Emergency and trauma radiology reporting involves quick interpretation on imaging studies (CT, X-ray, ultrasound) prescribed for acute injury to identify life-threatening conditions like hemorrhage, fractures, or organ injuries.
Trauma-related radiology is a diagnostic tool that diagnoses traumatic injuries in emergency departments. In emergencies/STAT conditions, the availability of on-site radiologists cannot be guaranteed. This can cause a delay in critical conditions. To provide rapid diagnostic results and guide medical decisions/interventions, remote radiology reporting services are used. These services consist of image analysis and interpretation by licensed radiologists from a remote setting. The diagnostic images for traumatic injuries are sent to a remotely operating radiologist, who analyzes them and prepares a diagnostic report, which is sent back to the healthcare provider for further processing.
To reduce the turnaround times, there are special adaptations made to the routine working of radiology reporting. These include fast-tracked analysis of radiology images, communicating the results directly, preparation of preliminary reports first, etc. These measures ensure that crucial diagnostic information is transferred to the healthcare provider without any supportive administrative activities.
X-ray Radiography:
X-ray radiography is the first-line imaging modality used for trauma-related cases in emergencies. It is a fast, rapid, and relatively simple technique, and hence, it is routinely performed in emergency departments. X-ray radiography utilizes ionizing radiation to produce simple 2D images of the abnormalities in the body. This imaging modality is effective for visualizing internal structures in the chest, pelvis, spine, and extremities of the body. It is generally used to diagnose conditions like pneumothorax, hemothorax, rib fractures, lung contusions, widened mediastinum, and misplaced tubes or lines.
Computed Tomography (CT):
CT scanning is similar to X-ray radiography as it employs ionizing radiation to visualize the anatomical structures. CT consists of capturing images from different views of the area under observation. This allows radiologists to view and analyze the affected organ from multiple planes. In the emergency department, a whole-body CT scan is normally used to detect intracranial hemorrhage, skull fractures, facial injuries, spinal trauma, thoracic and abdominal organ injuries, retroperitoneal bleeding, and pelvic fractures. To enhance visualization, a contrast-enhancing agent is used, which helps differentiate active bleeding from contained hematomas and assesses solid organ injuries (liver, spleen, kidneys). This imaging modality is also used to grade the extent of trauma and guide surgical procedures.
Ultrasound (FAST/eFAST):
Ultrasound imaging is widely used to visualize the organs and systems in compromised populations, where radiation exposure cannot be tolerated. It utilizes high-frequency sound waves to assess the internal structures. As the sound waves hit the tissues, they are reflected with a different frequency. Under this principle, each tissue reflects a unique frequency of sound waves. For emergency cases, ultrasound is optimized to get results in a limited time. There is Focused Assessment with Sonography for Trauma (FAST), which is a rapid, non-invasive screening tool that can be performed at the patient’s bedside. Additionally, extended FAST (eFAST) is a version of FAST ultrasound that helps in the visualization of pneumothorax and hemothorax.
