Trauma CT Research Articles

RSNA 2023 Abdominal Trauma AI Challenge Review and Outcomes Analysis.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To evaluate the performance of the winning machine learning (ML) models from the 2023 RSNA Abdominal Trauma Detection Artificial Intelligence Challenge. Materials and Methods The competition was hosted on Kaggle and took place between July 26, 2023, to October 15, 2023. The multicenter competition dataset consisted of 4,274 abdominal trauma CT scans in which solid organs (liver, spleen and kidneys) were annotated as healthy, low-grade or high-grade injury. Studies were labeled as positive or negative for the presence of bowel/mesenteric injury and active extravasation. In this study, performances of the 8 award-winning models were retrospectively assessed and compared using various metrics, including the area under the receiver operating characteristic curve (AUC), for each injury category. The reported mean values of these metrics were calculated by averaging the performance across all models for each specified injury type. Results The models exhibited strong performance in detecting solid organ injuries, particularly high-grade injuries. For binary detection of injuries, the models demonstrated mean AUC values of 0.92 (range:0.91-0.94) for liver, 0.91 (range:0.87-0.93) for splenic, and 0.94 (range:0.93-0.95) for kidney injuries. The models achieved mean AUC values of 0.98 (range:0.96-0.98) for high-grade liver, 0.98 (range:0.97-0.99) for high-grade splenic, and 0.98 (range:0.97-0.98) for high-grade kidney injuries. For the detection of bowel/mesenteric injuries and active extravasation, the models demonstrated mean AUC values of 0.85 (range:0.74-0.73) and 0.85 (range:0.79-0.89) respectively. Conclusion The award-winning models from the AI challenge demonstrated strong performance in the detection of traumatic abdominal injuries on CT scans, particularly high-grade injuries. These models may serve as a performance baseline for future investigations and algorithms. ©RSNA, 2024.

The RSNA Abdominal Traumatic Injury CT (RATIC) Dataset.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. The RSNA Abdominal Traumatic Injury CT (RATIC) dataset contains 4,274 abdominal CT studies with annotations related to traumatic injuries and is available at https://imaging.rsna.org/dataset/5 and https://www.kaggle.com/competitions/rsna-2023-abdominal-trauma-detection. ©RSNA, 2024.

A-102 Clinical Evaluation of Novel Markers in Brain Injury

Abstract Background Traumatic brain injury (TBI) is a significant health concern affecting individuals of all ages, demanding precise diagnostic methodologies to guide effective clinical management. According to the 2010 definition, a TBI results from an external force causing an alteration in brain function or other evidence of brain pathology. Current diagnostic tools, i.e. CT scans and the Glasgow Coma Scale (GCS), are inefficient because they are time and labor intensive. The need for rapid diagnostic tools is underscored by the drawbacks of existing methods, such as CT scans, which are expensive, expose patients to large amounts of radiation, and lead to delayed treatment. Recent advances in TBI diagnosis involve novel biomarkers, such as Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-Terminal Hydrolase L1 (UCH-L1), which have shown promise in revolutionizing the assessment of head traumas. GFAP, a glial-specific protein, is elevated in circulation after a TBI, distinguishing it from multi-trauma patients without brain injuries. UCH-L1, found in neurons, is significantly elevated in TBI patients compared to uninjured controls. A 2021 study further supports the clinical effectiveness of these biomarkers, demonstrating their capacity to exclude CT-positive injury in acute TBI cases. The primary aim of this study is to explore the clinical utility of the Abbott Alinity TBI assay, specifically biomarkers GFAP and UCH-L1, in emergency department patients with a history of head trauma. Methods A retrospective study involving 238 emergency department patients with a history of head trauma and noncontrast CT scans was conducted using the Abbott Alinity TBI assay. Serum samples were collected, and biomarker values were established and compared to CT scan results. The study was comprised of 94 females and 144 males spanning various age groups. The GFAP and UCH-L1 cutoffs used were FDA approved, at 35.0 ng/L and 400.0 ng/L, respectively. If either marker was above the cutoff the patient ruled at risk for TBI. Results Results demonstrated the assay correctly identified all CT-positive cases (100% sensitivity), placing them in the rule-in group, while identifying 44 patients with a 0 chance of TBI. The negative predictive value for the TBI overall was 100% (95% CI: 91.96%-100%). The GFAP assay alone identified 30/31 positive CT scans, reporting a 98.77% (95% CI: 92.03%-99.82%) negative predictive value. The UCH-L1 assay reported 26/31 positive CT scans with a negative predictive value of 94.68% (95% CI: 88.71-97.58%). Analyzing the data revealed the TBI assay would have reduced CT scans by 18.5%. Conclusions The results of this study did show a potential reduction in the number of patients sent to CT making it a valuable tool for triaging patients presenting with head trauma; however, the complexity of neurological problems may lead to increased false positives, reducing assay specificity. Despite this limitation, this study concludes that the GFAP and UCH-L1 markers could be used to triage patients into CT rule-out and rule-in groups, thereby streamlining clinical management. In conclusion, this assay, incorporating GFAP and UCH-L1 biomarkers, presents as a promising diagnostic tool for emergency departments.

