Tarek N. Hanna

After-Hours Radiology: Challenges and Strategies for the Radiologist.

OBJECTIVE Because of the increase in the use of 24-hour-a-day 7-day-a-week real-time radiologic interpretation, radiologists more frequently perform after-hours work. The purpose of this article was to examine the challenges arising from after-hours work and describe evidence-based strategies meant to limit the adverse physical and psychologic stresses of after-hours work. CONCLUSION Working nontraditional hours affects a radiologists health, social life, professional productivity, and possibly interpretive accuracy. Appropriate attention to these factors and targeted countermeasures can optimize the professional development and personal well-being of radiologists working after hours.

The 100 most-cited original articles in cardiac computed tomography: A bibliometric analysis.

Bibliometric analysis is the application of statistical methods to analyze quantitative data about scientific publications. It can evaluate research performance, author productivity, and manuscript impact. To the best of our knowledge, no bibliometric analysis has focused on cardiac computed tomography (CT). The purpose of this paper was to compile a list of the 100 most-cited articles related to cardiac CT literature using Scopus and Web of Science (WOS). A list of the 100 most-cited articles was compiled by order of citation frequency, as well a list of the top 10 most-cited guideline and review articles and the 20 most-cited articles of the years 2014-2015. The database of 100 most-cited articles was analyzed to identify characteristics of highly cited publications. For each manuscript, the number of authors, study design, size of patient cohort and departmental affiliations were cataloged. The 100 most-cited articles were published from 1990 to 2012, with the majority (53) published between 2005 and 2009. The total number of citations varied from 3354 to 196, and the number of citations per year varied from 9.5 to 129.0 with a median and mean of 30.9 and 38.7, respectively. The majority of publications had a study patients sample size of 200 patients or less. The USA and Germany were the nations with the highest number of frequently cited publications. This bibliometric analysis provides insights on the most-cited articles published on the subject of cardiac CT and calcium volume, thus helping to characterize the field and guide future research.

Imaging Foreign Bodies: Ingested, Aspirated, and Inserted.

Foreign bodies can gain entrance to the body through several mechanisms, ie, ingestion, aspiration, and purposeful insertion. For each of these common entry mechanisms, this article examines the epidemiology, clinical presentation, anatomic considerations, and key imaging characteristics associated with clinically relevant foreign bodies seen in the emergency department (ED) setting. We detail optimal use of multiple imaging techniques, including radiography, ultrasonography, fluoroscopy, and computed tomography to evaluate foreign bodies and their associated complications. Important imaging and clinical features of foreign bodies that can alter clinical management or may necessitate emergency intervention are discussed.

Firearms, bullets, and wound ballistics: An imaging primer

Based on its intrinsic mass and velocity, a bullet has an upper limit of wounding potential. Actual wound severity is a function of the bullet construction and trajectory, as well as the properties of the tissues traversed. Interpreting physicians must evaluate the bullet trajectory and describe patterns of injury resulting from the effect of energy transfer from the projectile into living tissue. A basic understanding of firearms, projectiles, and wound ballistics can help the interpreting physicians in conceptualizing these injuries and interpreting these cases.

Sacrum and Coccyx Radiographs Have Limited Clinical Impact in the Emergency Department

OBJECTIVE The purpose of this study was to determine the yield and clinical impact of sacrum and coccyx radiographs in the emergency department (ED). MATERIALS AND METHODS Consecutive sacrum and coccyx radiographs obtained in the EDs of four hospitals over a 6-year period were categorized as positive for acute fracture or dislocation, negative, or other. Five follow-up metrics were analyzed: follow-up advanced imaging in the same ED visit, follow-up advanced imaging within 30 days, new analgesic prescriptions, clinic follow-up, and surgical intervention within 60 days. RESULTS Sacrum and coccyx radiographs from 687 patients (mean age, 48.1 years; 61.6% women and 38.4% men) obtained at level-1 (n = 335) and level-2 (n = 352) trauma centers showed a positivity rate of 8.4% ± 2.1% (n = 58/687). None of the 58 positive cases had surgical intervention. At the level-1 trauma centers, there was no significant association between sacrum and coccyx radiograph positivity and analgesic prescription or clinical follow-up (p = 0.12; odds ratio [OR], 2.3; 95% CI, 0.81-6.20). At the level-2 trauma centers, 97.1% (n = 34/35) of patients with positive sacrum and coccyx radiographs received analgesic prescriptions or clinical referrals, whereas negative cases were at 82.9% (OR, 7.0; 95% CI, 0.94-52.50). Of all cases, 5.7% (n = 39) and 4.3% (n = 29) had advanced imaging in the same ED visit and within 30 days, respectively. Sacrum and coccyx radiography results had no significant correlation with advanced imaging in the same ED visit (level-1, p = 0.351; level-2, p = 0.179). There was no significant difference in 30-day advanced imaging at the level-1 trauma centers (p = 0.8), but there was at the level-2 trauma centers (p = 0.0493). CONCLUSION ED sacrum and coccyx radiographs showed a low positivity rate and had no quantifiable clinical impact. We recommend that sacrum and coccyx radiographs be eliminated from ED practice and patients treated conservatively on the basis of clinical parameters.

