Skip to main content
SpringerLink
Log in

Errors in Emergency and Trauma Radiology: C-Spine Imaging

  • Chapter
  • First Online:
Errors in Emergency and Trauma Radiology

  • 937 Accesses

Abstract

Errors and mistakes in interpretation of cervical spine imaging are multifactorial and can be attributed to technical, work environment, or radiologist-specific factors. To minimize these errors, radiologists should work in close collaboration with emergency physicians and other clinicians. They should obtain access to detailed clinical information and utilize a consistently accurate approach to interpret initial cervical spine CT imaging, as patients may have substantial and unstable ligamentous and/or vascular injuries despite subtle or no positive CT findings. Moreover, CT should be supplemented with CT angiography in suspected vascular injuries. MR imaging should be obtained in obtunded patients and those with potential ligamentous and/or spinal cord injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Centers for Disease Control and Prevention. National Hospital ambulatory medical care survey. Atlanta, GA: Centers for Disease Control and Prevention; 2015.

    Google Scholar 

  2. Sheikh K, Belfi LM, Sharma R, et al. Evaluation of acute cervical spine imaging based on ACR Appropriateness Criteria®. Emerg Radiol. 2012;19(1):11–7.

    Article  PubMed  Google Scholar 

  3. Munera F, Rivas LA, Nunez DB, et al. Imaging evaluation of adult spinal injuries: emphasis on multidetector CT in cervical spine trauma. Radiology. 2012;263(3):645–60.

    Article  PubMed  Google Scholar 

  4. Berlin L. Radiologic errors and malpractice: a blurry distinction. Am J Roentgenol. 2007;189(3):517–22.

    Article  Google Scholar 

  5. Pinto A, Reginelli A, Pinto F, et al. Errors in imaging patients in the emergency setting. Br J Radiol. 2016;89(1061):20150914.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Triantopoulou C, Tsalafoutas I, Maniatis P, et al. Analysis of radiological examination request forms in conjunction with justification of X-ray exposures. Eur J Radiol. 2005;53(2):306–11.

    Article  PubMed  Google Scholar 

  7. Kim YW, Mansfield LT. Fool me twice: delayed diagnoses in radiology with emphasis on perpetuated errors. Am J Roentgenol. 2014;202(3):465–70.

    Article  Google Scholar 

  8. Krupinski EA, Berbaum KS, Caldwell RT, et al. Long radiology workdays reduce detection and accommodation accuracy. J Am Coll Radiol. 2010;7(9):698–704.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Renfrew DL, Franken EA, Berbaum KS, et al. Error in radiology: classification and lessons in 182 cases presented at a problem case conference. Radiology. 1992;183(1):145–50.

    Article  CAS  PubMed  Google Scholar 

  10. Bruno MA, Walker EA, Abujudeh HH. Understanding and confronting our mistakes: the epidemiology of error in radiology and strategies for error reduction. Radiographics. 2015;35(6):1668–76.

    Article  PubMed  Google Scholar 

  11. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94–9.

    Article  CAS  PubMed  Google Scholar 

  12. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841–8.

    Article  CAS  PubMed  Google Scholar 

  13. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–8.

    Article  CAS  PubMed  Google Scholar 

  14. Stiell IG, Clement CM, O’Connor A, et al. Multicentre prospective validation of use of the Canadian C-Spine Rule by triage nurses in the emergency department. CMAJ. 2010;182(11):1173–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Stiell IG, Clement CM, Grimshaw J, et al. Implementation of the Canadian C-Spine Rule: prospective 12 centre cluster randomised trial. BMJ. 2009;339:b4146.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Paykin G, O’Reilly G, Ackland HM, et al. The NEXUS criteria are insufficient to exclude cervical spine fractures in older blunt trauma patients. Injury. 2017;48(5):1020–4.

    Article  PubMed  Google Scholar 

  17. Daffner RH. Helical CT of the cervical spine for trauma patients: a time study. Am J Roentgenol. 2001;177(3):677–9.

    Article  CAS  Google Scholar 

  18. Daffner RH, Weissman BN, Wippold FJ II, Angtuaco EJ, et al. Expert panels on musculoskeletal and neurologic imaging. ACR Appropriateness Criteria® suspected spine trauma. Reston, VA: American College of Radiology; 2012.

    Google Scholar 

  19. Becce F, Ben Salah Y, Verdun FR, et al. Computed tomography of the cervical spine: comparison of image quality between a standard-dose and a low dose protocol using filtered back-projection and iterative reconstruction. Skeletal Radiol. 2013;2(7):937–45.

    Article  Google Scholar 

  20. Sliker CW. Blunt cerebrovascular injuries: imaging with multidetector CT angiography. Radiographics. 2008;28(6):1689–708. discussion 1709–1710.

    Article  PubMed  Google Scholar 

  21. Burlew CC, Biffl WL, Moore EE, Barnett CC, Johnson JL, Bensard DD. Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 2012;72(2):330–5. discussion 336–337.

