Blunt abdominal trauma (BAT) remains a leading cause of morbidity and mortality in trauma patients, with vascular injuries to solid organs and the mesentery posing critical challenges. These injuries can lead to life-threatening hemorrhage or ischemia if not identified and managed promptly. FAST (Focused Assisted Sonography for Trauma) represents a standard first-line bedside imaging tool in the initial triage of blunt abdominal trauma, supporting early decision-making during resuscitation and minimizing delays to treatment. In hemodynamically stable (or stabilized) patients, contrast-enhanced CT remains the reference standard for the detection and characterization of vascular injuries and for follow-up assessment. This paper aims to present the European Society of Emergency Radiology’s (ESER) evidence-based recommendations for managing vascular injuries in BAT, focusing on appropriate imaging modalities, diagnostic criteria, and follow-up strategies that may help colleagues in their clinical practice.

OBJECTIVE:The primary objective of this study is to assess common sites of injury and the associated imaging findings in penetrating injuries. We pay particular attention to gluteal, anterior abdominal wall and junctional zone injuries. The aim is to highlight areas of diagnostic uncertainty and discrepancy between imaging and surgical findings, to improve review areas in trauma reporting. METHODS:A retrospective, observational study reviewing all paediatric admissions to the emergency department of a major trauma Centre with a penetrating injury, from 2015 to 2019. RESULTS:Gluteal penetrating injuries are by far the most commonly sustained injury in the adolescent population, making up over 1/3 of cases. The vast majority of these cases sustained superficial injuries or shallow intramuscular haematomas, however in a small group (15%), serious vascular or rectal injuries were demonstrated on dual phase CT, requiring emergent surgical or endovascular treatment. Penetrating injuries to the anterior abdominal wall and junctional zone are less common but are associated with higher morbidity, with 43% of cases demonstrating solid organ or bowel injury. These cases also lead to an increased degree of diagnostic uncertainty. CONCLUSION:Gluteal injuries are common and although the overall morbidity of these cases is low, these patients are at risk of serious and life threatening consequences such as vascular and rectal injury and it is imperative that these complications are considered and ruled out via dual phase CT or direct visualization. Anterior abdominal wall and junctional zone injuries are less common, but lead to greater morbidity and also greater diagnostic uncertainty. The use of other salient findings as described in this report can aid diagnostic accuracy and reduce discrepancies.

Introduction Hepatic pseudoaneurysm (HPA) is a rare but potentially life-threatening sequelae of blunt or penetrating liver trauma. At our institution, an imaging protocol for liver injury patients has been developed, with repeat computed tomographic (CT) angiography of the liver 48–72 h post-admission to assess for HPA. The purpose of this study was to evaluate the utility of this imaging pathway in liver trauma for the detection of HPAs. Methods A retrospective analysis was performed on patients who were admitted to our institution between January 2014 and January 2018, found to have either blunt or penetrating liver injury on initial CT imaging. Data collection included mechanism of injury, injury severity score (ISS), American Association for the Surgery of Trauma (AAST) liver injury score, initial and follow-up CT findings and secondary intervention. Results During the study period, 149 major trauma patients were admitted with liver injuries (mean age 35.6 years; 72% male, 28% female). Seventy two percent of patients suffered blunt (median ISS = 29; median AAST = 2.89) and 28% patients suffered penetrating injuries (median ISS = 16; median AAST = 2.88). The mean time to follow-up CT was 46.1 h. Follow-up CT identified 8 (5.4%) HPAs. 5 (62.5%) of these patients were treated with embolization. ISS and AAST were not associated with pseudoaneurysm formation according to logistic regression analysis; however, ISS (OR 1.06 [1.02, 1.09; p < 0.05]) and AAST (OR 2.24, [1.31, 3.83; p < 0.05]) were associated with requirement for embolization. Conclusion Our experience indicates a role for early detection of HPAs using a dedicated trauma imaging pathway.

