• Diagnosis
• Handover
• Radiology
• Surgery
• Surgical training

• CT scan
• Laparotomy
• Mortality
• NELA

• Humans
• Female
• Male
• Laparotomy/mortality
• Tomography, X-Ray Computed/statistics & numerical data
• Tomography, X-Ray Computed/standards
• Aged
• Middle Aged
• Guideline Adherence/statistics & numerical data
• United Kingdom
• Preoperative Care/standards
• Preoperative Care/methods
• Time Factors
• Aged, 80 and over
• Emergencies
• Adult
• Practice Guidelines as Topic

• brain imaging
• clinical significance
• cross-sectional study
• ct imaging
• discrepancy rates
• provisional reporting
• radiology

• Humans
• Abdomen, Acute/diagnostic imaging
• Abdomen, Acute/etiology
• Abdomen, Acute/history
• Abdomen, Acute/surgery
• Diagnosis, Differential
• History, 20th Century
• History, 21st Century

• Abdominal imaging
• Cholecystitis
• Dual-energy CT
• Gall bladder
• Mucosal integrity
• Peri-cholecystic liver enhancement

• Humans
• Female
• Male
• Cholecystitis, Acute/diagnostic imaging
• Middle Aged
• Tomography, X-Ray Computed/methods
• Aged
• Sensitivity and Specificity
• Retrospective Studies
• Adult
• Aged, 80 and over
• Bile/diagnostic imaging
• Contrast Media
• Radiography, Dual-Energy Scanned Projection/methods

• Abdominal emergencies
• Acute abdomen
• Peritonitis
• Pneumoperitoneum
• Shock

• Humans
• Emergencies
• Abdominal Pain/diagnosis
• Abdominal Pain/etiology
• Diagnosis, Differential

• Acute appendicitis
• Point-of-care ultrasound
• Ranson score
• Teleradiologist

• Humans
• Male
• Female
• Appendicitis/diagnostic imaging
• Point-of-Care Systems
• Sensitivity and Specificity
• Ultrasonography/methods
• Acute Disease
• Emergency Service, Hospital
• Physicians

• Dose-response
• Epidemiology
• Linear no-threshold model
• Radiation protection
• Radiobiology
• Radiophobia

• Dose-Response Relationship, Radiation
• Humans
• Linear Models
• Neoplasms, Radiation-Induced/epidemiology
• Neoplasms, Radiation-Induced/genetics
• Radiation Monitoring
• Radiation Protection
• Radiation, Ionizing
• Risk Assessment/methods

• appendicitis
• computed tomography
• radiograph
• ultrasound

• Abdominal pain
• Computed tomography
• Emergencies
• Ovarian neoplasms

To determine the clinical impact of the second examination when both CT and TVUS are obtained in the same ED visit for acute pelvic/lower abdominal symptoms in non-pregnant premenopausal women.

200 consecutive non-pregnant premenopausal women (mean age, 31.8 years; range, 18–49 years) who underwent both ED-based TVUS and abdominopelvic CT evaluation for acute symptoms over a 12 month period were included; 107 women had TVUS first, followed by CT; 93 women had CT first. All relevant clinical, radiologic, and pathologic findings were reviewed to establish a final diagnosis. Any additional clinical impact provided by the second imaging test was assessed by two experienced abdominal radiologists.

Initial TVUS was interpreted as normal (n = 63) or mentioned incidental findings (n = 11) in 69% (74/107); subsequent CT established a non-gynecologic GI/GU etiology in 25 (34%). For 37% (34/93) of CT exams interpreted as normal, TVUS added no new information. In 32 cases (34%), TVUS further excluded ovarian torsion/adnexal pathology when initial CT was indeterminate/equivocal. Overall, CT following TVUS provided a key new or alternative diagnosis in 26% (28/107), whereas TVUS after CT provided a relevant new/alternative diagnosis in only 1/93 cases (p < 0.001). In nine cases (8%), CT confirmed a positive US diagnosis but detected relevant additional diagnostic information.

