Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury

Objective To investigate if patients with confirmed traumatic abdominal injury and a false-negative focused abdominal sonography for trauma (FAST) examination have a more favorable prognosis than those with a true-positive FAST. Methods This study included 97 consecutive patients with confirmed traumatic abdominal injury (based on computed tomography [CT] and/or surgical findings) who underwent FAST. Results FAST was false-negative in 40 patients (41.2%) and true-positive in 57 patients (58.8%). Twenty-two patients (22.7%) had an unfavorable outcome (defined as the need for an interventional radiologic procedure, laparotomy, or death due to abdominal injury). Univariately, a false-negative FAST (odds ratio [OR] 0.24; p = 0.017) and a higher systolic blood pressure (OR, 0.97 per mmHg increase; p = 0.034) were significantly associated with a favorable outcome, whereas contrast extravasation on CT (OR, 7.17; p = 0.001) and shock index classification (OR, 1.89 for each higher class; p = 0.046) were significantly associated with an unfavorable outcome. Multivariately, only contrast extravasation on CT remained significantly associated with an unfavorable outcome (OR, 4.64; p = 0.016). When excluding contrast extravasation on CT from multivariate analysis, only a false-negative FAST result was predictive of a favorable outcome (OR, 0.28; p = 0.038). Conclusion Trauma patients with confirmed abdominal injury and a false-negative FAST have a better outcome than those with a positive FAST. FAST may be valuable for risk stratification and prognostication in patients with a high suspicion of abdominal injury when CT has not been performed yet or when CT is not available.

The Genotoxic Effect of Interventional Cardiac Radiologic Procedures on Human Chromosomes

In recent years, an important part of the ionizing radiation (IR) that human have been exposed for diagnostic purposes are interventional radiologic procedures. The X-rays and contrast media are used in angiography. The patients and staff members are exposed to X-ray during these procedures. While it is known that X-rays cause DNA damage and carcinogenesis, the effect of the contrast agent is still unknown. The aim of this study was to investigate the effect of X-rays and contrast agent on chromosomes of human patients. Peripheral blood samples were taken from 50 patients (30 males, 20 females, ages between 38-75 years). Chromosome analysis of peripheral lymphocytes in 50 patients were performed at 3 different periods; before the interventional radiologic procedure, 24 hours and 1-3 months after the procedure. Also, chromosome analysis was performed on 17 staff members working during interventional radiological procedures to investigate the effect of X-rays. Standard cytogenetic analysis techniques were used for this study. The frequency of chromosomal aberrations (CAs) was significantly higher in patients 24 hours after the interventional radiologic procedures than pretreatment (p=0,000). At the same time, CAs after 24 hours compared with those taken 1-3 months later, shown that the CAs were significantly reduced after 1-3 months (p=0,000). We also found that the frequency of CAs was also statistically higher in patients exposed to high radiation doses (p=0,042). Compared with the control group (n=30), CAs were found significantly higher in workers exposed to radiation. Our findings have shown that X-rays and contrast agents that used in interventional radiological cause chromosomal damage. For this reason, the dose of radiation to be given to the patient must be carefully selected. Due to the potentially high genetic damage of patients with coronary artery disease (CAD), the type and amount of medication to be given and the frequency of radiological diagnostic procedures to be performed should be meticulously adjusted.

Developing Interventional Radiology Anticoagulation Guidelines: Process and Benefits †

We created, posted, and updated radiology department anticoagulation guidelines and identified various steps in the process, including triggering events, consensus building, legal analysis, education, and distribution of the guidelines to nurses and clinicians. Supporting data collected retrospectively, before and after implementation, included nursing satisfaction survey results and the number of procedure cancellations. After the guidelines were developed and posted, significantly fewer procedures were cancelled, nursing satisfaction was higher, and radiologists performed procedures with less variability. Anecdotally, radiologists had fewer queries about anticoagulation. The development and dissemination of radiologic procedure anticoagulation guidelines should be considered as a departmental quality improvement project.