BACKGROUND:The use of artificial intelligence applications in medicine is becoming increasingly common. At the same time, however, there are few initiatives to teach this important and timely topic to medical students. One reason for this is the predetermined medical curriculum, which leaves very little room for new topics that were not included before. We present a flipped classroom course designed to give undergraduate medical students an elaborated first impression of AI and to increase their "AI readiness".METHODS:The course was tested and evaluated at Bonn Medical School in Germany with medical students in semester three or higher and consisted of a mixture of online self-study units and online classroom lessons. While the online content provided the theoretical underpinnings and demonstrated different perspectives on AI in medical imaging, the classroom sessions offered deeper insight into how "human" diagnostic decision-making differs from AI diagnoses. This was achieved through interactive exercises in which students first diagnosed medical image data themselves and then compared their results with the AI diagnoses. We adapted the "Medical Artificial Intelligence Scale for Medical Students" to evaluate differences in "AI readiness" before and after taking part in the course. These differences were measured by calculating the so called "comparative self-assessment gain" (CSA gain) which enables a valid and reliable representation of changes in behaviour, attitudes, or knowledge.RESULTS:We found a statistically significant increase in perceived AI readiness. While values of CSA gain were different across items and factors, the overall CSA gain regarding AI readiness was satisfactory.CONCLUSION:Attending a course developed to increase knowledge about AI in medical imaging can increase self-perceived AI readiness in medical students.

Emergency Radiology is a clinical practice and an academic discipline that has rapidly gained increasing global recognition among radiology and emergency/critical care departments and trauma services around the world. As with other subspecialties, Emergency Radiology practice has a unique scope and purpose and presents with its own unique challenges. There are several advantages of having a dedicated Emergency Radiology section, perhaps most important of which is the broad clinical skillset that Emergency Radiologists are known for. This multi-society paper, representing the views of Emergency Radiology societies in Canada and Europe, outlines several value-oriented contributions of Emergency Radiologists and briefly discusses the current state of Emergency Radiology as a subspecialty.

Whole body contrast-enhanced multidetector CT (WB-CE MDCT) is integral to the assessment of the severely injured patient with stable haemodynamic parameters or in those who respond to resuscitation with blood products. WB-CE MDCT is able to identify the number and severity of injuries sustained by the patient and enable time critical intervention. In this narrative review article we discuss how communication within the trauma team, including the radiologists and appropriate clinicians is crucial in optimizing the effectiveness of WB-CE MDCT. We review the time critical imaging findings and their clinical relevance, which should be included in a succinct CT primary survey report. We also discuss the process through which the effectiveness of the trauma report may be maximised and how non technical factors including teamwork may be optimised to facilitate decision making in this high pressure environment.

A variety of different external and internal medical devices are used in the acute setting to maintain life support and manage severely injured and unstable trauma or emergency patients. These devices are inserted into the acutely ill patient with the specific purpose of improving outcome, but misplacement can cause additional morbidity and mortality. Consequently, meaningful interpretation of the position of devices can affect acute management. Some devices such as nasopharyngeal, nasogastric and endotracheal tubes and chest and surgical drains are well known to most clinicians, however, little formal training exists for radiologists in composing their report on the imaging of these devices. The novice radiologist often relies on tips and phrases handed down in an aural tradition or resorts to phrases such as: “position as shown”. Furthermore, radiologists with limited experience in trauma might not be familiar with the radiological appearance of other more specific devices. This review will focus on the most common medical devices used in acute trauma patients, indications, radiological appearance and their correct and suboptimal positioning.

