Emergency Radiology Research Articles

Associations between 24/7 workforce coverage, organizational challenges, and well-being of emergency radiologists: a national survey.

The last decade has seen a surge in the demand for imaging exams in emergency radiology (ER), necessitating an evolution in organizational systems for departments offering round-the-clock care, while safeguarding patient care quality and physician well-being to prevent burnout. To develop a nationwide overview of ER organizations in France and identify structures that promote job satisfaction. Two surveys were sent to 709 radiological centers across France from March to June 2022, inquiring about organizational aspects and quality of life (QOL), incorporating four validated QOL questionnaires. The organization of each center was mapped, and correlations between respondent characteristics and mental health were analyzed using Pearson's and Wilcoxon tests. A total of 284 centers answered the organizational survey, with a response rate of about 41.6%. Among them, there were 32 university hospitals, 208 general hospitals, 2 teaching army hospitals, and 42 private facilities. Of these, night-time operations showed 14% on-site coverage, 12% on-call from home, 69% utilized external teleradiology, and 4% used in-house teleradiology. These trends persisted over weekends and holidays. Regarding the quality of working life, academic, general, and private radiologists are more satisfied with their practice compared to trainees. Depersonalization, part of the three dimensions of burnout, was high in every class, at 60% (n = 210/350). Outside of university hospitals, most radiology centers in France no longer have on-site radiologists during off hours. Residents are prone to lower job satisfaction and quality of life than more experienced radiologists. The survey illustrates how French ER is structured, pointing out the escalating significance of teleradiology and noting that radiologists generally experience high job satisfaction while also confronting typical organizational challenges. The need for continuous radiology coverage comes with unique logistical challenges, especially in ER. Night shifts show a significant reliance on teleradiology services, especially by external companies. Pay, shift patterns, and seniority affect the well-being of emergency radiologists, particularly the residents.

OSL dosimetry with table salt for mass screening of individual doses during radiological or nuclear emergencies

The ongoing war in Ukraine is associated with unprecedented radiological threats to the public in Ukraine and the neighboring countries. This calls for fundamental revision of the preparedness plans and established approaches to radiological monitoring of the populations affected by potential radiological emergencies. Dosimetric information will be needed for triage of victims and support to decision makers for prioritizing mitigation actions. Retrospective dosimetry methods strive to find a solution that would achieve this and enable fast and accurate feedback with information on individual doses to the concerned public. All known approaches to emergency dosimetry, both in biological and physical (instrumental) dosimetry have limitations, in particular – preventive cost, limited availability of samples for analysis, insufficient sensitivity (high dose threshold) and/or stability of radiation-induced markers (i.e. high fading). At the moment each of considered dose assessment methods possesses some combination of the aforesaid limitations. A suggestion to overcome these deficiencies is to use ordinary table salt (NaCl), read by optically stimulated luminescence (OSL), with well-known good dosimetric properties, and which allows anybody to prepare improvised individual dosemeters at home to be carried like a regular personal dosemeter until readout of the OSL signal is possible. This paper considers pros and cons of the use of NaCl as an OSL dosemeter in an emergency situation, with emphasis on practical aspects of its application for mass dose assessments for individuals among populations affected by radiological emergency situations.

Calibration for in vivo monitoring of thyroid of exposed population at risk of intakes of radioiodine isotopes due to a nuclear or radiological emergency

This work presents an improvement of the calibration of a broad energy germanium detector (BEGe) using age dependent neck-thyroid phantoms for thyroid monitoring of exposed individuals (workers and members of the public), allowing the detection and quantification of incorporated radioiodine isotopes in a nuclear medicine frame or in case of accident of a nuclear reactor.A BEGe detector was calibrated using a family of age-dependent thyroid-neck phantoms that simulate thyroids of 1, 5, 10, 15 year-old children and (male and female) adults, based in ICRP Publication 8 (ICRP, 2002) and ANSI 13.44 Standard (ANSI, 2014).The calibration of the BEGe detector for all neck phantoms was performed with the same counting geometry, centered under the BE Ge detector and at the same distance of 15 cm. Using same counting parameters allows to compare efficiency curves of thyroid monitoring depending with age. The in vivo measurements with the BE Ge detector allow to identify X rays and gamma emissions between 10 and 1000 keV with a great resolution and to quantify activities of radioiodine isotopes in the thyroid of exposed population.Calibration curves have been obtained for different sizes of the thyroid, depending with age. This study of counting efficiency using the main energies of the most important radioiodine isotopes result in accurate activity calculations. Detection limits were obtained for each radioiodine isotope, using blank phantoms of each age.

