Search

Patient-centered emergency diagnostic imaging relies on efficient communication and multispecialty care coordination to ensure optimal imaging utilization. The construct of the emergency diagnostic imaging care coordination cycle with three main phases (pretest, test, and posttest) provides a useful framework to evaluate care coordination in patient-centered emergency diagnostic imaging. This article summarizes findings reached during the patient-centered outcomes session of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The primary objective was to develop a research agenda focused on 1) defining component parts of the emergency diagnostic imaging care coordination process, 2) identifying gaps in communication that affect emergency diagnostic imaging, and 3) defining optimal methods of communication and multidisciplinary care coordination that ensure patient-centered emergency diagnostic imaging. Prioritized research questions provided the framework to define a research agenda for multidisciplinary care coordination in emergency diagnostic imaging.

Objectives The objective was to evaluate variation in the current estimated radiation dose index for pediatric cervical spine (c-spine) computed tomography (CT) examinations. Methods This was a retrospective analysis of pediatric (age younger than 19 years) c-spine CT examinations from the American College of Radiology Dose Index Registry, July 2011 through December 2014. We used the volume CT dose index (CTDIvol) as the radiation dose estimate and used summary statistics to describe patient and hospital characteristics. Results There were 12,218 pediatric CT c-spine examinations performed across 296 participating hospitals. Fifty-six percent were in male patients, and 79% were in children older than 10 years. Most hospitals (55%) were community hospitals without trauma designations, and the largest proportion of examinations (41%) were performed at these hospitals. The median CTDIvol was 15 mGy (interquartile range = 9 to 23 mGy) representing a more than 2.5-fold difference between the 25th and 75th percentiles. Pediatric hospitals (both trauma and nontrauma centers) delivered the lowest CTDIvol across all age groups and showed the least amount of variability in dose. Conclusions There is significant variation in the radiation dose index for pediatric c-spine CT examinations. Pediatric hospitals practice at lower CT dose estimates than other hospitals. Individual hospitals should examine their practices in an effort to ensure standardization and optimization of CT parameters to minimize radiation exposures to pediatric patients.

In evaluating the accuracy of diagnostic tests there are many situations where the true disease status can be one of multiple disorders. For example, when paediatric patients suffer acute abdominal pain, the underlying diagnosis could be appendicitis, intestinal obstruction, gastroenteritis, urinary tract infection, etc. In this paper we describe a format for collecting data for the case of multiple truth states. This new format allows one to make pairwise comparisons of the diagnostic accuracy between all of the different truth states. We propose a summary measure of accuracy which is a weighted average of the pairwise estimates of accuracy. Estimators are derived for the variance and covariance of the estimated summary accuracy. The small sample properties of the estimators are evaluated in a Monte Carlo simulation study. The new data collection format and summary measure were used in a paediatric acute abdominal pain study; data from this study are used to illustrate the methods.

Trisomy 9 syndrome is characterized by "bulbous" nose, microphthalmia, dislocated limbs, and other anomalies of skeletal, cardiac, genitourinary, and central nervous systems. With the exception of one reported case study, all surviving infants have had severe mental impairment. The prospect of severe mental retardation often overwhelms parents who are faced with prenatal diagnosis of trisomy 9. We report on two new cases of mosaic trisomy 9, both of whom are only mildly developmentally delayed. One patient presented with the distinctive facial appearance, large fontanels, and joint abnormalities. The other had none of the typical congenital abnormalities. However, the patient was found to have a congenital heart defect and hypoplastic left heart syndrome, which to our knowledge has not been reported previously in the trisomy 9 syndrome. When these two patients are added to the published patients with this syndrome, there appears to be a range of manifestations, especially with respect to mental status, which has not fully been recognized.

We report an unusual case of superficial venous thrombosis in a cyanotic 12-year-old child who had undergone recent appendectomy. Although compression, color Doppler, and duplex ultrasound techniques remain the keys to the diagnosis of venous thrombosis, SieScape sonography was beneficial in demonstrating the extent of the thrombi and their location along a superficial thrombosed vein. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:470–473, 1998.

Iterative Reconstruction Methods in Computed Tomography ‐ J. Webster Stayman, Ph.D. Sophisticated iterative reconstruction methods for computed tomography have seen more widespread adoption with the availability of increased computational power and the desire for improved dose utilization. While improved image quality and dose reduction are possible with iterative approaches, there is a (sometimes confusing) diversity of algorithm choices. This presentation will introduce the basic concepts behind iterative reconstruction and statistical methods, including how such approaches are formed and illustrating different classes of reconstruction algorithm. Differences between iterative approaches and traditional reconstructions will be discussed ‐ both in terms of how data is processed as well as the differing image properties that arise from each type of algorithm. The lecture will highlight advantages and limitations of iterative reconstructions and provide listeners with a basic introduction of the inner workings of the iterative methodology.CT Dose Optimization: The Image Gently and Image Wisely Campaigns — Kimberly E. Applegate, MD The radiology community (radiologists, medical physicists, and radiologic technologists) has led the educational and awareness efforts to reduce radiation dose to our patients through effective collaborations that bridge traditional specialty silos and reach all stakeholders. These successful collaborations have included CT vendors and regulators, with the overarching goal of dose reduction while attaining the required image quality. As an example of where the collaboration of radiologists, physicists and technologists can bear fruit is in the optimization of CT scanning parameters to account not only for size but for the differences in physiology and pathology between children and adults. In some instances this allows us to reduce the dose in children significantly while not compromising the diagnosis. It is critical that the entire radiology sciences community continue to act as leaders in these efforts. In order to be successful, we must understand the current state of the science and what resources are available to us. Learning Objectives: 1. Understand the fundamentals of how iterative methods are formed and how to identify particular classes of iterative methods. 2. Gain intuition into the flexibility of iterative methods and why these approaches can have an advantage over other techniques. 3. Learn about the nature of iteratively reconstructed images and how images produced by these methods can have significantly different image properties from those produced by traditional analytic approaches. 4. Provide the current state of the science regarding cancer risk from medical procedures using ionizing radiation 5. Understand the radiation dose reduction goals and educational materials for all stakeholders involved in imaging children (Image Gently) and in imaging adults (Image Wisely) 6. Understand the differences in imaging requirements between children and adults in order to foster optimal CT scanning techniques 7. Become familiar with the 'tChoosing Wisely Campaign't that promotes appropriate use of medical resources