Use Of Computed Tomography Research Articles

Miles to go before we sleep: Does increasing abdominal computed tomography utilization really improve patient-oriented outcomes?

Miles to go before we sleep: Does increasing abdominal computed tomography utilization really improve patient-oriented outcomes?

Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report.

Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient's feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.

Less Dose, Same Care: Evaluating Computed Tomography Utilization for Pediatric Appendicitis

BackgroundAn ultrasonography-first, magnetic resonance imaging-second protocol, and attention to dose reduction was implemented to reduce computed tomography rates for appendicitis at our institution. We aimed to compare current computed tomography usage and report radiation doses at our children's associated system hospitals and referring nonsystem hospitals. MethodsA retrospective study of pediatric patients who underwent appendectomy and had a preoperative computed tomography scan between June 2020 and June 2023 was performed. Demographics and imaging details were abstracted from the medical record. Size-specific dose estimates and effective dose estimates were calculated for each computed tomography. Size-specific dose estimates were compared with American College of Radiology Dose Index Registry diagnostic reference levels. ResultsOf 1,419 patients, 409 (29%) received a computed tomography for appendicitis, a 56% reduction from previous years (2012–2015) (P < .001). Overall, 352 computed tomography scans had dose data available, of which 291 (83%) were performed at system hospitals and 61 (17%) at nonsystem hospitals. The median size-specific dose estimate per computed tomography was 11.0 mGy (interquartile range 7.0, 17.4) for nonsystem hospitals and 9.1 mGy (interquartile range 6.6, 14.0) for system hospitals. The median effective dose per computed tomography was 6.7 mSv (interquartile range 4.3, 12.9) at nonsystem hospitals and 5.1 mSv (interquartile range 3.3, 9.4) at system hospitals. Nienty-three (n = 273) computed tomography scans performed at system hospitals and 30 computed tomography scans (n = 61) at nonsystem hospitals exceeded American College of Radiology Dose Index Registry age-based diagnostic reference levels. ConclusionThe ultrasonography-first, magnetic resonance imaging–second protocol resulted in a significant decrease in computed tomography use for appendicitis diagnosis. Comparison of doses to American College of Radiology Dose Index Registry reference levels suggests that computed tomography protocol optimization may allow for dose reduction at some facilities.

Utilization of computed tomography for extremity cellulitis: a retrospective single-center analysis

PurposeRoutine imaging of soft tissue infection is not recommended and represents a potential area of computed tomography (CT) overuse. The utility of CT in patients with superficial soft tissue infection of the extremities is unknown. The purpose of this study is to evaluate the utilization and clinical impact of CT ordered in the setting of extremity cellulitis. MethodsWe retrospectively analyzed patients with extremity cellulitis examined with CT between 2012-2021 at a single center. We collected patient history, diagnostic imaging characteristics, and subsequent surgery decision. We hypothesized that yield of CT for deep infection was significantly lower than 10% and that yield was decreasing over time. These hypotheses were evaluated with Rao-Scott Chi-Square tests and repeated measures logistic regression. ResultsThere were 496 eligible encounters among 463 patients. Yield of positive CT among lower extremity patients was 5.5% (95%CI 3.33-7.75), significantly less than our hypothesis of 10% (p=0.003). In 71.8% of encounters, patients underwent diagnostic imaging studies in addition to CT. Utilization rose from 0.08% per hospital visit in 2012-2013 to 0.14% in 2020-2021, with differences in yield between time periods not reaching statistical significance (p=0.059). Among 496 encounters, 62 received surgery (12.1%), with 21 of these cases preceded by a positive CT for deep infection. ConclusionsOur 10-year single-center analysis of CT use for extremity cellulitis demonstrated a low yield of positive CT findings for deep infection and limited impact of CT on surgical management. A high incidence of patients undergoing multiple radiologic exams suggests uncertainty in selecting appropriate imaging modalities in this clinical scenario.