Comparison of dose measurements using environmental and personal dosimeters in real scenarios to deal with radiological and nuclear emergencies

Assessment of dose rates with environmental dosimeters typically takes much longer than with personal dosimeters. This work compares the results of two dosimetry systems with the aim of showing how to use personal dosimeters as environmental dosimeters in the case of radiological and nuclear emergencies, when the processing of a large number of dosimeters is essential. For this purpose, a long-term study has been carried out on the variability of the response of personal (CaSO4:Tm) and environmental (LiF:Mg,Cu,P) dosimeters corrected for the influence of secondary cosmic radiation (SCR). Comparison with each other provided a correlation factor between measurements made using these two passive dosimetry systems. The SCR response of the personal dosimeter was found to be 0.41 (σ = 0.03) significantly lower than 1.24 (Uk=2 = 0.12) that of the environmental dosimeter, which notably affects the comparison of dose measurements made with these two systems in free field. The correlation factor found of 0.86 (σ = 0.08) between the personal and environmental dosimeters allows preparing the personal dosimeters to be used in environmental radiation monitoring.

Spectrum of Cognitive Biases in Diagnostic Radiology.

Cognitive biases are systematic thought processes involving the use of a filter of personal experiences and preferences arising from the tendency of the human brain to simplify information processing, especially when taking in vast amounts of data such as from imaging studies. These biases encompass a wide spectrum of thought processes and frequently overlap in their concepts, with multiple biases usually in operation when interpretive and perceptual errors occur in radiology. The authors review the gamut of cognitive biases that occur in radiology. These biases are organized according to their expected stage of occurrence while the radiologist reads and interprets an imaging study. In addition, the authors propose several additional cognitive biases that have not yet, to their knowledge, been defined in the radiologic literature but are applicable to diagnostic radiology. Case examples are used to illustrate potential biases and their impact, with emergency radiology serving as the clinical paradigm, given the associated high imaging volumes, wide diversity of imaging examinations, and rapid pace, which can further increase a radiologist's reliance on biases and heuristics. Potential strategies to recognize and overcome one's personal biases at each stage of image interpretation are also discussed. Awareness of such biases and their unintended effects on imaging interpretations and patient outcomes may help make radiologists cognizant of their own biases that can result in diagnostic errors. Identification of cognitive bias in departmental and systematic quality improvement practices may represent another tool to prevent diagnostic errors in radiology. ©RSNA, 2024 See the invited commentary by Larson in this issue.

Preparedness and emergency response strategies for chemical, biological, radiological and nuclear emergencies in disaster management: A qualitative systematic review

AbstractDisaster management, mainly related to chemical, biological, radiological and nuclear (CBRN) incidents, is a critical field that requires constant evaluation to improve preparedness and response strategies. This review synthesises evidence on global health sector strategies for CBRN preparedness, gathering lessons to enhance policymaking for future response and readiness. This review included original English and French research addressing healthcare preparedness for CBRN threats. Database searches, such as EBSCO, ScienceDirect, PubMed, Ovid, Lissa, and Santécom, were conducted until November 2022. The Joanna Briggs Institute's tools were utilised to assess the risk of bias. Al‐Raayan® and Nvivo® version 12 software were employed for the review and analysis. 57 articles in English and 6 in French met the inclusion criteria. The analysis identified numerous strategies, concentrating on chemical and biological incidents (Chemical and biological bioterrorism: n = 27; Epidemics and Outbreak: n = 15). “Hospitals”, “responsibility”, and “health” emerged as prominent keywords, emphasising institutional roles and health outcomes in CBRN incidents preparedness. Key findings highlighted the need for a unified global definition of bioterrorism to align international efforts. Hospital‐level initiatives were emphasised as the foundation for national preparedness, emphasising specialised training, community engagement, and robust coordination mechanisms. Geographical variability in response strategies was noted, necessitating a harmonised global approach. Continuous research, epidemic management, and addressing radiological/nuclear threats emerged as crucial elements. Among others, strategies defined under “Emergency Response Preparedness” and “Intersectoral Policy Development” outlined comprehensive preparedness contexts for CBRN incidents. The review suggests an imperative shift towards building collaborative networks and enhancing health sector operational readiness to mitigate the impacts of CBRN incidents.