Time of Brain Imaging In Patients With An Acute Traumatic Intracranial Haemorrhage

Abstract Background We observed variation in timing of CT brain imaging in patients presenting with a history of trauma. The objective of this audit was to determine adherence to local ED CT Head Criteria in patients with a confirmed traumatic ICH. Methods Retrospective point prevalence audit of patients with a confirmed intracranial haemorrhage over a five-month period using our neurotrauma work-stream data. Exploration of CT timing between Criteria A (within 60 minutes) and Criteria B (within 8 hours). Characteristics reviewed included Gender, Age, Time of presentation to ED, Day of Arrival, GCS on presentation, Mechanism of Injury and Time of CT completion. Results 68 patients over the five-month period had a confirmed ICH: 48 male, 20 female. The median age was 62 years (range 17-97). Falls of less than 2 metres were the most frequent cause of injury (n=44, 65%), with 60% of these occurring in patients aged over 65 years of age. 67% (n=31) of patients meeting Criteria A did not have a CT Brain completed within 60 minutes. 14% (n=3) of patients meeting Criteria B did not have a CT Brain completed within 8 hours. Of patients meeting criteria who did not have a timely CT, 11 patients presented out of hours. Patients aged less than 65 years of age were less likely to meet target CT timing; 71% (n=24). Conclusion This audit highlights that only 33% of patients meeting Criteria A had brain imaging within one hour. Older adults were more likely to meet target CT timing than younger adults. Lack of ED access to radiology out of hours was deemed to be the main barrier to meeting target CT timing. We are working alongside our radiology department to secure no discussion trauma CT scans in ED out of hours. We plan to re-audit following the implementation of this change.

SP7.5 - Time to CT for Acute General Surgery and Trauma in patients undergoing emergency laparotomy. A major trauma centre experience

Abstract Introduction In our institution separate care pathways exist for patients presenting with major trauma and acute abdomen (AA). Trauma patients activate a Consultant led trauma team attendance on arrival and CT imaging within 30 minutes where indicated. Our acute abdomen pathway attracts ST3+ general surgical review within 2 hours of emergency department referral and CT within a further 1 hour. We aimed to compare the two laparotomy cohorts with respect to clinical outcomes. Methods A retrospective analysis was performed on patients that underwent an emergency laparotomy following CT at our institution between December 2020 and February 2022. Patients were identified from the NELA and TARN databases. Results 66 trauma and 64 AA patients were identified. The mean time to CT in trauma was 56.1 minutes ± 24.8 and in AA 390.7 minutes ± 306.1 (p<0.001). There was no difference in length of ITU stay (mean days 3.1 ± 8.1 vs 4.2 ±9.8 p=0.260) or hospital stay (mean days 13.7 ± 19.2 vs 13.8 ±11.7 p=0.494). no correlation between time to CT and length of hospital stay (r=0.233 p=0.97) or ITU stay (r=0.224 p=0.964) in trauma patients or AA (r=0.217 p=0.58 and -0.001 p=0.562 respectively for hospital and ITU stays) was detected. However, there was a trend towards lower mortality in the trauma cohort (3% vs 7.8% p=0.227). Conclusion Trauma patients were scanned quicker than acute abdomen presentations likely due to greater personnel resource and better care pathways. This was associated with a trend towards lower mortality because of earlier pathology detection and Consultant directed care from hospital arrival.

