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2Emergency Imaging

ments and grading assignments necessary for surgical planning are usually best left to the treating physician, who usually has direct access to images and considerably more detailed clinical information than the radiologist does.

◆Incidental Findings

“Incidentalomas”—cysts, nodules, osseous lesions, and visceral or other soft tissue masses—are frequently detected on im-aging studies. Most are obviously benign, such as simple renal cysts or small ovar-ian cysts in reproductive-age women, and need not even be described. The radiolo-gist should report any unexpected finding that could potentially endanger the patient in the future or that needs further imag-ing evaluation.At minimum, any patient with such a finding should be directed to appropriate primary or specialist physician referral. The radiologist should document that this has been communicated to the emergency physician in the report. Com-mon incidental findings will be addressed by anatomic region in each section of this book. The most commonly encountered in-cidental findings include lung nodules and abdominal visceral cysts or masses.

◆Learning Radiology

Diagnostic radiology is a broad discipline, and the scope of essential knowledge can be daunting to the student or resident. It is helpful to define learning goals at dier-ent stages of training and to remember that learning radiology, like learning anything, is a cyclical process of returning to the be-ginning again and again. Because one aim of this book is to support the novice radiolo-gist and the learning that takes place in the first year of residency, the following sug-gestions are presented for consideration.

As a first-year resident, one’s focus should be on learning the relevant anatomy for each rotation, learning to communicate results clearly both in reports and verbally, and acquainting oneself with the several hundred conditions likely to be encoun-tered in the emergency setting. These also

counted for on a single report, list each one on a separate line rather than in a densely packed paragraph. Summarize the pattern or condition in the report’s impression.

Avoid using “there is” before each find-ing. “No pneumothorax,” for example, de-livers the same information as “There is no pneumothorax.”

Avoid “is seen,” “is noted,” “is demon-strated,” and the like. These are the equiva-lent of putting “there is” in front of each finding. Simply state the finding.

Avoid “of the.” It is usually possible (and preferred) to put an adjective in front of the noun it modifies. “The neck of the femur” is better described as “the femoral neck.”

Avoid abbreviations and jargon. You do not know who will be reading your report. MR can mean mitral regurgitation to one physician and mental retardation to anoth-er. It is best to spell out most words and use conventional anatomic terminology: “The first carpometacarpal joint,” for example, is understood by anyone who knows basic anatomy. Its synonym, “the basal joint,” is known to hand surgeons but not necessar-ily to psychiatrists or internists, who may be caring for the patient.

While eponyms make for useful short-hand, they should be used in addition to, rather than in place of, a clear anatomic description: “A transverse, extra-articular, fifth metatarsal fracture, one centimeter from the base (Jones fracture)” is prefer-able to “fifth metatarsal Jones fracture.”

Finally, if a word or phrase doesn’t add to the meaning of the report, delete it. Ra-diologists are not meant to create a mood, develop a complex story line, or vividly paint a character. Our aim is to eciently and eectively interpret the visual evi-dence presented in order to support an accurate clinical diagnosis and help direct treatment.

◆Grading and Measuring

When a measurement is necessary to es-tablish a diagnosis, or to provide the ap-proximate size of a mass, it should be recorded in either one dimension (round masses/cysts) or three dimensions (oblong or complex masses). Specific measure-