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Background: Orally administered water-soluble contrast (WSC) can track resolution of small-bowel obstruction (SBO), but no universal pathway for its use exists. We developed and implemented an evidence-based guideline for the use of WSC in the management of adhesive SBO, to be implemented across hospitals affiliated with the University of Toronto. Methods: We performed a systematic review and created a clinical practice guideline for WSC use in the management of adhesive SBO. The guideline was approved through consensus by an expert panel and implemented in 2018. We performed a prospective cohort study of guideline implementation at 1 pilot site (a large academic tertiary care centre), facilitated by the centre's acute care general surgery service. Primary outcomes included compliance with the guideline and hospital length of stay (LOS). Secondary outcomes included rates of failure of nonoperative management, morbidity, mortality and readmission for recurrence of SBO within 1 year. Patients with adhesive SBO admitted in 2016 served as a control cohort. Results: We analyzed the data for 152 patients with adhesive SBO admitted to the centre, 65 in 2016 (historical cohort), 56 in January-June 2018 (transitional cohort) and 31 in July-December 2018 (implementation cohort). There was a significant increase in compliance with the WSC protocol in 2018, with the proportion of patients receiving WSC increasing from 45% (n = 25) in the transitional cohort to 71% (n = 22) in the implementation cohort (p < 0.001). The median LOS did not differ across the cohorts (p = 0.06). There was a significantly lower readmission rate in the transitional and implementation cohorts (13 [23%] and 9 [29%], respectively) than in the historical cohort (29 [45%]) (p = 0.04). Among patients assigned to nonoperative management initially, a significantly higher proportion of those who received WSC than those who did not receive WSC went on to undergo surgery (14.6% v. 3.6%, p = 0.01), with no difference in median time to surgery (p = 0.2). Conclusion: An evidence-based guideline for WSC use in SBO management was successfully developed and implemented; no difference in LOS or time to surgery was seen after implementation, but rates of immediate operation increased and readmission rates decreased. Our experience shows that implementation of an evidencebased clinical practice guideline is feasible through multidisciplinary efforts and coordination. Contexte : La resolution de l'occlusion de l'intestin grele (OIG) peut etre surveillee par l'administration de produit de contraste hydrosoluble (PCH) par voie orale, mais il n'existe pas de protocole universel. Afin de pallier cette lacune, nous avons cree et mis en oeuvre une ligne directrice factuelle, destinee aux hopitaux afflies a l'Universite de Toronto, pour l'administration de PCH dans la prise en charge de l'OIG sur adherences. Methodes : Nous avons realise une revue systematique puis elabore un guide de pratique clinique, valide par consensus par un comite d'experts avant d'etre mis en oeuvre en 2018. Une etude de cohorte prospective sur sa mise en oeuvre a ete conduite au service de chirurgie generale d'urgence d'un etablissement pilote (grand centre universitaire de soins tertiaires). Les indicateurs de resultats principaux etaient l'adhesion au guide et la duree d'hospitalisation; les secondaires comprenaient le taux d'echec de la prise en charge conservatrice, la morbidite, la mortalite et le taux de readmission pour recidive d'OIG dans l'annee. La cohorte temoin se composait de patients hospitalises en 2016 pour une OIG sur adherences. Resultats : Nous avons analyse les donnees de 152 patients atteints d'OIG sur adherences admis au centre : 65 en 2016 (cohorte historique), 56 entre janvier et juin 2018 (cohorte de transition) et 31 entre juillet et decembre 2018 (cohorte d'appli cation). Le respect du protocole d'administration de PCH a largement augmente en 2018 : le pourcentage est passe de 45 % (n = 25) dans la cohorte de transition a 71 % (n = 22) dans la cohorte d'application (p < 0,001). La duree d'hospita lisation mediane est restee identique (p = 0,06), mais le taux de readmission etait beaucoup plus faible dans les cohortes de transition et d'application (13 [23 %] et 9 [29 %]) que dans la cohorte historique (29 [45 %]) (p = 0,04). L'administration de PCH dans le cadre de la prise en charge conservatrice de premiere intention est associee a une augmentation significative du taux de traitement chirurgical (14,6 % contre 3,6 % sans PCH; p = 0,01), sans variation du delai avant l'intervention (p = 0,2). Conclusion : Une ligne directrice factuelle sur l'administration de PCH dans la prise en charge de l'OIG a ete concue et mise en oeuvre. Aucune variation de la duree d'hospi talisation ou du delai avant l'intervention chirurgicale n'a ete observee apres l'application. Toutefois, le taux d'intervention chirurgicale a court terme a augmente tandis que le taux de readmission a diminue. Notre experience montre que les efforts et la coordination pluridisciplinaires permettent d'appliquer un guide de pratique clinique fonde sur des donnees probantes., Adhesions after abdominal surgery are the most common cause of small-bowel obstruction (SBO). (1-3) Surgical intervention for SBO is sometimes necessary, and delays in treatment can lead to illness and [...]

