The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Caring for the major trauma victim: the role for radiology

Two innovations have improved the care of the major trauma victim in the past 20 years. Both depend on active radiologist participation. The first has been the progressive nationwide development of the Emergency Medical Service System, which identifies trauma centers by a process of categorization, regionalization, and verification. The hospital must be staffed and equipped to perform computed tomography, angiography, and sonography. Trauma centers effectively reduce morbidity and mortality of the accident patient. The second innovation has been the intensive use of computed tomography (CT) for immediate patient evaluation. CT surpasses other imaging methods in examination for craniocerebral, abdominal, spinal, pelvic, and facial trauma. In craniocerebral trauma, the precise diagnosis afforded by CT reduces the fatality rate by permitting early surgical intervention. In abdominal trauma, CT examination supports nonoperative management of hemodynamically stable patients with solid organ injury. In spinal, pelvic, and facial injuries, CT provides diagnostic information not available with conventional radiography.     

Aorto-enteric fistulae: the role of radiology

Four patients with aorto-enteric fistulae are reported and a fifth case of jejunal ulceration is included, which is thought to be the early state of fistula formation. The clinical presentation and radiological investigation of these patients is described and discussed. The most important presenting symptom is of bleeding from the upper gastrointestinal tract. Analysis of the pre-operative investigations showed that barium studies were diagnostic in each of the cases. The important role of the radiologist, in making the diagnosis of an aortoenteric fistula in patients who have had aortic reconstructive surgery, is emphasised.     

Interventional radiology of trauma.

Percutaneous transcatheter embolization has become an integral part of the trauma team's armamentarium. Still, it is probably underused in many centers because of lack of familiarity on the part of both the trauma team and the radiologists. Recognition of the role of interventional radiology in vascular trauma can have a significant impact in decreasing the morbidity and mortality associated with this ever-growing problem in our society.     

Gastrointestinal bleeding: the role of radiology

Gastrointestinal bleeding represents a diagnostic challenge both in its acute presentation, which requires the point of bleeding to be located quickly, and in its chronic presentation, which requires repeated examinations to determine its etiology. Although the diagnosis and treatment of gastrointestinal bleeding is based on endoscopic examinations, radiological studies like computed tomography (CT) angiography for acute bleeding or CT enterography for chronic bleeding are becoming more and more common in clinical practice, even though they have not yet been included in the clinical guidelines for gastrointestinal bleeding. CT can replace angiography as the diagnostic test of choice in acute massive gastrointestinal bleeding, and CT can complement the endoscopic capsule and scintigraphy in chronic or recurrent bleeding suspected to originate in the small bowel. Angiography is currently used to complement endoscopy for the treatment of gastrointestinal bleeding.     

Cost-effectiveness of trauma CT in the trauma room versus the radiology department: the REACT trial

Objective

To determine the cost-effectiveness of trauma room CT compared with CT performed at the radiology department.

Methods

In this randomised controlled trial, adult patients requiring evaluation in a level 1 trauma centre were included. In the intervention hospital the CT system was located within the trauma room and in the control hospital within the radiology department. Direct and indirect medical costs of the institutionalised stay and diagnostic and therapeutic procedures were calculated.

Results

A total of 1,124 patients were randomised with comparable demographic characteristics. Mean number of non-institutionalised days alive was 322.5 in the intervention group (95?% CI 314?C331) and 320.7 in the control group (95?% CI 312.1?C329.2). Mean costs of diagnostic and therapeutic procedures per hospital inpatient day were ?554 for the intervention group and ?468 for the control group. Total mean costs in the intervention group were ?16,002 (95?% CI 13,075?C18,929) and ?16,635 (95?% CI 13,528?C19,743) for the control group (P?=?0.77).

Conclusion

The present study showed that in trauma patients the setting with a CT system located in the trauma room did not provide any advantages or disadvantages from a health economics perspective over a CT system located in the radiology department.

Key Points

? Computed tomography has become increasingly important in patients who have suffered trauma. ? Emergency departments either use embedded CT facilities or CT machines in the radiology department. ? The cost-effectiveness of CT was not influenced by the location of CT. ? The number of non-institutionalised days alive was not influenced by the location. ? Further assessment of optimal location of CT units is required.     