10 Influence of Physician Experience on Computed Tomography Utilization in the Emergency Department

10 Influence of Physician Experience on Computed Tomography Utilization in the Emergency Department

Utility of computed tomography in assessing caustic ingestion damage to the esogastric tract

BackgroundIngestion of corrosive substances represents a frequent and consequential medical scenario, significantly impacting both vital and functional prognoses through the emergence of acute complications or stenosis, which pose considerable therapeutic challenges. Currently, endoscopy remains the cornerstone modality for diagnostic assessment and management. Nevertheless, recent research highlights computed tomography (CT) as a promising alternative, avoiding the risks associated with endoscopy and reducing the unnecessary surgical interventions based on its findings.MethodsOur retrospective study, spanning three years, encompassed 28 patients who had ingested corrosive substances. Among them, 24 underwent both CT scanning and endoscopic evaluation using CT and endoscopic scores.ResultsEmploying Standardized CT scoring criteria alongside the Zargar’s endoscopic classification, our findings revealed significant concordance between the two modalities, particularly in discerning trans-parietal necrosis within the esophagus and stomach. Notably, radiographic evidence of digestive tract injury was found to be predictive of complications in over 80% of cases, demonstrating high sensitivity and negative predictive value. Furthermore, CT scores indicating moderate to severe injury were significantly associated with stenosis, with slightly inferior performance compared to endoscopy. Of particular note, a CT score indicative of severe injury was found to be a good predictor of mortality, further underscoring the prognostic value of CT in these cases.ConclusionWhile the utility of CT in this context is undeniable, its integration with endoscopic findings remains imperative. We advocate for a systematic approach incorporating CT scanning, with further prospective research warranted to explore the feasibility of CT as a standalone diagnostic tool, as suggested by some scholars.

Imaging the Impact: Computed Tomography Thorax in COVID-19 - A Comprehensive Review and Clinical Analysis

This comprehensive review and clinical analysis explore the pivotal role of thorax computed tomography (CT) in the context of COVID-19. As the world grapples with the ongoing pandemic, the need for effective diagnostic tools and management strategies remains paramount. This review meticulously examines the impact of thorax CT imaging on the understanding, diagnosis, and clinical management of COVID-19. The review encompasses an extensive analysis of the existing literature, shedding light on the nuances of thorax CT findings in COVID-19 patients. It explores the characteristic imaging features, such as ground-glass opacities, consolidations, and other pulmonary abnormalities, providing insights into the pathophysiology of the disease. Furthermore, the clinical analysis component synthesizes data from diverse studies to elucidate the diagnostic accuracy and sensitivity of thorax CT, particularly in cases where molecular testing may present challenges. The review also delves into the role of thorax CT in early detection, risk stratification, and longitudinal monitoring of patients with COVID-19, offering valuable perspectives for healthcare professionals. Importantly, considerations of radiation exposure and ethical use of thorax CT are addressed, emphasizing the judicious integration of imaging into clinical practice. The article concludes with practical recommendations for optimizing the utility of thorax CT in the broader context of COVID-19 diagnosis and patient care.

Flank pain, hypertension, and hematuria: CT and 3D cinematic rendering in the evaluation of renal artery emergencies-a pictorial essay.

Non-traumatic acute renal artery emergencies encompass a spectrum of etiologies, including renal artery stenosis, arteriovenous malformations, aneurysms and pseudoaneurysms, dissections, thrombosis, and vasculitis. Prompt and accurate diagnosis in the emergency setting is crucial due to the potential for significant morbidity and mortality. Computed tomography (CT) and CT angiography (CTA) are the mainstay imaging modalities, offering rapid acquisition and high diagnostic accuracy. The integration of 3D postprocessing techniques, such as 3D cinematic rendering (CR), improves the diagnostic workflow by providing photorealistic and anatomically accurate visualizations. This pictorial essay illustrates the diagnostic utility of CT and CTA, supplemented by 3D CR, through a series of 10 cases of non-traumatic renal artery emergencies. The added value of 3D CR in improving diagnostic confidence, surgical planning, and understanding of complex vascular anatomy is emphasized.

Failure to Significantly Reduce Radiation Exposure in Children with Suspected Appendicitis in the United States

