To evaluate the diagnostic yield, temporal trends, and clinical implications of concurrent non-contrast head and cervical spine computed tomography (CT) in emergency department trauma patients over a 10-year period. This single-center retrospective cohort study included 9,359 consecutive patients who underwent concurrent head and cervical-spine CT for suspected trauma between May 2012 and April 2022. Patient demographics, trauma mechanisms, alcohol documentation, imaging findings, and management of cervical fractures were analyzed. Diagnostic yields were calculated overall and by age, mechanism (with focus on ground-level falls), and time period. Temporal trends and predictors of cervical-spine fracture were assessed using regression models. Acute cervical-spine fractures were present in 4.9
Regional skeletal maturation can influence injury pattern and treatment selection. This study aimed to systematically characterize pediatric proximal humerus fractures to identify radiographic findings that impact treatment selection. This IRB-approved retrospective comparative study included pediatric patients (< 18 years), who underwent pre-treatment radiographic examination for proximal humerus fractures (2014–2024). Demographics, injury mechanism, skeletal maturity, physeal involvement and pattern, maximum displacement, angulation, and treatment were collected. Findings between surgically and non-surgically treated fractures were compared using descriptive statistics and using optimal cutoff values, determined using the receiver operating characteristic (ROC) analysis and the Youden index, with additional regression modeling to identify independent predictors of surgery. This study of 418 children (mean age, 9.8 ± 3.6 years; 53.1
To assess whether intravenous iodinated contrast administered for computed tomography is associated with early or delayed acute kidney injury (AKI) in critically ill adults. We conducted a retrospective target trial emulation using the Medical Information Mart for Intensive Care IV (MIMIC-IV), a single-center, deidentified electronic health record database of hospital and intensive care admissions. Adults undergoing contrast-enhanced CT (CECT) or non-contrast CT (NCCT) during or immediately before intensive care admission were included. The primary outcome was creatinine-defined AKI within 48 h. Inverse probability of treatment weighting (IPTW) addressed measured confounding. Among 7,772 patients, 5,319 underwent CECT and 2,453 underwent NCCT. AKI within 48 h occurred in 19.3
Acute critical conditions such as stroke, severe trauma and sepsis represent major causes of mortality, disability and financial pressure on health systems. In these time-dependent scenarios, computed tomography (CT) and magnetic resonance imaging (MRI) are fundamental for diagnostic and therapeutic decision-making; however, delays in access to imaging may represent structural bottlenecks associated with clinical and health-system outcomes. To map and synthesise the available evidence on the relationship between timely access to CT and MRI and clinical and health system outcomes in acute critical conditions. A scoping review was conducted in accordance with the Joanna Briggs Institute guidelines and reported following PRISMA-ScR. A structured search was performed in PubMed, Scopus, Web of Science and ScienceDirect (January 2010–February 2026). Studies involving patients with stroke, trauma or sepsis that evaluated imaging access metrics and their association with clinical or system outcomes were included. Twenty-seven studies were included. Eleven reported adjusted associations between longer time-to-imaging intervals and adverse clinical outcomes, including higher in-hospital mortality, reduced functional independence or loss of therapeutic eligibility, particularly in stroke and vascular trauma. Eight reported associations with system metrics, such as prolonged hospital length of stay and reduced operational efficiency. The remaining studies identified structural factors associated with diagnostic delay related to care pathway organisation, resource availability and architectural factors. Timely access to CT and MRI may serve as a marker of health-system performance associated with clinical and operational outcomes in acute time-dependent conditions. Incorporating time-to-imaging metrics as potential performance indicators may support the planning and evaluation of acute care delivery.
Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of high-energy trauma that can lead to ischemic stroke if undetected. Computed tomography angiography (CTA) is the primary screening modality, though optimal patient selection criteria remain debated. Rising CTA utilization at our institution prompted a quality improvement review to evaluate the diagnostic yield and identify clinical predictors of BCVI. A retrospective review was conducted of trauma patients who underwent CTA of the head and neck at a Level I trauma center between January and December 2023.Clinical variables were compared between patients with and without BCVI on univariate analysis, and independent predictors were identified using multivariate logistic regression. Among 305 patients screened, BCVI was identified in 40 patients (13.1
To evaluate contemporary computed tomography (CT) imaging pathways for Emergency Department (ED) patients with suspected oesophageal perforation or leak, with a particular focus on oral contrast utilisation, radiologic findings and downstream investigations following the index CT examination. We performed a single-centre retrospective observational study of all adult ED patients who underwent CT imaging including the chest for suspected oesophageal perforation or leak between January 2015 and March 2026. Patients were identified through radiology database search. Demographics, clinical indications, oral contrast use, radiologic findings and investigations performed within five days of the index CT were recorded. A total of 107 patients were included, with six (5.6
Tibial-sided posterior cruciate ligament (PCL) avulsion fractures are a variant of PCL injury. Current literature on tibial-sided PCL injuries consists of small case reports or series in adults. There are no studies in the pediatric population describing the associated injuries and if concomitant injuries impact clinical decision-making. This study aims to identify common concomitant injuries in pediatric patients with tibial-sided PCL avulsion fractures and determine the utility of MRI in identification of concomitant injuries. A retrospective review of the electronic medical record identified all patients presenting to a single tertiary pediatric hospital with tibial-sided PCL avulsion fractures 1/2012-6/2024. MRI exams were reviewed by a musculoskeletal pediatric radiologist. Operative reports and clinical encounter notes were reviewed by a pediatric orthopedic surgeon. Twenty-seven patients met the inclusion criteria, and 26 concomitant injuries were identified in 16 (59
Our Emergency Department (ED), like many others in the US, experiences chronic congestion, slow flow, and long wait times – all of which have notably worsened in recent years. For many of our patients, computed tomography (CT) turnaround time is a key determinant of ED flow, yet strategies to reduce preacquisition delays remain under-described. Our objective was to reduce CT order-to-exam start time by 25
To assess for associations between pulmonary contusion volume and complications of thoracic trauma. Consecutive patients were retrospectively identified as sustaining thoracic trauma in a single tertiary level 1 trauma center from January 1, 2013 to October 31, 2017. Individuals ≥ 16 years old presenting with blunt thoracic trauma who underwent computed tomography (CT) within 24 hours of admission and Injury Severity Score (ISS) ≥ 15 were included. Exclusion criteria were penetrating injury, death before CT, intracranial injury, or unavailable imaging. A body fellowship-trained radiologist with more than 12 years of clinical experience manually measured pulmonary contusion, blinded to clinical data using the three largest orthogonal dimensions in axial and sagittal planes. Outcomes included mortality, severe hypoxemia, and ventilator-associated pneumonia (VAP). Logistic regression was used to evaluate the association between outcome variables and pulmonary contusion volume. Of the 1,116 patients, 153 were included in the study. The number of pulmonary lobes injured on CT was associated with severe hypoxemia (p= 0.0047). For every 100 mL increase in contusion volume, the odds of death increased by 20
To evaluate the diagnostic agreement between emergency medicine residents after dedicated appendix ultrasound training and radiologists in the ultrasonographic evaluation of suspected acute appendicitis. This prospective, single-center observational study included patients presenting to a tertiary emergency department with non-traumatic abdominal pain and clinical suspicion of acute appendicitis between March 2020 and May 2021. Clinical suspicion was based on right lower quadrant pain or tenderness and supportive clinical, laboratory, or scoring findings. Emergency medicine residents performed focused right lower quadrant ultrasonography after dedicated appendix ultrasound training, followed by radiologist-performed abdominal ultrasonography using the same device. Radiologists were not informed of the resident-performed ultrasound findings. Agreement was assessed using Cohen’s kappa coefficient. Diagnostic accuracy was calculated against the final diagnosis, which was established using pathology, computed tomography when available, surgical consultation, and 30-day follow-up. Of 260 enrolled patients, 250 were included in the final analysis. Acute appendicitis was confirmed in 66 patients (26.4
Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of trauma. This study aims to evaluate the impact of Computed Tomography Angiography (CTA) timing on stroke and outcomes in BCVI, and to identify predictors of stroke. The ACS-TQIP database (2017–2024) was used to analyze the effect of CTA timing on outcomes and to identify predictors of stroke using multivariable regression models in adult polytrauma patients with moderate-severe BCVI. Patients were stratified by injury type, grade, and concomitant traumatic brain injury (TBI). The primary outcome was stroke occurrence, and secondary outcomes included mortality, complications, ICU-LOS, VFDs, and discharge disposition. Early CTA was associated with reduced stroke (aOR: 0.394, p < 0.001), decreased complications, and reduced intensive care unit length of stay (ICU-LOS) (β: -2.425, p < 0.001), but increased mortality. Among patients with isolated carotid or vertebral injuries, early CTA reduced strokes without increasing mortality. Low-grade injuries experienced reduced stroke (aOR: 0.396, p < 0.001) and shorter ICU-LOS (β: -1.769, p = 0.006). In contrast, high-grade injuries and concomitant moderate-severe TBI were accompanied by increases in mortality. Advanced age (aOR: 1.352, p = 0.047), high-grade injuries (aOR: 2.297, p < 0.001), severe injury severity score (aOR: 2.791, p < 0.001), and concomitant TBI (aOR: 1.522, p < 0.001) were predictors of stroke. Early CTA is associated with reduced stroke risk and improved outcomes, including fewer complications and shorter ICU stay. Benefits are greatest in low-grade injuries and isolated carotid or vertebral involvement. In contrast, high-grade injuries and concomitant moderate-severe TBI show reduced stroke but increased mortality, likely reflecting greater injury severity.
