Background Although some national recommendations for the role of radiology in a polytrauma service exist, there are no European guidelines to date. Additionally, for many interdisciplinary guidelines, radiology tends to be under-represented. These factors motivated the European Society of Emergency Radiology (ESER) to develop radiologically-centred polytrauma guidelines. Results Evidence-based decisions were made on 68 individual aspects of polytrauma imaging at two ESER consensus conferences. For severely injured patients, whole-body CT (WBCT) has been shown to significantly reduce mortality when compared to targeted, selective CT. However, this advantage must be balanced against the radiation risk of performing more WBCTs, especially in less severely injured patients. For this reason, we recommend a second lower dose WBCT protocol as an alternative in certain clinical scenarios. The ESER Guideline on Radiological Polytrauma Imaging and Service is published in two versions: a full version (download from the ESER homepage, https://www.eser-society.org) and a short version also covering all recommendations (this article). Conclusions Once a patient has been accurately classified as polytrauma, each institution should be able to choose from at least two WBCT protocols. One protocol should be optimised regarding time and precision, and is already used by most institutions (variant A). The second protocol should be dose reduced and used for clinically stable and oriented patients who nonetheless require a CT because the history suggests possible serious injury (variant B). Reading, interpretation and communication of the report should be structured clinically following the ABCDE format, i.e. diagnose first what kills first.

The aim of this study was to describe the clinical, mammographic, and sonographic findings of phyllodes tumor of the breast and correlate them to the benign or malignant pathological nature of the lesion and its clinical behavior. We retrospectively reviewed the clinical, radiologic, and pathologic findings of 12 cases of phyllodes tumors diagnosed in our hospital in the past 6 years, 6 of which were malignant. The surgical management and clinical course of the patients were also reviewed. Mammographically, soft tissue masses ranging from 2.5 to 15 cm were present in all patients. One patient had a mixed fat and water density mass and 2 patients had masses associated with coarse calcifications. At sonography, all tumors were well circumscribed; two of them were homogeneously hypoechoic, and the rest had heterogeneous internal echoes. Eight patients showed internal cystic areas. None of these characteristics proved to be useful in ascertaining the benign or malignant nature of the tumor. At surgery, 5 patients underwent mastectomy and 7 patients local excision of the tumor. Three of the later tumors, one benign and two malignant, recurred after several months. Fine-needle aspiration biopsy suggested the diagnosis of phyllodes tumor in only 3 cases. After surgery, six tumors were classified as benign and six as malignant, three of which being of low-grade malignancy. None of the clinical or radiologic characteristics of the tumors were useful in predicting their histological nature or their behavior after surgery. Preoperative fine-needle aspiration biopsy often misdiagnosed the tumor as benign fibroadenoma. Only the histopathologic features of the excised mass proved to be helpful in assessing malignancy.

Background Femoroacetabular impingement (FAI) has been stated as one of the main causes of early osteoarthritis in the hip. This is particularly important in young athletes. However, there are no data available about the prevalence of radiological signs of FAI in the asymptomatic population. These data would improve the evaluation of athletes with groin pain to prevent further injuries. Objective The aim of this study is to show the prevalence of radiological signs of FAI in non-symptomatic athletes. Design Descriptive study. Setting Soccer and basketball players enrolled in elite division leagues. Participants Players were selected from the teams of the Federation of Soccer and Basketball of Murcia. Interventions Participants were clinical and radiologically evaluated. Clinical exam included: range of motion, and anterior and posterior hip impingement tests. Radiological exam included both anteroposterior radiographs of the pelvis and axial (frog-leg) views of both hips. Main outcome Radiographs were assessed to detect signs of FAI (both cam and pincer type). These signs were: pistol grip deformity (PG), coxa vara, alfa angle higher than 50°, anterior offset ratio (OR) lower than 0.18, coxa profunda/Protasio acetabuli (CP/PA), acetabular index lower o equal to 0°, cross-over sign (CO), and posterior wall sign (PW). Results 80 athletes were evaluated (mean (SD) age 24.43 (3.21)). PG was present in the 28.8%, alfa was higher than 50° in the 43.8%, CP/PA was detected in the 41.25%, CO was seen in the 25%, and PW in the 8.8%. Clinical signs of FAI, that is, groin pain with provocative test, were positive in the 13.8% of the patients. Conclusion Radiological evaluation shows a high prevalence of signs of FAI in athletic population. However, clinical signs are only present in a few of them.

Emergency Radiology is a clinical practice and an academic discipline that has rapidly gained increasing global recognition among radiology and emergency/critical care departments and trauma services around the world. As with other subspecialties, Emergency Radiology practice has a unique scope and purpose and presents with its own unique challenges. There are several advantages of having a dedicated Emergency Radiology section, perhaps most important of which is the broad clinical skillset that Emergency Radiologists are known for. This multi-society paper, representing the views of Emergency Radiology societies in Canada and Europe, outlines several value-oriented contributions of Emergency Radiologists and briefly discusses the current state of Emergency Radiology as a subspecialty.

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