BackgroundUltrasound (US) or magnetic resonance imaging (MRI) is recommended over computed tomography (CT) as the initial imaging modality when considering a diagnosis of appendicitis in children. This reduces unnecessary radiation exposure and has excellent accuracy. We hypothesized a significant increase in US utilization and a reduction in CT utilization in hospitals across the United States. MethodsWe retrospectively reviewed NSQIP-P data from 2015 to 2021 for patients <18 years undergoing appendectomy for acute appendicitis. Rates of US, CT, and MRI usage were compared between NSQIP-P hospitals and referring non-NSQIP-P hospitals. ResultsOf the 115,186 children included, 66,303 (57.6%) were imaged in NSQIP-P hospitals, 37,962 (33.0%) in non-NSQIP-P hospitals, and 7947 (6.9%) in both. US alone was used in 53.3%, followed by CT alone in 25.1%, both US + CT in 16.4%, and MRI ± CT/US in 2.6%. Non-NSIQP-P hospitals used less US than NSQIP-P centers (38.6% vs 90.8%, P < 0.0001) and more CT (74.0% vs 25.4%, P < 0.0001). From 2015 to 2021, overall US utilization increased from 68.5% to 72.3% (p < 0.0001) while CT utilization remained unchanged (43.1%–43.2%, P = 0.07). US use increased in non-NSQIP-P centers (18.8%–25.7%, P < 0.0001) but not in NSQIP-P (71.7% vs 70.9%, p = 0.28), while CT alone decreased in both (NSQIP-P: 10.1%–7.7%, P < 0.0001; non-NSQIP-P: 71.0%–59.8%, P < 0.0001). ConclusionUS and MRI remain underutilized in diagnosing pediatric appendicitis, especially in non-NSQIP-P hospitals. Trends show modest increase in US utilization; however, CT alone remains a highly used modality in non-NSQIP-P hospitals. Adopting diagnostic strategies from NSQIP-P centers could optimize diagnostic imaging in children. Level of EvidenceIII.

A Review of Pediatric Appendicitis Imaging Trends from 2006 – 2020 Using the Nationwide Emergency Department Sample

BackgroundAppendicitis is a common surgical emergency in the pediatric population, affecting over 70,000 children per year in the United States alone. While historically practitioners predominately used computed tomography (CT) as the main diagnostic imaging modality, multiple professional societies have released guidelines recommending an ultrasound (US) first strategy when using imaging to confirm suspected appendicitis in pediatric populations. To date, no studies have quantified the change in imaging trends for pediatric appendicitis across the spectrum of healthcare facilities in the United States utilizing the Nationwide Emergency Department Sample (NEDS). ObjectivesWe aimed to evaluate the imaging trends for pediatric appendicitis across the nation, stratified by age and gender. Specifically, we wanted to delineate the use of CT alone versus US alone or US first imaging strategies. MethodsThis retrospective cross-sectional study utilized data from the NEDS spanning from 2006 through 2020. We examined and analyzed the total number of patients, the number of patients with available imaging data, sex, age, and included imaging modalities utilizing descriptive statistics and regression analyses. Similarly, regression analysis was employed to discern differences in imaging rates in time intervals following societal imaging recommendations. ResultsFrom 2006 to 2020 the database recorded 160,828 encounters for pediatric appendicitis. Imaging data was available for 101,248 encounters, accounting for 63% of the total sample. Over the study period, both rates of ‘US only’ and ‘US first’ imaging modalities increased (from 5.5% to 38.9% and 8.9% to 55.6%, respectively), while rates of CT utilization in isolation declined (from 91.1% to 44%). ConclusionWhile there is an increasing trend towards US being used as the first imaging modality to diagnose pediatric appendicitis across the spectrum of facilities included in the NEDS, continued utilization of CT to diagnose appendicitis remains unacceptably high in the pediatric population within the limits of this retrospective study.

Characteristics of Post-traumatic Shunt-dependent Hydrocephalus After Decompressive Craniectomy: Are Computed Tomography Scoring Systems Predictors?

ObjectiveTraumatic brain injury (TBI) significantly contributes to morbidity rates. While computed tomography (CT) scoring systems have been recognized as predictive factors for TBI outcomes, their association with shunt dependency in patients undergoing decompressive craniectomy (DC) has not been investigated. This study aimed to evaluate the predictive utility of CT scoring systems concerning shunt-dependent hydrocephalus in patients post-DC for TBI. MethodsIn this retrospective study, we enrolled 162 patients who underwent DC and survived more than 7 days following TBI. The pre-DC CT scans were evaluated using the Marshall, Rotterdam, and Helsinki CT scoring systems. The primary event of interest was shunt-dependent hydrocephalus during the follow-up period, with unfavorable outcomes denoted by a Glasgow Outcome Scale score ranging from 1 to 3. ResultsAnalysis of the CT scans showed that the Rotterdam scores had a mean of 4.81 ± 0.91 for the group with shunt-dependent hydrocephalus and 4.41 ± 1.24 for the non-shunt-dependent hydrocephalus group (p = 0.033). However, multivariate logistic regression revealed no significant correlation between the Rotterdam CT score and shunt-dependent hydrocephalus, showing an odds ratio of 1.09 and a 95% confidence interval of 0.71 to 1.67 (p = 0.684). Notably, the Kaplan-Meier outcome curves highlighted a pronounced difference between groups based on shunt dependency (log-rank test: p = 0.012). ConclusionsThe CT scoring systems proved insufficient for predicting shunt-dependent hydrocephalus following DC for TBI. However, our observations underscore a significant correlation between post-traumatic shunt dependency after DC and an increased incidence of unfavorable outcomes during long-term follow-up.

