BACKGROUND: Imaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients.
METHODS: This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated.
RESULTS: Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans.
CONCLUSIONS: CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.

Gender-affirming surgery (GAS) is increasingly being performed. GAS is tailored to the patient leading to a diverse spectrum of radiologic post-operative findings. Radiologists who are unfamiliar with expected anatomic alterations after GAS may misdiagnose important complications leading to adverse patient outcomes. This collaborative multi-institutional review aims to: Describe relevant embryology and native anatomy. Describe relevant Gender-Affirming Surgery (GAS) techniques and expected neo-anatomy with associated complications, including common terminology. Review expected imaging appearance of neo-anatomy/postoperative findings. Review multi-modality [ultrasound, plain film, retrograde urethrogram, computed tomography] emergent imaging findings. Understand unique patient evaluation and imaging protocol considerations in the GAS population. Discuss pearls and pitfalls of imaging in the acute post-GAS setting.

OBJECTIVE: Long acquisition times limit the feasibility of established non-contrast-enhanced MRA (non-CE-MRA) techniques. The purpose of this study was to evaluate a highly accelerated flow-independent sequence (Relaxation-Enhanced Angiography without Contrast and Triggering [REACT]) for imaging of the extracranial arteries in acute ischemic stroke (AIS).
METHODS: Compressed SENSE (CS) accelerated (factor 7) 3D isotropic REACT (fixed scan time: 01:22 min, reconstructed voxel size 0.625 × 0.625 × 0.75 mm3) and CE-MRA (CS factor 6, scan time: 1:08 min, reconstructed voxel size 0.5 mm3) were acquired in 76 AIS patients (69.4 ± 14.3 years, 33 females) at 3 Tesla. Two radiologists assessed scans for the presence of internal carotid artery (ICA) stenosis and stated their diagnostic confidence using a 5-point scale (5 = excellent). Vessel quality of cervical arteries as well as the impact of artifacts and image noise were scored on 5-point scales (5 = excellent/none). Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for the common carotid artery (CCA) and ICA (C1-segment).
RESULTS: REACT provided a sensitivity of 88.5% and specificity of 100% for clinically relevant (≥50%) ICA stenosis with substantial concordance to CE-MRA regarding stenosis grading (Cohen\'s kappa 0.778) and similar diagnostic confidence (REACT: mean 4.5 ± 0.4 vs. CE-MRA: 4.5 ± 0.6; P = 0.674). Presence of artifacts (3.6 ± 0.5 vs. 3.5 ± 0.7; P = 0.985) and vessel quality (all segments: 3.6 ± 0.7 vs. 3.8 ± 0.7; P = 0.004) were comparable between both techniques with REACT showing higher scores at the CCA (4.3 ± 0.6 vs. 3.8 ± 0.9; P < 0.001) and CE-MRA at V2- (3.3 ± 0.5 vs. 3.9 ± 0.8; P < 0.001) and V3-segments (3.3 ± 0.5 vs. 4.0 ± 0.8; P < 0.001). For all vessels, REACT showed a lower impact of image noise (3.8 ± 0.6 vs. 3.6 ± 0.7; P = 0.024) while yielding higher aSNR (52.5 ± 15.1 vs. 37.9 ± 12.5; P < 0.001) and aCNR (49.4 ± 15.0 vs. 34.7 ± 12.3; P < 0.001) for all vessels combined.
CONCLUSIONS: In patients with acute ischemic stroke, highly accelerated REACT provides an accurate detection of ICA stenosis with vessel quality and scan time comparable to CE-MRA.

A Bravo device is a continuous pH monitor, produced by Medtronic (Minneapolis, MN), that is placed on the esophageal mucosa during endoscopy and can be used in the evaluation of gastroesophageal reflux disease (GERD). The device detaches by itself and passes with feces in approximately 7-10 days. Because of its brief presence in the body, the device is an unusual finding on imaging and could easily be mistaken for a more ominous foreign body. The Bravo device is typically well tolerated but can be a source of severe discomfort. Its presence is an important consideration in the differential of chest pain and a contraindication to MRI. Here, we discuss a case of a patient presenting to the emergency department (ED) with acute chest pain who underwent Bravo device placement several days prior.

Severe spinal trauma is uncommon in the pediatric population, but due to the potentially devastating consequences of missed injury, it poses a diagnostic challenge in emergency departments. Diagnostic imaging is often needed to exclude or confirm the injury and to assess its extent. Magnetic resonance imaging (MRI) offers an excellent view of both bony and soft tissue structures and their traumatic findings without exposing children to ionizing radiation. Our pictorial review aims to demonstrate the typical traumatic findings, physiological phenomena, and potential pitfalls of emergency MRI in the trauma of the growing spine.

