Emergency Radiology: Helical CT in Acute Abdomen Ravi Kumar, Jagdish Singh, Vandana Verma Marwah, Srinivas M
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Helical CT in Acute Abdomen
Series Editor Arjun Kalyanpur MD ABR Chief Radiologist Teleradiology Solutions Textbook Editors Arjun Kalyanpur MD ABR Chief Radiologist Teleradiology Solutions Jagdish Singh DNB DMRD Consultant Radiologist Teleradiology Solutions Authors Jagdish Singh DNB DMRD Consultant Radiologist Teleradiology Solutions Vandana Verma Marwah MD Consultant Radiologist Teleradiology Solutions Ravi Kumar MD Consultant Radiologist Teleradiology Solutions Srinivas M DNB DMRD Consultant Radiologist Teleradiology Solutions
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Step by Step in Emergency Radiology
© 2006, Editors
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2006
Typeset at JPBMP typesetting unit
Printed at Gopsons Paper Ltd, Noida
Dr Arjun Kalyanpur and Dr Sunita Maheswari for their motivation and guidance
Neetu Jagdish Singh and Dr. Deepa Ravikumar for helping in writing the manuscript
Akram Pervez and Munnawar Pasha, medical transcriptionists, Teleradiology Solutions, for typing out the written text
Siddharth Ghosh, medical transcriptionist, Teleradiology Solutions for helping in downloading and printing the material needed for writing the book
Family members of the authors for their moral support.
All our colleagues at Teleradiology Solutions for their support.
Emergency Radiology in India represents an idea whose time has come. Quality emergency medical services are the crying need of the hour. In all other respects, our country has evolved rapidly in recent years in terms of medical care delivery, exemplified in the radiology setting by the number of recent installations of helical and multidetector-row CT scanners throughout the country. The anatomy of the abdomen and pelvis is revealed in startling detail to us with multiplanar CT imaging, allowing us to diagnose pathology with a high degree of sensitivity and accuracy.
Another paradigm shift that is taking place is the switch to reading studies on monitors rather than on hard copy film. Given economic constraints, reading off film is inherently unsafe as in an effort to cut costs, the minimum possible number of window settings is typically presented to the radiologist. Soft copy review has opened up the Pandora's Box (i.e. the abdomen/pelvis) to radiologists throughout the country. When I began residency training in the US in the early 90s I was amazed at the amount of mesenteric pathology that was revealed to me just by virtue of having the luxury of being able to window and level to my heart's desire. One of the shortcomings of radiologic practice and training in India at the time was the lack of emphasis on the CT imaging of mesenteric 6disease. Although I learned a great deal during my residency training in New Delhi, I credit my US training with giving me the ability to spot tiny amounts of mesenteric fluid and air and the subtlest of ‘fat stranding’ and to use these findings as a clue/pointer to make the actual diagnosis. It is these signs/findings that we have attempted to highlight in this book.
The imaging equipment and workstations are now in place, now it is up to us as radiologists to train ourselves in the art and science of emergency abdominal imaging to meet the challenges that our patients present to us. This book is written with the goal of increasing the awareness of our community to our potential as radiologists in effecting enhanced patient care. It represents the cumulative results of three years of emergency imaging and a lot of hard work by our team at Teleradiology Solutions, spearheaded by Dr Jagdish Singh. We hope you enjoy it. If even a single patient benefits from your perusal of it, our purpose is fulfilled.
Arjun Kalyanpur