Utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy placement.

PURPOSE: To evaluate the utility of pre-procedural CT and abdominal radiography before percutaneous radiologic gastrostomy tube placement. METHODS: A retrospective review of gastrostomy tube placements was conducted at a tertiary care radiology department. During the studied period, all percutaneous radiologic G-tube placements (PRG) at the institution required a pre-procedural abdominal CT. Whether the CT was interpreted to have an adequate window for PRG was recorded. The same patients with pre-procedural abdominal radiographs were also identified and retrospectively reviewed for the presence of satisfactory anatomy for PRG. Outcomes of tube placements were reviewed. RESULTS: 126 PRG requests were identified, all with abdominal CTs. 110 also had an abdominal radiograph. An adequate window for PRG was present in 83% of patients by CT and 73% by radiography. Of patients in whom it was attempted, 94% underwent successful PRG with a 7.4% minor complication rate. Of those refused for PRG based on CT, 9% had successful percutaneous endoscopic G-tube placement, resulting in a sensitivity of 98%. 97% of patients with satisfactory anatomy by radiograph underwent successful PRG. Of those with no window, 66% had a window by CT, and 94% in whom it was attempted had successful PRG placement. This resulted in a sensitivity of 77% for radiography. Concordance between CT and radiography was 73%. CONCLUSIONS: Pre-procedural CT interpretation is highly predictive of successful and uncomplicated PRG. Abdominal radiography also predicts successful PRG, but with a lower accuracy, limiting its utility as a pre-procedural exam.

Contained Rupture of an Abdominal Aortic Aneurysm With Extensive Vertebral Body and Retroperitoneal Space Destruction.

Chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion most commonly presents with symptoms of low back pain. Although not well known, vertebral body erosion or destruction may be seen in up to 25% of patients with sealed or contained rupture of an abdominal aortic aneurysm. This appearance on cross-sectional imaging may mimic a malignant or infectious process. Although these cases can present a diagnostic challenge, published cases of chronic contained rupture of an abdominal aortic aneurysm with vertebral body erosion demonstrate clinical and imaging similarities that, when recognized, can assist in diagnosis.

On-call resident outside study overreads: Our department's experience streamlining workflow and improving resident supervision while providing a new source of revenue.

Handling the interpretation of outside studies or "curbside" consults can be a daily problem for many radiology departments. In this article, we describe the efforts of a resident quality improvement project to create a more streamlined workflow for the interpretation of outside studies. The principle goal of this project was to ensure that at our teaching hospital, any outside study presented to a resident on call also received a final staff interpretation. An additional goal of this project was to use the digital tools available in our department to streamline the workflow for providing these outside interpretations. The result is an integrated workflow that allows for increased resident supervision as well as a potential new source of revenue in being able to generate billable interpretations.