Do you need to look at the topogram (scoutview) on all cases of CT scanning? |
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Post-Op Pain and Fever: ? Retained Barium  |
Retained Metal Malleable Retractor  |
Do you need to look at the topogram (scoutview) on all cases of CT scanning? Editorial: Reviewing the CT scout view: medicolegal and ethical considerations. Berlin L AJR 2014 Jun;202(6):1256-63 |
Methods: 2032 scout views were reviewed retrospectively by 2 radiologists blinded to history and CT findings. All cases with major findings (defined as any abnormality that would prompt additional diagnostic tests or require management) were correlated with the CT, other imaging or medical record when necessary by a 3rd radiologist to determine (1) validity of the scout view finding, and (2) whether it was identifiable on the current CT scan. |
“The CT scout view showed a significant finding in up to 23% of cases, usually in an anatomic region imaged by CT. In as many as 2% of cases, the abnormality disclosed on the scout view may not be included in the CT FOV.” The CT Scout View: Does It Need to Be Routinely Reviewed as Part of the CT Interpretation Johnson PT, Scott WW, Gayler BW, Lewin JS, Fishman EK AJR 2014; 202:1256-1263 |
“ Our results support routine review of the anatomic regions on the scout view that are not imaged on CT and suggest that interpreting the scout view will not generate unnecessary testing if the limitations of the scout view are recognized.” The CT Scout View: Does It Need to Be Routinely Reviewed as Part of the CT Interpretation Johnson PT, Scott WW, Gayler BW, Lewin JS, Fishman EK AJR 2014; 202:1256-1263 |
“ There are no written statements in the ACR Practice Guidelines or related documents that refer to, much less require, routine evaluation and interpretation of scout views obtained on CT studies.” Reviewing the CT Scout View: Medicolegal and Ethical Considerations Berlin L AJR 2014;202:1264-1266 |
“ Although 2% appears to be a low percentage, extrapolating Johnson et al.’s data to the 85 million patients who undergo CT each year means that as many as 1.7 million patients may have a major abnormal finding that is seen on a scout view but not on the related axial CT images.” Reviewing the CT Scout View: Medicolegal and Ethical Considerations Berlin L AJR 2014;202:1264-1266 |
“ Johnson et al. concluded that their findings support the routine review of the scout view when interpreting a CT study. Reasonable medical practice, logic, and medicolegal as well as ethical considerations confirm their conclusion.” Reviewing the CT Scout View: Medicolegal and Ethical Considerations Berlin L AJR 2014;202:1264-1266 |
“Scout images are an integral part of any CT examination and should be carefully reviewed for findings that may or may not be included in the FOV of the study.” Reviewing CT Scout Images: Observations of an Expert Witness Daffner RH AJR 2015; 205:589–591 |
“Scout views have been shown to contribute significantly to diagnosis. A systematic neglect of the scout views on cross-sectional imaging studies can result in important diagnoses being missed. A simple and effective remedy for this type of bias is to routinely review the scout images and include a field in the report template labeled “Scout views.” Heuristics and Cognitive Error in Medical Imaging Itri JN, Patel SH AJR 2018; 210:1097–1105 |
Bladder Cancer: Facts
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Bladder Cancer as an Incidental Finding
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Missed Bladder Cancer in Patient with Ischemic Colitis ( 2 studies 3 years apart)  |
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Bladder Cancer as an Incidental Finding: Thoughts
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Incidental Bladder Cancer  |
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Incidental Bladder Cancer  |
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“The presence of a discrete bladder mass or nodule should be considered suspicious for malignancy . In many cases, such lesions may be better appreciated on early phase images when surrounded by low-attenuation urine, particularly when the lesion is avidly enhancing, although a discrete filling defect may not be difficult to appreciate on delayed images when the nodule is large.” Bladder Malignancies on CT: The Underrated Role of CT in Diagnosis Raman SP, Fishman EK AJR 2014; 203:347–354 |
“In other words, although TCC has typically been regarded as a hypovascular tumor, these lesions have considerable urothelial hypervascularity and are typically most conspicuous on early phase images. As a result, any focal hyperenhancement of the bladder urothelium must be considered suspicious for malignancy.” Malignancies on CT: The Underrated Role of CT in Diagnosis Raman SP, Fishman EK AJR 2014; 203:347–354 |
Common Sources of Error
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Unsuspected Pulmonary Embolism
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Unsuspected Pulmonary Embolism- Solution
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Incidental PE  |
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Incidental PE  |
Incidental PE  |
“ This study shows that missed PE can occur on abdominal CT. It is recommended that interpretation include a careful search of the lower pulmonary arterial vasculature on contrast-enhanced abdominal CT scans.” Missed Pulmonary Embolism on Abdominal CT Lim KY, Kligerman SJ, Lin CT, White CS AJR 2014; 202:738-743 |
“ The challenge in identifying PE is clearly greater on abdominal CT than on chest CT. In addition to the multiple pitfalls described already, the lungs are typically not a primary target of abdominal CT interpretation, and only a limited part of the pulmonary anatomy is included.” Missed Pulmonary Embolism on Abdominal CT Lim KY, Kligerman SJ, Lin CT, White CS AJR 2014; 202:738-743 |