Introducing AEM-RADS: A novel reporting and data system for abdominal emergencies.

The Reporting and Data System (RADS) has proven successful in various medical settings, but a standardized reporting system for abdominal emergencies is lacking. In this study, the Abdominal Emergency Reporting and Data System (AEM-RADS) for urgent findings on abdominal CT scans is introduced to address the need for consistency in emergency radiology. In this prospective observational study, conducted over a six-month period, the urgency of abdominal CT scans was assessed using the proposed AEM-RADS scoring system. The committee developed a scale ranging from AEM-RADS 1 (normal) to AEM-RADS 5 (urgent disease). Interobserver agreement between two observers with different experience was evaluated, and robust AEM-RADS reference values were established by radiologists who were not observers. Statistical analysis used mean, standard deviations and Kendall's tau analysis for interobserver agreement. Among 2656 patients who underwent CT for abdominal emergencies, the AEM-RADS distribution was 17.50% AEM-RADS 1, 28.57% AEM-RADS 2, 7.22% AEM-RADS 3, 35.61% AEM-RADS 4, and 11.06% AEM-RADS 5. Interobserver agreement was high, especially for urgent and emergent cases (p < 0.0001). Notable discrepancies were observed in AEM-RADS categories 2C-D and 3B-C, emphasizing the influence of radiologists' experience on interpretation. However, the interobserver agreement for both AEM-RADS 2C-D and 3B-C were statistically significant (p < 0.001). AEM-RADS showed promising reliability, particularly in identifying urgent and emergent cases. Despite some inter-observer discrepancies, the system showed potential for standardized emergency workups. AEM-RADS could significantly enhance diagnostic accuracy in abdominal emergencies and provide a structured framework for shared decision-making between clinicians and radiologists.0.

Awareness and preparedness level of medical workers for radiation and nuclear emergency response.

Radiological science and nuclear technology have made great strides in the twenty-first century, with wide-ranging applications in various fields, including energy, medicine, and industry. However, those developments have been accompanied by the inherent risks of exposure to nuclear radiation, which is a source of concern owing to its potentially adverse effects on human health and safety and which is of particular relevance to medical personnel who may be exposed to certain cancers associated with low-dose radiation in their working environment. While medical radiation workers have seen a decrease in their occupational exposure since the 1950s thanks to improved measures for radiation protection, a concerning lack of understanding and awareness persists among medical professionals regarding these potential hazards and the required safety precautions. This issue is further compounded by insufficient capabilities in emergency response. This highlights the urgent need to strengthen radiation safety education and training to ensure the well-being of medical staff who play a critical role in radiological and nuclear emergencies. This review examines the health hazards of nuclear radiation to healthcare workers and the awareness and willingness and education of healthcare workers on radiation protection, calling for improved training programs and emergency response skills to mitigate the risks of radiation exposure in the occupational environment, providing a catalyst for future enhancement of radiation safety protocols and fostering of a culture of safety in the medical community.

