinical manifestations, surgery, colonoscopy, and pathology. An SR template for small bowel imaging was developed, and six radiologists were divided into inexperienced and experienced groups. Sixty cases with small intestinal MSCT data were available for FTRs and another 60 cases for SRs after training. The report accuracy, satisfaction, and completion time were compared between the two reporting methods. Results: The writing time of SRs was significantly shorter than that of FTRs. By using FTRs, the experienced group showed higher levels of sensitivity for all diseases (i.e., intestinal wall, intestinal peripheral artery, blood vessel, bone, and other abdominal organ diseases) (P &lt; 0.05). The experienced group showed a low misdiagnosis rate for all diseases (P &lt; 0.05), except for bone disease (P = 0.161). By using SRs, the experienced group only showed a low misdiagnosis rate for the intestinal wall disease (P &lt; 0.05). High sensitivity for the intestinal wall disease (P &lt; 0.05) and intestinal peripheral artery disease (P = 0.024), along with improved sensitivity for bone lesions (P &lt; 0.05), was reported in this group. In the inexperienced group, SRs improved sensitivity for all diseases (P &lt; 0.05), except for intestinal wall disease (P &gt; 0.05). The satisfaction scores for both inexperienced and experienced groups improved by using SRs (4 vs. 2.6 for the inexperienced group and 4.1 vs. 3.2 for the experienced group; P &lt; 0.05 for both). Conclusion: The SRs were superior to FTRs in terms of writing efficiency, accuracy, and satisfaction. They could improve the accuracy of inexperienced radiologists in diagnosis and help detect SBDs.

Risk Factors for High Symptom Burden Three Months after Traumatic Brain Injury and Implications for Clinical Trial Design: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study.

More than 75% of patients presenting to level I trauma centers in the United States with suspicion of TBI sufficient to require a clinical computed tomography scan report injury-related symptoms 3 months later. There are currently no approved treatments, and few clinical trials have evaluated possible treatments. Efficient trials will require subject inclusion and exclusion criteria that balance cost-effective recruitment with enrolling individuals with a higher chance of benefiting from the interventions. Using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, we examined the relationship of 3-month symptoms to pre-injury, demographic, and acute characteristics as well as 2-week symptoms and blood-based biomarkers to identify and evaluate factors that may be used for sample enrichment for clinical trials. Many of the risk factors for TBI symptoms reported in the literature were supported, but the effect sizes of each were small or moderate (< 0.5). The only factors with large effect sizes when predicting 3-month symptom burden were TBI-related (i.e., post-concussive) and post-traumatic stress symptom levels at 2 weeks (respective effect sizes 1.13 and 1.34). TBI severity was not significantly associated with 3-month symptom burden (p = 0.37). Using simulated data to evaluate the effect of enrichment, we showed that including only people with high symptom burden at 2 weeks would permit trials to reduce the sample size by half, with minimal increase in screening, as compared with enrolling an unenriched sample. Clinical trials aimed at reducing symptoms after TBI can be efficiently conducted by enriching the included sample with people reporting a high early symptom burden.

After-hours radiology reporting in an Australian tertiary hospital: Factors influencing the rate of discrepancy for computed tomography reporting.

Demand for after-hours radiology services across Australia has been rapidly increasing for many years. Public hospital radiology departments are generally staffed by trainees after hours, often 1-2 doctors. This study reviewed 1 year of after-hours data at a tertiary hospital in Sydney, to determine overall discrepancy rates and factors which influenced the rate of discrepancy after hours. Overall radiology and after-hours case volumes are increasing, and the goal was to ensure that our department practices are within safe limits at current staffing levels. After-hours computed tomography scan reports issued by registrars were reviewed over 1 year between 01 January 2019 and 01 January 2020. Data recorded included overall case numbers on each shift, discrepancy rates and rates of clinically significant discrepancy. Caseload was measured by equivalent ascribed reporting time as described by Pitman etal. (2018). There were 10,886 cases reported after hours during the study period and 1,412 discrepancies (13% cases). Of these, 300 (3.7%) were clinically significant. Factors that increased the rate of significant discrepancy included shifts with caseloads greater than 3 h of equivalent consultant reporting time per 8-h shift and the radiology trainee's level of training. The frequency of discrepancy for trauma cases was similar to non-trauma after adjusting for study type; however, the frequency of significant discrepancy was higher. In all instances, the rates of discrepancy and clinically significant discrepancy remained well within ranges previously described.

