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The novel coronavirus disease 2019 (COVID-19) emerged as the source of a global pandemic in late 2019 and early 2020 and quickly spread throughout the world becoming one of the worst pandemics in recent history. This chapter reviews the most up to date radiological literature and outlines the utility of thoracic imaging in COVID-19, defining both the common and the less typical imaging appearances during the acute and subacute phases of COVID-19. The short term complications and the long term sequela will also be discussed in the context of radiology, including pulmonary emboli, acute respiratory distress syndrome, superimposed infections, barotrauma, cardiac manifestations, pulmonary parenchymal scarring and fibrosis. [ABSTRACT FROM AUTHOR]

Description Of Problem: Streamlining communication between radiology and referring services is vital to ensure appropriate care with minimal delays. Increased subspecialization has led to compartmentalization of the radiology department with many physicians working in disparate areas. At our hospital, we anecdotally noted that a significant portion of incoming phone calls were misdirected to the wrong workstations. This resulted in wasted time, unnecessary interruptions, and delays in care because the referring clinicians could not efficiently navigate the radiology department staffing structure. Our quality improvement project involved developing a web-based tool allowing the emergency department (ED) to more efficiently contact the appropriate radiology desk and reduce misdirected phone calls.Institutional Approach Employed To Address the Problem: Surveys were sent to radiology residents and ED providers (attendings, residents, physician assistants) to assess how often phone calls were misdirected to the wrong radiology station. Radiology residents were asked which stations received the most misdirected phone calls, and what station the caller was often looking for. ED providers were asked which stations they intended when they were told they called the wrong station, and a series of questions in the survey assessed their knowledge of commonly called radiology station (Plain Film, CT Body, Ultrasound, Neuoradiology, Pediatrics, and Overnight Desk). ED and radiology physicians worked together to design a simple, easily accessed web-based tool that allowed the ED clinicians to determine which station should be called during for each hour of the day, which integrated differences in staffing by radiology throughout the day. After the tool had been implemented for 8 months, surveys were again sent to radiology residents and ED clinicians asking the same questions as before to assess for any significant change in response. Additional questions were added to the ED survey to assess awareness of the new tool.Description Of Outcomes in Change Of Practice: An interactive, easily updated schedule with optimal contact numbers was made available through the ED intranet. The design allowed for easy modification of contact numbers over time to accommodate changes in coverage location or staffing models. Prior to implementation contact information was presented on a static screen, which was unable to be changed and included multiple incorrect and defunct numbers. Additionally, contact defaulted to a general radiology pager, which was carried by a resident only responsible for plain films for most of the day. Numbers included in the new intranet tool were all pertinent reading room stations, all scheduling desks, and all technologist workspaces. Different schedules were provided for weekdays and weekends. Initial survey results showed that prior to the intervention, 74% of radiology residents said they received misdirected phone calls at least twice a day, and 57.9% of ED respondents reached the wrong recipient at least once per day. Frequencies of misdirected calls dropped to 58.4% of radiology residents (P = 0.37) and 17.9% of ED respondents (P < 0.01) on follow-up surveys 8 months after the tool was established. After establishing the new tool, 82.1% of ED respondents were aware of the new intranet contact tool and were using it to contact radiology. On the series of questions assessing ED respondents' knowledge of radiology numbers, over 50% of respondents knew the correct answer or answered using the call sheet after implementation; this resulted in statistically significant increases in accuracy for Body, Neuroradiology, and Pediatric radiology stations. Furthermore, with the exception of ED plain films, there was a statistically significant reduction in number of responses who said the general radiology pager should be called for reads. Fifty percent of radiology residents believed there was a reduction in the number of misdirected phone calls from the ED with this tool.Conclusion, Limitations, and Descriptions Of Future Directions: Our tool was successful in accomplishing multiple goals. First, over 80% of ED respondents adopted the new tool. Second, the number of misdirected phone calls based on the subjective perception of ED respondents and radiology residents was reduced. Third, we objectively improved the ED respondents' behavior pattern in contacting the radiology department by either calling the correct number using the call tool, and by reducing the number of respondents who use the pager. Going forward, we hope to be able to expand use of this tool throughout the hospital in order to provide more timely and efficient care with other services by streamlining access between referring services and the appropriate radiology recipients. [ABSTRACT FROM AUTHOR]