    Article  PubMed  Google Scholar 

  22. White AA, Panjabi MM. Clinical biomechanics of the spine. 2nd ed. Philadelphia, PA: Lippincott; 1990. 

    Google Scholar 

  23. Schwartz ED, Flanders AE. Spinal trauma: imaging, diagnosis, and management. Philadelphia, PA: Lippincott Williams & Wilkins; 2007. 

    Google Scholar 

  24. Denis F. Spinal stability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;Oct(189):65–76.

    Google Scholar 

  25. Daffner RH, Deeb ZL, Rothfus WE. “Fingerprints” of vertebral trauma-a unifying concept based on mechanism. Skeletal Radiol. 1986;15(7):518–25.

    Article  CAS  PubMed  Google Scholar 

  26. Dvorak MF, Fisher CG, Fehlings MG, et al. The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine. 2007;32(23):2620–9.

    Article  PubMed  Google Scholar 

  27. Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma. 2005;58(5):902–5.

    Article  PubMed  Google Scholar 

  28. Berquist TH. Imaging of adult cervical spine trauma. Radiographics. 1988;8(4):667–94.

    Article  CAS  PubMed  Google Scholar 

  29. Banerjee A, Clayton-Jolly A, Mbamalu D. The radiological assessment of injuries to the atlanto-axial-occipital complex (C1 and C2 vertebrae). Trauma. 2008;10(4):231–8.

    Article  Google Scholar 

  30. Rojas CA, Bertozzi JC, Martinex CR, et al. Reassessment of the craniocervical junction: normal values on CT. Am J Neuroradiol. 2007;28(9):1819–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Green JD, Harle TS, Harris JH Jr. Anterior subluxation of the cervical spine: hyperflexion sprain. Am J Neuroradiol. 1981;2(3):243–50.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Smoker WR. Craniovertebral junction: normal anatomy, craniotomy, and congenital anomalies. Radiographics. 1994;14(2):255–77.

    Article  CAS  PubMed  Google Scholar 

  33. Chang W, Alexander MT, Mirvis SE. Diagnostic determinants of craniocervical distraction injury in adults. Am J Roentgenol. 2009;192(1):52–8.

    Article  Google Scholar 

  34. Hanson JA, Deliganis AV, Baxter AB, et al. Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients. AJR Am J Roentgenol. 2002;178(5):1261–8.

    Article  PubMed  Google Scholar 

  35. Leone A, Cerase A, Colosimo C, Lauro L, Puca A, Marano P. Occipital condylar fractures: a review. Radiology. 2002;2016(3):635–44.

    Article  Google Scholar 

  36. Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine (Phila Pa 1976). 1988;13(7):731–6.

    Article  CAS  Google Scholar 

  37. Gehweiler JA Jr, Duff DE, Martinex S, Miller MD, Clark WM. Fractures of the atlas vertebra. Skeletal Radiol. 1976;1(2):97–102.

    Article  Google Scholar 

  38. Anderson LD, D’Alonxo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663–74.

    Article  CAS  PubMed  Google Scholar 

  39. Junewick JJ. Pediatric craniocervical junction injuries. Am J Roentgenol. 2011;196(5):1003–10.

    Article  Google Scholar 

  40. Dreizin D, Michael L, Sliker CW, Chokshi FH, Bodanapally U, Mirvis S, et al. Multidetector CT of blunt cervical spine trauma in adults. Radiographics. 2014;34(7):1842–65.

    Article  PubMed  Google Scholar 

  41. Levine AM, Edwards CC. Fractures of the atlas. J Bone Joint Surg Am. 1991;73(5):680–91.

    Article  CAS  PubMed  Google Scholar 

  42. Hagedorn JC II, Emery SE, France JC, et al. Does CT angiography matter for patients with cervical spine injuries? J Bone Joint Surg Am. 2014;96(11):951–5.

    Article  PubMed  Google Scholar 

  43. Rankine JJ. Spinal trauma. In: Adam A, editor. Grainger & Allison’s diagnostic radiology. 6th ed. London: Churchill Livingstone Elsevier; 2015. p. 1374–89.

    Google Scholar 

  44. Raniga SB, Menon V, Al Muzahmi KS, et al. MDCT of acute subaxial cervical spine trauma: a mechanism-based approach. Insights Imaging. 2014;5(3):321–38.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kim KS, Chen HH, Russell EJ, et al. Flexion teardrop fracture of the cervical spine: radiographic characteristics. Am J Roentgenol. 1989;152(2):319–26.

    Article  CAS  Google Scholar 

  46. Posthuma de Boer J, van Wulfften Palthe AF, Stadhouder A, et al. The clay shoveler’s fracture: a case report and review of the literature. J Emerg Med. 2016;51(3):292–7.

    Article  PubMed  Google Scholar 

  47. Lin JT, Lee JL, Lee ST. Evaluation of occult cervical spine fractures on radiographs and CT. Emerg Radiol. 2003;10(3):128–34.