Correlation Between the Revised Physiological Trauma Score and CT Scan Results.

Background Trauma-scoring systems are used to triage patients and assist in clinical decision-making. Physiological trauma scores are used for quantitative evaluation of injury severity. However, only a few, such as the Revised Physiological Trauma Score (rPTS), have been proven effective in pre-clinical use. There is a constant need for clinical decision tools that aim to reduce the unnecessary use of CT scans among trauma patients. To our knowledge, no study has directly correlated the rPTS and CT findings. This study aimed to investigate whether the rPTS is correlated with CT scan results and can be used to decrease the use of CT. Methodology This retrospective chart review examined all patients who underwent a pan-CT for trauma in theEmergency Department of King Abdulaziz Medical City, Jeddah, from 2008 to 2012. Results We analyzed 235 patients. There was a significant difference in the mean rPTS between those with negative versus positive pan-CT scans (11.4 ± 1.3 vs. 10.9 ± 1.7, respectively; p = 0.032). Furthermore, the rate of positive CT scans was significantly higher in those with an rPTS <11 than those with an rPTS of 11 or 12 (87% vs. 74.1%, respectively; p = 0.044). However, 72.7% of patients with an rPTS of 12/12 had a positive pan-CT scan. Conclusions Despite the difference in the frequency of abnormal CT scans, too many patients with normal rPTS had abnormal CT findings. Therefore, the rPTS cannot be used to safely reduce the use of CT scans.

Thermal insulation does not hamper assessment of injuries in trauma CT scans.

The use of thermal insulations reduces the risk of hypothermia, therefore decreases the risk of death in trauma victims. The aim of the study was to assess whether thermal insulations cause artifacts, which may hinder the diagnosis of injuries, and how the used thermo-systems alter the radiation dose in polytrauma computed tomography. Computed tomography scans were made using the road accident victim body wrapped consecutively with 7 different covers. 14 injury areas were listed and evaluated by 22 radiologists. The radiation dose was measured using a dosimeter placed on the victim in the abdominal area. No significant artifacts in any of the tested covers were observed. The presence of few minor artifacts did not hinder the assessment of injuries. Certain materials increased (up to 19,1%) and some decreased (up to -30,3%) the absorbed radiation dose. Thermal insulation systems tested in this study do not cause significant artifacts hindering assessment of injuries in CT scans. Concern for artifacts and increased radiation dose should not be a reason to remove patients' thermal insulation during performing trauma CT-scanning.

670 Investigating Delay During Presentation of Trauma in Young Adults: A UK Major Trauma Centre Retrospective Audit and a Systematic Review of the Literature

Abstract Introduction The current evidence in major trauma highlights that delays at multiple points along the patient care pathway, from incident to surgery, are associated with decreased survival. The aim of this audit was to assess performance across select delay parameters in juveniles aged 16-18 presenting to an adult MTC service following a systematic review of the literature. Method Patient records were interrogated between 1/10/2022-1/3/2023 and audited against 3 national standards: (1) Ambulance Response and Transfer (7 and 45mins respectively) (2) Tranexamic Acid infusion (&amp;lt;3hrs) and (3) CT scan (&amp;lt;60mins). A systematic search was also performed using EMBASE and OVID databases (01/01/2005-/01/11/2023). All studies assessing impact of time to theatre in patients with acute trauma were considered. Results 32 consecutive patients (3F:29M) (median 18 years[16-18]) were identified within the audit period. 40%(n=13) presented following penetrating injury and 35%(n=11) following a road traffic accident. Mean time from incident to admission was 83mins[±36], from incident to tranexamic acid infusion 50mins[±35], and from admission to CT Trauma Series 61mins[+/-100]. Median length of stay was 4 days [IQR=5]. The systematic search yielded 25 studies which were included in the analysis. An Incident2Surgery framework is presented which highlights key time-critical points for diagnosis and intervention. Conclusions Local compliance to national standards for tranexamic acid infusion in appropriate patients and performance of trauma CT was excellent with poor compliance to ambulance arrival and transfer time. The proposed Incident2Surgery framework could be incorporated into mortality prediction and audit tools and assist in the assessment of interventions.