Combined Radiologic-Urologic Procedure for the Placement of Ureteral Stent in a Case of Bilateral Iatrogenic Ureteral Lesion

Introduction Iatrogenic ureteral lesions are well-known complications of abdominal and pelvic surgery. A combined radiologic-urologic approach might be necessary to repair these lesions. Materials and Methods A 69-year-old woman underwent bilateral hysteroannessectomy for endometrial cancer. She then became anuric. A CT scan showed multiple urinomas caused by bilateral ureteral lesions. The continuity of the two urinary tracts was restored using ureteral stents in a combined urologic and radiologic procedure. Results The patient improved clinically and the renal function returned within normal limits. Conclusions The combined antegrade-retrograde approach is an effective technique to solve iatrogenic ureteral lesions.

Cardiopulmonary Arrest Occurring in the Radiology Department: Patient Characteristics, Incidence, and Outcomes

Despite efforts for patient stabilization before radiologic procedures, cardiopulmonary arrests still occur. The purpose of our study was to define the incidence, patient characteristics, and outcomes of patients having cardiopulmonary arrest in a radiology department. We retrospectively reviewed patients sustaining cardiopulmonary arrest in the radiology department from 2002 to 2007. Patient characteristics and outcomes were documented. Descriptive statistics were calculated. Over the 6 years of the study, 1,480,578 radiographic procedures were performed, and 27 patients sustained a cardiopulmonary arrest in the radiology department for an incidence rate of 0.002 per cent. The average patient age was 66 years (range, 35 to 88 years); 12 were male (44%). Radiological procedures were diagnostic in 15 cases and therapeutic in 12 cases. The most common locations for arrest were in the CT area (9 patients) and the vascular procedures area (8 patients). The most common preprocedural patient locations were the hospital wards (11 patients [41%]), the emergency department/trauma bay (5 patients [19%]), the intensive care unit (4 patients [15%]), and an outpatient setting (four patients [15%]). Nineteen patients (70%) survived the initial code, 14 patients (52%) survived 24 hours, and 9 patients (33%) survived until discharge. Survival to discharge was significantly impacted by body mass index ( P = 0.005) and type of radiologic procedure ( P = 0.04) but not by the preprocedure patient location. Cardiopulmonary arrest occurring in the radiology department is a rare but potentially lethal occurrence. Patients undergoing vascular access procedures may be an at-risk group. Further study is needed to evaluate potential risk factors for cardiopulmonary arrest occurring in the radiology department.

CT Air-Contrast Scanning of the Internal Auditory Canal

Two hundred and four patients with audiometric and vestibular findings suggestive of a retrocochlear lesion were studied prospectively by computed tomographic scan with air contrast of the internal auditory canal. With this technique tumor limits are clearly defined. In the absence of disease the internal auditory canal has been completely air-filled in over 97% of cases. Soft tissue masses occluding the internal auditory canal were demonstrated in 11 patients. Four studies were inconclusive and there was one false positive. Headaches have been the only side effect and there have been no complications. In reporting their results the authors examine the indications, accuracy and limitations of this technique. This study demonstrates that computed tomographic scan with air contrast of the internal auditory canal should be considered as the radiologic procedure of choice for the evaluation of small acoustic tumors.

Excretory Urography for Evaluation of Enuresis

Enuresis is the involuntary discharge of urine occurring beyond the age when control of the urinary bladder should have been acquired.1 Eighty percent of children with enuresis have problems staying dry at night, 5% in the day, and 15% both day and night.2 The age at which children can be expected to stay dry at night is not well established and is often cause for extreme concern for parents and children alike. Most children are still not dry at night by age 2 years. In a study of 315 children, Klackenberg reported 87% dry by 3 years and 96% dry by 6 years. Essen and Peckham,4 reviewing the records of 12,000 children, found enuresis more prevalent in older ages. More than 10% of their patients were enuretic between ages 5 and 7 years and almost 5% were still having problems at 11 years of age. The etiology of enuresis is also difficult to define, and many different theories have been advanced. Bindelglas5 grouped these into five major categories: (1) organo-urogenic, including urologic malformations; (2) psychogenic; (3) developmental; (4) genetic; (5) environmental. The first of these categories must be of primary concern to the physician when confronted with an enuretic child, ie, could the symptoms possibly reflect a surgically correctable urologic abnormality? Radiologic procedures such as excretory urography and micturition cystourethrography are the studies usually relied on to exclude an underlying anatomic lesion. Because of the potential risk and expense of any radiologic procedure as well as the possible low yield in this condition, the Committee on Radiology examined the utility of these studies in the routine evaluation of enuresis.