Trauma is the leading non-obstetric cause of maternal and fetal mortality and affects an estimated 5–7% of all pregnancies. Pregnant women, thankfully, are a small subset of patients presenting in the trauma bay, but they do have distinctive physiologic and anatomic changes. These increase the risk of certain traumatic injuries, and the gravid uterus can both be the primary site of injury and mask other injuries. The primary focus of the initial management of the pregnant trauma patient should be that of maternal stabilization and treatment since it directly affects the fetal outcome. Diagnostic imaging plays a pivotal role in initial traumatic injury assessment and should not deviate from normal routine in the pregnant patient. Radiographs and focused assessment with sonography in the trauma bay will direct the use of contrast-enhanced computed tomography (CT), which remains the cornerstone to evaluate the potential presence of further management-altering injuries. A thorough understanding of its risks and benefits is paramount, especially in the pregnant patient. However, like any other trauma patient, if evaluation for injury with CT is indicated, it should not be denied to a pregnant trauma patient due to fear of radiation exposure.

Benefits of overnight attending radiologist final reports are debated, often stating low resident discrepancy rates, usually assessed retrospectively. The objective of this study was to assess the impact of overnight final reporting on the recall rates for patients in the emergency department (ED) receiving overnight imaging. Retrospective matched cohorts of two separate years prior (prior-16 and prior-17) and 1 year after (post-18) introduction of overnight attending radiologist final reporting. Patients receiving imaging between 22:00 and 07:00 h and returned to ED within 48 h of initial visit discharge were electronically identified. String matching identified return visits possibly related to imaging completed on first visit. Identified return visit notes were scored by three observers individually. Unclear and discrepant cases were resolved by consensus meeting, using full patient charts where needed. Incidences were provided and logistic regression analysis defined if coverage model was a predictor for recall. Odds ratios were calculated. ED patient count with imaging completed overnight in prior-16 was 9200, in prior-17 was 9543, and in post-18 was 9992. The number of overnight imaging studies performed was respectively 13,883, 14,463, and 15,112. Imaging-related ED recalls were respectively 54, 61, and 7, a decrease with the new coverage model of 89% to true and at least 90% of expected recalls.Logistic regression demonstrated that coverage model was a significant predictor of ED recalls with chi-square of 59.86 and p < 0.001, an R2 of 0.03 (Hosmer and Lemeshow). Compared to post-18, ED patients had an odds ratio of 8.42 (prior-16) and 9.18 (prior-17) to be called back to ED. Overnight final reporting significantly decreases ED recalls for patients receiving diagnostic imaging overnight. While numbers are low even prior to rollout, the number should be minimized wherever possible to diminish patient anxiety and discomfort, reduce ED overcrowding and expedite definitive management. Section 1: What is already known on this subject • Radiology resident preliminary report discrepancy rates are low. • Overnight attending radiologist coverage is a model increasingly applied in academic and large non-academic centers. • Patient recalls to the ED are a burden to the patient and impact patient throughput in (over)crowded EDs. Section 2: What this study adds • First study to look at the impact of overnight attending final reports on the recall rate for ED patients with overnight imaging performed. • While absolute numbers are low, there is a significant decrease in patients returning to ED for imaging related issues after introducing overnight attending coverage. • Resident autonomy can be preserved and training enhanced while increasing patient safety and comfort

A mass casualty incident (MCI) is an event that generates more patients at one time than locally available resources can manage using routine procedures. By their nature, many of these incidents have no prior notice but result in large numbers of casualties with injuries that range in severity. They can happen anywhere and at any time and regional hospitals and health-care providers have to mount a response quickly and effectively to save as many lives as possible. Radiologists must go from passenger to pilot when it comes to MCI planning. When involved at the hospital-wide planning stage, they can offer valuable expertise on how radiology can improve triage accuracy and at what cost in terms of time and resources and thereby contribute a pragmatic understanding of radiology's role and value during MCIs. By taking ownership of MCI planning in their own departments, radiologists can ensure that the radiology department can respond quickly and effectively to unforeseen emergencies. Well-designed radiology protocols will save lives in an MCI setting.