CT following negative TVUS frequently identified a non-gynecologic cause of acute pelvic or lower abdominal symptoms in non-pregnant premenopausal women, whereas the main benefit of TVUS after CT was more confident exclusion of ovarian torsion.

The online version contains supplementary material available at 10.1007/s00261-022-03504-6.

• Computed tomography
• Non-traumatic abdominal pain
• Nonpregnant
• Premenopausal
• Ultrasound

Easy accessibility, high sensitivity and specificity of CT scans have markedly increased its usage in developed countries. Its importance is undeniably considered integral for the diagnosis of various pathologies. However, sometimes this costly resource is wasted when used unnecessary. This paper is an audit on CT scans performed to look for surgical pathologies between July 2018 and April 2019 recapitulating the numbers of CT scan's abnormal and normal findings.

Anonymized record of all the patients seen by the surgical team in the emergency department was reviewed. Retrospective data of every patient who had the CT scan was taken through Mckesson Radiology software of an Irish Hospital. Analysis was done using SPSS. Findings of 102 CT scans was broken down in to three different groups depending at which departmental level CT was performed, namely:Emergency department, Inpatient and Outpatient.

102 CT Scans were performed of which 51 (50%) patients out of all the three groups had unremarkable.

Adequate history, proper clinical examination and strong clinical knowledge may bring down the number of unnecessary CT scans.

•

Representation of a picture from Ireland about trends of use of CT scan.

• abdominal pain
• analgesia
• anxiety
• computed tomography
• depression
• emergency department
• low-risk
• opioid
• recurrent
• ultrasound

Accurate interpretation of computed tomography (CT) scans is critical for patient care in the emergency department. We aimed to identify factors associated with an incorrect interpretation of abdominal CT by novice emergency residents and to analyze the characteristics of incorrectly interpreted scans.

This retrospective analysis of a prospective observational cohort was conducted at three urban emergency departments. Discrepancies between the interpretations by postgraduate year-1 (PGY-1) emergency residents and the final radiologists’ reports were assessed by independent adjudicators. Potential factors associated with incorrect interpretation included patient age, sex, time of interpretation, and organ category. Adjusted odds ratios (aORs) for incorrect interpretation were calculated using multivariable logistic regression analysis.

Among 1,628 eligible cases, 270 (16.6%) were incorrect. The urinary system was the most correctly interpreted organ system (95.8%, 365/381), while the biliary tract was the most incorrectly interpreted (28.4%, 48/169). Normal CT images showed high false-positive rates of incorrect interpretation (28.2%, 96/340). Organ category was found to be a major determinant of incorrect interpretation. Using the urinary system as a reference, the aOR for incorrect interpretation of biliary tract disease was 9.20 (95% confidence interval, 5.0–16.90) and the aOR for incorrectly interpreting normal CT images was 8.47 (95% confidence interval, 4.85–14.78).

Biliary tract disease is a major factor associated with incorrect preliminary interpretations of abdominal CT scans by PGY-1 emergency residents. PGY-1 residents also showed high false-positive interpretation rates for normal CT images. Emergency residents’ training should focus on these two areas to improve abdominal CT interpretation accuracy.

• Acute abdomen
• Computed tomography
• Emergency medicine
• Internship and residency
• Medical education

• Abdomen
• CT
• Informatics
• Pelvis

• Abdomen, Acute
• Clinical decision-making
• Diagnostic imaging;
• Tomography, X-ray computed

• CT
• abdominal pain
• appendicitis
• appendicolith

• Convolutional neural networks
• Deep learning
• Dose reduction
• Generative adversarial networks
• Machine learning

• Colitis
• Computerised tomography
• Cross-sectional imaging
• Infectious colitis

• Academic Medical Centers
• Acute Disease
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Colitis/diagnostic imaging
• Colitis/pathology
• Emergency Service, Hospital
• Female
• Hospitalization
• Humans
• Ireland
• Male
• Middle Aged
• Treatment Outcome
• Young Adult

Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients.