Photon-Counting Detector CT Virtual Monoenergetic Images in Cervical Trauma Imaging-Optimization of Dental Metal Artifacts and Image Quality.

The aim of this study was to analyze the extent of dental metal artifacts in virtual monoenergetic (VME) images, as they often compromise image quality by obscuring soft tissue affecting vascular attenuation reducing sensitivity in the detection of dissections. Neck photon-counting CT datasets of 50 patients undergoing contrast-enhanced trauma CT were analyzed. Hyperattenuation and hypoattenuation artifacts, muscle with and without artifacts and vessels with and without artifacts were measured at energy levels from 40 keV to 190 keV. The corrected artifact burden, corrected image noise and artifact index were calculated. We also assessed subjective image quality on a Likert-scale. Our study showed a lower artifact burden and less noise in artifact-affected areas above the energy levels of 70 keV for hyperattenuation artifacts (conventional polychromatic CT images 1123 ± 625 HU vs. 70 keV VME 1089 ± 733 HU, p = 0.125) and above of 80 keV for hypoattenuation artifacts (conventional CT images -1166 ± 779 HU vs. 80 keV VME -1170 ± 851 HU, p = 0.927). Vascular structures were less hampered by metal artifacts than muscles (e.g., corrected artifact burden at 40 keV muscle 158 ± 125 HU vs. vessels -63 ± 158 HU p < 0.001), which was also reflected in the subjective image assessment, which showed better ratings at higher keV values and overall better ratings for vascular structures than for the overall artifact burden. Our research suggests 70 keV might be the best compromise for reducing metal artifacts affecting vascular structures and preventing vascular contrast if solely using VME reconstructions. VME imaging shows only significant effects on the general artifact burden. Vascular structures generally experience fewer metal artifacts than soft tissue due to their greater distance from the teeth, which are a common source of such artifacts.

Automated volumetric evaluation of intracranial compartments and cerebrospinal fluid distribution on emergency trauma head CT scans to quantify mass effect.

Intracranial space is divided into three compartments by the falx cerebri and tentorium cerebelli. We assessed whether cerebrospinal fluid (CSF) distribution evaluated by a specifically developed deep-learning neural network (DLNN) could assist in quantifying mass effect. Head trauma CT scans from a high-volume emergency department between 2018 and 2020 were retrospectively analyzed. Manual segmentations of intracranial compartments and CSF served as the ground truth to develop a DLNN model to automate the segmentation process. Dice Similarity Coefficient (DSC) was used to evaluate the segmentation performance. Supratentorial CSF Ratio was calculated by dividing the volume of CSF on the side with reduced CSF reserve by the volume of CSF on the opposite side. Two hundred and seventy-four patients (mean age, 61 years ± 18.6) after traumatic brain injury (TBI) who had an emergency head CT scan were included. The average DSC for training and validation datasets were respectively: 0.782 and 0.765. Lower DSC were observed in the segmentation of CSF, respectively 0.589, 0.615, and 0.572 for the right supratentorial, left supratentorial, and infratentorial CSF regions in the training dataset, and slightly lower values in the validation dataset, respectively 0.567, 0.574, and 0.556. Twenty-two patients (8%) had midline shift exceeding 5 mm, and 24 (8.8%) presented with high/mixed density lesion exceeding >25 ml. Fifty-five patients (20.1%) exhibited mass effect requiring neurosurgical treatment. They had lower supratentorial CSF volume and lower Supratentorial CSF Ratio (both p < 0.001). A Supratentorial CSF Ratio below 60% had a sensitivity of 74.5% and specificity of 87.7% (AUC 0.88, 95%CI 0.82-0.94) in identifying patients that require neurosurgical treatment for mass effect. On the other hand, patients with CSF constituting 10-20% of the intracranial space, with 80-90% of CSF specifically in the supratentorial compartment, and whose Supratentorial CSF Ratio exceeded 80% had minimal risk. CSF distribution may be presented as quantifiable ratios that help to predict surgery in patients after TBI. Automated segmentation of intracranial compartments using the DLNN model demonstrates a potential of artificial intelligence in quantifying mass effect. Further validation of the described method is necessary to confirm its efficacy in triaging patients and identifying those who require neurosurgical treatment.