Background Dual-energy CT (DECT) has shown tremendous potential as a novel non-invasive method of urate detection in patients with gout. Objectives Our aim was to determine the concordance between urate volume and distribution measured on DECT with clinical presentation among patients with gout. Methods We conducted a retrospective descriptive study of patients with gout who were referred by a rheumatologist for gout DECT scans between January 2008 and February 2018. At our institution, routine DECT scans for gout consist of four sets of images with limbs scanned in pairs: the hands/wrists, elbows, knees and ankles/feet. We obtained volumetric measurements for all four anatomical regions, and assessed the concordance with clinical presentation as retrieved from patient electronic health record. Results A total of 182 patients were included in this study; 96 patients (80.2% male, age range: 27-90, mean age: 62) had urate deposits on DECT scans. Among urate-positive patients, the mean total volume of deposits was 2.45 cm3 (hands/wrists: 0.17 cm3, 7%; elbows: 0.62 cm3, 25%; knees: 0.70 cm3, 28%; ankles/feet: 0.96 cm3, 39%). The average number of urate-positive joints was 2.5, higher than that of clinically symptomatic joints (1.9). Discordance between DECT results and clinical symptoms were seen more often in elbows (46 urate-positive vs. 22 symptomatic) and knees (68 vs. 43), compared with hands/wrists (31 vs. 30) and ankles/feet (90 vs. 87). Only in 25 (26.0%) patients, the distribution of symptomatic joints fully matched the distribution of urate deposits. In 6 patients (6.3%), there was no overlap between these two distribution patterns. Conclusion On DECT scans, most urate deposits in gout patients occur in the ankles/feet, followed by knees, elbows, and hands/wrists. DECT scans can reveal urate deposit in asymptomatic joints, especially in elbows and knees. Assessing the concordance of urate distribution with clinical presentation in all limb joints in gout patients, our results can help understand the pathophysiology of urate deposition in gout, and guide the development of DECT protocols for the screening, assessment and follow-up management of gout patients. Reference [1] Nicolaou S, Liang T, Murphy DT, Korzan JR, Ouellette H, Munk P. Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. AJR Am J Roentgenol. 2012; 199:S78-86. Disclosure of Interests Bo Gong: None declared, Mark Warwas: None declared, Michael O’Keeffe: None declared, Nicole Tsao: None declared, Mary De Vera: None declared, Kamran Shojania Shareholder of: Stock options in Augurex – biotech company., Grant/research support from: Doing a vasculitis study with BMS, Faisal Khosa: None declared, Savvas Nicolaou Grant/research support from: The Department of Radiology, Vancouver General Hospital has a Master Research Agreement with Siemens Healthcare, Forcheim, Germany (non-pharmaceutical company).

This study aims to identify the 50 most highly cited articles on dual energy computed tomography (DECT) in abdominal radiology. Thomson Reuters Web of Science All Databases was queried without year or language restriction. Only original research articles with a primary focus on abdominal radiology using DECT were selected. Review articles, meta-analyses, and studies without human subjects were excluded. Fifty articles with the highest average yearly citation were identified. These articles were published between 2007 and 2017 in 12 journals, with the most in Radiology (12 articles). Articles had a median of 7 authors, with all first authors but one primarily affiliated to radiology departments. The United States of America produced the most articles (16), followed by Germany (13 articles), and China (7 articles). Most studies used Dual Source DECT technology (35 articles), followed by Rapid Kilovoltage Switching (14 articles), and Sequential Scanning (1 article). The top three scanned organs were the liver (24%), kidney (16%), and urinary tract (15%). The most commonly studied pathology was urinary calculi (28%), renal lesion/tumor (23%), and hepatic lesion/tumor (20%). Our study identifies intellectual milestones in the applications of DECT in abdominal radiology. The diversity of the articles reflects on the characteristics and quality of the most influential publications related to DECT.

La enfermedad traumática es una patología grave y compleja, que requiere de la actuación coordinada de un equipo multidisciplinar.Las pruebas de imagen desempeñan un papel fundamental para un diagnóstico rápido y preciso; en particular, la tomografía computarizada (TC) de cuerpo completo se ha convertido en la herramienta clave. Existen diferentes protocolos de TC en función de la gravedad del paciente; en los más graves se prioriza una exploración más rápida a costa de aumentar la radiación (protocolo tiempo-precisión) y en los estables se pueden realizar protocolos con dosis optimizada.En los pacientes inestables que no pueden acceder a la TC, se emplean radiografías de tórax y pelvis, y ecografía Focused Assessment with Sonography for Trauma (FAST) o e-FAST, menos sensibles que la TC, pero que permiten diagnosticar situaciones que requieren un tratamiento inmediato.El objetivo del artículo es revisar las técnicas de imagen y los protocolos de TC en la atención inicial hospitalaria del paciente politraumatizado.Traumatic injuries can be severe and complex, requiring the coordinated efforts of a multidisciplinary team.Imaging tests play a fundamental role in rapid and accurate diagnosis. In particular, whole-body computed tomography (CT) has become a key tool. There are different CT protocols depending on the patient's condition; whereas dose-optimized protocols can be used in stable patients, time/precision protocols prioritizing speed at the cost of delivering higher doses of radiation should be used in more severe patients.In unstable patients who cannot be examined by CT, X-rays of the chest and pelvis and FAST or e-FAST ultrasound studies, although less sensitive than CT, enable the detection of situations that require immediate treatment.This article reviews the imaging techniques and CT protocols for the initial hospital workup for patients with multiple trauma.

Objective The aim of this study was to assess if a low-dose carotid computed tomography angiography (CTA) performed with pure iterative reconstruction (IR) is comparable to a conventional dose CTA protocol.Methods Twenty patients were included. Radiation dose was divided into a low-dose acquisition reconstructed with pure IR and a conventional dose acquisition reconstructed with 40% hybrid IR. Dose, image noise, contrast resolution, spatial resolution, and carotid artery stenosis were measured.Results Mean effective dose was significantly lower for low-dose than conventional dose studies (1.84 versus 3.71 mSv; P < 0.001). Subjective image noise, contrast resolution, and spatial resolution were significantly higher for the low-dose studies. There was excellent agreement for stenosis grading accuracy between low- and conventional dose studies (Cohen = 0.806).Conclusions A low-dose carotid CTA protocol reconstructed with pure IR is comparable to a conventional dose CTA protocol in terms of image quality and diagnostic accuracy while enabling a dose reduction of 49.6%.