Caceres’ Corner Case 169 (Update: Solution!)


Dear Friends,

Today I am showing a PA radiograph of a 48-year-old smoker with a persistent cough. What do you see?
As in last week’s case, I will show additional images on Wednesday morning.

Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

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30
Oct 2017
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DISCUSSION 25 Comments

Shortages of medical staff and equipment pose challenges in many emergency departments, says Romanian radiologist

This year, the main theme of the International Day of Radiology is emergency radiology. To get some insight into the field, we spoke to Dr. Radu Baz, an associate professor of radiology and head of the radiology department at Clinical County Hospital of Constanta, Romania.

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Radu Baz: The radiologist is one of the most important members of emergency-service teams in Romania’s major hospitals. Radiologists here must examine and formulate rapid results for a large number of patients.
Because many emergency hospitals don’t have radiology imaging in emergency departments, radiologists dictate cases from the radiology department on emergency devices. In just one 24-hour period radiologists in our department dictated 220 x-rays, 70 ultrasounds and 45 CTs.

ESR: What does a typical day in the emergency department look like for a radiologist?
RB: Shifts start at 8:00, 14:00 and 20:00. During the morning and afternoon shifts there are three radiologists for conventional radiography, CT and MRI; ultrasound examinations often are conducted by the colleague responsible for conventional radiography. In most emergency hospitals, there are two radiologists on call: one who provides ultrasound and standard radiological assessments, and another for emergency CTs.

Dr. Radu Baz is an associate professor of radiology and head of the radiology department at Clinical County Hospital of Constanta, Romania.

Imaging (e.g. radiographic, CT and MRI) examinations are performed by radiology technicians or nurses, often under the direct supervision of physicians, who prioritise all cases. Physicians perform ultrasound examinations. Images are immediately transmitted to the hospital network for the use of clinicians and emergency physicians. Radiologists interpret images immediately from the x-ray console or from work stations in the reading room. Also, radiologists review complex cases in detail with clinician colleagues to assure proper case management.

ESR: Teamwork is crucial in an emergency department. How is this accomplished in your department and who is involved?
RB: Yes, indeed. Teamwork is essential in an emergency department. Direct and immediate collaboration with radiologists and their clinician colleagues helps us get through difficult cases. There often are situations when we call to ask advice from a radiologist colleague or ask to examine images while collecting clinical data. Also, there often are situations when we simply need to consult with a clinician on a case for a more in-depth approach.

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CT examinations up by more than 300% over 15 years, while number of emergency patients has increased only 10% says Swiss specialist

This year, the main theme of the International Day of Radiology is emergency radiology. To get some insight into the field, we spoke to Swiss radiologist Prof. Pierre-Alexandre Poletti, currently in charge of the emergency radiology unit and vice-chairman of the radiology service at the University Hospital of Geneva in Geneva, Switzerland.

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Pierre-Alexandre Poletti: Emergency radiologists in Switzerland adhere to the most appropriate imaging protocols and algorithms for emergency patients to optimise and expedite the radiological management of emergency-department patients in term of quality of care and improvement of workflow.
Also, radiologists have to teach the fundamentals and the specifics of emergency radiology to the radiology residents in the emergency department. They must establish links and close collaborations between the emergency radiology team and the various subspecialties in radiology.

Prof. Pierre-Alexandre Poletti is currently in charge of the emergency radiology unit and vice-chairman of the radiology service at the University Hospital of Geneva in Geneva, Switzerland.

ESR: What does a typical day in the emergency department look like for a radiologist?
PAP: As part of their workflow, emergency radiologists work using various imaging modalities (mainly CT, ultrasound and conventional radiology) chosen to adapt to the specific clinical suspicions of the emergency physician. The senior radiologists supervise the examinations performed by the residents to discuss specific problems they may have. The radiologists participate in multidisciplinary events, such as case presentations, journal clubs, and morbidity and mortality meetings.

ESR: Teamwork is crucial in the emergency department. How is this accomplished in your department and who is involved?
PAP: Representatives of the radiological team have regular meetings with various emergency-team members to address the radiological and clinical-management concerns of emergency patients. Complex problems, such as the optimisation of imaging protocols and algorithms, are referred to small reflection groups, who will meet and return to their colleagues with a proposed solution.

ESR: How satisfied are you with the workflow and your role in your department? How do you think it could be improved?
PAP: Workflow is one of the main problems radiologists face in the emergency room, especially as it relates to CT imaging. Indeed, in our institution, like probably in many other hospitals, the number of CT examinations performed annually has increased by more than 300% (4,500 to 15,000) over a 15-years period, while emergency department admissions have increased only by about 10% during the same period. The satisfaction of emergency radiologists is linked directly to their ability to solve problems associated with this increased workload: long wait times for CT scans; psychological effects of heavy workloads on the radiological team; and disagreement with clinician colleagues regarding patient triage for the scanner. Read more…

Financial, structural and legal changes are necessary to improve radiology workflow, says Ukrainian radiologist

This year, the main theme of the International Day of Radiology is emergency radiology. To get some insight into the field, we spoke to Dr. Anton Nosov, MD, head of the radiology department at the Kyiv City Children’s Diagnostic Center in Kyiv, Ukraine

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Anton Nosov: In our country, the role of a radiologist in the emergency department depends on situations outside of the hospital. Usually, radiologists are members of a multidisciplinary team, where they provide high quality, timely final readings for patients, which guarantees that decisions are made in consensus.
But everything changes in the case of extreme conditions, such as an unexpected military conflict (as we faced in eastern Ukraine) or other situations with enormous casualties (e.g. technogenic disasters or terrorist attacks). Such situations require rapid decision-making in conditions where there is a shortage of medical staff. In those cases, radiologists must draw quick conclusions directly from CTs or x-rays based on triage priority to ensure the survival of the most patients. This is a difficult job psychologically.