As the 2019 novel coronavirus disease (COVID-19) continues to spread, some patients are presenting with abdominal symptoms without respiratory complaints. Our case series documents four patients who presented with abdominal symptoms whose abdominopelvic CT revealed incidental pulmonary parenchymal findings in the imaged lung bases and were subsequently confirmed positive for COVID-19 via laboratory testing. It remains to be seen whether these patients will eventually develop respiratory symptoms. While it is possible that the patients' abdominal complaints are coincidental with CT findings, it is interesting that patients can have such extensive incidental disease in the lungs on CT without respiratory symptoms. • Abdominal pain is being more recognized as a potential presenting for COVID-19. • Lung findings in COVID-19 patients may not correlate to respiratory symptoms. • Noting atypical presentation of COVID-19 allows for earlier quarantine and testing. • Early identification can further limit spread of COVID-19. [ABSTRACT FROM AUTHOR]

Chest tube placement is a commonly performed procedure, but it is not without complication. Our case report discusses a unique complication of chest tube placement with the use of minimally invasive techniques in order to treat it. • Chest tube placement is a common procedure with many documented complications, including misplacement into the liver and heart. • Fluoroscopy provides live visualization of malpositioned devices to assess for potential injuries and aid in treatment. • Tract embolization with glue and gelatin substances is an effective technique in preventing bleeding after hepatic injury. [ABSTRACT FROM AUTHOR]

Pancreas transplants are an important treatment options for patients with severe diabetes mellitus and other medical conditions. Multiple-imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound (US) are available to evaluate the pancreas transplants and their vascular supply, with the graft having a characteristic appearance on each modality. Complications of the graft and its vascular supply present interesting challenges to the clinicians and radiologists caring for this patient population. Being able to identify the imaging appearance of normal and abnormal pancreas transplants, it is necessary to ensure these patients are provided optimal care. [ABSTRACT FROM AUTHOR]

Radioembolization with yttrium-90 microspheres has a growing role in the interventional oncological management of patient's with hepatocellular carcinoma. Patients with Barcelona Clinic Liver Cancer early or intermediate hepatocellular carcinoma may be offered radioembolization in order to control tumor burden while awaiting a transplant organ-referred to as "bridging" a patient to transplantation-or to reduce tumor burden such that patients will subsequently meet criteria for curative therapies-known as "downstaging" a patient to eligible tumor characteristics. More specific applications of radioembolization have been developed over the past two decades. Radioembolization may be employed to perform a radiation "lobectomy" in order to induce regression of the treated segments and hypertrophy of the untreated liver lobe such that the future liver remnant is sizeable enough to sustain life following resection. Similarly, the concept of radiation "segmentectomy"-involving the more selective administration of yttrium-90 microspheres with the intention of treating tumor and leading to the regression of the treated segment over time-has been proposed as a potential curative application of radioembolization. These radioembolization applications combine to augment the treatment options available to hepatocellular carcinoma patients both within and beyond transplantation criteria. [ABSTRACT FROM AUTHOR]

Editor: As hospitals across the United States confront the burden of the 2019 novel coronavirus disease (COVID-19) pandemic, interventional radiology (IR) departments have been asked to perform nontraditional roles to support outbreak efforts. The department has ensured that IR nurses, physicians, technologists, and patient care associates have had adequate protective equipment, and to date, none have contracted COVID-19 during IR duties. [Extracted from the article]

Aorto-atrial fistulas are a rare diagnosis with limited reports in the clinical literature. These findings are often characterized by echocardiography alone; however, the advent and increased availability and use of CT angiography to diagnose cardiac abnormalities provides improved anatomic visibility of potential defects. We are reporting a case of a 76-year-old male with decompensated heart failure secondary to a fistula between the aorta and left atrium after remote history of bioprosthetic aortic valve replacement. [ABSTRACT FROM AUTHOR]

