Foreign bodies: radiopaque compared to what?

Current abdominal X-rays practice in accident and emergency

INTRODUCTION

Previous literature reviews revealed that abdominal X-rays (AXR) performed for the accident and emergency department (A&E), had low sensitivity, high further imaging and non-alignment rate to the Royal College of Radiologists (RCR) guidelines. A study was performed to investigate the current practice with the aim of making recommendations to improve practice, which can reduce patients' radiation exposures, while can re-routing resources to other priorities.

METHODS

A study was performed in one of the UK's largest A&Es, in accordance with the RCR guidelines. All the AXR requests from A&E, regardless of the patient's age, within a 28-day period, were retrospectively assessed. Non-A&E patients and abandoned examinations due to uncooperative patients were excluded. The total number of AXR requests received by the A&E imaging department was 169, with 28/169 falling into the exclusion criteria.

RESULTS

Of the 141 included requests, five unjustified requests were correctly rejected. The remaining 136 requests were accepted and performed, though only 115/136 (84.6%) of these were justified. The most common justified and unjustified indications were obstruction and renal stones, respectively. Only 4% of reported AXR had pathological abnormalities, while 45/136 patients had further imaging.

CONCLUSIONS

The small proportion of significant findings echoed previous studies, suggesting an AXR overuse. Over 80% of non-compliant requests were performed, and awareness of the justification guidelines can be increased by clinical governance, posters, or an algorithm previously presented. The 32.4% further imaging rate recorded in this study, as opposed to the 73.7% reported in previous literature, merits attention.

IMPLICATIONS TO PRACTICE

Stopping the overuse of AXR can minimise the radiation dose received and relieve the mounting pressure in imaging and reporting, which can serve other patients who would benefit from the services otherwise.

Sonographic features of various dental materials and foreign bodies

OBJECTIVE

To reveal the sonographic characteristics of various foreign bodies and dental materials to aid diagnosis.

METHODS AND MATERIALS

24 objects consisting of various dental materials and foreign bodies were included in the study. Objects were embedded in bovine gelatin. Images of the objects were obtained by conventional radiography and ultrasonography (USG). Opacities were evaluated by conventional radiography. Their visibility and posterior acoustic behaviors were examined by USG. In addition, the actual sizes of the objects and their dimensions measured by USG were compared.

RESULTS

All objects included in the study, including non-opaque ones, could be visualized by USG. When the posterior acoustic behavior of objects was examined, 15 of the objects (62.5%) caused posterior acoustic shadowing on USG. While 6 of the objects (25%) did not have any USG artifacts, 2 of them (8,3%) had comet tail artifact and 1 of them (4,2%) had reverberation artifact. There was no statistically significant difference between the actual dimensions of the objects and their dimensions measured by USG (p > 0,05).

CONCLUSION

USG is a very useful technique for imaging foreign bodies and dental materials, it can even show objects that cannot be seen in X-rays on in-vitro environment.

Foreign bodies of body orifices: A pictorial review

INTRODUCTION

Ingestion, inhalation, and insertion of foreign bodies (FB) are commonly encountered problems in the emergency departments (ED). Radiologists pay a key role in their diagnosis and management. Selecting an appropriate imaging modality is important depending on the route of entry and reported type of FB. Diagnosing FB is time sensitive and requires radiologists to be astute and familiar with varied imaging appearances of FB. In this article, we review imaging features of most common FB seen in clinical practice and their complications.

TEACHING POINTS

SUMMARY: FB in body orifices are frequently seen in the ED. Imaging plays a pivotal role in the management in majority of the cases. In this article, we present several cases of commonly encountered FB.

Multimodality Imaging of Foreign Bodies: New Insights into Old Challenges

Traumatic wounds and lacerations are a common reason for patients to present to emergency departments, with retained foreign bodies (FBs) accounting for 7%-15% of cases, particularly those involving the extremities. These retained materials result in a granulomatous tissue response known as an FB reaction, a pathologic attempt to isolate the FB from the host. The most common FB materials are glass, metal, and wood, but other compositions can also be found, such as plastic and animal-derived materials. Clinical history, physical examination, and wound exploration are essential in investigation of retained material but are not sufficient to exclude an FB, and additional investigation is required. Imaging evaluation is a useful tool to help depict and locate an FB, assess possible complications, and guide removal. Conventional radiography, the first-line method in this scenario, is a widely available low-cost depiction method that has good sensitivity for depicting FBs. If the retained material is not depicted at conventional radiography, US can be performed. US is highly sensitive in depicting both radiolucent and radiopaque FBs in superficial locations. For deeper objects, CT may be necessary. MRI is the best imaging modality to delineate local soft-tissue and osseous complications. Retained FBs can result in early and delayed complications, with infection being the most frequent complication. To avoid preventable morbidities related to FBs, radiologists should be familiar with imaging findings and provide essential information to help the attending physician treat each patient. Online supplemental material is available for this article. ^©RSNA, 2020.

No stone left unturned and nothing left behind - A pictorial guide for retained surgical items

Retained surgical instruments (RSI) remain an unsolved problem with serious implications for patients and healthcare providers. Although radiographs are commonly obtained whenever a surgical count is incorrect or incomplete, they have a very low prevalence of positive findings. With the majority of these studies being negative, it is difficult for radiologists and trainees to develop expertise in the detection of RSI, and comfort with reporting and documenting their findings. It is also important for the radiologist to be familiar with the documentation and communication requirements of their own institution in regards to intraoperative radiographs and their interpretation. This pictorial essay is intended to provide guidance to these "best practices" for the management of these cases. A series of case examples is also provided. In this manuscript we illustrate potential pitfalls and avoidable sources of error in the interpretation of these challenging cases.

Seasonal foreign bodies: the dangers of winter holiday ornamentation

Foreign bodies, whether ingested, aspirated or retained in the soft tissues, are a particular hazard to pediatric patients. Ornamentation associated with the winter holidays is an uncommon source of foreign bodies in children, and many of these foreign bodies have a distinct appearance on imaging. Knowledge of these appearances and the unusual features of winter holiday foreign bodies might facilitate their identification.

Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol. 2014;202:946-959. [PMID: 24758646 DOI: 10.2214/ajr.13.11661]

OBJECTIVE

The purpose of this article is to describe the indications and techniques for bowel ultrasound for inflammatory bowel disease and other common and uncommon entities and describe and illustrate their imaging appearances, including endoscopic or surgical correlation.

CONCLUSION

Ultrasound is a useful tool for the evaluation of inflammatory bowel disease and many other bowel diseases. Radiologists must become familiar with the full potential of ultrasound in the evaluation of the bowel in children because the need for alternative radiation-free imaging techniques continues to grow.