Anton Nosov, MD is a radiologist with a special clinical and research interest in emergency radiology.

ESR: What does a typical day in the emergency department look like for a radiologist?
AN: Of course, in the emergency department we face many cases every day, but the vast majority of them are trauma cases.
Trauma is a tremendous burden for hospitals and healthcare systems, affecting 135 million people worldwide annually. In Ukraine, the majority of these injuries are caused by motor-vehicle accidents, falls from heights and violent altercations.
The most pressing concern of any trauma team is stopping active haemorrhage, which is the most common cause of death in polytrauma patients.
Modern trauma management heavily relies on imaging, particularly CT scans. Most major centres now forego plain x-ray imaging in favour of diagnostic CT, which provides much higher sensitivity and can detect any active extravasation or bleeding. Our evidence suggests that well-timed use of CT increases the chance of survival in polytraumatised patients.

ESR: Teamwork is crucial in the emergency department. How is this accomplished in your department and who is involved?
AN: A multidisciplinary team is the only way to approach complex cases, such as polytrauma. We don’t have a fixed trauma team, but usually such a team consists of an anaesthesiologist, a radiologist, and a trauma surgeon or neurosurgeon. Trauma surgeons often serve as the case managers. The anaesthesiologist initiates ventilation of the patient; the radiologist interprets the imaging studies, and the trauma surgeon manages the case.

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Dr. Pepe’s Diploma Casebook: Case 114 – SOLVED!

Dear Friends,

Today I am presenting radiographs of an 80-year-old man with productive cough and fever. What do you see?

Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

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23
Oct 2017
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Severe shortage of radiologists creates growing demand for teleradiology services and forces hospitals to outsource, says UK specialist

This year, the main theme of the International Day of Radiology is emergency radiology. To get some insight into the field, we spoke to Dr. Elizabeth Dick, BSc, MD, consultant radiologist and honorary senior lecturer at Imperial College London, United Kingdom.

European Society of Radiology: Could you please describe the role of the radiologist in a typical emergency department in your country?
Elizabeth Dick: It varies. In many hospitals, traditional model remains; radiology and emergency departments are distant from each other. There may be one or two consultant radiologists with an interest in emergency imaging who are the ‘go to’ radiologists for the emergency team during the day. After hours, on-call radiologists will be the point of contact, but they are busy with many services, and increasingly may be remote from the hospital they cover.

Dr. Elizabeth Dick, BSc, MD has worked as a consultant radiologist and honorary senior lecturer at Imperial College London since 2002.

Teleradiology often is used to deliver after-hours care, with obvious advantages. The result is an inevitable loss of personal interaction between the radiology and emergency departments. However, set against this traditional model is the ‘gold standard’. Since 2010, a network of major trauma centres was set up across the UK to deliver excellence in trauma care. In these centres, radiologists usually are an integral part of the trauma team, and the CT scanner is usually co-located in the emergency department. This has a ripple effect: Not only is trauma imaging improved, with resulting lower morbidity and mortality, but all emergency patients benefit from a closer relationship between radiologists and the emergency department team.

ESR: What does a typical day in the emergency department look like for a radiologist?
ED: I start my day at 7am by checking all the reports from the night before so that I can speak to the emergency teams as they do their ward rounds at 8am. Our radiology registrars and residents do two, twelve-hour shifts (8am to 8pm), so this is a good opportunity for the on-call registrars to discuss cases they found particularly challenging. Like all hospitals, we perform more imaging examinations each year. On average, there are at least 25 patients who get imaging (mainly CT) overnight, which means a huge responsibility for the radiology registrars on call. Although they may reach out to the duty consultant during their call, for most scans, registrars issue a report based on their own findings. We regularly audit their reports, and the discrepancy rate is very low – probably due to the fact that they strive to work hard to learn. Also, they get a lot of training and support before, during and after being on call.

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Caceres’ Corner Case 168 (Update: Solution!)

Dear Friends,

Today I want to try a new way of presenting cases: conventional PA and lateral radiographs will be shown on Monday, followed by additional images on Wednesday. Hope this approach will have more educational value. If it works well, I will do it more often.

Today’s radiographs belong to a 74-year-old woman with mild respiratory infection.

What do you see?

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16
Oct 2017
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Dr. Pepe’s Diploma Casebook: Case 113 – SOLVED!

Dear Friends,

Glad to be back. I have missed my fans! Planning big surprises for next year. In the meantime, have a look at this preoperative chest radiograph for goiter in a 47-year-old woman. What do you see?

Check the image below, leave your thoughts in the comments section and come back on Friday for the answer.

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09
Oct 2017
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Caceres’ Corner Case 167 (Update: Solution)

Dear Friends,

Today I am showing a case seen one month ago. Radiographs belong to a 64-year-old man with intermittent fever for the previous two weeks. What do you see?

Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

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02
Oct 2017
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DISCUSSION 25 Comments

Caceres’ Corner Case 166 (Update: Solution)

Dear Friends,

This weeks’ radiographs belong to a 31-year-old male with vague chest complaints. What do you see?

Check the images below, leave your thoughts in the comments section and come back on Friday for the answer.

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25
Sep 2017
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DISCUSSION 20 Comments