Unrecognized bone fractures of the extremities in Emergency Radiology: the invisible become visible on 3D 80 micron

PurposeIn the last few years CBCT’s applications have expanded, especially in the field of musculoskeletal. In this study, we aim to analyze the diagnostic value and the use of CBCT in Emergency Radiology for the evaluation of extremity trauma.MethodsThe present retrospective study included a total of 72 distal limb trauma cases who were admitted in the Emergency Radiology Department of “Policlinico Riuniti di Foggia” during September 2022 to December 2023. All the cases required further medical diagnostic investigation after an initial examination CR. Among these, 12 were excluded for suspected poly-traumas and MDCT was directly performed. Of the 60, divided into 2 groups, 42 had negative or non-diagnostic CR result, and CBCT was performed as second-level exam, 18 with a fracture confirmed by CR underwent CBCT for surgical planning.ResultsIn the first group, 17 (40.5%) had negative CR results, and 25 (59.5%) had doubtful/non-diagnostic CR results. 25 (59.5%) presented a positive CBCT exam for fracture. In the second group, anyone required further diagnostic investigations for orthopedic surgery.ConclusionsThanks to high spatial resolution, low radiation dose, fast acquisition, and its three-dimensionality in space (3D), CBCT could be the first investigation in the cases of fractures clinically suspicious in locations with bone overlap.

Medicaid Acceptance Varies by Physician Seniority and Specialty in California.

Given varied insurance acceptances and differing pay between insurances, our objective was to examine the number of California physicians enrolled in Medicare and Medicaid (Medi-Cal), stratified by specialty and graduation year. Medi-Cal and Medicare providers were extracted from publicly available databases (Centers for Medicare & Medicaid Services and California Health and Human Services) and were subsequently merged into one dataset using National Provider Identifier. From there, we stratified physicians by specialty and graduation year. We found that emergency medicine, radiology, pathology, anesthesiology, general surgery, and internal medicine had the highest percent of Medi-Cal-accepting physicians, whereas dermatology, psychiatry, physical medicine & rehabilitation, and plastic & reconstructive surgery physicians had the lowest. There also appears to be an inverse relationship between acceptance of Medi-Cal and earlier year of graduation (P < 0.05). This study demonstrated striking variability in Medi-Cal acceptance based upon physician years in practice and specialty. Older, experienced physicians, as well as physicians of certain specialties, are less likely to accept Medi-Cal.

CETARS/CAR Practice Guideline on Imaging the Pregnant Trauma Patient.

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently.

Improved differentiation of cavernous malformation and acute intraparenchymal hemorrhage on CT using an AI algorithm

This study aimed to evaluate the utility of an artificial intelligence (AI) algorithm in differentiating between cerebral cavernous malformation (CCM) and acute intraparenchymal hemorrhage (AIH) on brain computed tomography (CT). A retrospective, multireader, randomized study was conducted to validate the performance of an AI algorithm in differentiating AIH from CCM on brain CT. CT images of CM and AIH (< 3 cm) were identified from the database. Six blinded reviewers, including two neuroradiologists, two radiology residents, and two emergency department physicians, evaluated CT images from 288 patients (CCM, n = 173; AIH, n = 115) with and without AI assistance, comparing diagnostic performance. Brain CT interpretation with AI assistance resulted in significantly higher diagnostic accuracy than without (86.92% vs. 79.86%, p < 0.001). Radiology residents and emergency department physicians showed significantly improved accuracy of CT interpretation with AI assistance than without (84.21% vs. 75.35%, 80.73% vs. 72.57%; respectively, p < 0.05). Neuroradiologists showed a trend of higher accuracy with AI assistance in the interpretation but lacked statistical significance (95.83% vs. 91.67%, p = 0.56). The use of an AI algorithm can enhance the differentiation of AIH from CCM in brain CT interpretation, particularly for nonexperts in neuroradiology.