Optimizing precision rhinoplasty: comprehensive preoperative planning with nasal computed tomography for functional and aesthetic enhancement

BackgroundThe evolving field of rhinoplasty increasingly recognizes the importance of clinical expertise over routine preoperative nasal computed tomography (CT) for planning surgical interventions. This study evaluates the clinical utility of preoperative nasal CT in enhancing the precision of open structured rhinoplasty, focusing on both functional and aesthetic outcomes without compromising patient safety through unnecessary radiation exposure. The study aimed to assess the impact of preoperative nasal CT on surgical planning and intraoperative maneuvers.MethodsA prospective cohort study involved patients undergoing open structured rhinoplasty with or without preoperative nasal CT. Participants were divided into a study group, receiving preoperative nasal CT, and a control group, undergoing rhinoplasty without such imaging. Surgical modifications were tailored based on CT findings, with outcomes evaluated through postoperative nasal airflow and aesthetic satisfaction.ResultsThe study included 205 patients in the CT group and 514 in the control group, with comparable demographics. The CT group demonstrated significant improvements in nasal breathing and higher aesthetic satisfaction postoperatively, with a notable decrease in the NOSE score and an increase in the ROE score compared to the control group. Minor complications were observed in a small percentage of the CT group, showcasing a nuanced approach to addressing individual anatomical variations.ConclusionsPreoperative nasal CT in open structured rhinoplasty significantly enhances surgical precision, optimizing functional and aesthetic outcomes. This study underscores the utility of preoperative CT in individualized surgical planning, suggesting its pivotal role in the advancement of rhinoplasty practices. Future research should explore long-term benefits and further validate these findings across diverse populations.

Reducing Postoperative CT Imaging for Children With Complicated Appendicitis: A Pediatric Surgical Quality Collaborative Quality Improvement Project

BackgroundDespite widespread initiatives to reduce ionizing radiation for appendicitis diagnosis, computed tomography (CT) scanning postoperatively remains common. The Pediatric Surgery Quality Collaborative (PSQC) aimed to identify differences between children's hospitals with high and low postoperative CT usage for complicated appendicitis. MethodsUsing National Surgery Quality Improvement Program Pediatric data from PSQC children's hospitals, we compared postoperative CT imaging for complicated appendicitis (April 2020–March 2021). Key stakeholders from 11 hospitals (5 low CT utilization, 6 high CT utilization) participated in semi-structured interviews regarding postoperative imaging. Qualitative analysis of transcripts was performed deductively and inductively based on the Theoretical Domains Framework (TDF). ResultsFive of twelve TDF domains were most prominent in influencing CT use: skills, beliefs about capabilities, intentions/goals, memory and decision processes, and environment. Children's hospitals with lower rates of postoperative CT use tended to: trust and educate the ultrasound technicians; believe US strengths outweigh weaknesses; image no sooner than 7 days postoperatively; have access to sufficient quality improvement resources; maintain trusting relationships between specialties; and prioritize radiation stewardship. ConclusionHospitals at extremes of postoperative CT use for complicated appendicitis reveal strategies for improvement, which include imaging protocol development and adherence, quality improvement resource availability, interdisciplinary collaboration, and promoting radiation stewardship. Level of EvidenceLevel V.