Management of urolithiasis with individualised homoeopathy – A case report

Introduction: The population of the North-eastern region of India is prone to develop renal stones, and the prevalence and recurrence rate of renal stone disease is thus higher. A stone more than 0.5 cm diameter can cause painful ureteric obstruction. Stones of size more than 0.7 cm almost always require surgical intervention, as believed in conventional medicine. Repeated surgical interventions may remove obstruction but may not be a solution for altering the tendency for renal stone formation. Homoeopathy, an alternative system of medicine can offer holistic approach in treating such cases non-invasively. Case Summary: A 32 years old male patient presented with continuous severe pain in the left renal region for 15 days. A 1.0 × 0.4 cm calculus was found in the left distal ureter causing mild left-sided hydronephrosis as per computed tomography (CT) scan. According to symptoms similarity, homoeopathic medicine Tabacum was prescribed followed by Belladonna. Subsequently, the stone was expelled through urine. The pain was completely relieved, and the CT scan report showed no abnormality. On the basis of the patient’s constitution Calcarea carbonica was prescribed to remove the tendency to form the renal stone. This case of renal stone suggests that homoeopathic medicine can enable expulsion of a relatively bigger renal stones and check recurrence. However, more conclusive researches are required.

Retrospective review of patients with lung cancer identified in the emergency department.

Obtaining a diagnosis of cancer following an emergency department (ED) visit is associated with poor outcomes and advanced stage. Limited data is available from EDs in the United States. We describe a cohort of patients that obtained a diagnosis of lung cancer because of an ED visit. This is a single center, retrospective cohort of patients with lung cancer who presented to the ED between December 2016 and December 2019. We investigated demographics, access to primary care, previous cancer screening, cancer type/stage, mortality, and imaging study that suggested cancer. The primary outcome is the percentage of lung cancer diagnoses over a 4-year period that resulted from an ED visit. Among the 268 patients with lung cancer, 152 patients (57.6%) had presented to the ED with a workup that was concerning for lung cancer. Patients were generally elderly (median 62-years old), African American (n=77, 51%), and smokers (n=145, 95.4%) with a median smoking pack years of 40. Only 24 patients (15.8%) had seen a primary care physician within 1year of diagnosis, and only 8 patients were appropriately screened for lung cancer. The most common type of cancer was non-small-cell carcinoma (111, 73.0%), with 61.3% of those being adenocarcinoma (n=68). Patients were most likely to be stage IV (n=86, 56.6%), and the overall mortality was 53.3% (n=81, 1year follow-up). Most patients (88/152, 57.9%) of patients were admitted to the hospital, and Medicare patients (OR 2.7, 95% CI 1.37-5.23) and patients with stage IV disease (OR 2.22, 95% CI1.15-4.29) were more likely to be admitted. Patients were more likely to have a concerning finding on computed tomography (CT) versus chest x-ray (55.9% versus 36.8%, respectively). CT scan reports were more likely to mention malignancy (OR 5.9, 95% CI 2.5-14.0) or metastasis (OR 30, 95% CI 7.1-127.1) than chest x-ray. Patients that have lung cancer diagnosed through the ED are more likely to be advanced stage at time of diagnosis and are more likely to have CT scans demonstrate concerning findings. Given the lack of previous cancer screening, the advanced stage at presentation of lung cancer to the ED, and high mortality rates, the ED may serve a public health role in addressing lung cancer screening.