Radiological or nuclear emergency OSL dosimetry using commonplace salt

During recovery phases following a nuclear or radiological incident, it is crucial to assess the radiation exposure of both the general public and responders. This assessment is vital for directing protective actions and for conducting subsequent analyses of the incident's impact. Several methods have been employed at different timescales after an incident, including assessments based on measurements of materials present at the time of the incident. Common salt has previously been shown to have potential for retrospective dosimetry in the μGy-mGy dose range using portable OSL instruments. This study aims to explore the effects of sample storage under light and dark conditions on OSL signals. The OSL signals indicate a brief decrease in luminescence during the initial days after irradiation, followed by a gradual rise with extended storage. The period from 8 days to 64 days is characterized by relatively stable results, which encompass a significant portion of the timeframe relevant for dose estimation during both the early and later phases of responding to radiological emergencies. Light exposure (simulated daylight) results in an extremely rapid loss of OSL signals. Results are discussed with reference to TL measurements of associated trapping systems which provide insight into potential zeroing mechanisms and the observed fading behaviour. The results are sufficiently favourable to conclude that these characteristics, together with the widespread availability and low cost of household salt, support its use for prompt emergency assessment and as a retrospective dosimeter, below 100 μGy.

Emergency department imaging utilization post-transcatheter aortic valve replacement: single institution 7-year experience

PurposeThis study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR).MethodsA retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified.ResultsOf the 146 post-TAVR patients, there were 168 ED visits within 30 days. The median time to ED after TAVR was 12 days. Respiratory symptoms were the most common complaint (27%). Neurological (23%) and cardiovascular symptoms (18%) followed. Cross-sectional imaging was conducted 250 times across visits, with an average of 1.7 scans per patient. CTs were most frequently used, followed by ultrasounds, especially echocardiograms and duplex extremity vasculature ultrasounds. 30.1% of patients had acute findings from imaging. Specific findings included heart failure (5.5%), access site complications (5.5%), pneumonia (5.5%), intracranial pathologies (3.4% for strokes and 0.7% for hematoma), and pleural effusion (3.4%). Echocardiograms and CTA chest were most associated with significant acute findings.ConclusionOur study highlights the vital role of early and accurate imaging in post-TAVR patients within 30 days post-procedure. As transcatheter approaches rise in popularity, emergency radiologists become instrumental in diagnosing common post-procedural presentations. Continued research is essential to devise post-discharge strategies to curtail readmissions and related costs. Proper imaging ensures prompt, effective care, enhancing overall patient outcomes.

A calibration methodology for the novel radioluminescence detector systems

Radioluminescence mapping using well-characterized and optimized optical systems is an effective method for localizing contamination with alpha-emitting radionuclides. To apply this novel approach to radiological emergency management, nuclear safeguards, nuclear decommissioning, and nuclear forensics, an established traceability chain is required. This work presents the development and implementation of a novel calibration methodology to provide valuable information about, and confidence in, the performance of radioluminescence detection systems. The proposed calibration methodology is based on two complementary approaches: (a) application of well-characterized activity standards to establish a traceable relationship between radioluminescence intensity and alpha activity, and (b) use of all optical radiation-based devices that, when calibrated against an alpha activity standard, simulate the radioluminescence induced in nitrogen (N2) and nitric oxide (NO) gases by alpha particles in specific spectral regions. A dedicated 210Po alpha activity standard with a narrow peak of less than 32keV FWHM at 5.3MeV has been developed and used to characterize a lens-based radioluminescence detection system in terms of its sensitivity to alpha-induced radioluminescence in different atmospheres (air, N2, N2 ＋ NO mixture) in the UV-A and UV-C (solar blind) spectral regions. The characterized lens system was then used as an intermediary transfer device to cross-calibrate two portable integrating sphere-based radiance standards designed to simulate radioluminescence in the UV-A and UV-C spectral regions. Both radiance standards can be used as transfer standards simulating up to 510MBq when used in the UV-A and up to 8.7GBq when used in the UV-C spectral regions. They substantially simplify routine quality control of radioluminescence detection systems by eliminating the need for open alpha sources, which are always associated with strict radiation safety precautions. Furthermore, since radiance standards can operate in a wide range of intensities, linearity and detection limits of radioluminescence detectors can be readily determined. The design, construction, radiometric characterization, and calibration of dedicated transfer standards, as well as the development of new calibration procedures for radiometric traceability of radioluminescence detection systems, will enable appropriate accident and post-accident radiation measurements that will lead to more effective countermeasures and better protection of people, wildlife, and the environment.

