Completion CT of Chest, Abdomen, and Pelvis after Acute Head and Cervical Spine Trauma: Incidence of Acute Traumatic Findings in the Setting of Low-Velocity Trauma.

PURPOSE: To determine the frequency of acute traumatic findings in computed tomographic (CT) chest abdomen pelvis (CAP) examinations in patients with acute traumatic head and/or cervical spine injury and no evidence suggesting bodily injury. MATERIALS AND METHODS: After institutional review board approval with a waiver of informed consent was obtained, a HIPAA-compliant retrospective study was performed. A review of the electronic medical records and dictated reports identified patients who met the following criteria: CT-documented acute head and/or cervical spine trauma, CT CAP performed at least 20 minutes after initial brain and/or cervical spine CT, and no evidence of bodily injury at physical examination or on initial plain radiographs. The types of head and/or cervical injury, as well as mechanisms of injury in these patients, were analyzed. The frequency of acute traumatic injury in the CT CAP examinations was also determined, and 95% confidence intervals were calculated. RESULTS: There were 115 patients who met the study criteria (average age, 67.3 years). Sixty-three (54.8%) patients were male. The average injury severity score was 9.3. No patients who met the criteria for this study were found to have an acute traumatic injury to the chest, abdomen, or pelvis. These 115 CT CAP examinations comprised 7.5% (115 of 1530) of all CT CAP examinations performed in the emergency department over the 15-month study period. CONCLUSION: CT CAP examinations rarely if ever reveal acute traumatic injury in patients who have experienced low-velocity trauma and have acute head and/or cervical spine trauma in the absence of evidence of bodily injury.

Reshaping the emergency radiology call experience after the merger of two programs: the Yale experience.

In the summer of 2013, 16 radiology residents from the Hospital of Saint Raphael (HSR) joined the 38 residents of Yale-New Haven Hospital (YNHH) to become a single 54-resident program. This posed a significant challenge given the number of residents and very different call structures of the two institutions. After evaluating the emergency radiology volume at both hospitals, it was determined that implementing YNHH's traditional call system at HSR would increase call by approximately 25 %. In order to negate this increase, the SRC rotation was created at HSR. This Monday-Friday rotation covered by R3s starts at 1 p.m. with afternoon conference. Residents then read cases on a subspecialty service from 2-5 p.m. and then cover the entire hospital until 10 p.m. with a single attending. Because of this rotation, call did not increase for the YNHH residents and third year residents were provided with increased responsibility. For programs not undergoing a merger, call rotations can also be extremely beneficial. These rotations allow third year residents to have more "call-free" weeks prior to the ABR core exam. Also, patient care can be improved, as the shift length for on-call residents is reduced, which has been shown to improve accuracy.

Tarsal Coalitions: Radiographic, CT, and MR Imaging Findings.

BACKGROUND: Tarsal coalitions affect up to 13% of the population and can be a cause of chronic ankle and hindfoot pain. They can be subdivided as osseous, cartilaginous, or fibrous types, each with unique radiographic, CT, and MR imaging findings. In particular, MR imaging offers the unique ability to determine the exact type of tarsal coalition that is present as well as whether any associated soft tissue abnormalities are present. QUESTIONS/PURPOSES: The purposes of this paper were to (1) review the anatomy of the hindfoot; (2) review the radiographic, CT, and MR imaging findings of tarsal coalitions; and (3) review the imaging appearance of the specific types of tarsal coalitions. METHODS: Online searches were performed using Google Scholar with the search criteria of "tarsal coalition," "hindfoot anatomy," and "subtalar coalition," and limiting the searches to papers published in the last 10 years in major radiology journals. RESULTS: The anatomy of the hindfoot is complex but essential to understand. There are various radiographic, CT, and MR imaging findings that can be consistently noted in cases of tarsal coalition. The specific types of tarsal coalition demonstrate characteristic imaging findings. CONCLUSIONS: Knowledge of the normal anatomy of the foot, in particular the hindfoot, combined with the knowledge of the imaging characteristics of different histologic subtypes of coalitions (osseous, cartilaginous, and fibrous) is essential for interpreting radiographic, CT, and MR images of the ankle and foot.

Middle subtalar osseous coalition with associated fusion of the sinus tarsi: a previously undescribed type of tarsal coalition.

Tarsal coalitions affect up to 13% of the population and may cause chronic ankle and hindfoot pain. Coalitions can be subdivided as osseous, cartilaginous, or fibrous types. The most common type of tarsal coalition involvesthe talocalcaneal joint, where it usually affects the middle subtalar joint. In this article, we describe a previously unpublished form of talocalcaneal coalition with osseous coalition at the level of the middle subtalar joint with associated fusion of the sinus tarsi.

MRI of heel pain.

OBJECTIVE: The purpose of this article is to review the normal anatomy of the posterior ankle and hindfoot and review the causes of heel pain, with attention to the clinical, radio-graphic, and MRI findings. CONCLUSION: Heel pain is a common problem that may be due to a variety of soft-tissue and osseous abnormalities. Knowledge of the anatomy of the posterior ankle and hind-foot offers a useful way in approaching heel pain. Some of the more common causes include Achilles tendinosis, Haglund phenomenon, and plantar fasciitis. MRI offers superior soft-tissue contrast resolution and can be helpful in diagnosis as well as in presurgical planning.