Sir—Training has been one of the challenges of the COVID-19 pandemic because of changed caseload, social distancing, and trainee redeployment. The Royal College of Radiologists (RCR) have recognised this with new coding for Annual Review of Competency Progression (ARCP) outcomes.1The Royal College of Radiologists Trainee progression and coronavirus (COVID-19).https://www.rcr.ac.uk/college/coronavirus-covid-19-what-rcr-doing/training/trainee-progression-and-coronavirus-covid-19Date accessed: May 30, 2020Google Scholar Protecting medical training is crucial, potentially more so in radiology given the workforce shortage.2The Royal College of Radiologists Clinical radiology workforce census 2019 report key findings.https://www.rcr.ac.uk/sites/default/files/clinical-radiology-uk-workforce-census-2019-key-findings.pdfDate accessed: May 30, 2020Google Scholar Departments across the country have risen to this challenge, taking advantage of innovative screen-sharing platforms including Zoom, Microsoft Teams and GotoWebinar, to deliver digital or e-learning. For example, the disrupting effect of COVID-19 accelerated the rollout of Microsoft Teams by NHS Digital.3NHS Digital Messaging tool for NHS to support remote working during coronavirus outbreak.https://digital.nhs.uk/news-and-events/latest-news/messaging-tool-for-nhs-to-support-remote-working-during-coronavirus-outbreakDate accessed: May 30, 2020Google Scholar Although initially developed for virtual meetings, its value in teaching has been quickly exploited through sharing of presentations, review of cases on picture archiving and communication systems (PACS), and question and answer sessions through the application's chat facility or use of its audio capabilities. Online learning possesses several advantages, especially at a time when physical distancing is essential. It allows for wide-reaching dissemination of teaching; valuable for Trusts and training programmes spanning multiple sites, and offers greater flexibility through its recording facilities for the learner to access teaching at a time convenient to them. In light of changes to trainee rotas, redeployment and delays to examinations with associated anxieties caused, this has provided a means to maintain regular teaching and encourage cohesion within radiology departments despite the unprecedented circumstances. Similarly, several national and international organisations have harnessed the potential of online learning as a means to preserve education during this period. Free-to-view webinars produced by a variety of organisations, including the RCR, European Society of Radiology, Royal Society of Medicine and Radiopaedia, have proven popular, and social media platforms, such as Instagram and Twitter, have also provided opportunity for educators to share content. Meanwhile, the RCR moved rapidly to provide a comprehensive programme of webinars for ST1 to ST3s enabling a new connectedness for trainees nationally. With new technologies come limitations. As online learning and screen-sharing applications become more seamless, one must remain mindful of requirements to prevent the inadvertent sharing of sensitive information when teaching. Compared to face-to-face teaching, the response-lag and loss of non-verbal cues mean that a teacher has to work harder to be inclusive and personalised in a live session.4Arkorful V. Abaidoo N. The role of e-learning, the advantages and disadvantages of its adoption in higher education.Int J Educ Res. 2014; 2: 397-410Google Scholar Design of pre-recorded or asynchronous teaching needs to avoid being simply a lecture recording by incorporating active learning and maximising digital engagement.5Rahim S. Ros P. Moving away from spoon-feeding as a teaching style in radiology.AJR Am J Roentgenol. 2016; 207: 1232-1238Crossref PubMed Scopus (16) Google Scholar In addition, trainees in difficulty might need extra attention to avoid becoming more invisible. We hope life in radiology departments will return to a new normal promptly, but anticipate that ongoing changes to the environment will not only affect our clinical practice but also our education, including local training, exam preparation courses and congresses. We must capitalise on the swift integration of online learning into radiology education and maintain these positive changes into the post-COVID period. Elizabeth Dick was hosted by Everlight Radiology Ltd in 2019 for remote reporting. Elizabeth Dick donated a £750 honorarium for teaching for Guerbet at ECR 2019 to an ESER/Kenyan Radiology Association travel scholarship.

AIM:To assess the benefits and challenges of remote reporting using an intra-departmental teleradiology system.MATERIALS AND METHODS:A pilot of an in-hospital Trust radiologist reporting on in-hospital Trust patients via a remote login was undertaken. Reporting output, training impact, and quality improvement were measured.RESULTS:Reporting output increased by 140%. Trainee satisfaction was high in a qualitative survey, particularly for out-of-hours support and teaching. Clinicians found the service to be similar to the same service provided by a locally based radiologist.CONCLUSION:In the COVID-19 era, remote working has developed rapidly. This study shows that radiology departments can provide remote reporting that is equal in standard to reporting from within the hospital, and in addition, that there are advantages to output and training.