Abstract P179: A Text Processing Tool To Identify And Characterize Carotid Artery Stenosis In Radiology Reports

Introduction: We aimed to identify and characterize carotid artery stenosis (CAS), defined as ≥40% stenosis in the internal carotid artery (ICA) or the common carotid artery (CCA), among participants of the Mayo Vascular Disease Biorepository (VDB, n = 11,814). Hypothesis: A string-based text processing (TP) tool coded in R can analyze radiology text reports to ascertain and characterize CAS. Methods: After importing a radiology report into R, it was segmented for analysis and each segment was tested for 22 unique features. The TP tool was able to i) identify stenosis in the ICA or the CCA while excluding stenosis of vertebral arteries, subclavian arteries, or external carotid arteries, ii) recognize both quantitative and qualitative descriptions of CAS, iii) interpret numerical expressions by considering the surrounding text, iv) detect negations, and v) ascertain previous revascularization procedures if mentioned in the text. We manually ascertained CAS and characterized it in 800 randomly selected radiology reports to assess the performance of the TP tool in terms of precision, recall, and F-score. Results: We retrieved 21,651 imaging reports for 6,342 unique patients including 20,461 ultrasonography reports, 812 magnetic resonance imaging reports, 357 computed tomography scan reports, and 21interventional radiology reports. The performance of TP is outlined in Table 1 . Conclusion: We demonstrate that a string-based TP tool coded in R is efficient and accurate in identifying and characterizing CAS from carotid radiology reports. The tool does not require natural language processing and could be used in a wide range of settings for genetic and biomarker studies.

A new computed tomography scoring system to assess osteochondral allograft transplantation for the knee: inter-observer and intra-observer agreement.

To describe a new semiquantitative computed tomography (CT) scoring system for multi-feature analysis of cartilage defect repair by osteochondral allografts for the knee and to assess its intra-observer and inter-observer variability. A semiquantitative assessment CT osteochondral allograft (ACTOCA) scoring system was designed based on fresh osteochondral allograft transplantations for the knee. The system includes five CT features: density relative to host bone, integration at the host-graft junction, surface percentage with a discernible cleft at the host-graft junction, cystic changes, and intra-articular fragments. Inter-observer variability was calculated by three observers blinded to the patient's medical history and treatment. Intra-observer variability was also determined. Inter-observer agreement was moderate to substantial for all CT score components and intra-observer agreement was moderate to almost perfect for all CT score components (κ > 0.5, p < 0.05). The ACTOCA score is a reliable tool to evaluate integration of osteochondral allograft transplantations. It provides an accurate evaluation of bone changes and may help to standardize CT scan reports following osteochondral allograft transplantation for the knee.

Utility, Appropriateness of Request and Report of Computed Tomography Scan for the Diagnosis of Paranasal Sinuses Pathologies in a Sub-Saharan Africa Urban Setting

Background: Computed tomography (CT) Scan is the imaging of choice for the diagnosis of sino nasal (SN) pathologies in sub-Saharan African setting. However, it is often requested by non experienced practitioners. We aimed to describe the utility and the appropriateness of CT Scan request forms and results in the diagnosis of SN pathologies. Method: We conducted a retrospective cross-sectional study in four health facilities in Yaoundé, Cameroun, from October 2018 to September 2019. All patients to whom SN CT Scan was performed were called for an appointment. After informed consent, data on the appropriateness and conformity of the request form were collected and compared to the guidelines of the French society of radiology. CT Scan results were also collected and the quality of the report was evaluated. Results: A total of 206 SN CT Scan request forms and reports were included, with a mean patient age of 37.7 ± 16.1 years. The request form was conformed to guidelines in 8.3% of cases and was found appropriate in 62.6% of cases. No CT Scan report had all the items required, and 159 (77.2%) reports were useful. The most common diagnosis in patients with abnormal results was chronic sinusitis (49.5%) and SN polyp or polyposis (19.4%). Conclusion: Most of SN CT Scan requested were appropriate and useful. However, the conformity of request forms and reports to the guidelines is low. Suggesting the need for capacity building for the diagnosis of SN pathologies especially for non specialists like general practitioners and nurses.

