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Hamilton MCK, Harries I, Lopez-Bernal T, Karteszi H, Redfern E, Lyen S, Manghat NE. Electrocardiography-gated CT for acute aortic syndrome: quantifying the potential impact of subspecialty national recommendations on emergency general radiology reporting. Clin Radiol 2021; 77:e27-e32. [PMID: 34579863 DOI: 10.1016/j.crad.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the detection of acute aortic syndrome (AAS) and the prevalence of alternative diagnoses that may explain the presentation or require follow-up. MATERIALS AND METHODS This was a retrospective, blinded re-evaluation of consecutive electrocardiography (ECG)-gated computed tomography (CT) aortic studies by a cardiovascular radiologist performed between September 2019 and May 2020 in a tertiary-referral cardiothoracic centre. RESULTS There were 118 identified examinations, six examinations were excluded leaving 112 (mean age = 61 ± 17; 56% male). Three cases of AAS were present (prevalence 2.7%); only one was reported on initial review. There were no false-positive diagnoses of AAS. The heart was mentioned in 79 (70.5%) reports and 73 (65.2%) of reviews revealed a total of 114 new observations; 111 (97.4%) of these were cardiovascular with 44/112 (39.3%) patients potentially having a significant previously unsuspected cardiovascular diagnosis. CONCLUSION The implementation of national clinical guidance to increase testing and improve image quality led to a series of challenges. The real value of ECG-gated CT may lie in detecting other diseases that mimic AAS. With the additional workload, increased subspecialty expertise is required but there needs to be a willingness to learn with an adequate support infrastructure.
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Affiliation(s)
- M C K Hamilton
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - I Harries
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - T Lopez-Bernal
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - H Karteszi
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - E Redfern
- Department of Emergency Medicine, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - S Lyen
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - N E Manghat
- Department of Clinical Radiology, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK; Department of Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK.
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Halpin S. Re: Recent changes in UK medical law: implications for radiologists. A reply. Clin Radiol 2021; 76:234. [PMID: 33446326 DOI: 10.1016/j.crad.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Affiliation(s)
- S Halpin
- Cwm Taf Morgannwg UHB, Llantrisant, Wales, UK.
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