Recent studies have demonstrated a complex interplay between comorbid cardiovascular disease, COVID-19 pathophysiology, and poor clinical outcomes. Coronary artery calcification (CAC) may therefore aid in risk stratification of COVID-19 patients. Non-contrast chest CT studies on 180 COVID-19 patients ≥ age 21 admitted from March 1, 2020 to April 27, 2020 were retrospectively reviewed by two radiologists to determine CAC scores. Following feature selection, multivariable logistic regression was utilized to evaluate the relationship between CAC scores and patient outcomes. The presence of any identified CAC was associated with intubation (AOR: 3.6, CI: 1.4–9.6) and mortality (AOR: 3.2, CI: 1.4–7.9). Severe CAC was independently associated with intubation (AOR: 4.0, CI: 1.3–13) and mortality (AOR: 5.1, CI: 1.9–15). A greater CAC score (UOR: 1.2, CI: 1.02–1.3) and number of vessels with calcium (UOR: 1.3, CI: 1.02–1.6) was associated with mortality. Visualized coronary stent or coronary artery bypass graft surgery (CABG) had no statistically significant association with intubation (AOR: 1.9, CI: 0.4–7.7) or death (AOR: 3.4, CI: 1.0–12). COVID-19 patients with any CAC were more likely to require intubation and die than those without CAC. Increasing CAC and number of affected arteries was associated with mortality. Severe CAC was associated with higher intubation risk. Prior CABG or stenting had no association with elevated intubation or death. • Presence of coronary artery calcification on CT was linked to increased intubation and death in admitted COVID-19 patients. • Increased degree of coronary artery calcifications and number of involved vessels was associated with increased mortality. • Calcium scoring on routine non-contrast chest CTs was feasible in most COVID-19 patients, with high inter-reader agreement. [ABSTRACT FROM AUTHOR]

Objective: To compare transperineal (TP-TBx) and transrectal (TR-TBx) targeted prostate biopsy in a prospective non randomized single surgeon series of MR/US fusion-guided targeted biopsy performed using an electromagnetic tracking platform (NCT04026763).Materials and Methods: In this single-institution prospective study, 168 patients who underwent transperineal systematic 12-core biopsy and TP-TBx with electromagnetic tracking (UroNav, Invivo, Gainesville, FL) were compared to 211 patients who underwent a similar procedure by a transrectal approach. Univariate and multivariate analyses were used to assess if biopsy technique impacted all cancer detection rates or clinically significant (Gleason score >3+4) cancer detection rates.Results: Patients who underwent TP-TBx were older (68 vs 65 y, P = .014), with a slightly higher rate of PI-RADSv2.0 score (39% vs 28%, P = .039) and higher lesion volume on mpMRI (0.54 vs 0.41 cc, P = .039). The rates of CS disease detection by TP-TBx and TR-TBx were 59% and 54%, respectively. In a multivariate analysis adjusting for PSA, previous biopsy status, prostate volume, PI-RADS score, lesion volume, and lesion location, there was no statistically significant difference in likelihood to detect any PCa (OR, 0.98; 95% CI, 0.56-1.71; P = .940) or CS PCa (OR, 0.94, 95% CI, 0.58-1.51; P = .791).Conclusion: Transperineal targeted biopsy with electromagnetic-tracking is comparable to the transrectal fusion-guided approach in the detection of any PCa and csPCa cancer. [ABSTRACT FROM AUTHOR]

We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population. • COVID-19 patients were observed to form subcutaneous air and pneumomediastinum in the absence of mechanical ventilation. • Patients in this cohort presented mainly with respiratory symptoms including mild hypoxia, but otherwise stable vital signs. • On initial presentation, all patients demonstrated abnormalities in inflammatory markers. • On initial presentation, all patients demonstrated abnormalities in inflammatory markers. [ABSTRACT FROM AUTHOR]