Faculty Bibliography

PURPOSE/OBJECTIVE:The purpose of our study was to validate the hypothesis that eliminating the use of oral contrast for multidetector computed tomography (MDCT) would not affect the detection of acute abdominal abnormalities in emergency room patients. METHODS:We conducted a retrospective study to assess the effect of discontinuing oral contrast use for MDCT scans of the abdomen and pelvis for patients presenting with acute abdominal pain and body mass index (BMI) >25. Patients with BMI <25 continued to receive oral contrast. The medical records were reviewed to determine the rate of repeat imaging within 7 days from the initial CT scan, as well as delayed or missed diagnoses related to the absence of oral contrast. The study was approved by the research ethics board at our institution. RESULTS:A total of 1378 patients had an MDCT examination of the abdomen and pelvis between November 1, 2012, and October 31, 2013. 375 patients met the inclusion criteria (174 males and 201 females; mean age 57 years; range 18-97 years). Seven of 375 (1.9%) patients had a repeat CT examination with oral contrast within 7 days. Of these 7 patients, none had a change in the course of their management due to the utilization of oral contrast. No delayed or missed diagnoses related to the absence of oral contrast were identified. CONCLUSION/CONCLUSIONS:Omitting oral contrast for imaging patients with BMI >25 presenting with acute abdominal pain resulted in no delayed or missed diagnoses, in our retrospective study. The benefits of prompt imaging diagnosis outweigh the unlikely need for repeat imaging.

Since its establishment in 1998, the Radiological Society of North America (RSNA) Editorial Fellowship has been offering unique opportunities to radiologists from around the world who have a strong interest in radiologic journalism. For the past 16 years, the selected RSNA Editorial Fellows have learned essential processes involved in the production of Radiology and RadioGraphics by working closely with the editors, associate editors, and staff. The editorial fellowship for radiology attending physicians was renamed the RSNA William R. Eyler Editorial Fellowship, in honor of the founding editor of RadioGraphics, with the first Eyler fellow selected in 2005. Additionally, several years ago, a second fellowship was created for radiology trainees, which is now named the RSNA William W. Olmsted Editorial Fellowship for Trainees, in honor of the most recent emeritus editor of RadioGraphics. For the special centennial year of the journal Radiology, several former editorial fellows were interested in knowing what the previous fellows are up to presently and how their experience and learning from the fellowship influenced and contributed to their academic career development. The invitation to share their experience of the RSNA Editorial Fellowship was sent to 19 previous RSNA Editorial Fellows. We report the findings from 16 of these fellows who responded. We found that almost all previous RSNA Editorial Fellows (15 of 16, 94%) stayed in academic radiology, and each is currently leading a successful academic career. All of them are currently actively serving in one or more positions as an editor, associate editor, reviewer, and/or editorial board member of various radiology journals and clinical journals related to their area(s) of academic expertise. Among the 16 previous editorial fellows who responded, there are four chairs and six vice-chairs of their respective radiology departments. All of them reported that the experience and knowledge they gained from the RSNA Editorial Fellowship was crucial for their academic and professional development. Their views on the experience of being an RSNA Editorial Fellow, accomplishments achieved after the fellowship, and current activities are included here.

The subserous space is a large, anatomically continuous potential space that interconnects the chest, abdomen, and pelvis. The subserous space is formed from areolar and adipose tissue, and contains branches of the vascular, lymphatic, and nervous systems. As such, it provides one large continuous space in which many disease processes can spread between the chest, abdomen, and the pelvis.

The most common cause of acute right lower quadrant (RLQ) pain requiring surgery is acute appendicitis (AA). This narrative's focus is on imaging procedures in the diagnosis of AA, with consideration of other diseases causing RLQ pain. In general, Computed Tomography (CT) is the most accurate imaging study for evaluating suspected AA and alternative etiologies of RLQ pain. Data favor intravenous contrast use for CT, but the need for enteric contrast when intravenous contrast is used is not strongly favored. Radiation exposure concerns from CT have led to increased investigation in minimizing CT radiation dose while maintaining diagnostic accuracy and in using algorithms with ultrasound as a first imaging examination followed by CT in inconclusive cases. In children, ultrasound is the preferred initial examination, as it is nearly as accurate as CT for the diagnosis of AA in this population and without ionizing radiation exposure. In pregnant women, ultrasound is preferred initially with MRI as a second imaging examination in inconclusive cases, which is the majority.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

OBJECTIVE:Cosmetic plastic surgery procedures, as well as implants, are increasingly being performed. These implants are often encountered on routine imaging examinations, and radiologists are often asked to evaluate for complications or evidence of failure. Pectoral augmentation, gluteal augmentation, body lift and abdominoplasty, and penile and testicular prostheses are reviewed in this article. CONCLUSION/CONCLUSIONS:The typical appearance of common cosmetic implants and cosmetic techniques used in the human body is presented, along with the imaging spectrum of their potential complications.

Several techniques for the surgical management of obesity are available to bariatric surgeons. These interventions are performed more frequently with worsening of the obesity epidemic. Radiologists should be familiar with the surgical techniques, normal postoperative appearances, and potential complications for which imaging may be employed to establish a diagnosis to optimize patient care.

Radiation injuries often occur during or after radiation therapy in the abdomen or pelvis. Although any organ in the abdomen or pelvis may be exposed to and injured by radiation therapy directed to a nearby organ, this article focuses on more frequently encountered imaging findings of inadvertent radiation damage. It is important for the radiologist to be familiar with the imaging appearances of inadvertent radiation damage to abdominopelvic viscera in order to sustain clinical relevance and not mistake radiation injuries for other entities.