Radiology Department Disaster Preparedness: Practice, Strategies and Emergency Response

In order to respond effectively to any radiological emergencies, the implementation of disaster management practices is an essential and invaluable aspect. It can be difficult to know in advance exactly what you will be facing when you go to help people in a disaster situation brought about by hurricanes, earthquakes and other events, but the more compact medical technology you can bring in with you, the more you can accurately diagnose and assist those in need. Our disaster plans need to be programmatic, flexible, and should be continuously reviewed and updated. Within a few minutes of a disaster operationalize hospital support for the initial treatment of several injured patients and for ongoing care up to many hours is required. The Radiology Department is at the forefront of patient care in emergency situations, such as mass casualty incidents and natural disasters, providing critical diagnostic services to prioritize and triage patient needs. Radiological imaging is critical for improving patient outcomes and lowering morbidity and mortality, from detecting potentially fatal injuries to guiding surgical procedures. Radiologic technologists, radiologists, nurses, and other paramedic staff must actively participate in patient care. This paper provides an overview of the comprehensive strategy needed to maximize the radiology department’s preparedness and response for disasters.

Role of ChatGPT 3.5 in emergency radiology, with a focus on cardiothoracic emergencies: Proof with examples

Role of ChatGPT 3.5 in emergency radiology, with a focus on cardiothoracic emergencies: Proof with examples

Factors of Increasing Intention to Use Information Systems

This research is based on information from the IT division regarding non-performance of implementation since the use of HIS at RSU Bhakti Asih began in 2005 until 2022, which has changed three times and none of the implementation achievements for the three HIS have ever reached 100 percent. The aim of this research is to empirically reveal the influence of training and utility on intention to use HIS with work motivation as a mediating variable. This type of research is quantitative with a causality design. The population used is health workers consisting of outpatient nurses, inpatient nurses, emergency room nurses, pharmacy departments, laboratory departments and radiology departments. The sampling technique used proportional sampling, with calculations using the Slovin formula with an error rate of 5 percent, so that the sample size was determined to be 175 respondents. Data collection analysis techniques use survey methods, and data analysis techniques use SEM with the help of the Lisrel program and three box method analysis. The results of the analysis prove that training and utility influence the intention to use HIS with work motivation as a mediator, training influences utility, training and utility influence work motivation and intention to use HIS, and work motivation influences intention to use HIS and is also able to provide positive intervention on the influence training and utility on intentions to use HIS, so that with work motivation, the effectiveness of training and utility will be higher in increasing intentions to use HIS.

A Study on the Radiological Emergency Plan for Decommissioning Nuclear Power Plant

A Study on the Radiological Emergency Plan for Decommissioning Nuclear Power Plant

Assessment of existing emergency dosimetry protocols for electronic devices - a feasibility study to support emergency response

This study examines the potential use of components from electronic appliances as emergency dosimeters. The research aims to evaluate the accuracy and reliability of these electronic components in providing precise dose estimations during radiological incidents. Surface mounted devices (SMD) resistors were extracted from a previously irradiated CD-ROM and laptop, as well as pieces of the laptop's screen glass. The irradiation was carried out using a Co-60 source and MTS detectors (LiF:Mg,Ti) were used for the reference. The optically stimulated signal from the element samples was measured using a standardized protocol. Accidental dose was reconstructed using elements extracted from printed circuit boards of a CD-ROM and a laptop using the universal signal fading correction of SMDs extracted from mobile phones. The results showed high efficiency even seven days after exposure. Additionally, the results obtained from the tested SMD samples were comparable to those obtained from the MTS detectors. However, the study found that laptop screen glass samples were slightly overestimated, indicating a need for further investigation into their non-radiation induced signals and fading characteristics.In summary, the study demonstrates that certain laptop and CD-ROM components have dosimetric potential as alternative dosimeters in emergency situations compared to mobile phones, emphasizing their replaceability and low cost. The findings support the feasibility of incorporating electronic components for rapid dose assessment and triage in radiological emergencies, thereby contributing to enhanced emergency response preparedness.