editorial imaging and image transfer in emergency...

Hindawi Publishing CorporationEmergency Medicine InternationalVolume 2013, Article ID 952672, 3 pageshttp://dx.doi.org/10.1155/2013/952672

EditorialImaging and Image Transfer in Emergency Medicine

Tobias Lindner,1 Hein Lamprecht,2 Efthyvoulos Kyriacou,3 Raoul Breitkreutz,4

Stefan Puig,5 and Aristomenis K. Exadaktylos6

1 Department of Emergency Medicine, Campus Virchow, Charite-Universitatsmedizin Berlin, 13353 Berlin, Germany2Division of Emergency Medicine, Stellenbosch University, Cape Town 7925, South Africa3 Department of Computer Science and Engineering, Frederick University, 3080 Lemesos, Cyprus4Department of Emergency Medicine, Klinikum Frankfurt Hochst GmbH, 65929 Frankfurt am Main, Germany5Department of Diagnostic Radiology, Inselspital Bern, University of Bern, Diagnostische, Interventionelle und Padiatrische Radiologie,3010 Bern, Switzerland

6Department of Emergency Medicine, Inselspital Bern, University of Bern, 3010 Bern, Switzerland

Correspondence should be addressed to Tobias Lindner; [email protected]

Received 28 November 2013; Accepted 28 November 2013

Copyright © 2013 Tobias Lindner et al.This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This special issue presents an international forum forresearchers to summarise the most recent developments andideas in the field of emergency imaging and image transfer,with a special emphasis on the technical and observationalresults obtained within the last five years.

First of all, we would like to thank all the authors for theircontributions. For reasons of space, we were forced to rejectother submitted papers. Secondly, we are very much obligedto our reviewers for their excellent and punctual work.

It is a basic duty of emergency medicine to rule outsevere illness or to recognise it and treat it at once. Likepoint-of-care biomarkers, bedside imaging techniques mayplay a substantial role in coping with this task. In times ofincreasing pressure on emergency physicians to deliver fasterand better results, rational use of imaging techniques duringthe very first minutes and hours from the time of admissionis of the greatest interest. This not only improves outcomeand decreases morbidity and mortality but also saves moneyand enhances patient satisfaction. C. A. Pfortmueller etal. address the issue of quality management on emergencywards. By comparing six different methods of assessingpatient satisfaction, they concluded that patient-optimizedonline assessment performed in the hospital can give a verygood response rate. Pfortmueller et al. recommend involvingan external institute, as this can save time and money.

Ultrasound (US) is a 24/7 bedside and also prehospitalpoint-of-care imaging tool and was the theme of severalstudies submitted to this special issue. M. J. El Sayed andE. Zaghrini review current and future indications of pre-clinical US. They point out that US can help prehospitalproviders to guide management in several settings (e.g.,trauma, cardiopulmonary resuscitation). Despite the greatprehospital potential for US, they see problems in developingan adequate training concept for nonphysicians, in order toensure that they gain andmaintain sufficient skills. Moreover,further outcome research is needed to show the benefits ofpreclinical US. R. Breitkreutz et al. tested the influence ofthe integration of personalised US on in-hospital patientmanagement. They conducted four substudies on imagequality, work distribution, and diagnostic and proceduralquality of US in critical care medicine. They found out thatintegration of personalised US during their regular wardrounds significantly reduced average contact time per patientand lowered the patient referral rate to an echo lab from 20%to 2%.

In a retrospective study enrolling almost 20,000 patientsin a level 1 trauma centre, A. Y. Sheng et al. show thatthe introduction in recent decades of focused assessmentwith sonography in trauma (FAST) has led to an equiva-lent reduction in the annual rate of abdominal computed

2 Emergency Medicine International

tomography (CT) (around 2%), whereas the overall use of CTin emergency departments has risen during this period. Theauthors conclude that FAST can avoid unnecessary radiationexposure and also reduce costs in a relevant number oftrauma patients.Their future aim is to establish a safe “FAST-only” algorithm. In another ultrasound study, K. Layman andcolleagues focus on the use of US in the ED in the evaluationof pain or bleeding in the first trimester of pregnancy. On thebasis of three typical cases, they review common pitfalls anddiscuss key principles of US use in this setting.

Four further papers on ultrasound deal with teachingconcepts and protocols for the clinical use of ultrasound, evenby inexperienced examiners. T. V. Mai et al. investigate thefeasibility of a brief cardiac limited US examination protocol(CLUE) performed by three trainees who have no prior USexperience at all and who use a pocket-sized ultrasounddevice (PUD) under wireless audiovisual guidance froman off-site cardiologist. Data were transmitted through thecamera of a phone attached to the PUD. The technicalquality of the images and diagnostic accuracy (LV systolicdysfunction, LA enlargement, ultrasound lung comets, andelevated CVP) were compared to clinical routine (on-siteecho threshold). Referring to their results, authors concludethat, under these circumstances, a novice can perform theCLUE protocol and facilitate off-site/bedside medical deci-sion making. M. Campo dell’Orto et al. describe a self-madephantom training model using a celluloid table tennis ballfor ultrasound-guided pericardiocentesis. On the basis ofits evaluation by 67 participants in the course of a focusedechocardiography training session, they conclude that theirphantom is an effective training tool for acute and criticalcare physicians. C. Cuca et al. (a member of the samegroup) evaluated a self-developed interactive online trainingprogram for the ultrasound of the thorax, trachea, andlung by comparing the success of independent theoreticalskill development through their individual e-learning coursecompared to a day-long training seminar with personal atten-dance. They found that e-learning almost equalled scoresof classroom-based training with respect to the gain andretention of factual knowledge. They therefore consideredthat this was set to become a vital part of theoreticaltraining in lung ultrasound. The third paper on trainingconcepts for ultrasound skills from R. Breitkreutz et al.’s veryactive research group describes the development and assess-ment of a structured clinical examination curriculum forfocused thorax, trachea, and lung (THOLUUSE) ultrasoundin emergency and critical care medicine. In a prospectiveeducational study, medical students, anaesthesiologists, andtrauma surgeons underwent a one-day training course struc-tured according to their concept. Training included lecturesin physiology, the sonoanatomy and sonopathology of thethorax, case presentations, and hands-on training, includingultrasound phantoms, puncture models, and healthy modelsand selected patients. They concluded that their coursesignificantly improves theoretical and practical skills forthe diagnosis of acute thoracic lesions, including pleuraleffusion/haemothorax and pneumothorax.