Bibliometric Analysis of Manuscript Characteristics That Influence Citations: A Comparison of Six Major Radiology Journals

OBJECTIVE The objective of our study was to investigate radiology manuscript characteristics that influence citation rate, capturing features of manuscript construction that are discrete from study design. MATERIALS AND METHODS Consecutive articles published from January 2004 to June 2004 were collected from the six major radiology journals with the highest impact factors: Radiology (impact factor, 5.076), Investigative Radiology (2.320), American Journal of Neuroradiology (AJNR) (2.384), RadioGraphics (2.494), European Radiology (2.364), and American Journal of Roentgenology (2.406). The citation count for these articles was retrieved from the Web of Science, and 29 article characteristics were tabulated manually. A point-biserial correlation, Spearman rank-order correlation, and multiple regression model were performed to predict citation number from the collected variables. RESULTS A total of 703 articles-211 published in Radiology, 48 in Investigative Radiology, 106 in AJNR, 52 in RadioGraphics, 129 in European Radiology, and 157 in AJR-were evaluated. Punctuation was included in the title in 55% of the articles and had the highest statistically significant positive correlation to citation rate (point-biserial correlation coefficient [rpb] = 0.85, p < 0.05). Open access status provided a low-magnitude, but significant, correlation to citation rate (rpb = 0.140, p < 0.001). The following variables created a significant multiple regression model to predict citation count (p < 0.005, R2 = 0.186): study findings in the title, abstract word count, abstract character count, total number of words, country of origin, and all authors in the field of radiology. CONCLUSION Using bibliometric knowledge, authors can craft a title, abstract, and text that may enhance visibility and citation count over what they would otherwise experience.

Pearls and pitfalls of hepatobiliary and splenic trauma: what every trauma radiologist needs to know

With the universal acceptance of contrast-enhanced computed tomography (CT) as the imaging modality of first resort in the assessment of blunt abdominal injury, the trauma radiologist must be able to accurately and rapidly identify the range of CT manifestations of the traumatized abdomen. In this article, we lay out the fundamental principles in CT interpretation of blunt trauma to the hepatobiliary system and spleen, including vascular injury, with a focus on technical and interpretive pearls and pitfalls. This review will help radiologists and trainees become more familiar with key aspects of abdominal CT trauma protocol selection, CT-based solid organ injury grading, and the various appearances and mimics of hepatobiliary and splenic injury.

Inefficient Resource Use for Patients Who Receive Both a Chest Radiograph and Chest CT in a Single Emergency Department Visit

PURPOSE The goal of this study was to examine emergency department (ED) ordering practices in patients receiving both chest radiography (CXR) and chest CT (CCT). METHODS Consecutive ED patients receiving both CXR and CCT in a single ED visit from January 2009 to December 2013 were included. For each examination, the time of order entry, time of study completion, and time of final interpretation were recorded and analyzed. RESULTS A total of 3,627 patients met the inclusion criteria. In 3,437 (94.8%) patients, the CXR was ordered first; in 43 (1.2%), the CCT was ordered first; and in 91 (2.5%), the CCT and CXR were ordered simultaneously. In 50.3% (1,826 of 3,627) of all cases, imaging in the second modality (whether CCT or CXR) was ordered before final report availability of the first exam. In 9.8% (n = 354 of 3,627) of all cases, imaging in the second modality (whether CCT or CXR) was ordered before image availability from the first examination. CONCLUSIONS These results suggest inefficient resource usage, for which targeted technology solutions may be helpful.

A systematic, multimodality approach to emergency elbow imaging

The elbow is a complex synovial hinge joint that is frequently involved in both athletic and nonathletic injuries. A thorough understanding of the normal anatomy and various injury patterns is essential when utilizing diagnostic imaging to identify damaged structures and to assist in surgical planning. In this review, the elbow anatomy will be scrutinized in a systematic approach. This will be followed by a comprehensive presentation of elbow injuries that are commonly seen in the emergency department accompanied by multimodality imaging findings. A short discussion regarding pitfalls in elbow imaging is also included.

Small bowel diverticulitis: an imaging review of an uncommon entity

In this review, we discuss the clinical and radiologic findings of small bowel diverticulosis, which is infrequently encountered during practice and far less common than colonic diverticulosis. Small bowel diverticulosis can present with a range of emergent symptomatic complications including diverticulitis, perforation, or hemorrhage. Here, we focus on the clinical features, pathogenesis, radiologic findings, and treatment of small bowel diverticulitis. Although not routinely considered in the differential diagnosis of an acute abdomen, prospective radiologic diagnosis of small bowel diverticulitis is important and can lead to conservative treatment thus preventing unnecessary exploratory laparotomy.