(O-B1) A Retrospective Cohort Study to Determine the Injury Prevalence of Cervical Spine Injuries in Elderly Patients Undergoing Full Trauma CT

(O-B1) A Retrospective Cohort Study to Determine the Injury Prevalence of Cervical Spine Injuries in Elderly Patients Undergoing Full Trauma CT

Contrast-enhanced Computed Tomography Versus Contrast and Non-contrast Enhanced Computed Tomography for Detecting Blunt Abdominal Injury

Objective: This study aimed to compare the diagnostic ability of contrast-enhanced computed tomography (CECT) and CECT combined with non-contrast computed tomography (NCT) for intraabdominal organ injury in patients with blunt abdominal injury.Material and Methods: Overall, 195 adult patients having had blunt abdominal trauma underwent CT at this institution; from 2016 and 2021. All CT images were retrospectively reviewed by two radiologists. The efficacy of detection of organ injuries and the degree of intra-abdominal injury were recorded. The radiologists scored their diagnostic confidence for each CT image dataset on a five-point scale: inter-observer agreement was also calculated.Results: All included patients underwent CT for blunt abdominal trauma. The most common cause of injury was motorcycle accident (59.5%), with patients being predominantly male: the mean patient age was 44 years. Hemoperitoneum was the most common CT finding, with a significantly higher detection rate on CECT combined with NCT than on CECT alone. There was no statistically significant difference in the diagnostic efficacy of the detected organ injury nor other types of organ injuries between CECT alone and CECT combined with NCT. Nevertheless, the accuracy of CECT in detecting hemoperitoneum may diminish in patients with severe fatty liver disease; especially in the perihepatic region.Conclusion: CECT alone is a potential tool for detecting abdominal injuries in patients with blunt trauma. NCT provides no additional benefits in detecting organ injury; except in cases of severe fatty liver disease. NCT is recommended as an optional protocol; particularly for patients with obesity.

THU673 Unusual Metastasis Of Differentiated Thyroid Carcinoma

Abstract Disclosure: M. Aiad: None. O.A. Aluko: None. B. Bhatt: None. Background: Papillary thyroid cancer (PTC) is the most common form of differentiated thyroid malignancy. Distant metastasis of PTC are rare and usually occur in the bones, lungs, and lymph nodes of the neck. Retinal and skin metastases are extremely rare. We present a case of PTC with metastasis to the distal extremity with sites including retina, skin and breasts. Clinical Case: A 40-year-old Caucasian female with a past medical history of papillary thyroid cancer at age 16 status post total thyroidectomy followed by two radioactive iodine treatments, who is incidentally found to have recurrent metastatic disease to lungs, retina, subcutaneous soft tissue and bones. After having an accident, trauma CT revealed pulmonary nodules and around the time patient started to notice subcutaneous lumps on the chest and gradually worsening blurry vision indicating further imaging as well as ophthalmological evaluation. The biopsy of the right lower lung nodules showed metastatic differentiated follicular variant papillary thyroid cancer, positive for RET mutation. TSH was appropriately suppressed at 0.128uIU/mL on levothyroxine 100 mcg daily, with elevated thyroglobulin level 47ng/mL and antibody 1.7IU/mL. The molecular testing was positive for RET gene mutation; thus she started targeted therapy with selpercatinib 120 mg twice daily. Shortly after starting therapy, she presented to the ER with complaints of headaches and refractory nausea. Imaging done showed evidence of intracranial metastases, bilateral intraocular lesions in the posterior globe as well as intraventricular hemorrhage. She received IV steroids, selpercatinib was held due to the possibility of exacerbating intraventricular hemorrhage. Following multidisciplinary discussion between neuro-oncology and radiation oncology, she started stereotactic radiotherapy (SRT) to choroidal plexus lesions with a plan to restart systemic therapy once SRT is completed. Conclusion: The epidemiological aspects of thyroid metastases in rare sites are likely unknown and could significantly impact patient management. Most cases of uncommon metastasis have been reported after several years of diagnosis such as in our patient who developed multiple metastasis to rare sites including skin, retina, breast and choroid plexus. Presentation: Thursday, June 15, 2023

Evolution of Pulmonary Contusions in Patients With Severe Rib Fractures: Cause for Concern?