Suspected renal colic is a frequent emergency department presentation. Bedside hydronephrosis assessment may support early triage, consultation, and disposition decisions. This study evaluated whether emergency medicine residents can reliably detect hydronephrosis and classify its severity using bedside urinary ultrasonography in adults with suspected renal colic. This prospective observational agreement study included 272 adults with suspected renal colic. Bedside urinary ultrasonography was performed by 16 emergency medicine residents with at least two years of residency training and structured ultrasonography education. Before enrollment, residents completed standardized theoretical, hands-on, and supervised radiologist-guided renal ultrasonography training focused on hydronephrosis assessment. Radiologist-performed ultrasonography was completed within 2 h of emergency department admission by an experienced radiologist blinded to residents’ findings. Both groups used the same severity categories: absent, mild, moderate, and severe. Diagnostic performance, agreement, and severity-level concordance were analyzed at the patient level. Computed tomography (CT)-based analyses were exploratory and evaluated CT-detected hydronephrosis rather than stone detection. Hydronephrosis was detected in 81 patients by both residents and the radiologist. Overall agreement was 91.18
Extreme alpine summer sports are increasingly popular and expose participants to high-energy trauma in remote mountain environments. This pictorial essay reviews the emergency radiology of severe acute injuries associated with down-hill mountain biking, rock climbing, paragliding, BASE jumping, canyoning, and rafting, with emphasis on mechanism-based imaging interpretation. Injury patterns differ across disciplines but are largely determined by velocity, fall height, landing posture, impact surface, axial loading, torsional forces, and water-related hazards. Down-hill mountain biking commonly produces extremity, thoracic, craniofacial, abdominal, and spinal injuries after high-speed crashes or handlebar impact. Rock climbing and paragliding frequently involve falls from height and hard landings, leading to thoracolumbar fractures, pelvic trauma, calcaneal or ankle injuries, and, in severe cases, neurologic compromise or visceral injury. BASE jumping is associated with high-velocity landing trauma, particularly involving the lower limbs, pelvis, and spine. Canyoning and rafting combine blunt trauma with environmental risks such as submersion, aspiration, hypothermia, and drowning-related complications. In high-energy trauma or polytrauma, whole-body computed tomography is the cornerstone of emergency assessment, enabling rapid evaluation of head, spine, chest, abdomen, and pelvis. Radiography remains useful for isolated appendicular injuries, whereas magnetic resonance imaging is essential for spinal cord, ligamentous, marrow, and selected soft-tissue injuries. Awareness of sport-specific mechanisms helps radiologists optimize image selection, maintain an appropriate search pattern, recognize injuries that may coexist after axial loading, and communicate urgent findings promptly. A mechanism-oriented approach may improve diagnostic accuracy, guide multidisciplinary management, and reduce missed injuries in patients presenting after alpine summer extreme sports trauma.
Bibliometric benchmarks for academic emergency radiology faculty are not well established. We assessed the bibliometric profiles of U.S. academic emergency radiology faculty and determined the independent contributions of academic rank, faculty track, sex, and fellowship institution affiliation to scholarly productivity. A secondary aim was to compare bibliometric productivity of emergency radiology faculty against four other radiology subspecialties using rank-adjusted cross-subspecialty models. This cross-sectional bibliometric analysis included 518 emergency radiology faculty from 67 U.S. institutions, with data collected from Scopus between September and December 2025. For cross-subspecialty comparisons, linear mixed-effects models adjusting for rank and institutional clustering were applied. No significant sex differences were found at any rank after Bonferroni correction. Research/tenure-track faculty were significantly more productive than clinical-track faculty at the associate and full professor levels, but not at the assistant professor level. The productivity advantage of ASER-recognized fellowship institutions was entirely explained by their higher proportion of research/tenure-track faculty. After rank adjustment, emergency radiology faculty had significantly lower bibliometric output than neuroradiology and cardiothoracic imaging faculty (all p < 0.001). Interventional radiology was the most comparable subspecialty, with no significant differences in citations or h-index. Academic rank is the primary driver of bibliometric productivity in emergency radiology. Based on the findings of this study, faculty track independently influences output at mid- and senior career stages. No significant sex differences were identified. The fellowship institution productivity advantage reflects track composition rather than program presence. Emergency radiology faculty demonstrate lower rank-adjusted output than neuroradiology and cardiothoracic imaging, while remaining most comparable to interventional radiology.