The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients’ therapeutic approach.

The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8–12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required.

Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients’ mean age was 56 (27–93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented.

Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.

• Abdominal Pain
• Emergency Service, Hospital
• Radiologists
• Tomography, X-Ray Computed

• ALARA
• CT scan
• LNT
• X-ray
• low-dose radiation
• radiation protection

• CBP NonProfit, Inc.

• ACR, American College of Radiology
• Abdominal CT scan
• Acute abnormality
• CT, computed tomography
• ED, Emergency Department
• LLQ, left lower quadrant
• LUQ, left upper quadrant
• Laboratory results
• NTAP, non-traumatic abdominal pain
• Non-traumatic abdominal pain
• RLQ, right lower quadrant
• RUQ, right upper quadrant
• Surgical diagnosis
• US, ultrasound

• CT contrast material
• abdominal CT
• oral contrast material

• CTDI
• Dual-energy CT
• Radiation dose

• Emergency department
• Imaging
• Non-traumatic acute abdominal pain
• Ultrasound

• Abdominal Pain/diagnosis
• Adult
• Aged
• Cohort Studies
• Diagnostic Imaging/methods
• Diagnostic Imaging/trends
• Emergency Service, Hospital/organization & administration
• Emergency Service, Hospital/statistics & numerical data
• Female
• Humans
• Italy
• Male
• Middle Aged
• Radiography/methods
• Retrospective Studies
• Tomography, X-Ray Computed/methods
• Ultrasonography/methods

• Abdominal pain
• Appendicitis
• CT
• Diverticulitis

• Abdominal Neoplasms/complications
• Abdominal Neoplasms/diagnostic imaging
• Abdominal Pain/etiology
• Acute Disease
• Adnexal Diseases/complications
• Adnexal Diseases/diagnostic imaging
• Adolescent
• Adult
• Aged
• Cohort Studies
• Contrast Media
• Digestive System Diseases/complications
• Digestive System Diseases/diagnostic imaging
• Female
• Humans
• Male
• Middle Aged
• Radiographic Image Enhancement/methods
• Radiography, Abdominal/methods
• Retrospective Studies
• Tomography, Spiral Computed/methods
• Urolithiasis/complications
• Urolithiasis/diagnostic imaging
• Young Adult

• Abdominal pain
• Abdominal x‑ray
• Computed tomography
• Systematic approach
• Ultrasound

• CT abdomen and pelvis
• IV contrast
• Radiology
• Repeat CT

• Acute abdominal pain
• Computed tomography
• Emergency
• Leukocytosis
• Relative lymphopenia

• contrast induced nephropathy
• acute abdomen
• emergency department
• acute kidney injury
• prevention strategy

• Abdomen, Acute/diagnostic imaging
• Acute Kidney Injury/chemically induced
• Acute Kidney Injury/prevention & control
• Clinical Trials as Topic
• Contraindications, Drug
• Contrast Media/administration & dosage
• Contrast Media/adverse effects
• Emergencies
• Emergency Service, Hospital
• Humans
• Incidence
• Injections, Intravenous
• Meta-Analysis as Topic
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Selection Bias
• Tomography, X-Ray Computed

• CT
• abdominal pain
• emergency medicine
• health policy
• resource utilization

Recurrent CT imaging is believed to significantly increase lifetime malignancy risk. We previously reported that high acuity, admitted trauma patients who received a whole-body CT in the emergency department (ED) had a history of prior CT imaging in 14% of cases. The primary objective of this study was to determine the CT imaging history for trauma patients who received a whole-body CT but were ultimately deemed safe for discharge directly home from the ED.