The progression of pulmonary contusions remains poorly understood. This study aimed to measure the radiographic change in pulmonary contusions over time and evaluate the association of the radiographic change with clinical outcomes and surgical stabilization of rib fractures (SSRF). This retrospective cohort study included adults admitted with three or more displaced rib fractures or flail segment on trauma CT and when a chest CT was repeated within one week after trauma. Radiographic severity of pulmonary contusions was assessed using the Blunt Pulmonary Contusion Score (BPC18). Logistic regression was performed to evaluate the relation between SSRF and worsening contusions on repeat CT, adjusted for potential confounders. Of 231 patients, 56 (24%) had a repeat CT scan. Of these, 55 (98%) had pulmonary contusion on the first CT scan with a median BPC18 score of 5 (P25-P75 3-7). Repeat CTs showed an overall decrease of the median BPC18 score to 4 (P25-P75 2-6, P = .02), but demonstrated a worsening of the pulmonary contusion in 16 patients (29%). All repeat CTs conducted within 12hours post-injury demonstrated increasing BPC18. Radiographic worsening of pulmonary contusions was not associated with SSRF, nor with worse respiratory outcomes or intensive care length of stay, compared to patients with radiographically stable or improving contusions. In patients with severe rib fracture patterns who undergo repeat imaging, pulmonary contusions are prevalent and become radiographically worse within at least the first 12hours after injury. No association between radiographic worsening and clinical outcomes was found.

Reliable Initial Trauma CT Findings of Supraclavicular Brachial Plexus Injury in Patients Sustaining Blunt Injuries.

Traumatic brachial plexus injuries are uncommon but can be debilitating. Early diagnosis is critical. Most patients undergo CT after trauma. We sought to identify correlative CT findings of supraclavicular brachial plexus injuries to discern who may require further evaluation with MR imaging and to measure multireviewer performance for their interpretations. We identified all MR imaging examinations of the brachial plexus from our institution from January 2010 to January 2021 and included those performed for trauma. We excluded patients with penetrating or infraclavicular injuries and without preceding CTA of the neck or CT of the cervical spine. The cohort of 36 cases and 50 controls remained for analysis and were assessed for 6 findings: scalene muscle edema/enlargement, interscalene fat pad effacement, first rib fracture, cervical spine lateral mass/transverse process fracture, extra-axial cervical spinal hemorrhage, and cervical spinal cord eccentricity, forming a reference key. A resident physician and 2 neuroradiologists (blinded to the MR imaging) independently reviewed each CT scan for these findings. We measured agreement (Cohen κ) between observers and against the reference key. Interscalene fat pad effacement (sensitivity, specificity, 94.44%, 90.00%; OR = 130.33; P < .001) and scalene muscle edema/enlargement (sensitivity, specificity, 94.44%, 88.00%; OR = 153.00; P < .001) correlated significantly with brachial plexus injury. Agreement between observers and the key was almost perfect for those findings and fractures (pooled κ ≥ 0.84; P < .001). Agreement between observers was variable (κ = 0.48-0.97; P < .001). CT can accurately predict brachial plexus injuries, potentially enabling earlier definitive evaluation. High interobserver agreement suggests that findings are consistently learned and applied.