Cerebral venous sinus thrombosis (CVST) is a rare neurological emergency condition with non-specific symptoms. Imaging options to rule out CVST are computed tomography (CT) and magnetic resonance imaging (MRI). This study aimed to determine the imaging outcomes of emergency MRI as a first-line imaging method in patients with suspected CVST. In this retrospective cohort study, we analyzed emergency brain MRI referrals from a five-year period in a tertiary hospital for suspicion of CVST. We recorded patient characteristics, risk factors mentioned in the referrals, and imaging outcomes. Altogether 327 patients underwent emergency MRI on the grounds of suspected CVST. MRI showed evidence of CVST among five patients (1.5%). Imaging showed other clinically significant pathology in 15% of the patients and incidental findings in 5% of the patients. Despite clinical suspicion, the diagnostic yield of emergency MRI for CVST is low and similar to that previously reported for CT. MRI is an alternative imaging method devoid of ionizing radiation in patients with suspected CVST.

Herein we share our preliminary experience with an ultrafast brain MRI technique for use in the ED consisting of axial T1-weighted (40 s), axial T2-weighted (62 s), axial diffusion-weighted (80 s), axial FLAIR (96 s), axial T2* (6 s), and axial susceptibility-weighted (108 s) imaging for a total scan time of 6 min and 53 s. Utilization of this ultrafast technique yields an efficient assessment of the brain, decreases ED length of stay and inpatient observation admissions, and may obviate the need for vascular imaging with either CTA or MRA in the ED.

In the United States, gunshot wounds (GSWs) have become a critical public health concern with substantial annual morbidity, disability, and mortality. Vascular injuries associated with GSW may pose a clinical challenge to the physicians in the emergency department. Patients demonstrating hard signs require immediate intervention, whereas patients with soft signs can undergo further diagnostic testing for better injury delineation. Although digital subtraction angiography is the gold standard modality to assess vascular injuries, non-invasive techniques such as Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography have evolved as appropriate alternatives. This article discusses penetrating bodily vascular injuries, specifically ballistic and stab wounds, and the corresponding radiological presentations.

Radiographers provide imaging services in multiple healthcare settings, including emergency and trauma. Transitioning to a qualified radiographer is already a time of vulnerability - with the increasing complexity and unpredictable nature of the emergency and trauma healthcare environment, recently qualified radiographers may experience this environment distinct from other service delivery areas.
The study explored recently qualified radiographers\' expectations and experiences in emergency and trauma imaging service delivery.
An inductive qualitative phenomenological approach with a purposive sampling technique recruited recently qualified radiographers (n=19) involved in the delivery of emergency and trauma imaging services. Transcribed semi-structured individual interviews were thematically analysed.
Two themes and related categories were identified: 1. The multiplexity of diagnostic emergency and trauma imaging service delivery and 2. Approaching the complex nature of emergency and trauma imaging.
The expectations and experiences of emergency and trauma imaging varied, aligned to previous exposure to emergency and trauma imaging. Even though emergency and trauma imaging was challenging, the fast pace, patient dynamics and multidisciplinary deliverance; the experience was considered rewarding and an opportunity to improve skills. Participants coped through debriefing and calming strategies; however, radiology-specific debriefing was recommended to further foster the recently qualified radiographers\' well-being.

OBJECTIVE: Joint dislocations are orthopedic emergencies that require prompt intervention. Automatic identification of these injuries could help improve timely patient care because diagnostic delays increase the difficulty of reduction. In this study, we developed convolutional neural networks (CNNs) to detect elbow and shoulder dislocations, and tested their generalizability on external datasets.
METHODS: We collected 106 elbow radiographs (53 with dislocation [50 %]) and 140 shoulder radiographs (70 with dislocation [50 %]) from a level-1 trauma center. After performing 24× data augmentation on training/validation data, we trained multiple CNNs to detect elbow and shoulder dislocations, and also evaluated the best-performing models using external datasets from an external hospital and online radiology repositories. To examine CNN decision-making, we generated class activation maps (CAMs) to visualize areas of images that contributed the most to model decisions.
RESULTS: On all internal test sets, CNNs achieved AUCs >0.99, and on all external test sets, CNNs achieved AUCs >0.97. CAMs demonstrated that the CNNs were focused on relevant joints in decision-making regardless of whether or not dislocations were present.
CONCLUSIONS: Joint dislocations in both shoulders and elbows were readily identified with high accuracy by CNNs with excellent generalizability to external test sets. These findings suggest that CNNs could expedite access to intervention by assisting in diagnosing dislocations.