Computerized tomography scan in acute appendicitis with eventual negative appendectomy

Acute appendicitis (AA) is traditionally considered a clinical diagnosis and negative appendectomy (NA) rates vary across health-care systems. Computed tomography (CT) scans have been shown to aid in the reduction of NA rates. Our study aimed to determine the pre-operative imaging characteristics in patients undergoing appendectomy with eventual normal histology. An audit of all patients with a discharge diagnosis of AA was conducted from January 2011 to December 2015. Histology reports of all patients who underwent appendectomies were reviewed, and medical records of patients with NA were included in the study. To study the impact of CT scan reporting in NA patients, CT scan images of patients with NA were reviewed retrospectively by two blinded radiologists. A total of 2603 patients underwent appendectomy for suspected AA, and NA rate was 3.34% (n=87). The mean age of patients with NA was 30.3 (14.8-69.8) years with no gender difference (51.7% male). Sixty-six (75.9%) patients had laparoscopic appendectomy with 3.5% open conversion rate. CT scans were done in 47 patients. Pre-operative CT scan report was more likely to report dilated appendix (n=26 [55.3%] vs. n=7 [14.9%], P=0.0001). Post-operative blinded radiology review was more like to report other pathology (n=27 [57.4%] vs. n=2 [4.3%], P=0.0001) and normal appendix (n=26 [55.3%] vs. n=5 (10.6%), P=0.0001). The NA rate is low. There needs to be standardized reporting for imaging features of prominent/dilated appendix. Appendectomy must be avoided in patients with a normal CT scan and when another pathological diagnosis is established. Liberal imaging policy assists to reduce NA rates. Imaging features of prominent or dilated appendix can be subjective and international collaboration is needed to define thresholds for imaging diagnosis of AA.

External Validation of a Tool to Predict Neurosurgery in Patients with Isolated Subdural Hematoma

Subdural hematoma (SDH) is the most common form of traumatic intracranial hemorrhage. Orlando and colleagues derived a prediction tool for neurosurgical intervention, the "Orlando Tool," consisting of (a) maximum thickness of hematoma, and (b) presence of acute-on-chronic (AOC) hematoma. This study externally validated the Orlando Tool. We performed a retrospective chart review of consecutive patients aged ≥16 years with a Glasgow Coma Scale score ≥13, and a computed tomography-documented isolated, traumatic SDH, who presented to a university-affiliated, urban, 100,000-annual-visit emergency department from 2009-2015. The primary outcome was neurosurgical intervention. Thickness of hematoma and presence of AOC hematoma were abstracted from cranial computed tomography scan reports by 2 trained physician abstractors. A total of 607 patients with isolated SDH were included in the validation dataset. Median hematoma thickness was 6 mm. AOC hematoma was noted in 13% of patients. Mortality was 2.5%, and 15.7% of patients underwent neurosurgery. The Orlando Tool had an area under the curve of 0.93 in the validation, comparable to 0.94 reported in their derivation set. At the prespecified cutoff of 9.96% risk, the tool had a 88% (95% CI, 80-94) sensitivity in the validation cohort compared with 94% in the derivation cohort. The specificity of 82% (95% CI, 78-85) was comparable with 84% in the derivation group. Negative likelihood ratio was 0.14 (95% CI, 0.08-0.25), compared with 0.09 in derivation. The Orlando Tool accurately predicts neurosurgical intervention in patients with isolated, traumatic SDH and preserved consciousness.