    Article  PubMed  Google Scholar 

  48. Han SR, Sohn MJ. Twelve contiguous spinous process fracture of cervicothoracic spine. Korean J Spine. 2014;11(3):212–3.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Regenbogen VS, Rogers LF, Atlas SW, et al. Cervical spine cord injuries in patients with cervical lordosis. Am J Roentgenol. 1986;146(2):277–84.

    Article  CAS  Google Scholar 

  50. Scher AT. Hyperextension trauma in the elderly: an easily overlooked spinal injury. J Trauma. 1983;23(12):1066–8.

    Article  CAS  PubMed  Google Scholar 

  51. Edeiken-Monroe B, Wagner LK, Harris JHJ. Hyperextension dislocation of the cervical spine. Am J Roentgenol. 1986;146(4):803–8.

    Article  CAS  Google Scholar 

  52. Daffner RH, Daffner SD. Vertebral injuries: detection and implications. Eur J Radiol. 2002;42(2):100–16.

    Article  PubMed  Google Scholar 

  53. Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord. 2016;17:310–41.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Selden NR, Quint DJ, Patel N, et al. Emergency magnetic resonance imaging of cervical spinal cord injuries: clinical correlation and prognosis. Neurosurgery. 1999;44(4):785–92. discussion 792–783.

    Article  CAS  PubMed  Google Scholar 

  55. Chandra J, Sheerin F, Lopez de Heredia L, et al. MRI in acute and subacute post-traumatic spinal cord injury: pictorial review. Spinal Cord. 2012;50(1):2–7.

    Article  CAS  PubMed  Google Scholar 

  56. Song J, Mizuno J, Inoue T, et al. Clinical evaluation of traumatic central cord syndrome: emphasis on clinical significance of prevertebral hyperintensity, cord compression, and intramedullary high-signal intensity on magnetic resonance imaging. Surg Neurol. 2006;65(2):117–23.

    Article  PubMed  Google Scholar 

  57. Wu SK, Kuo LC, Lan HC, et al. The quantitative measurements of the intervertebral angulation and translation during cervical flexion and extension. Eur Spine J. 2007;16(9):1435–44.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Molliqaj G, Payer M, Schaller K, et al. Acute traumatic central cord syndrome: a comprehensive review. Neurochirurgie. 2014;60(1-2):5–11.

    Article  CAS  PubMed  Google Scholar 

  59. Harada K, Chiko Y, Toyokawa T. Anterior spinal cord syndrome-“owl’s eye sign”. J Gen Fam Med. 2018;19(2):63–4.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Matsubayashi J, Tsuchiya K, Shimizu S, et al. Posterior spinal artery syndrome showing marked swelling of the spinal cord: a clinico-pathological study. J Spinal Cord Med. 2013;36(1):31–5.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pratt ES, Green DA, Spengler DM. Herniated intervertebral discs associated with unstable spinal injuries. Spine (Phila Pa 1976). 1990;15(7):662–6.

    Article  CAS  Google Scholar 

  62. Harrington JF, Likavec MJ, Smith AS. Disc herniation in cervical fracture subluxation. Neurosurgery. 1991;29(3):374–9.

    Article  CAS  PubMed  Google Scholar 

  63. Hadley MN, Walters BC, Grabb BC, et al. Initial closed reduction of cervical spine fracture-dislocation injuries. Neurosurgery. 2002;50(3 Suppl):S44–50.

    CAS  PubMed  Google Scholar 

  64. Andreas C, Johannes H, Christoph O, Christian W, Stefan U, Lukas E. CT dose and image quality in the last three scanner generations. World J Radiol. 2013;5(11):421–9.

    Article  Google Scholar 

  65. Piazzolla A, Solarino G, Lamartina C, et al. Vertebral bone marrow edema (VBME) in conservatively treated acute vertebral compression fractures (VCFs): evolution and clinical correlations. Spine. 2015;40(14):E842–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada

    Sadia R. Qamar, Yuhao Wu & Luck Louis

  2. Department of Radiology, Jim Pattison Pavilion South, Vancouver General Hospital, Vancouver, BC, Canada

    Savvas Nicolaou

Authors
  1. Sadia R. Qamar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuhao Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luck Louis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Savvas Nicolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sadia R. Qamar .

Editor information

Editors and Affiliations

  1. Department of Radiology, McMaster University, Hamilton, ON, Canada

    Michael N. Patlas

  2. Department of Radiology, NYU Winthrop Hospital, Mineola, NY, USA

    Douglas S. Katz

  3. Department of Imaging, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy

    Mariano Scaglione

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Qamar, S.R., Wu, Y., Louis, L., Nicolaou, S. (2019). Errors in Emergency and Trauma Radiology: C-Spine Imaging. In: Patlas, M., Katz, D., Scaglione, M. (eds) Errors in Emergency and Trauma Radiology. Springer, Cham. https://doi.org/10.1007/978-3-030-05548-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-05548-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-05547-9

  • Online ISBN: 978-3-030-05548-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation