Current practice of emergency radiology in Turkey and future expectations: a survey study

PURPOSEThe development of emergency radiology (ER) in Turkey has accelerated with the increase in the number of patients admitted to emergency departments. We aimed to present and discuss the responses to a survey distributed to radiologists in Turkey, which included questions about the current practice of ER and future expectations.METHODSA survey with 29 questions enquiring about the infrastructure of respondents’ hospitals and radiology units, information about emergency services and ER (including patient volume), the number of staff and equipment, the ER working plan and reporting method, and training in the field of ER were distributed to members of the Turkish Radiological Society by email.RESULTSThe response rate was 21.97% (328/1.493). The presence of distinct ER units in radiology departments was confirmed by 40.55% of respondents, while for 34.25%, ER was located inside the emergency room. Of the respondents, 26.96% stated they believed that emergency cases should be reported by emergency radiologists, and the necessity for an ER subunit in the emergency room was agreed upon by 58.64% of contributors. The majority of respondents (69.54%) agreed with the opinion that residents should receive their ER training in an ER unit.CONCLUSIONKeeping abreast of current ER practices and radiologists’ expectations may be helpful for improving national ER practices and academic studies

Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study

PURPOSE: To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS: This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS: Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION: Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19

CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices

PURPOSE:To compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD).METHODS:A total of 224 patients [ICD group (n = 155) and LVAD group (n = 69)] who had at least one cranial CT scan were enrolled from three medical centers. The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential, tube current, tube rotation time (TI), slice collimation (cSL), and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), total dose length product (DLP) were analyzed.RESULTS:The mean DLP value of Center A and mean CTDIvol values of Center A and C were significantly lower than Center B (p < 0.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than the LVAD group (p<0.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and CT scanning technique as sequential or spiral according to multivariate linear regression analysis.CONCLUSION:Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events

Retrograde Cerebral Air Embolism In A Patient With Intestinal Necrosis: A Case Report

Background: Cerebral venous air embolism is a severe clinical condition related to an unfavourable outcome in patients with neurological impairment. Cerebral venous air embolism may occur secondarily to arterial or venous interventions. A rare mechanism of cerebral venous air embolism is retrograde embolism, which is characterized by gas flow in a direction that is opposite to that of the normal blood flow. Case Report: A 69-year-old female was admitted to our hospital with shortness of breath and abdominal pain. Abdominal computed tomography revealed intramural gas in the bowel and free gas in the mesenteric veins and portal vein. Cranial computed tomography, which was performed due to impaired consciousness, demonstrated cerebral air embolism with the appearance of a gyriform pattern. A bedside echocardiography and chest computed tomography revealed no evidence of right-to-left shunt. Conclusion: Cerebral venous air embolism may occur after pneumatosis intestinalis by a retrograde flow of air from the mesenteric veins and portal vein. Low cardiac output and supine position are contributing factors for a retrograde flow of air bubbles into the venous circulation of the brain.PubMedWoSScopu

The Contribution of Preoperative Mri to the Surgical Management of Anal Fistulas

PURPOSE Anal fistula is an abnormal tract or cavity between the anal canal and perianal skin. Surgical treatment of anal fistulas requires the identification of the course of the primary and secondary tracts and their relation with the sphincter musculature in order to appropriately manage them and drain any abscess. Physical examination alone is not as accurate as imaging modalities in detecting these features of the fistula, and recurrences are usually due to missed or inadequately managed infective components. Magnetic resonance imaging (MRI) is the preferred imaging modality for detecting anal fistulas, but which patient group should undergo preoperative MRI is a matter of debate.The aim of this study was to determine the contribution of MRI in the surgical management of anal fistulas. METHODS Medical records of patients who underwent surgery for primary anal fistula and preoperative MRI in our University Hospitals from January 1, 2008 to April 15, 2018 were collected anonymously and retrospectively. Any discrepancies between operative findings and MRI reports were noted. Two study groups were formed as per the contribution of preoperative MRI: significant and non-significant contribution groups. The significant contribution group included patients with secondary (blind) tracts, horseshoe fistulas, or abscesses undiagnosed at physical examination and examination under anesthesia; those with the location of the internal orifice different from that identified by physical examination; or those with the grade of the fistula assessed to be more advanced after preoperative MRI. RESULTS The total number of surgeries was 136. Mean patient age was 43 +/- 13 years. There were 106 males. In total, 47 patients suffered from recurrent fistulas. MRI contribution to clinical evaluation was significant in 33.8% of the patients. MRI more frequently provided significant information for complex fistulas than for simple fistulas. Significant preoperative MRI contribution was more frequent if the external opening was more than 2 cm away from the anal canal or when a horseshoe fistula was present. CONCLUSION Our study is valuable in linking physical examination findings with preoperative MRI findings. The distance of the external opening from the anal canal was not studied in the literature; our findings support the use of MRI for fistulas with external opening located more than 2 cm from the anus. These fistulas also tend to be complex and have a higher grade. In recurrent cases, MRI contributes not only by establishing the fistula anatomy but also by identifying possible sphincter damage.WoSScopu

Assessment of Foreign Body Aspiration Material Using A Virtual Bronchoscopy Model: Time-Density and Time-Volume Relationships

Background: During foreign body aspiration (FBA), identifying the type of object is frequently problematic. Objectives: This study assessed density changes over time in the most common organic, FBA materials using virtual bronchoscopy. We also examined volumetric changes in materials to determine the optimal removal time for each type of foreign body. Materials and Methods: Size-appropriate slots for each type of foreign body were created on a 2 x 30 x 30 cm sponge plate. Objects ( shelled and blanched peanuts, roasted chickpeas, hazelnuts, walnuts, almonds, pistachios, watermelon seeds, shelled and unshelled sunflower seeds, shelled and unshelled pumpkin seeds, chickpeas, beans, lemon seeds, and apple seeds) were placed into the slots, after which a second sponge, with identical dimensions, was placed over the top of the first sponge to achieve closure. A moist environment was maintained for 7 days at body temperature (37 degrees C). Multidetector computed tomography (MDCT) images of the sponges, volume and density measurements of objects performed each day were recorded. Intra-object differences in density and volume over time on MDCT were evaluated using time-density and time-volume curves, respectively. The SPSS for Windows software package (ver. 21.0; SPSS Inc., Chicago, IL, USA) was used to perform analyses. Pearson correlation analyses were used to determine differences in the volume and density of FBA materials across days. A time volumetric graph was also obtained. P < 0.05 was considered as significant. Results: Following aspiration, organic material volumes on day 7 were below baseline values, although objects exhibited a 30% average increase in volume during the first 4 days. The density values of objects increased between days 2 and 5, and decreased thereafter. Conclusions: Measuring daily changes in density allows for the identification of FBA materials. Our data indicate that object removal during days 1 - 3, and on day 7 should be easier compared to days 4 - 6