A Correction to this paper has been published: https://doi.org/10.1007/s00330-020-07520-2

Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally. The elderly have different physiological reserves and a different response to trauma due to premorbid frailty, co-existing conditions and prescribed medication. These factors need to be appreciated in trauma triaging, radiological assessment and clinical management. A lower threshold for trauma-call activation is recommended, including a lower threshold for advanced imaging, We will review general principles of trauma in the elderly, outline injury patterns in this age group and illustrate the radiological features per anatomical site, from head to pelvis and the extremities, We advocate using contrast-enhanced computed tomography as the primary diagnostic imaging modality as concern about intravenous contrast agent-induced nephropathy is relatively minor, Prompt investigation and diagnosis leads to timely appropriate treatment, therefore the radiologist can discerningly improve morbidity and mortality in this vulnerable group.

A ruptured gastric artery aneurysm is a rare but important possible cause of massive intra-abdominal or gastrointestinal haemorrhage. and carries a high risk of mortality. Although aneurysms of the gastric arteries are uncommon, emergency radiologists and clinicians should be familiar;with the clinical presentation, imaging findings and pathophysiology. We present two cases of massive intra-abdominal haemorrhage and haemodynamic shock secondary to acute rupture of previously occult gastric artery aneurysm and review the relevant anatomy, imaging findings and pathophysiology of gastric and other visceral artery aneurysms. By virtue of its location in the lesser omentum, a ruptured gastric artery aneurysm may result in a typical pattern and distribution of adjacent haematoma in the upper abdomen. Our description of imaging findings highlights a characteristic epicentre of intraperitoneal haemorrhage, and its typical mass effect displacement of surrounding viscera. to aid the emergent diagnosis of gastric artery aneurysm rupture.

Major Trauma Centres and Emergency Departments are treating an increasing number of elderly trauma patients in the UK. Elderly patients, defined as those over the age of 65 years, are more susceptible to injury from lesser mechanisms of trauma than younger adults. The number of elderly trauma cases is rising yearly, accounting for >25% of all major trauma nationally. The elderly have different physiological reserves and a different response to trauma due to premorbid frailty, co-existing conditions and prescribed medication. These factors need to be appreciated in trauma triaging, radiological assessment and clinical management. A lower threshold for trauma-call activation is recommended, including a lower threshold for advanced imaging. We will review general principles of trauma in the elderly, outline injury patterns in this age group and illustrate the radiological features per anatomical site, from head to pelvis and the extremities. We advocate using contrast-enhanced computed tomography as the primary diagnostic imaging modality as concern about intravenous contrast agent-induced nephropathy is relatively minor. Prompt investigation and diagnosis leads to timely appropriate treatment, therefore the radiologist can discerningly improve morbidity and mortality in this vulnerable group.

Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high-velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist. It is therefore of paramount importance that radiologists are familiar with both the direct (intimal flap, pseudoaneurysm, aortic contour irregularity and contrast extravasation) and indirect (periaortic haematoma) imaging findings of TAI. Furthermore, it is critical that technical (breathing artefact and cardiac motion artefact) as well as anatomical (ductus diverticulum, aortic spindle and mediastinal structures which imitate periaortic haematoma) pitfalls are recognised to avoid misdiagnosis. This pictorial review will help the diagnostic radiologist to recognise the patterns of injury and imaging features associated with TAI, as well as highlighting potential mimics when interrogating CTangiography (CTA) in major trauma.

