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Review Essays of Academic, Professional & Technical Books in the Humanities & Sciences



Diagnostic Imaging for the Emergency Physician: Expert Consult – Online and Print by Joshua Broder, MD (Elsevier Saunders) …I have no doubt that this text is destined to become one of our specialty's landmark textbooks, a classic that will be considered a must-have resource for all emergency physicians and emergency departments. My kudos go to Dr. Broder for his tremendous work. This textbook represents a valuable addition to the emergency medicine litera­ture…. – Amal Mattu, MD, FAAEM, FACEP, Director, Emergency Medicine Residency, Director, Faculty Development Fellowship, Professor of Emergency Medicine, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore

It is often said that a picture is worth a thousand words. Although this quote originated in the advertising industry, it certainly applies to the field of medicine as well. Visual findings are the cornerstone of diagnosis for many medical conditions. One might argue, in fact, that the field of radiology was born out of the need to look beyond a patient's external findings – essentially, internal visual diagnosis – without the need for surgical exploration.

Diagnostic Imaging for the Emergency Physiciana, written and edited by a practicing emergency physician for emergency physicians, takes a step-by-step approach to the selection and interpretation of commonly ordered diagnostic imaging tests. Joshua Broder presents validated clinical decision rules, describes time-efficient approaches for the emergency physician to identify critical radiographic findings that impact clinical management and discusses hot topics such as radiation risks, oral and IV contrast in abdominal CT, and MRI versus CT for occult hip injury. Detailed explanations and numerous images – in print and online – help clinicians order and interpret studies, understand the radiologist's interpretations, and make the best choices for their patients. Broder, MD, FACEP, is Associate Professor, Associate Residency Program Director, Division of Emergency Medicine, Duke University Medical Center, Durham, NC.

With Diagnostic Imaging for the Emergency Physician clinicians are able to:

  • Access the fully searchable text online, along with downloadable images suitable for use in educational presentations.
  • Choose the best test for each indication through clear explanations of the ‘how’ and ‘why’ behind emergency imaging.
  • Interpret head, spine, chest, and abdominal CT images using a detailed and efficient approach to time-sensitive emergency findings.
  • Stay on top of current developments in the field, including evidence-based analysis of tough controversies – such as indications for oral and IV contrast in abdominal CT and MRI versus CT for occult hip injury; high-risk pathology that can be missed by routine diagnostic imaging-including subarachnoid hemorrhage, bowel injury, mesenteric ischemia, and scaphoid fractures; radiation risks of diagnostic imaging – with practical summaries balancing the need for emergency diagnosis against long-terms risks.
  • Optimize diagnosis through evidence-based guidelines that assist clinicians in discussions with radiologists, coverage of the limits of ‘negative’ or ‘normal’ imaging studies for safe discharge, indications for contrast, and validated clinical decision rules that allow reduced use of diagnostic imaging.
  • Recognize findings and anatomy on radiographs for all major diagnostic modalities used in emergency medicine from more than 1000 images.
  • Find information quickly with streamlined content specific to emergency medicine written and edited by an emergency physician and organized by body system.

Contents of Diagnostic Imaging for the Emergency Physician include:

  1. Imaging the Head and Brain – with Robert Preston
  2. Imaging the Face
  3. Imaging the Cervical, Thoracic, and Lumbar Spine
  4. Imaging Soft Tissues of the Neck
  5. Imaging the Chest: The Chest Radiograph
  6. Imaging Chest Trauma
  7. ImImaging of Pulmonary Embolism and Nontraumatic Aortic Pathology
  8. Cardiac Computed Tomography (abstract for online chapter)
  9. ImImaging of Nontraumatic Abdominal Conditions
  10. Imaging Abdominal and Flank Trauma li>
  11. Imaging Abdominal Vascular Catastrophes
  12. Imaging the Genitourinary Tract
  13. Imaging the Extremities
  14. Emergency Department Applications of Musculoskeletal Magnetic Resonance
  15. Imaging: An Evidence-Based Assessment (abstract for online chapter)
  16. "Therapeutic Imaging": Image-Guided Therapies in Emergency Medicine (abstract for online chapter)

AcAccording to Amal Mattu in the preface, Diagnostic Imaging for the Emergency Physician covers every aspect of imaging, from head to toe, and from x-ray to CT to magnetic resonance imaging to US. Although there are several other textbooks on the market focused on emergency radiology, there are notable characteristics of this text that set it apart from the rest. The images in this text are outstanding in quality; these images tell the complete story. Readers will note that the images themselves contain text, arrows, highlights – all the usual features that other textbooks relegate to hard-to-read legends. Broder's textbook also is written in a prose that demonstrates the consistency of a single writer. Many other texts suffer from inconsistencies in writing style and image format from chapter to chapter because multiple authors are used.

