Initial Imaging of Pregnant Patients in the Trauma Bay-Discussion and Review of Presentations at a Level-1 Trauma Centre.

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.

Equity, diversity & inclusion in academic radiology: An elusive dream.

BACKGROUND: Disparities in sex and race/ethnicity continue to persist in the academic radiology. This study addresses the sex/racial underrepresentation and evolution in the academic radiology. PURPOSE: To evaluate academic radiology temporal trends disparities by analyzing sex and race/ethnicity diversity in academic degree and tenure status. MATERIALS AND METHODS: A retrospective cross-sectional analysis conducted using American Association of Medical College database between 2007 and 2018. Trends in academic degree, tenure status, race/ethnicity, and sex assessed with linear regression analysis and Poisson regression model for annual percent change with statistical significance of p < 0.05. RESULTS: Out of 107,213 radiologists 72%, n = 76,893 males and 64%, n = 68,738 white faculty with 1277 males and 872 females. White MD-degree radiologists constitute 67.2%, Asian (20.9%), Black (2.5%), Hispanic (3.2%), multiple (3.4%), unknown (1.8%) and "other" (1%) races with a similar PhD/other doctoral and dual-degree. White faculty recruitment trend (n2007 = 955, n2018 = 703) and representation (-0.82% per year; 95% CI, -1.00 to -0.63; p < 0.0001) decreased, while Asian URM decreased respectively (n2007 = 152, n2018 = 205) (0.68% per year; 95% CI, 0.58 to 0.77; p < 0.0001). Females were underrepresented in all categories. CONCLUSION: URM and females are underrepresented in academic radiology. Academic degree types and tenure track may contribute to White and male academic radiologists overrepresentation.

National Institutes of Health: Gender Differences in Radiology Funding.

RATIONALE AND OBJECTIVE: Radiology has traditionally remained one of the most male-dominated specialties, although a higher proportion of women are now beginning to occupy roles as academic radiologists than their male counterparts. The present study investigated trends in National Institutes of Health (NIH) funding within Diagnostic Radiology stratified by gender, and correlated with measures of academic output, including h-index. MATERIALS AND METHODS: Data on funding was obtained from the online NIH Research Portfolio Online Reporting Tools Expenditure and Results for fiscal years 2016-2019, and information regarding each Principal Investigator (PI) was obtained from the Scopus database and departmental websites. Mann-Whitney U tests were performed on collected data for statistical comparison of continuous variables. RESULTS: Of the 2929 grants included in this analysis, 1789 (61.07%) were awarded to male PIs and 1140 (38.9%) to female PIs.  Among PIs holding a PhD degree, male PIs had a higher mean grant amount ($619,807.00) compared to female PIs ($158,486.00). CONCLUSION: Although female representation within academic radiology has been increasing, the mean NIH grants awarded to women is less than that awarded to men. Reasons for this are numerous and may include differential prioritization of career objectives among men and women, although such rationalization is inevitably speculative in nature. Significant gender differences in NIH funding were seen at the PhD level, and the strongest correlation between NIH funding and academic output was observed for the h-index of female PIs. These results underscore the fact that women are ostensibly being held to a higher academic standard than men in terms of funding decisions.

Clinical Applications of Dual-Energy CT.

Dual-energy CT (DECT) provides insights into the material properties of tissues and can differentiate between tissues with similar attenuation on conventional single-energy imaging. In the conventional CT scanner, differences in the X-ray attenuation between adjacent structures are dependent on the atomic number of the materials involved, whereas in DECT, the difference in the attenuation is dependent on both the atomic number and electron density. The basic principle of DECT is to obtain two datasets with different X-ray energy levels from the same anatomic region and material decomposition based on attenuation differences at different energy levels. In this article, we discuss the clinical applications of DECT and its potential robust improvements in performance and postprocessing capabilities.

Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making.

Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.

Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen.

Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.

State of the Art Imaging Review of Blunt and Penetrating Cardiac Trauma.

