The Clinical Impact of Resident-attending Discrepancies in On-call Radiology Reporting: A Retrospective Assessment.

RATIONALE AND OBJECTIVES: The purpose of this study is to quantify the clinical impact of resident-attending discrepancies at a tertiary referral academic radiology residency program by assessing rates of intervention, discrepancy confirmation, recall rate, and management change rate; furthermore, a discrepancy categorization system will be assessed. MATERIALS AND METHODS: Retrospective review of the records was performed for n = 1482 discrepancies that occurred in the 17-month study period to assess the clinical impact of discrepancies. Discrepancies were grouped according to a previously published classification system. Management changes were recorded and grouped by severity. The recall rate was estimated for discharged patients. Any confirmatory testing was reviewed to evaluate the accuracy of the discrepant report. Categorical variables were compared to the chi-square test. RESULTS: The 1482 discrepancies led to management change in 661 cases (44.6%). The most common management change was follow-up imaging. Procedural interventions including surgery occurred in 50 cases (3.3%). The recall rate was 2.6%. Management changes were more severe with computed tomography examinations, inpatients, and when the discrepancy was in the chest and abdomen subspecialty. Also, management changes correlated with the discrepancy category assigned by the attending at the time of review. CONCLUSIONS: Resident-attending discrepancies do cause management changes in 44.6% of discrepancies (0.62% overall); the most frequent change is follow-up imaging. The discrepancy categorization assigned by the attending correlated with the severity of management change.

Role of lower extremity run-off CT angiography in the evaluation of acute vascular disease.

In the acute care setting, radiologists are frequently asked to assist in the evaluation of patients presenting with signs and symptoms of lower extremity peripheral vascular disease. Non-traumatic peripheral vascular emergencies are most commonly the result of thrombosis, either in a native vessel or within a bypass graft or stent. Arterial emboli, peripheral aneurysm with embolus or thrombosis, and direct arterial trauma are additional, less common causes. Traumatic peripheral vascular emergencies include vessel occlusion, transection, pseudoaneurysms, active extravasation, and arteriovenous fistulas. The high morbidity and mortality associated with acute limb ischemia makes rapid diagnosis and early initiation of therapy critical in the management of such patients. Computed tomographic angiography (CTA) offers the vascular specialist a rapid, widely available, and accurate means to diagnose and grade the extent of vascular disease in the acute care setting. In this pictorial essay, the key elements of lower extremity run-off CTA are reviewed, including relevant anatomy, imaging approach, and spectrum of imaging findings.

Initial experience with a combined multidetector CT and biplane digital subtraction angiography suite with a single interactive table for the diagnosis and treatment of neurovascular disease.

BACKGROUND: A combined imaging suite is useful in the diagnosis and treatment of vascular disease involving the head and neck. This study demonstrates the utility of a multidetector row CT and biplane digital subtraction angiography (DSA) system (hybrid suite) with a single interactive table for the evaluation and treatment of neurovascular disease. METHODS: 30 patients were studied utilizing the hybrid suite. Direct intra-arterial and selective intravenous injection of contrast with CT imaging (IA-CTA and IV-CTV) was performed in nine vascular tumors, three intracranial arteriovenous malformations, four spinal vascular lesions, one aneurysm and two inferior petrosal sinus sampling cases. Angiography with CT perfusion (CTP) imaging was obtained in five temporary balloon occlusion tests, two ischemic stroke and two vasospasm cases. A CT scan of the head was obtained in two cases during aneurysm coiling. The value of the IA-CTA and IV-CTV images compared with conventional CT and MRI images was qualitatively assessed. RESULTS: All studies were technically successful with no complications. IA-CTA and IV-CTV were useful in the diagnosis and treatment of vascular disease. All IA-CTA and IV-CTV images were qualitatively graded as superior to conventional imaging. CTP imaging provided information about the penumbra and area of infarction in five temporary balloon test occlusions, two ischemic stroke and two vasospasm cases. A CT scan of the head provided timely information in two aneurysm coiling cases. The hybrid suite allowed angiography and CT scanning to be performed immediately without patient transfer. CONCLUSION: This hybrid suite improves the diagnostic and therapeutic capabilities of treating a multitude of neurovascular diseases.

Extra-abdominal desmoid tumor with osseous involvement.

Deep fibromatoses, or desmoid tumors, arise from connective tissue. Imaging can frequently suggest the diagnosis of these aggressive, benign neoplasms. Cross-sectional imaging commonly demonstrates an enhancing solid mass that resembles scar tissue, typically without osseous involvement. We report a case of an extra-abdominal desmoid tumor involving the teres minor muscle in a symptomatic 42-year-old woman with unusual features of medullary involvement and negative nuclear beta-catenin staining.

Delayed development of brain abscesses following stent-graft placement in a head and neck cancer patient presenting with carotid blowout syndrome.

We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.