This was a retrospective cohort study conducted at an academic ED. All trauma patients who were discharged directly home from the ED after whole-body CT were analyzed. The decision to utilize whole-body CT was at the discretion of the caring physician during the study period. Clinical data for the most recent trauma visit was recorded in a structured fashion on a standardized data collection instrument utilizing the hospital system electronic medical record (EMR). Subsequently, study investigators reviewed a shared, electronic radiological archive for the 6-hospital system to evaluate prior CT exposure for each patient.

165 patients were in the study group. The mean age of the study group was 39+/− 16 years old, 40% were female and 64% were Hispanic. The most common mechanism of injury in our study group was motor vehicle crash (MVC) (66%). In our study group, 25% had at least one prior CT. The most common prior studies performed were: CT abdomen/pelvis (13%), CT head (9.1%), CT face (6.7%), and CT chest (1.8%). Within a multivariate logistic regression model we found that the large majority of patient characteristics and mechanisms of injury were not associated with a positive prior CT imaging history.

We found a positive history for prior CT for 25% of trauma patients who received whole-body CT scan but were discharged from the ED to home.

• Acute traumatic injury
• CT scans
• Discharge from ED

• acute appendicitis
• computed tomography
• diagnostic efficiency

• Acute care
• CT
• CT screening
• Early diagnostics
• Emergency department
• Emergency radiology

The aim of this study was to evaluate the diagnostic utility and impact on clinical management of after-hours CT scans investigating abdominal pain in surgical patients.

After-hours CT A/P reports investigating the acute surgical abdomen were compared with clinical outcomes and histopathological findings to assess sensitivity and specificity of CT reporting. Comparisons between CT reports and clinical notes were made. CT scans were categorised as having direct effects on clinical management, ruling out a serious pathology, ruling out a nonserious pathology, or having no effect. Discrepancies between information in case-notes and information provided to radiologists were also analysed.

79 clinical notes were located. After-hours CT demonstrated 91% sensitivity and 82% reporting specificity using clinical outcomes as the standard. In the 26 patients with histopathological findings, CT reports demonstrated 91% sensitivity. In 79.7% of cases, CT scanning had an impact on management. In 35.4% of cases, an indication for scanning was not documented with variation in clinical information in 8.9% of cases.

This study demonstrates after-hours CT A/P reports result in significant impacts on clinical management of surgical patients with acute abdominal pain. Improvements in providing information when requesting scans are however needed to facilitate accurate reporting.

To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans.

This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis. Secondary outcomes were cumulative numbers of accurate abdominal CT interpretations regardless of initial clinical impression and training period.

PGY-1 residents recorded a total of 230 interpretation checklists. There were 53, 51, 46, 44, and 36 checklists recorded by individual residents and 92, 92, 91, 91, and 61 respective training days in the emergency department, excluding rotation periods in other departments. After 16 to 20 interpretations of abdominal CT scans performed under suspicion of acute appendicitis, the residents could diagnose acute appendicitis with more than 95% accuracy. Overall, the sensitivity and specificity for diagnosing acute appendicitis were 97% (95% confidence interval, 94 to 100) and 83% (95% confidence interval, 80 to 87), respectively. After 61 to 80 abdominal CT interpretations regardless of suspicion of acute appendicitis and after 41 to 50 days in training, PGY-1 emergency department residents could diagnose acute appendicitis with more than 95% accuracy.

PGY-1 residents require 16 to 20 checklist interpretations to acquire acceptable abdominal CT interpretation. After performing 61 to 80 CT scans regardless of suspicion of acute appendicitis, they could diagnose acute appendicitis with acceptable accuracy.

• Acute appendicitis
• Computed tomography
• Interpretation
• Learning curve

• Oral contrast
• acute abdominal pain
• bowel pathology
• computed tomography
• emergency room

Since its introduction in the 1970s, computed tomography (CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses.

• Computed tomography
• Radiation dose
• Iterative reconstruction
• Neoplasia
• Carcinogenesis