Traumatic cardiovascular injuries are only second to the central nervous system injuries as a cause of death in young adult population. Multidetector computed tomography is the gold standard diagnostic modality in patients with blunt or penetrating chest trauma and clinical suspicion of cardiac injury. The imaging spectrum of cardiac injuries includes but not limits to pericardial rupture, myocardial contusions, valve rupture, coronary artery injuries, cardiac herniations, and cardiac tamponade. In this review article, we discuss clinical presentation, types, and mechanism of cardiac trauma with emphasis on the imaging findings and illustrations in blunt, penetrating traumatic, and iatrogenic cardiac injuries.

Gender Disparity Among Leaders of Canadian Academic Radiology Departments.

OBJECTIVE. Underrepresentation of women in the top hierarchy of academic medicine exists despite women comprising more than half of the medical school graduates and residency positions. The purpose of this study is to analyze and quantify the relationship of gender, research productivity, and career advancement in Canadian academic radiology departments. MATERIALS AND METHODS. Seventeen academic radiology departments with affiliated residency programs in Canada were searched for publicly available data on faculty to generate a database for gender and academic profiles of the radiologists. Bibliometric data were collected using Scopus archives. The associations of gender, academic ranks, and leadership positions were assessed, and a p value of ≤ 0.05 was defined as significant. Significant variables were analyzed using a multivariate linear regression model. RESULTS. Of 1266 faculty members, gender information and academic rank were available for 932 faculty members: 597 (64.05%) were men and 335 (35.95%) were women (χ2 = 21.82; p < 0.0001). Of a total of 563 assistant professors, 331 (58.79%) were men and 232 (41.21%) were women; of 258 associate professors, 177 (68.60%) were men and 81 (31.40%) were women; and of 111 professors, 89 (80.18%) were men and 22 (19.82%) were women. The gender gap widens at higher academic ranks, displaying a threefold drop in the ratio of women holding the rank of full professor (6.57%) compared with 14.91% male professors; 29.55% of women radiologists have first-in-command leadership positions compared with 70.45% of men. A comparable or higher h-index is noted for women Canadian radiologists after adjusting for number of citations, number of publications, and years of active research. CONCLUSION. Canadian academic radiology departments have fewer women radiologists in senior faculty and leadership positions. Our study results show that Canadian female radiologists at the professor level have more publications than their male counterparts.

Managing low back pain in active adolescents.

Adolescent low back pain has received limited research attention despite its potentially considerable impact on quality of life. The role of diagnostic triage to identify serious or specific pathology and/or order relevant investigations is considered. An overview of contemporary pain mechanisms is provided, with specific reference to the wide range of risk factors for persistent low back pain. Education and exercise framed within a biopsychosocial framework are the cornerstones of treatment. There is a lack of data on more comprehensive personalized treatment approaches among adolescents. One such approach - Cognitive Functional Therapy - which has shown promise in adults and active adolescents with low back pain, is described and illustrated using a case study. The most promising avenues, in practice and research, may be those that view adolescent low back pain as less of a local structural spinal issue and more of an indication of the general health of the adolescent.

Relationship of length of transverse process of seventh cervical vertebra with positive nerve conduction studies in cases of brachialgia.

OBJECTIVES: To determine the association between length of transverse process of seventh cervical vertebrae on plain x-ray cervical spine AP-view and nerve conduction studies of respective patients having brachialgia. METHODS: The study was carried out at Department of Radiology, Military Hospital Rawalpindi in collaboration with Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi from January 2004 to December 2004. A total of 160 adult subjects were enrolled in this study including 80 volunteers with no history of brachialgia. Eighty subjects suffered from brachialgia and were documented to have abnormal nerve conduction studies/Electromyography referred from AFIRM Rawalpindi. X-ray cervical spine AP-view of all patients was taken. Relative risk (RR) was calculated to determine the association. RESULTS: Eighty percent (64 out of 80) patients with brachialgia and documented abnormal nerve conduction studies had prominent transverse process of seventh cervical vertebrae on x-ray cervical spine AP-view. RR for developing brachialgia was 2.64 and association was statistically significant. CONCLUSION: X-ray cervical spine AP-view is a simple, quick and tolerable method of measuring transverse process of seventh cervical vertebra. This can predict which individuals are more likely to develop brachialgia.