Oxford Handbook of Emergencies in Radiology

412 Pages·2009·2.34 MB·English

by  Richard Graham

4A true life-threatening emergency. Memorizing these conditions may
help. Call immediately for help. Try to remain calm and quickly assess ABC.
Once the problem has been dealt with remember to reassess: other prob-
lems may have been forgotten or missed in the heat of the moment.
3These imaging tests are urgent and need to be performed as soon as
the patient is stabilized and can be brought to the department. Elective
and non-urgent imaging should be delayed to make time for these patients
to be imaged. Alternatively, portable imaging may need to be performed in
the emergency department or on the ward as rapidly as possible.
2Imaging is required rapidly and should be performed out of hours at the
next available opportunity.
1Imaging is non-urgent and can wait until the next day.
This scale is intended for guidance only and each case will need to be
considered in light of the clinical features on presentation. Some condi-
tions may fall into one or more categories depending on the severity of
symptoms and where appropriate this has been indicated.
Oxford Handbook of
Emergencies in
Clinical Radiology
Published and forthcoming titles in the Emergencies
in… series:
Emergencies in Anaesthesia
Edited by Keith Allman, Andrew McIndoe, and Iain H. Wilson
Emergencies in Cardiology
Edited by Saul G. Myerson, Robin P. Choudhury, and Andrew Mitchell
Emergencies in Clinical Surgery
Edited by Chris Callaghan, J. Andrew Bradley, and Christopher Watson
Emergencies in Critical Care
Edited by Martin Beed, Richard Sherman, and Ravi Mahajan
Emergencies in Nursing
Edited by Philip Downing
Emergencies in Obstetrics and Gynaecology
Edited by S. Arulkumaran
Emergencies in Oncology
Edited by Martin Scott-Brown, Roy A.J. Spence, and Patrick G. Johnston
Emergencies in Paediatrics and Neonatology
Edited by Stuart Crisp and Jo Rainbow
Emergencies in Palliative and Supportive Care
Edited by David Currow and Katherine Clark
Emergencies in Primary Care
Chantal Simon, Karen O’Reilly, John Buckmaster, and Robin Proctor
Emergencies in Psychiatry
Basant K. Puri and Ian H. Treasaden
Emergencies in Radiology
Edited by Richard Graham and Ferdia Gallagher
Emergencies in Respiratory Medicine
Edited by Robert Parker, Catherine Thomas, and Lesley Bennett
Head, Neck and Dental Emergencies
Edited by Mike Perry
Medical Emergencies in Dentistry
Nigel Robb and Jason Leitch
Oxford Handbook of
Emergencies
in Clinical
Radiology
Edited by
Richard Graham MA FRCR
Specialist Registrar in Radiology, John Radcliffe and
Churchill Hospitals, Oxford, UK
Lecturer in Medicine, Hertford College, University of
Oxford, Oxford, UK
and
Ferdia Gallagher MA MRCP
FRCR
Cancer Research UK and Royal College of Radiologists
Clinical Research Training Fellow, University of Cambridge
and CRUK Cambridge Research Institute, Cambridge, UK
Honorary Specialist Registrar, Addenbrooke’s Hospital,
Cambridge, UK
1
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v
Dedication
To Bessie, Anita and Ciara.
vi
Foreword
This is a very valuable contribution to the literature and will become a
standard reference book for radiologists young and old. Indeed all imaging
departments should have several copies close to hand in case of emergen-
cies. The market was crying out for just such a book, especially as Saxton
and Strickland’s ‘Procedures’ and Ansell’s ‘Complication’ books have now
become obsolete. Of course, with the rapid changes in technology and
guidelines, even this book will age quite quickly too. But it was good to see
the authors anticipate the future by considering CT as the initial investigation
for chest pain (the triple rule out – myocardial infarction, aortic dissection
and pulmonary embolism).
This young and energetic cast of editors and authors has assembled an
extraordinary amount of useful facts within a short space. By judicious use
of lists and a minimum of free text, they make it an ideal cramming book
before FRCR and other ‘board type’ examination. It may also prove popular
amongst medical students and allied health professionals (radiographers,
technicians, etc).
As an editor with relatively fi xed views on style, there are very few
terms that jar on the eyes. Just occasionally the reader may get confused by
which type of ‘scan’ is being referred to! And I am never quite sure what a
‘modality’ is. But these are minor quibbles from an ageing dinosaur. This is a
modern book with a modern feel.
All in all, this team has done a marvellous job. I wish the book (and its
subsequent revised editions) well.
Adrian K Dixon
Cambridge
vii
Preface
This book has arisen out of our own experiences as radiology trainees
and those of our colleagues. Trainees are often daunted by the breadth
of knowledge required to successfully manage an emergency radiology
service, particularly when on-call; radiology has equivalent subspecialties
for almost every branch of medicine and emergency radiology is an essen-
tial component of each. A very high proportion of patients who enter the
emergency department will undergo some form of imaging before leaving
hospital and these tests will often be central in determining their manage-
ment. It is unusual for a patient to undergo emergency surgery without
prior imaging and cranial CT is now crucial to clinical decision-making fol-
lowing head trauma.
Consequently, there has been a steady increase in demand for emer-
gency imaging, which can put huge pressure on radiology departments.
This pressure is also experienced by trainees who are frequently on the
front line of emergency radiology on-call and while there are many excel-
lent radiology textbooks there has been no single, easily assessable text
that provides guidance on how to successfully manage radiology on-calls.
It is from these observations made by ourselves, friends and colleagues
that the idea of this handbook was born.
The emergency radiologist faces two questions with each emergency
case: what is the correct imaging modality to answer the clinical question
and how should this be performed to optimize the imaging information
obtained? The answers to these questions are often not straightforward
and in the pressure of the emergency setting, when time is crucial, incor-
rect imaging may result leading to suboptimal patient management. This
book is a guide for the emergency radiologist as to which imaging is most
appropriate in what circumstance, how best to perform it, and how to
interpret the results. In all cases, discussion with an experienced clinician
will help to optimize the diagnostic power of the investigation.
Emergencies in Clinical Radiology is intended as a readily accessible refer-
ence for specialist trainees in clinical radiology as well as radiographers.
In addition, it will be of use to other hospital specialists involved in the
emergency care of patients as it provides advice on which radiological
investigation to request in a particular clinical setting. The text lists imaging
strategies for frequently presenting complaints and common conditions,
including the relative merits of each modality and advice on how they may
be optimized. It also discusses the expected radiological fi ndings to aid
interpretation of these tests.
We hope the use of this book will help all those involved in emergency
imaging and will ultimately enhance patient care. We would value any
feedback to improve future editions.
RG
FG
2008
viii
Ackowledgements
We would like to thank OUP for their help in the preparation of this
book, especially Chris Reid and Fiona Goodgame who have been very
supportive throughout the project. We would also like to thank Professor
Adrian Dixon for writing the foreword to the book.
Above all, we are indebted to our many teachers, students, and patients,
all of whom have taught us everything we know.