Another section of this special issue is dedicated torecent technical developments and their potential benefit in

medical care. M. Tabbara et al. introduce the Swiss LimmexEmergency Wristwatch, as launched in 2011. By pushinga button on this watch, the wearer can initiate multipleemergency calls and establish mobile communication with apreselected person, institution, or a search and rescue service.Due to the rising number of elderly people who want to liveon their own in their private homes, technical developmentslike this are of increasing importance. Such devices can assuresafe storage and automated or easy transmission of relevantpersonal medical data, supporting fast and reliable medicaltreatment in an emergency. In their study, the authors presentthe results of a survey with 620 answers (response rate 46%)of watch wearers with a mean age of 81.8 years. G. Lindnerand A. K. Exadaktylos review previous clinical studies on theaccuracy of noninvasive haemoglobin measurements usingpulse carboxyoximetry devices and discuss their potentialusefulness in different clinical settings, and also in prehospitaltriage. T. Lindner et al. present the clinical results of therecently introduced PneumoScan, a noninvasive bedsidedevice that uses micropower radar technology to detectpneumothorax. The authors consider that this device mightbe used in the prehospital setting and for triage in disastermedicine, as the scanner is not examiner dependent likeultrasound and is easy to use only after a short tutorial.However further clinical evaluation is necessary. A. K. Zisakiset al. describe several new and interesting devices that are stillin the early phase of clinical testing but one day could helpin diagnosing brain injury, measuring intracranial pressure,or even reopening occluded brain vessels. These devices arenot exclusive for neurosurgeons or neurologists but also fornonspecialists.

S. P. Whiley et al. present the new Johannesburg traumaprotocol which implements the Lodox Statscan, a low dose,full-body X-ray scanner. Its use as a triage tool is illustratedby the description of 63 patients scanned on entry to theED in a single shift at a level 1 trauma centre. The authorsdraw the conclusion that this method of imaging can be anefficient and accurate method of triage in underresourcedsituations. U. J. Gupp et al. ask if the radiation dose to severelyinjured patients in emergency CT scans can be reducedwhilst maintaining image quality. They therefore examinedthe impact of adaptive statistical iterative reconstruction(ASIR) on CT imaging quality, diagnostic interpretability,and radiation dose reduction for a proven CT acquisitionprotocol for total body trauma.They compared 30% and 40%of iterative reconstruction (IR) modification in the raw datadomain of the routine total body protocol with the routineprotocol itself. The authors presented only small numbersof patients in preliminary results and regarded their studyas a feasibility evaluation of IR algorithms in an emergencysetting. They cautiously concluded that the use of IR algo-rithms is a promising approach to reduce radiation exposurewithout compromising radiological interpretability, even inan emergency setting where image quality is paramount.

Finally, K. N. O’Laughlin et al. address the topic ofrisk stratification for brain herniation after lumbar puncture(LP). Firstly, they asked members of an expert panel todefine which head CT findings indicate an increased risk ofherniation following LP. Secondly, they used clinical data of a

Emergency Medicine International 3

cohort of patients who had a head CT for any reason to assessthe ability of history and physical examination to predictthose findings.They concluded that no patient history and nofindings during clinical examination alone or in combinationare adequately sensitive to detect head CT abnormalitiesbelieved to predict enhanced potential for brain herniationduring LP.

Acknowledgment

Once again, we would like to thank the authors, theircoworkers and our reviewers for contributing to this specialissue and hope the reader will find a lot of interesting andstimulating contents for his daily life in the medical service.

Tobias LindnerHein Lamprecht

Efthyvoulos KyriacouRaoul Breitkreutz

Stefan PuigAristomenis K. Exadaktylos

Submit your manuscripts athttp://www.hindawi.com

Stem CellsInternational

Hindawi Publishing Corporationhttp://www.hindawi.com Volume 2014


MEDIATORSINFLAMMATION

of


Behavioural Neurology

EndocrinologyInternational Journal of



Disease Markers


BioMed Research International

OncologyJournal of



Oxidative Medicine and Cellular Longevity


PPAR Research

The Scientific World JournalHindawi Publishing Corporation http://www.hindawi.com Volume 2014

Immunology ResearchHindawi Publishing Corporationhttp://www.hindawi.com Volume 2014

Journal of

ObesityJournal of



Computational and Mathematical Methods in Medicine

OphthalmologyJournal of


Diabetes ResearchJournal of



Research and TreatmentAIDS


Gastroenterology Research and Practice


Parkinson’s Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttp://www.hindawi.com

editorial imaging and image transfer in emergency...

Documents