A “High-Reliability Organization” Approach to Improve Trauma Imaging Performance

PurposeCT is the gold standard for triaging critically ill patients, including in trauma, and its use has increased over time. CT turnaround times (TATs) are frequently targeted for improvement. As opposed to linear reductionist processes such as Lean and Six Sigma, a high-reliability organization (HRO) approach focuses on culture and teams to enable rapid problem solving. The authors evaluated the HRO model to rapidly generate, trial, select, and implement improvement interventions to improve trauma patient CT performance. MethodsAll trauma patients presenting to a single institution’s emergency department during a 5-month period were included. Project periods included 2-month preintervention, 1-month wash-in, and 2-month postintervention. Each initial trauma CT encounter during the wash-in and postintervention periods created job briefs in which the radiologist ensured that all involved had the pertinent clinical information and agreed on the imaging needed, thereby creating a shared mental model as well as an opportunity to raise concerns and provide ideas for improvement. ResultsA total of 447 patients were included: 145 preintervention, 68 wash-in, and 234 postintervention. The seven selected interventions were trauma text alert; scripted CT technologist-radiologist communication; modification of CT acquisition, processing, sending, and interpretation; and trauma mobile phones. The seven selected interventions reduced trauma patient CT median TATs by 60% (78 vs 31 min, P < .001), demonstrating the effectiveness of an HRO approach to improvement. ConclusionsAn HRO-based approach was rapid in generating, trialing, selecting, and implementing improvement interventions, and the interventions were effective at substantially decreasing trauma patient CT TATs.

Association between thoracic and third lumbar CT-derived muscle mass and density in Caucasian patients without chronic disease: a proof-of-concept study

BackgroundComputed tomography (CT) is increasingly used in the clinical workup, and existing scan contains unused body composition data, potentially useful in a clinical setting. However, there is no healthy reference for contrast-enhanced thoracic CT-derived muscle measures. Therefore, we aimed at investigating whether there is a correlation between each of the thoracic and third lumbar vertebra level (L3) skeletal muscle area (SMA), skeletal muscle index (SMI), and skeletal muscle density (SMD) at contrast-enhanced CT in patients without chronic disease.MethodsA proof-of-concept retrospective observational study was based on Caucasian patients without chronic disease, who received CT for trauma between 2012 and 2014. Muscle measures were assessed using a semiautomated threshold-based software by two raters independently. Pearson’s correlation between each thoracic level and third lumbar and intraclass correlation between two raters and test–retest with SMA as proxy parameters were used.ResultsTwenty-one patients (11 males, 10 females; median age 29 years) were included. The second thoracic vertebra (T2) had the highest median of cumulated SMA (males 314.7 cm2, females 118.5 cm2) and SMI (97.8 cm2/m2 and 70.4 cm2/m2, respectively). The strongest SMA correlation was observed between T5 and L3 (r = 0.970), the SMI between T11 and L3 (r = 0.938), and the SMD between the T10 and L3 (r = 0.890).ConclusionsThis study suggests that any of the thoracic levels can be valid to assess skeletal muscle mass. However, the T5 may be most favourable for measuring SMA, the T11 for SMI, and T10 for SMD when using contrast-enhanced thoracic CT.Relevance statementIn COPD patients, a CT-derived thoracic muscle mass assessment may help identify who would benefit from focused pulmonary rehabilitation: thoracic contrast-enhanced CT conducted as part of the standard clinical workup can be used for this evaluation.Key points• Any thoracic level can be used to assess thoracic muscle mass.• Thoracic level 5 is strongly associated with the 3rd lumbar muscle area.• A strong correlation between the thoracic level 11 and the 3rd lumbar muscle index.• Thoracic level 10 is strongly associated with the 3rd lumbar muscle density.Graphical

Quality Improvement Project: Optimizing Compliance with NICE CG176 Head Injury CT Time Standards at Wexford General Hospital Emergency Department