Should We Report Incidental Low-Density Liver Lesions with Benign Features? A Retrospective Single-Center Analysis of Trauma CT Scans

Abstract Background Many incidental liver lesions are benign and require no additional workup. Investigation of such lesions can have a negative impact of both the patient and health care system. However, the impact of how radiologists report these incidental lesions is not clear. We aimed to investigate how reporting of incidental liver lesions on trauma computed tomography (CT) scan affects follow-up. Methods This is a retrospective single-center analysis of body CT scans performed following abdominal trauma. Information was collected on the reporting of incidental low-density liver lesions and any additional imaging performed. Results A total of 3,595 trauma body CT scan reports were reviewed. Incidental liver lesions were identified in 527 (15%) patients, with 347 (10%) fulfilling the inclusion criteria. Additional imaging was requested by the referring doctor for 43 out of 285 patients (15%) when lesions were mentioned in the body of the report only, compared with 41 out of 62 patients (66%) when mentioned in the conclusion (odds ratio [OR] = 10.99, p &lt; 0.0001). When additional imaging was recommended in the report, follow-up was arranged for 36 out of 52 patients (69%), compared with 48 out of 285 patients (16%) when it was not suggested (OR = 11.58, p &lt; 0.0001). Additional imaging was requested for 84 of the 347 patients (24%), with 24 of these performed at our institution. All patients followed-up at our institution were diagnosed with a benign lesion. Conclusion Reporting incidental hypodense liver lesions in the conclusion or specifically recommending further additional imaging, both led to significantly increased likelihood of additional imaging being performed. Radiologists who encounter such lesions should consider excluding them from the conclusion if there are no malignant features or patient risk factors.

Incidence of Cerebral Hemorrhage in Traumatic Patients using Computed Tomography in Tabuk City, Saudi Arabia

Computed Tomography (CT) is the most commonly used imaging modality in the evaluation of cerebral hemorrhage in the head trauma patients. Objective: To study the incidence of a cerebral hemorrhage in traumatic patients using computed tomography. Method: This retrospective study was conducted at King Khalid hospital in Tabuk city, Saudi Arabia, in the radiology department, in the period from September 2018 to April 2020. The study was done by collecting 471 CT reports of patients all of them were exposed to head trauma with deferent reasons. The data were analyzed by Statistical Package for the Social Sciences (SPSS) program (ver. 20) and presented in tables and graphs according to the checklist which includes: patient age, gender, type of trauma, CT finding, and type of hemorrhage. Results: The most age group suffered from head trauma was less than 20 years percentage (55%), The male patients more exposed to head trauma than female patients with percentage (84.5%), the road traffic accident (RTA) is the most common type of trauma by percentage (63.5%), according to the CT finding; the cerebral hemorrhage represented (15.5%) with the highest percentage in a subdural hematoma (31.2%), the fracture represented (2.8%) while the normal appearance represented (81.7%) as the highest percentage. Conclusion: Most of the traumatic brain injury in patients caused cerebral hemorrhage and the CT scan reports show that: the common type of cerebral hemorrhage is subdural hematoma and it is common in males which exposed to (RTA) in the age group (21 - 40) years old.

Interpretation of emergency CT scans in polytrauma: trauma surgeon vs radiologist.

IntroductionTime is critical in the trauma setting. Emergency computed tomography (CT) scans are usually interpreted by the attending doctor and plans to manage the patient are implemented before the formal radiological report is available. This study aims to investigate the discrepancy in interpretation of emergency whole body CT scans in trauma patients by the trauma surgeon and radiologist and to determine if the difference in trauma surgeon and radiologist interpretation of emergency trauma CT scans has an impact on patient management.MethodThis prospective observational comparative study was conducted over a 6 month period (01 April–30 September 2016) at the Inkosi Albert Luthuli Central Hospital which has a level 1 trauma department. The study population comprised 62 polytrauma patients who underwent a multiphase whole body CT scans as per the trauma imaging protocol. The trauma surgeons' initial interpretation of the CT scan and radiological report were compared. All CT scans reported by the radiology registrar were reviewed by a consultant radiologist. The time from completion of the CT scan and completion of the radiological report was analysed.ResultsSince the trauma surgeon accompanied the patient to radiology and reviewed the images as soon as the scan was complete, the initial interpretation of the CT was performed within 15–30 min. The median time between the CT scan completion and reporting turnaround time was 75 (16–218) min. Critical findings were missed by the trauma surgeon in 4.8% of patients (bronchial transection, abdominal aortic intimal tear and cervical spine fracture) and non-critical/incidental findings in 41.94%. The trauma surgeon correctly detected and graded visceral injury in all cases.ConclusionThere was no significant discrepancy in the critical findings on interpretation of whole body CT scans in polytrauma patients by the trauma surgeon and radiologist and therefore no negative impact on patient management from missed injury or misdiagnosis.The turnaround time for the radiology report does not allow for timeous management of the trauma patient.