Interventional radiology in hepatobiliary trauma

Interventional radiologic techniques have become an important treatment tool in hepatobiliary trauma. We review the different methods and indications for these treatments. These include hepatic artery embolization for ongoing hemorrhage, arteriovenous fistula, or the presence of hemobilia. Case examples of each are given. Treatment of post-traumatic abdominal fluid collections is also described.     

Central venous catheters: the role of radiology

The insertion and management of long-term venous catheters have long been the province of anaesthetists, intensive care physicians and surgeons. Radiologists are taking an increasing role in the insertion of central venous catheters (CVCs) because of their familiarity with the imaging equipment and their ability to manipulate catheters and guide-wires. The radiological management of the complications of CVCs has also expanded as a result. This article reviews the role of radiology in central venous access, covering the detection and management of their complications.     

The radiology of chest trauma.

This paper deals with chest trauma, both blunt and penetrative. The emphasis is on the significance of various manifestations of trauma and the indications for further radiologic study.     

Interventional radiology in the treatment of retroperitoneal trauma

Interventional radiology is used most often in the management of the trauma patient to control hemorrhage and drain fluid collections. Transcatheter arterial embolization is an effective, expeditious, and safe technique for the nonoperative control of renal and other retroperitoneal bleeding, arteriovenous fistulas, and pseudoaneurysms. Transcatheter drainage of renal and other retroperitoneal collections of pus, urine, and blood is successful in more than 90% of trauma patients; such drainage should be attempted prior to any surgical intervention. Other procedures, such as antegrade nephrostomy, ureteral stenting and dilatation, angioplasty of traumatic renal artery stenosis, and suprapubic cystostomy, are infrequently indicated but provide alternatives to standard surgical intervention.     

Interventional radiology in the treatment of retroperitoneal trauma

Interventional radiology is used most often in the management of the trauma patient to control hemorrhage and drain fluid collections. Transcatheter arterial embolization is an effective, expeditious, and safe technique for the nonoperative control of renal and other retroperitoneal bleeding, arteriovenous fistulas, and pseudoaneurysms. Transcatheter drainage of renal and other retroperitoneal collections of pus, urine, and blood is successful in more than 90% of trauma patients; such drainage should be attempted prior to any surgical intervention. Other procedures, such as antegrade nephrostomy, ureteral stenting and dilatation, angioplasty of traumatic renal artery stenosis, and suprapubic cystostomy, are infrequently indicated but provide alternatives to standard surgical intervention.     

Interventional radiology in appendicular skeletal trauma

Embolotherapy for extremity vascular injuries is a relatively new, effective, and safe treatment modality in selected patients. The resultant hemostasis decreases the morbidity or even mortality that can result from uncontrolled hemorrhage. In addition, surgery may be postponed until the patient is stabilized, or avoided altogether. Prompt diagnosis of vascular injury and embolization when indicated also contributes to the proper management of associated osseous and soft tissue injuries.     

Renal transplantation dysfunction: the role of interventional radiology

The aim of this article is to review the radiological management of complications following renal transplant.     

The role of the radiology nurse

The radiology nurse's role requires a high level of knowledge, expertise and independence because the department provides services to a wide variety of patients with diverse needs and about whom information may be limited. Radiology nurses routinely start or check peripheral i.v.s, assess infusaports, administer medications, monitor vital signs, suction patients, insert foleys and help patients with their personal needs. The nurse also informs the technologist or radiologist of any unusual patient needs and performs specialized nursing duties, such as administering i.v. sedation or analgesia during special procedures and closely monitoring patients with cardiac/pulse oximeters. Radiology departments call on nurses to care for patients transported from intensive care, patients in emergency situations and pediatric patients and others needing sedation. Teaching is another duty radiology nurses assume, instructing patients and their families, students, technologists, other nurses, radiologists and physicians about patient care. They also teach the radiology staff new nursing policies and national standards as such changes occur. Radiology nurses devote a lot of time to quality improvement and infection control programs: collecting data, keeping records and reporting results. Because radiology nursing is relatively new, the nurse may be called upon to help write patient care policies, design flowsheets or patient instruction sheets and develop protocols or care plans. Radiology nurses utilize skills employed in many other nursing specialties and incorporate them in the radiology setting. They must provide quality nursing care to a large, transient group of patients of all ages, be a spokesperson for patient care and a teacher to other radiology staff members on patient care issues.