Introduction:Head trauma is a high-risk presentation to the emergency department (ED). Preventing secondary brain injury through earlier diagnosis and intervention relies on timely access to head CT. Wexford General Hospital (WGH) ED uses NICE guidelines, which recommend specific timeframes for acquiring CT in head trauma. Following an audit demonstrating low compliance to NICE CG176 time standards in 2020 (34%), a quality improvement project was undertaken to optimize imaging pathways for head trauma.Method:94 head trauma CT scans were analyzed over a two-month period (June 14, 2022-August 14, 2022) from the NIMIS and IPMS databases to establish current time compliance and median wait times for CT.Following the implementation of a head injury assessment proforma at triage to prompt earlier evaluation of high-risk head injuries, 108 head trauma CT’s were reviewed over a two-month period (August 15, 2022-October 15, 2022) to determine if these parameters improved.Unpaired, two-tailed Mann-Whitney’s test was used to compare median wait times from triage to CT. Two-tailed Chi-square test was used to compare overall compliance rates.Results:Overall ED compliance to NICE time standards improved following implementation of the proforma (43% vs. 36%, p=0.401).For CT scans that were indicated within one hour, there was a statistically significant decrease in median wait time from triage to CT (134mins vs. 186mins, p=0.046). There was also a decrease in median wait time for scans indicated within 8 hours; however, this did not reach the threshold for statistical significance (216mins vs. 275mins, p=0.230).Conclusion:Although there was an overall reduction in wait times for CT, this did not translate to a significant improvement in compliance rates to NICE CG176 time standards. This suggests that, despite earlier identification of these high-risk head injuries at triage, other systemic barriers to obtaining head CT are present and warrant further investigation.

The Swirl Sign and Its Relationship to Patient Outcomes in Extradural Hematomas: A Retrospective Investigation

Introduction:" Swirl sign" is a relatively uncommon sign, seen on non-contrast CT scans in patients with head trauma who develop extradural hematoma the prognostic significance of which is controversial. This research aims to evaluate the predictive significance of the swirl sign in patients with an extradural hemorrhage. Material and Methods: It was a retrospective study and included 145 patients, with traumatic brain injury, who underwent surgical treatment at the Department of Neurosurgery Holy Family Hospital, Rawalpindi, Pakistan, between January 2022 and January 2023 and had traumatic EDH identified by computed tomography scan. Patients who did not undergo surgery or had combined or open craniocerebral injuries were eliminated. A Glasgow Outcome Scale score was used to evaluate outcomes after three months of traumatic brain injury. Mann-Whitney U test, the Chi-square test, and multivariate logistic regression were applied for descriptive and inferential analysis. Results: A total of 145 cases were evaluated, 19 (13.1%) demonstrated the sign on a CT scan of the brain. Analysis displayed a notable association between the incidence of the swirl sign and pupillary size, preoperative Glasgow Coma Scale score, time between trauma and first CT scan, and volume of hematoma measured intraoperatively. Patients displaying the swirl sign showed an increased mortality rate (25%) compared to patients without the swirl sign (5%) and worse outcomes at 3 months. Conclusion: The presence of the swirl sign on the CT scan had a significant association with worse outcomes. Early detection and prompt surgical evacuation are important for patients with this sign.

Implementation of structured reporting in clinical routine: a review of 7 years of institutional experience

BackgroundTo evaluate the implementation process of structured reporting (SR) in a tertiary care institution over a period of 7 years.MethodsWe analysed the content of our image database from January 2016 to December 2022 and compared the numbers of structured reports and free-text reports. For the ten most common SR templates, usage proportions were calculated on a quarterly basis. Annual modality-specific SR usage was calculated for ultrasound, CT, and MRI. During the implementation process, we surveyed radiologists and clinical referring physicians concerning their views on reporting in radiology.ResultsAs of December 2022, our reporting platform contained more than 22,000 structured reports. Use of the ten most common SR templates increased markedly since their implementation, leading to a mean SR usage of 77% in Q4 2022. The highest percentages of SR usage were shown for trauma CT, focussed assessment with ultrasound for trauma (FAST), and prostate MRI: 97%, 95%, and 92%, respectively, in 2022. Overall modality-specific SR usage was 17% for ultrasound, 13% for CT, and 6% for MRI in 2022. Both radiologists and referring physicians were more satisfied with structured reports and rated SR better than free-text reporting (FTR) on various attributes.ConclusionsThe increasing SR usage during the period under review and the positive attitude towards SR among both radiologists and clinical referrers show that SR can be successfully implemented. We therefore encourage others to take this step in order to benefit from the advantages of SR.Key pointsStructured reporting usage increased markedly since its implementation at our institution in 2016.Mean usage for the ten most popular structured reporting templates was 77% in 2022.Both radiologists and referring physicians preferred structured reports over free-text reports.Our data shows that structured reporting can be successfully implemented.We strongly encourage others to implement structured reporting at their institutions.