Updating national diagnostic reference levels for computed tomography in Greece: Challenges on patient protection optimisation

The escalating use of Computed Tomography (CT) imaging necessitates establishment and periodic revision of Diagnostic Reference Levels (DRLs) to ensure patient protection optimization. This paper presents the outcomes of a national survey conducted from 2019 to 2022, focusing on revising DRLs for adult CT examinations. Dosimetric data from 127 scanners in 120 medical facilities, representing 25% of the country's CT scanners, were collected, emphasizing geographic distribution and technology representation. Τhe parameters used for DRLs were the CTDIvol and the DLP of a typical acquisition of the region of interest (scan DLP). In addition to the 7 CT examination for which the DRL values were revised, establishment of DRLs for neck, cervical spine, pelvic bones-hips, coronary artery calcium (Ca) score and cardiac computed tomography angiography (CCTA) examinations was performed.Revised DRLs exhibited a 15 % average decrease in CTDIvol and a 7 % average decrease in scan DLP from the initial DRLs. This reduction of dosimetric values is relatively low compared to other national studies. The findings revealed wide variations in dosimetric values and scan lengths among scanners, emphasizing the need for standardization and optimization. Incorporation of advanced technologies like Iterative Reconstruction (IR) showcased potential for further dose reduction, yet challenges in uniform implementation persist. The study underscores the importance of ongoing optimisation efforts, particularly in the context of increased CT utilization and evolving technology. The revised DRLs have been officially adopted in Greece, emphasizing the commitment to safe and effective CT practices.

Non-destructive visualization of internal structural changes in humidified magnesium oxide tablets using X-ray computed tomography

Detailed examinations of the internal structure of tablets are imperative for comprehending their formulation, physical attributes, and ensuring their safe utilization. While X-ray computed tomography (CT) is valuable for noninvasively analyzing internal structural changes, the influence of humidity on these structural changes remains unexplored. Accordingly, we aimed to assess the viability of X-ray CT in non-destructively evaluating the internal structure of humidified magnesium oxide (MgO) tablets. MgO tablets were subjected to conditions of 40 °C and 75% humidity for 7 days, weighed pre- and post-humidification, and subsequently stored at room temperature (22–27 °C) until day 90. Their internal structure was evaluated using X-ray CT. We observed a substantial increase in the weight of MgO tablets concomitant with moisture absorption, with minimal changes observed upon storage at room temperature. The skewness reduced immediately post-moisture absorption, remained almost the same post-storage at room temperature, and failed to revert to pre-humidification levels during the storage period. These findings highlight the utility of X-ray CT as an effective tool for non-destructive, three-dimensional, and detailed evaluation of internal structural transformations in MgO tablets.

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.

Effect of an Evaluation Algorithm on CT Utilization in Identifying Appendicitis in Children.

Our objective was to determine if there was a significant change in computed tomography (CT) utilization or length of stay (LOS) among patients evaluated for acute appendicitis after implementation of an appendicitis evaluation algorithm. We conducted a retrospective chart review of patients aged 3-18 years in an urban, tertiary pediatric emergency department with acute abdominal pain, evaluated for appendicitis. Data were collected for 6 months preimplementation and postimplementation of the evaluation algorithm with a 3-month washout period between September 2018 and November 2019. Main outcomes were rate of CT utilization and LOS preimplementation and postimplementation and were analyzed using χ 2 test and Mann-Whitney U test, respectively. Descriptive analysis of demographics was performed, in addition to logistic regression to assess differences between the 2 study periods. A total of 2872 charts were identified with a chief complaint inclusive of "abdominal pain." Of these, 1510 met age requirements but did not meet at least 1 inclusion criteria; 229 more were excluded upon chart review for a final study sample of 1133 patients. Of these, 648 (57.2%) were female, 747 (65.9%) were White, and 988 (87.2%) were non-Hispanic. The majority of patients (770, 68%) were discharged home from the emergency department without a diagnosis of acute appendicitis. Neither CT (25.7% to 24.8%; P = 0.794) nor ultrasound (59.5% to 59.7%; P = 1.000) utilization significantly changed postimplementation. Total ED median LOS increased significantly (333.50 to 362.00 minutes; P = 0.011). Significant factors associated with CT utilization included fever, migration of pain, and right lower quadrant tenderness. Significant factors associated with appendicitis diagnosis included right lower quadrant pain, nausea/vomiting, migration of pain, and peritoneal signs. Overall, the appendicitis evaluation algorithm did not significantly decrease CT utilization or LOS. Equivocal grade 2 or 3 ultrasound finding rates were high, likely leading to higher rates of CT utilization and increasing LOS.

Perceived value of computed tomography imaging for patients with inflammatory bowel disease in the emergency department: a Canadian survey.