1. Chest X-ray
Pneumothorax
Hemothorax
Rib fractures
Flail chest
Pulmonary contusion
Mediastinal widening (suggestive of aortic injury)
Tube and line malposition
2. Pelvis X-ray
Pelvic ring fractures
Acetabular fractures
Pelvic instability
Indirect signs of pelvic hemorrhage
3. Spine X-ray
Vertebral compression fractures
Alignment abnormalities
Subluxation or dislocations
4. Extremity X-ray
Long bone fractures
Joint dislocations
Open fractures
Foreign bodies
1. Non-Contrast CT Brain
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Intracerebral hemorrhage
Cerebral contusions
Skull fractures
Brain edema and herniation
2. CT Cervical Spine
Vertebral fractures
Facet dislocations
Spinal canal compromise
Atlanto-axial injuries
3. Contrast-Enhanced CT Chest
Pulmonary contusion
Hemothorax
Pneumothorax
Tracheobronchial injury
Cardiac injury
Traumatic aortic injury
4. Contrast-Enhanced CT Abdomen & Pelvis
Liver laceration
Splenic injury
Renal trauma
Pancreatic injury
Bowel perforation
Mesenteric injury
Retroperitoneal hemorrhage
Bladder rupture
5. Whole-Body CT (Polytrauma CT)
Multi-organ injuries
Occult bleeding
Combined skeletal and visceral trauma
1. FAST Examination
Free intraperitoneal fluid
Hemoperitoneum
Pericardial effusion
Cardiac tamponade
2. Extended FAST (eFAST)
Pneumothorax
Hemothorax
Pleural effusion
3. Doppler Ultrasound (Trauma-Specific)
Vascular occlusion
Pseudoaneurysm
Post-traumatic thrombosis
1. MRI Brain
Diffuse axonal injury
Brainstem injury
Non-hemorrhagic contusions
Persistent neurological deficits
2. MRI Spine
Spinal cord contusion
Spinal cord edema
Cord transection
Ligamentous injury
Disc herniation due to trauma
3. MRI Musculoskeletal
Ligament tears
Tendon injuries
Muscle contusions
Occult fractures
1. Orthopedic Procedures
Fracture reduction
Joint relocation
Internal fixation guidance
2. Interventional Radiology
Embolization of bleeding vessels
Inferior vena cava (IVC) filter placement
Drainage procedures
1. Mobile Chest X-ray
Life-threatening chest injuries
Tube and line placement verification
2. Bedside Ultrasound
Rapid hemorrhage detection
Assessment of cardiac activity in trauma arrest
1. Head & Brain Trauma
Skull fractures
Epidural hematoma
Subdural hematoma
Subarachnoid hemorrhage
Intracerebral hemorrhage
Cerebral contusions
Diffuse axonal injury
Brain edema and herniation
2. Facial & Neck Injuries
Facial bone fractures (nasal, maxillary, zygomatic, orbital)
Mandibular fractures
Cervical spine fractures
Cervical spine subluxation/dislocation
Laryngeal and tracheal injuries
Carotid or vertebral artery injury
3. Spinal Trauma
Vertebral body fractures
Burst fractures
Chance fractures
Spinal cord compression
Spinal cord contusion or transection
Ligamentous injuries
4. Chest (Thoracic) Trauma
Pneumothorax
Tension pneumothorax
Hemothorax
Pulmonary contusion
Rib fractures
Flail chest
Cardiac contusion
Pericardial tamponade
Traumatic aortic injury
1. Blunt Trauma
Road traffic accidents
Falls from height
Assault with blunt objects
Sports-related injuries
Crush injuries
2. Penetrating Trauma
Stab wounds
Gunshot injuries
Impalement injuries
Industrial penetrating injuries
3. Polytrauma
Multiple system injuries
High-velocity impact injuries
Combined blunt and penetrating trauma
4. Head Trauma
Traumatic brain injury (TBI)
Skull and facial fractures
Intracranial hemorrhage
5. Spinal Trauma
Cervical, thoracic, and lumbar spine injuries
Spinal cord injury
6. Chest (Thoracic) Trauma
Blunt chest trauma
Penetrating chest trauma
Cardiac and great vessel injuries
7. Abdominal Trauma
Blunt abdominal trauma
Penetrating abdominal trauma
Solid organ and hollow viscus injuries
8. Pelvic Trauma
High-energy pelvic injuries
Pelvic ring disruption
9. Musculoskeletal Trauma
Long bone fractures
Joint dislocations
Open fractures
Crush injuries
10. Vascular Trauma
Arterial injury
Venous injury
Active hemorrhage
11. Burn Trauma
Thermal burns
Electrical burns
Chemical burns
Radiation injuries
12. Blast Trauma
Primary blast injuries
Secondary shrapnel injuries
Tertiary blunt trauma
13. Obstetric & Gynecologic Trauma
Trauma in pregnancy
Pelvic organ injury
14. Pediatric Trauma
Accidental injury
Non-accidental injury (abuse)
15. Special / Environmental Trauma
Drowning and near-drowning
Electrocution
Hypothermia
Heat stroke