Computed tomographic scan utilization in the diagnosis of otorhinolaryngological diseases

Background: Having an audit of common otorhinolaryngological diseases diagnosed on computed tomography (CT) scan in our environment is important as it will help elucidate the sociodemographics and pattern of referral for CT scan from an ear, nose, and throat (ENT) clinic as well as CT findings. Materials and Methods: The request forms as well as the CT scan reports of 203 patients who were referred from the ENT clinic between 2006 and 2014 and had CT scan were retrieved from our records. All CT scans were done using a four-slice BrightSpeed helical GE CT scan machine. Out of the 214 patients recruited for this study, only 203 patients were unanimously agreed upon by the authors as the remaining 11 patients had incomplete data. Results: There were 124 males (61.1%) and 79 females (38.9%). The mean age of patients with nasopharyngeal tumor was 40.67 ± 26.01 years, laryngeal tumor was 57.47 ± 15.64 years, antrochoanal carcinoma was 46.05 ± 22.95 years, and sinusitis was 44.96 ± 17.19 years, while that of otitis media was 43.33 ± 23.60 years. A total of 177 patients representing 87.2% of the study population had one or two pathological findings on CT scan. Sinusitis accounted for most findings on CT scan (12.8%), followed by laryngeal tumor (10.7%) and antrochoanal carcinoma (10.2%). Others were choanal polyp (9.7%), nasopharyngeal tumors (9.2%), rhinitis (6.1%), mastoiditis (5.1%), and mucocele of the sinuses (4.6%). Juvenile angiofibroma (1.0%) and palatal masses (1.0%) were the least in terms of occurrence of all ENT conditions. Conclusion: Common findings on CT scan of the ENT in our environment have been documented.

Evaluation of the impact of a brief educational message on clinicians\u2019 awareness of risks of ionising-radiation exposure in imaging investigations: a pilot pre-post intervention study

BackgroundIn the context of increasing availability of computed tomography (CT) scans, judicious use of ionising radiation is a priority to minimise the risk of future health problems. Hence, education of clinicians on the risks and benefits of CT scans in the management of patients is important.MethodsAn educational message about the associated lifetime cancer risk of a CT scan was added to all CT scan reports at a busy acute teaching hospital in the UK. An online multiple choice survey was completed by doctors before and after the intervention, assessing education and knowledge of the risks involved with exposure to ionising radiation.ResultsOf 546 doctors contacted at baseline, 170 (31%) responded. Over a third (35%) of respondents had received no formal education on the risks of exposure to ionising radiation. Over a quarter (27%) underestimated (selected 1 in 30,000 or negligible lifetime cancer risk) the risk associated with a chest, abdomen and pelvis CT scan for a 20 year old female. Following exposure to the intervention for 1 year there was a statistically significant improvement in plausible estimates of risk from 68.3 to 82.2% of respondents (p < 0.001). There was no change in the proportion of doctors correctly identifying imaging modalities that do or do not involve ionising radiation.ConclusionsTraining on the longterm risks associated with diagnostic radiation exposure is inadequate among hospital doctors. Exposure to a simple non-directional educational message for 1 year improved doctors’ awareness of risks associated with CT scans. This demonstrates the potential of the approach to improve knowledge that could improve clinical practice. This approach is easily deliverable and may have applications in other areas of clinical medicine. The wider and longer term impact on radiation awareness is unknown, however, and there may be a need for regular mandatory training in the risks of radiation exposure.