Non-iatrogenic intramural esophageal dissection is a rare condition caused by the transverse and longitudinal separation of the mucosal and submucosal layers of the esophageal wall, with or without perforation, which leads to the separation of the submucosal and muscular layers and forms a false submucosal lumen. It can occur spontaneously or be related to iatrogenic causes or trauma, with the latter often associated with the ingestion of certain foods or medical pills. We present three cases of non-iatrogenic intramural esophageal dissection and review relevant literature. We discuss the causes, symptoms, prognosis, and, primarily, the radiologist’s role in promptly diagnosing this condition, especially in the Emergency Department (ER).
To evaluate emergency CT interpretation demand during major sporting events, characterize surge-related backlog and turnaround time, and estimate how threshold-based teleradiology support could affect queue performance during short event-related imaging boluses. We developed a Monte Carlo discrete-event simulation in Python to model an 8-h emergency radiology shift with baseline CT demand and a 2-h event-related surge. CT arrivals followed a Poisson process. Local and teleradiology radiologists were modeled as parallel servers with stochastic interpretation times. Two scenarios were compared across 500 Monte Carlo iterations: local radiologists only and local radiologists supplemented by a rapid-response teleradiology team activated when the unread CT backlog reached 10 cases. Primary outcomes included mean turnaround time, 90th percentile turnaround time, unread queue wait time, maximum unread backlog, number of cases delayed for more than 60 min, and time above the activation threshold. The model generated a mean of 132.7 CT examinations per shift in both scenarios. Local-only coverage resulted in a mean turnaround time of 48.7 min and a 90th percentile turnaround time of 89.6 min. With teleradiology support, the mean turnaround time decreased to 18.0 min, and the 90th percentile to 37.3 min. Mean maximum unread backlog decreased from 27.7 to 16.2 cases, and the mean number of cases delayed longer than 60 min decreased from 47.4 to 2.0. Sensitivity analysis showed that saturation risk increased sharply when surge arrivals rose and local staffing remained limited. Discrete-event simulation can help emergency radiology departments estimate when CT interpretation workflows may become saturated during major sporting events. In this model, threshold-based teleradiology reduced backlog and turnaround time but functioned as a surge buffer rather than a substitute for adequate local staffing and predefined escalation pathways.
Pediatric testicular rupture is rare, and detailed descriptions of its ultrasonographic (US) findings with operative correlation remain limited. This paper reviews the characteristic ultrasonographic findings of pediatric testicular rupture and correlates them with operative findings and postoperative outcomes. Among 27 male patients who underwent US for suspected testicular trauma over a 23-year period, four cases with surgically confirmed testicular rupture were retrospectively reviewed. Clinical presentation, physical examination findings, timing of presentation and surgery, preoperative US findings, operative findings, and postoperative outcomes were evaluated. The patients ranged in age from 11 to 14 years, with two right-sided and two left-sided injuries. Mechanisms of injury included sports-related trauma (n = 2) and physical assault (n = 2). Presenting symptoms included scrotal swelling, scrotal/lower abdominal pain, and vomiting. Physical examination demonstrated scrotal tenderness in all patients, scrotal swelling in three, and erythema in one. The interval from injury to presentation ranged from 2 to 60 h (median, 34 h), and the interval from injury to surgery ranged from 28 to 130 h (median, 54 h). All patients demonstrated characteristic US findings suggestive of testicular rupture, including discontinuity of the tunica albuginea, poorly defined testicular margins, heterogeneous echotexture of the extruded testicular parenchyma, and decreased blood flow in the extruded area. Associated findings included intratesticular or scrotal hematoma and scrotal wall thickening. Operative findings confirmed rupture of the tunica albuginea in all cases and correlated well with preoperative US findings. During follow-up (mean, 9 months), ipsilateral testicular atrophy developed in three patients, whereas one patient showed preserved testicular volume without abnormal US findings. Pediatric testicular rupture demonstrates characteristic ultrasonographic findings that correlate well with operative findings. Recognition of these findings may facilitate early diagnosis and prompt surgical consultation. Because postoperative testicular atrophy may occur despite testicular preservation, continued ultrasonographic follow-up is important.