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. [ABSTRACT FROM AUTHOR]

Imaging of pregnant patients who sustained trauma often causes fear and confusion among patients, their families, and health care professionals regarding the potential for detrimental effects from radiation exposure to the fetus. Unnecessary delays or potentially harmful avoidance of the justified imaging studies may result from this understandable anxiety. This guideline was developed by the Canadian Emergency, Trauma and Acute Care Radiology Society (CETARS) and the Canadian Association of Radiologists (CAR) Working Group on Imaging the Pregnant Trauma Patient, informed by a literature review as well as multidisciplinary expert panel opinions and discussions. The working group included academic subspecialty radiologists, a trauma team leader, an emergency physician, and an obstetriciangynaecologist/maternal fetal medicine specialist, who were brought together to provide updated, evidence-based recommendations for the imaging of pregnant trauma patients, including patient safety aspects (eg, radiation and contrast concerns) and counselling, initial imaging in maternal trauma, specific considerations for the use of fluoroscopy, angiography, and magnetic resonance imaging. The guideline strives to achieve clarity and prevent added anxiety in an already stressful situation of injury to a pregnant patient, who should not be imaged differently. [ABSTRACT FROM AUTHOR]

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence . This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To evaluate the performance of the winning machine learning (ML) models from the 2023 RSNA Abdominal Trauma Detection Artificial Intelligence Challenge. Materials and Methods The competition was hosted on Kaggle and took place between July 26, 2023, to October 15, 2023. The multicenter competition dataset consisted of 4,274 abdominal trauma CT scans in which solid organs (liver, spleen and kidneys) were annotated as healthy, low-grade or high-grade injury. Studies were labeled as positive or negative for the presence of bowel/mesenteric injury and active extravasation. In this study, performances of the 8 award-winning models were retrospectively assessed and compared using various metrics, including the area under the receiver operating characteristic curve (AUC), for each injury category. The reported mean values of these metrics were calculated by averaging the performance across all models for each specified injury type. Results The models exhibited strong performance in detecting solid organ injuries, particularly high-grade injuries. For binary detection of injuries, the models demonstrated mean AUC values of 0.92 (range:0.91-0.94) for liver, 0.91 (range:0.87-0.93) for splenic, and 0.94 (range:0.93-0.95) for kidney injuries. The models achieved mean AUC values of 0.98 (range:0.96-0.98) for high-grade liver, 0.98 (range:0.97-0.99) for high-grade splenic, and 0.98 (range:0.97-0.98) for high-grade kidney injuries. For the detection of bowel/mesenteric injuries and active extravasation, the models demonstrated mean AUC values of 0.85 (range:0.74-0.73) and 0.85 (range:0.79-0.89) respectively. Conclusion The award-winning models from the AI challenge demonstrated strong performance in the detection of traumatic abdominal injuries on CT scans, particularly high-grade injuries. These models may serve as a performance baseline for future investigations and algorithms. ©RSNA, 2024.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence . This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. The RSNA Abdominal Traumatic Injury CT (RATIC) dataset contains 4,274 abdominal CT studies with annotations related to traumatic injuries and is available at https://imaging.rsna.org/dataset/5 and https://www.kaggle.com/competitions/rsna-2023-abdominal-trauma-detection . ©RSNA, 2024.

Objective: The hypothesis of this study was that the use of dual-energy spectral techniques in CT can improve accuracy in the diagnosis of acute gangrenous appendicitis., Materials and Methods: This retrospective study included 209 patients with a pathologic diagnosis of appendicitis. Two board-certified abdominal radiologists reviewed 120-kV simulated images, 40-keV virtual monoenergetic images, and color-coded iodine overlay images. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), accuracy, and interobserver agreement were calculated for each set of images., Results: Forty-four patients (21.0%) had histopathologic results positive for gangrenous appendicitis. The sensitivity of 40-kV virtual monoenergetic imaging was 100% (44/44); specificity, 81.2% (134/165); PPV, 58.7% (44/75); NPV, 100% (134/134); accuracy, 85.2%; and interobserver agreement, 0.99. The corresponding values for the iodine overlay imaging datasets were 100% (44/44), 80.0% (132/165), 57.1% (44/77), 100% (132/132), 84.2%, and 0.99 and for 120-kV simulated imaging were 22.7% (10/44), 96.4% (159/165), 62.5% (10/16), 82.4% (159/193), 77.5%, and 0.93. All cases of gangrenous appendicitis had true-positive results of virtual monoenergetic and iodine overlay imaging. There were no false-negative results of virtual monoenergetic or iodine overlay imaging., Conclusion: In cases of suspected appendicitis, dual-energy CT that includes virtual monoenergetic and iodine overlay imaging is accurate for confirming and excluding the presence of gangrenous appendicitis with high sensitivity and specificity.