Blast injuries are complex, severe, and outside of our everyday clinical practice, but every radiologist needs to understand them. By their nature, bomb blasts are unpredictable and affect multiple victims, yet require an immediate, coordinated, and whole-hearted response from all members of the clinical team, including all radiology staff. This article will help you gain the requisite expertise in blast imaging including recognising primary, secondary, and tertiary blast injuries. It will also help you understand the fundamental role that imaging plays during mass casualty attacks and how to avoid radiology becoming a bottleneck to the forward flow of severely injured patients as they are triaged and treated.

Introduction: Radiology plays a crucial role in the emergency care setting by delivering early and precise diagnoses under pressure of time, right at the beginning of patient treatment. Although there is a need for postgraduate education in emergency radiology, most of the national bodies responsible do not offer it in a uniform fashion and a general proof of qualification is missing in Europe. Therefore, the European Society of Radiology (ESR) has founded the (Sub-)Society of Emergency Radiology (ESER), prompting them to develop a European curriculum. This trend, which is currently also encouraged in many other non-radiological specialties which demand the highest professional qualifications, often lacks expertise in medical education. Goals: The goal of this article is the general description of the curricular planning process for a European postgraduate subspecialisation programme, using the example of Emergency Radiology (European Diploma in Emergency Radiology, EDER), including the utilisation of TOOLS and recommendations derived from comparable projects. Project description: The project was divided into partial steps: the timeline displayed in a GANTT chart, and tasks and responsibilities assigned in a RASCI matrix. The curriculum was iteratively developed using the KERN approach and steps were prioritised using the PARETO principle. Furthermore, the following TOOLS were used: limitations and needs assessment, SWOT analysis, formulating learning objectives and categorising them after MILLER and SCLO, and using BLOOM’s taxonomy for cognitive learning objectives and operationalising them according to MAGER. Psychomotoric and affective learning objectives were assigned to CANMEDS roles, grouped by topic using CLUSTERING, and then mapped by MATRIX analysis to appropriate learning and evaluation methods. Striving for continuous improvement, the curriculum was finally embedded in curricular quality management. Results: The standardisation of the EDER access, considering the different national conditions, the minimisation of European learners’ attendance phases, restricting expenses by best possible use of existing structures, respecting the requirements and retaining the support of the European umbrella society ESR, finishing the project by a specific deadline and the demands of continuous improvement were particular challenges. A curriculum with the eligibility of five years’ speciality training in general radiology has evolved on schedule. The subspeciality training lasts at least one year and is divided into webinars, workshops during congresses (e.g. the annual ESR and ESER congresses) and one year practical training at the individual learner’s corresponding local hospitals, which adhere to a catalogue of requirements, comparable to national educational policies. The curriculum is completed by passing a written and oral exam (diploma) and re-accreditation every five years. Conclusions: Despite complex requirements, the TOOLS utilised allowed an almost seamless, resource-minimised, professional, location-independent distributed development of a European subspeciality curriculum within one year. The definitive implementation is still due. If any deviations from the draft presented should become necessary in the future, the embedment in the curricular quality management will lead to a redirection in the right way and, furthermore, secure a continuous improvement in the best way possible.

Soft tissue sarcomas (STS) are rare tumours that require prompt diagnosis and treatment at a specialist centre. Magnetic resonance imaging (MRI) has become the modality of choice for identification, characterisation, biopsy planning and staging of soft tissue masses. MRI enables both the operating surgeon and patient to be optimally prepared prior to surgery for the likelihood of margin-negative resection and to anticipate possible sacrifice of adjacent structures and consequent loss of function. The aim of this review is to aid the radiologist in performing and reporting MRI studies of soft tissue sarcomas, with particular reference to the requirements of the surgical oncologist.

Complex physiological and biochemical changes occur in women during the post-partum period, many of which are incompletely understood. There are limited descriptions within the medical literature about expected imaging findings during this period and this review aims to illustrate 'normal' appearances following vaginal delivery and Cesarean section. We will also discuss some of the pertinent clinical challenges and imaging pitfalls encountered in assessing the post-partum female.