Khalid W. Shaqdan

Current status of nephrogenic systemic fibrosis

Nephrogenic systemic fibrosis (NSF) occurs in patients with advanced chronic kidney disease (CKD) or acute renal failure, most commonly following exposure to gadolinium-based contrast agents (GBCAs). NSF can be debilitating and associated with increased mortality. The putative association of NSF with GBCAs prompted the development of guidelines to limit the use of these contrast agents in at-risk patients. Indeed, the incidence of NSF has decreased dramatically following application of these guidelines, which appears to be the only effective means of decreasing NSF incidence. Thus, increasing clinician awareness of these updated guidelines is important. The present review introduces and compares updated guidelines for GBCA use and discusses the latest advances in the understanding of the pathogenic mechanisms and treatment of NSF.

Contrast-Induced Nephropathy: Identifying the Risks, Choosing the Right Agent, and Reviewing Effective Prevention and Management Methods

With the rise in the use of intravenous iodinated contrast media for both computed tomography scan and angiographic studies, there is a greater likelihood of complications. One of the most well-known adverse effects is contrast-induced media nephropathy, which is also called contrast-induced acute kidney injury. This is third most common cause of hospital acquired acute renal failure. It is associated with an increase in morbidity, mortality, and greater financial burden on healthcare system. Because of these factors, it is important for the radiologist to not only recognize risk factors, as well as the signs and symptoms, but also to know how to manage patients appropriately.

Dual-energy computed tomography (DECT) in emergency radiology: basic principles, techniques, and limitations.

Recent advances in computed tomography (CT) technology allow for acquisition of two CT datasets with different X-ray spectra. There are different dual-energy computed tomography (DECT) technical approaches such as: the dual-source CT, the fast kilovoltage-switching method, and the sandwich detectors technique. There are various postprocessing algorithms that are available to provide clinically relevant spectral information. There are several clinical applications of DECT that are easily accessible in the emergency setting. In this review article, we aim to provide the emergency radiologist with a discussion on how this new technology works and how some of its applications can be useful in the emergency room setting.

Contrast Media Extravasation of Computed Tomography and Magnetic Resonance Imaging: Management Guidelines for the Radiologist

Intravenous contrast administration has been of great importance in diagnostic radiology, but it is not without risks either due to the local, systemic allergic reactions or due to subcutaneous extravasation of contrast media. Subcutaneous contrast medium extravasationis an infrequent, yet a well-recognized complication. However, most incidents are minor and can be managed conservatively, but there are a few cases that require immediate surgical intervention. This article discusses the risks factors, clinical manifestations, and conservative and surgical approaches of subcutaneous contrast media extravasation for both computed tomography and magnetic resonance imaging.

Rates of safety incident reporting in MRI in a large academic medical center.

To describe our multiyear experience in incident reporting related to magnetic resonance imaging (MRI) in a large academic medical center.

Key Principles in Quality and Safety in Radiology

OBJECTIVE The purpose of this article is to introduce the reader to basic concepts of quality and safety in radiology. CONCLUSION Concepts are introduced that are keys to identifying, understanding, and utilizing certain quality tools with the aim of making process improvements. Challenges, opportunities, and change drivers can be mapped from the radiology quality perspective. Best practices, informatics, and benchmarks can profoundly affect the outcome of the quality improvement initiative we all aim to achieve.

CT and MRI manifestations of luxatio erecta humeri and a review of the literature

AIM We aimed to study luxatio erecta humeri using advanced imaging modalities. METHOD Patients with luxatio erecta humeri and a subsequent magnetic resonance imaging (MRI) and/or computed tomography (CT) scan were included in this study. RESULTS Among 10 identified cases, we detected 2 rotator cuff, 4 labral, and 2 inferior glenohumeral ligament tears as well as 2 glenohumeral cartilage defects. We observed six comminuted displaced greater tuberosity fractures, four anterior inferior glenoid fractures, and four impaction fractures of humeral head. CONCLUSION This study provides detailed radiologic findings associated with luxatio erecta humeri using MRI and CT.

Rating and Classification of Incident Reporting in Radiology in a Large Academic Medical Center

The purpose of this article is to provide a rate of safety incident report of adverse events in a large academic radiology department and to share the various types that may occur. This is a Health Insurance Portability and Accountability Act compliant, institutional review board-approved study. Consent requirement was waived. All incident reports from April 2006-September 2012 were retrieved. Events were further classified as follows: diagnostic test orders, identity document or documentation or consent, safety or security or conduct, service coordination, surgery or procedure, line or tube, fall, medication or intravenous safety, employee general incident, environment or equipment, adverse drug reaction (ADR), skin or tissue, and diagnosis or treatment. Overall rates and subclassification rates were calculated. There were 10,224 incident reports and 4,324,208 radiology examinations (rate = 0.23%). The highest rates of the incident reports were due to diagnostic test orders (34.3%; 3509/10,224), followed by service coordination (12.2%; 1248/10,224) and ADR (10.3%; 1052/4,324,208). The rate of incident reporting was highest in inpatient (0.30%; 2949/970,622), followed by emergency radiology (0.22%; 1500/672,958) and outpatient (0.18%; 4957/2,680,628). Approximately 48.5% (4947/10,202) of incidents had no patient harm and did not affect the patient, followed by no patient harm, but did affect the patient (35.2%, 3589/10,202), temporary or minor patient harm (15.5%, 1584/10,202), permanent or major patient harm (0.6%, 62/10,202), and patient death (0.2%, 20/10,202). Within an academic radiology department, the rate of incident reports was only 0.23%, usually did not harm the patient, and occurred at higher rates in inpatients. The most common incident type was in the category of diagnostic test orders, followed by service coordination, and ADRs.

Detecting Aortic Graft Complications: A Spectrum of Computed Tomography Findings.

Endovascular aneurysm repair (EVAR) is a successful technique as well as an excellent alternative to the surgical management of abdominal aortic aneurysms. EVAR has improved the mortality and morbidity of many patients who would have otherwise suffered greatly from the consequences of abdominal aortic aneurysms. However, EVAR is not without complications. Some complications require lifelong surveillance, whereas others may necessitate immediate surgical intervention. We discuss the various modalities available for the surveillance as well as the common complications that can be seen on computed tomography.

Role of dual energy CT to improve diagnosis of non-traumatic abdominal vascular emergencies

Computed tomography angiography (CTA) is the modality of choice to evaluate abdominal vascular emergencies (AVE). CTA protocols are often complex and require acquisition of multiple phases to enable a variety of diagnosis such as acute bleeding, pseudoaneurysms, bowel ischemia, and dissection. With single energy CT (SECT), differentiating between calcium, coagulated blood, and contrast agents can be challenging based on their attenuation, especially when in small quantity or present as a mixture. With dual-energy CT (DECT), virtual monoenergetic (VM) and material decomposition (MD) image reconstructions enable more robust tissue characterization, improve contrast-enhancement, and reduce beam hardening artifacts. This article will demonstrate how radiologists can utilize DECT for various clinical scenarios in assessment of non-traumatic AVE.