Transition to computed radiography： can emergency medicine doctors accurately predict the need of film printing to facilitate optimal patient care？

BACKGROUND： This study aimed to evaluate emergency medicine doctors＇ accuracy in predicting the need of film printing in a simulated setting of computed radiography and assess whether this can facilitate optimal patient care.METHODS： Cross sectional study was conducted from 20 March 2009 to 3 April 2009 in 1334 patients. After clinical assessment of those patients who needed X-ray examination, doctors in the emergency department would indicate whether film printing was necessary for subsequent patient care in a simulated computed radiography setting. The fi nal discharge plan was then retrieved from each patient record. Accuracy of doctors＇ prediction was calculated by comparing the initial request for radiographic film printing and the final need of film. Doctors with different level of emergency medicine experience would also be analyzed and compared.RESULTS： The sensitivity of predicting fi lm printing was 84.5% and the specifi city of predicting no fi lm printing was 91.2%. Positive predictive value was 88.4% while negative predictive value was 88.2%. The overall accuracy was 88.2%. The accuracy of doctors stratified into groups of fellows, higher trainees and basic trainees were 85.4%, 90.5% and 88.5% respectively （P=0.073）.CONCLUSIONS： Our study showed that doctors can reliably predict whether film printing is needed after clinical assessment of patients, before actual image viewing. Advanced indication for film printing at the time of imaging request for selected patients can save time for all parties with minimal wastage.

Knowledge of radiation exposure associated with common trauma imaging modalities among orthopaedic surgeons,emergency medicine physicians,and general surgeons in the United States

BACKGROUND:Few contemporary studies have assessed physicians’knowledge of radiation exposure associated with common imaging studies,especially in trauma care.The purpose of this study was to assess the knowledge of physicians involved in caring for trauma patients regarding the effective radiation doses of musculoskeletal(MSK)imaging studies routinely utilized in the trauma setting.METHODS:An electronic survey was distributed to United States orthopaedic surgery,general surgery,and emergency medicine(EM)residency programs.Participants were asked to estimate the radiation dose for common imaging modalities of the pelvis,lumbar spine,and lower extremity,in terms of chest X-ray(CXR)equivalents.Physician estimates were compared to the true effective radiation doses.Additionally,participants were asked to report the frequency of discussing radiation risk with patients.RESULTS:A total of 218 physicians completed the survey;102(46.8%)were EM physicians,88(40.4%)wereorthopaedicsurgeons,and28(12.8%)weregeneralsurgeons.Physicians underestimated the effective radiation doses of nearly all imaging modalities,most notably for pelvic computed tomaography(CT)(median 50 CXR estimation vs.162 CXR actual)and lumbar CT(median 50 CXR estimation vs.638 CXR actual).There was no difference between physician specialties regarding estimation accuracy(P=0.133).Physicians who regularly discussed radiation risks with patients more accurately estimated radiation exposure(P=0.007).CONCLUSION:The knowledge among orthopaedic and general surgeons and EM physicians regarding the radiation exposure associated with common MSK trauma imaging is lacking.Further investigation with larger scale studies is warranted,and additional education in this area may improve care.

Chest X-rays in detecting injuries caused by blunt trauma

BACKGROUND:The appropriate sequence of different imagings and indications of thoracic computed tomography(TCT)in evaluating chest trauma have not yet been clarified at present.The current study was undertaken to determine the value of chest X-ray(CXR)in detecting chest injuries in patients with blunt trauma.METHODS:A total of 447 patients with blunt thoracic trauma who had been admitted to the emergency department(ED)in the period of 2009–2013 were retrospectively reviewed.The patients met inclusion criteria(age>8 years,blunt injury to the chest,hemodynamically stable,and neurologically intact)and underwent both TCT and upright CXR in the ED.Radiological imagings were re-interpreted after they were collected from the hospital database by two skilled radiologists.RESULTS:Of the 447 patients,309(69.1%)were male.The mean age of the 447 patients was 39.5±19.2(range 9 and 87 years).158(35.3%)patients were injured in motor vehicle accidents(MVA).CXR showed the highest sensitivity in detecting clavicle fractures[95%CI 78.3(63.6–89)]but the lowest in pneuomediastinum[95%CI 11.8(1.5–36.4)].The specificity of CXR was close to 100%in detecting a wide array of entities.CONCLUSION:CXR remains to be the first choice in hemodynamically unstable patients with blunt chest trauma.Moreover,stable patients with normal CXR are candidates who should undergo TCT if significant injury has not been ruled out.

DR9500系统在急诊X线摄影中的应用价值

目的:通过深入分析研究新型柯达DIREECTVIEW DR9500系统的成像原理,成像方式及拍片检查技术,评价其对急诊X线拍片临床应用价值。方法:随机选择2008年12月至2009年12月应用新型柯达DIREECTVIEWDR9500系统进行急诊拍片患者1 500例,分别与NSX-DR500和富士公司的FCR系统及普通X线摄影进行比较分析与讨论。结果:DR9500系统具有更加强大的实时成像、影像后处理及远程传输功能。结论:DR9500系统明显提升了医务人员的工作效率,影像质量得到进一步的改善;同时简化了工作程序,降低了劳动负荷,并且具有强大的诊断质量保证,为临床的诊断和治疗争取了宝贵的救治时间。

DR成像技术在急诊X线拍片中的应用

目的通过分析研究直接数字化(DR)成像方式拍片检查技术,评价其对急诊X线拍片临床应用价值。方法随机选择2006年8月-2008年3月应用DR成像技术方式急诊拍片患者1000例进行分析,检查设备采用荷兰飞利浦公司PHILIPS DR Digital Diagnost VS/TH2双板DR。结果DR系统具有实时成像、强大的影像后处理及远程传输功能。结论DR优化了我们的工作流程,减轻了医务人员的负荷,提高了工作效率及影像质量,为临床及时救治急诊患者提供了诊断质量保证。

The Utility of Diagnostic Imaging in Fish Bone Impaction

Objectives: The purpose of this pilot study was to obtain an Australian perspective on evaluating the utility of plain film radiography and computed tomography (CT) to rule out fish bone impaction in the upper aerodigestive tract in the emergency department (ED) setting. Methods: A retrospective multicentre cohort study was conducted. A total of 73 patients met the inclusion criteria. A subgroup of patients underwent CT. We studied the sensitivity and specificity of x-ray and CT along with other demographic variables to determine the likelihood of true fish bone impaction. Results: Out of the 73 patients, 28 patients had true bone impaction. The sensitivity for x-ray was 42.9% and specificity was 73.3%. The sensitivity of CT was 87.5% and specificity was 71.4%. We found a significant difference in the mean age of presentation for true bone and false bone impaction, P = 0.02. Conclusion: Due to the low sensitivity of x-ray we do not recommend the utilisation of plain film radiography to rule out bone impaction Advances in low dose radiation multidetector CT scanners may replace plain film radiography as a screening tool.