There are high rates of computed tomography (CT) utilization in the emergency department (ED) for patients with inflammatory bowel disease (IBD), despite guidelines recommending judicious use. We performed a national survey to better understand perceptions and practice patterns of Canadian physicians related to CT imaging in the ED. Our survey was developed by a multistep iterative process with input from key stakeholders between 2021 and 2022. It evaluated Canadian gastroenterologists', surgeons', and emergency physicians' (1) perceived rates of IBD findings detected by CT, (2) likelihood of performing CT for specific presentations and (3) comfort in diagnosing IBD phenotypes/complications without CT. A total of 208 physicians responded to our survey: median age 44 years (IQR, 37-50), 63% male, 68% academic, 44% emergency physicians, 39% gastroenterologists, and 17% surgeons. Compared with emergency physicians and surgeons, gastroenterologists more often perceived that CT would detect inflammation alone and less often IBD complications. Based on established rates in the literature, 13 (16%) gastroenterologists, 33 (40%) emergency physicians, and 21 (60%) surgeons overestimated the rates of at least one IBD complication. Although most physicians were more comfortable diagnosing inflammation compared to IBD complications without CT, gastroenterologists were significantly less likely to recommend CT imaging for non-obstructive/penetrating presentations compared with emergency physicians and surgeons with results that varied by IBD subtype. This national survey demonstrates differences in physician perceptions and practices regarding CT utilization in the ED and can be used as a framework for educational initiatives regarding appropriate usage of this modality.

Improved detection of air-filled lesions using computed tomography in dogs with recurrent spontaneous pneumothorax through reduction of pulmonary atelectasis via positive pressure ventilation.

Spontaneous pneumothorax in dogs is predominantly caused by the rupture of air-filled lesions, such as bullae or blebs. The efficacy of Computed Tomography (CT) in detecting these lesions has been deemed limited due to its reportedly low sensitivity. This retrospective, cross-sectional study investigates the utility of CT in eight dogs diagnosed with recurrent pneumothorax, all of which had surgical confirmation of the cause of the pneumothorax. Thoracic radiographs were obtained before and the day following the CT studies. Initially, a CT study was conducted without positive pressure ventilation (pre-PPV CT). Subsequent CT studies were performed post-evacuation of pneumothorax and with positive pressure ventilation of 15 cmH2O until lung atelectasis was resolved (post-PPV CT). The pre-PPV CT and post-PPV CT images were anonymized and reviewed by two board-certified radiologists. The presence and morphology of air-filled lesions were evaluated on all images. Surgical findings were recorded and compared to the CT findings. Air-filled lesions were detected in 5 out of 8 dogs in the pre-PPV CT studies and in all 8 dogs in the post-PPV CT studies. The CT findings of air-filled lesions were consistent with surgical findings. None of the dogs showed increased severity of pneumothorax in radiographs taken the day following the CT studies. The study concludes that the resolution of lung atelectasis by evacuation of pneumothorax and positive pressure ventilation during CT studies is feasible and enhances the detection of air-filled lesions in dogs with recurrent spontaneous pneumothorax. This could potentially aid in improving surgical planning.

Association between emergency department computed tomography utilization rate and patient satisfaction: A clinician level analysis across a regional healthcare system

BackgroundComputed Tomography (CT) use is common during emergency department (ED) visits, and ED clinicians may order CTs for myriad reasons, including desire to improve patient satisfaction. ObjectivesTo determine if greater CT use by ED clinicians is associated with increased average patient satisfaction scores for those providers. MethodsThe study took part across 15 non-pediatric hospitals in a regional healthcare system. We compared clinician CT use rate for adult patients discharged from the ED with Net Promotor Score (NPS) for that clinician. NPS is a patient satisfaction metric with a possible range of scores from −100 to +100. We included ED clinicians (physicians and non-physician providers (NPPs)) with at least 500 adult patient encounters resulting in ED discharge from July 2020 through June 2022. We assessed for an association between CT use and clinician NPS using univariate and multivariate regression models. ResultsAcross the 15 hospitals, 166 physicians and 74 NPPs were included in the study. The median CT rate was 25.7 ​% (range 7.1 ​%–48.9 ​%). In both models, there was a statistical association between CT utilization and NPS such that every absolute increase in CT use by 10 ​% resulted in a 3-point improvement in provider NPS on the 200-point scale. When examined in a sensitivity analysis, none of the hospitals individually showed this same association. ConclusionsWe found a 26 ​% rate of CT use by clinicians for adults discharged from the ED, with wide variation in utilization between clinicians. There was a small and inconsistent association between CT utilization and clinician specific NPS scores.