Features of Diagnostic Imaging for the Emergency Physician include:

  1. Chapters organized by body region rather than by imaging modalities, conveying information tailored to the approach of an emergency physician in evaluating a patient.
  2. Annotated images, designed to allow clinicians to interpret imaging studies themselves and to understand the findings described by the radiologist. Each figure in the book can be used to understand a disease process without reference to the text. Whenever possible, Broder includes multiple imaging modalities from the same patient to demonstrate the strengths and weaknesses of different imaging techniques and to emphasize the similarities and differences in findings using different modalities. Diagnostic Imaging for the Emergency Physician illustrates only those findings that Broder himself could identify.
  3. Detailed strategies for the systematic interpretation of imaging studies, including computed tomography (CT). These discussions are meant to augment the information provided in the figure legends. Today's emergency physicians need to be able to recognize time-dependent conditions themselves, before the interpretation of a radiologist is available. His approach focuses on imaging findings requiring immediate interventions. Recognizing the time limits of emergency medicine practice, he encapsulates the discussions of important medical conditions so that each section stands alone. For readers with time to read whole sections, the discussion builds upon earlier sections, leading to a more advanced interpretation ability.
  4. Critical analysis of the evidence behind imaging techniques. Although this is not a book on research methodology, statistics, or evidence-based medicine, modern emergency physicians are sophisticated medical practitioners who need to know the reliability of the diagnostic strategies they employ. Without dwelling on technical detail, he uncovers weaknesses of evidence, particularly when these might mislead the physician, leading to misdiagnosis or unnecessary additional workup. He reviews some evidence-based medicine concepts when necessary to the discussion.
  5. ClClinically oriented discussions of frequently asked questions Broder has encountered in his practice, such as the indications for oral and IV contrast in abdominal CT and the differences between CT pulmonary angiography and aortography. He equips the emergency physician with evidence to facilitate discussions with the radiologist. Throughout Diagnostic Imaging for the Emergency Physiciana, he highlights areas where strong evidence and expert consensus guidelines from major emergency medicine and radiology professional organizations support the elimination of contrast agents, potentially benefiting patients by reducing risks of allergy, contrast nephropathy, and diagnostic delay.
  6. Detailed discussions of the indications for diagnostic imaging and application of clinical decision rules to limit unnecessary diagnostic imaging and radiation exposure. Broder emphasizes areas in which clinical decision rules can achieve the goals of patient safety, faster throughput, decreased patient exposure to radiation, and reduced cost.
  7. Discussion of risks of ionizing radiation from diagnostic imaging. He says he had originally considered a separate chapter on radiation risks but instead chose to incorporate this discussion into each chapter on body regions. Emergency physicians need to understand the risks and benefits of diagnostic imaging, which has become a major source of radiation exposure in the U.S. population.
  8. Discussions of the economics of various imaging strategies. Because much of the diagnostic workup occurs in emergency departments today, a few hours in an emergency department can result in significant expenditures on diagnostic imaging. Knowledgeable emergency physicians can provide high-quality care while managing expense.

Diagnostic Imaging for the Emergency Physician i is the ‘must-have’ resource for emergency physicians to make critical diagnostic imaging decisions. It makes optimal use of imaging modalities for emergency patients. Written by a master educator, the book teaches clinicians how to use and interpret images in the diagnosis of emergency conditions. Since the entire text was written by one person, it is a more integrated text than books with chapters authored by a multitude of practitioners. Broder provides clinical information valuable to practitioners at multiple levels of training, with or without prior training in diagnostic imaging. Broder’s writing style, like his teaching style, is simple, practical, and understandable, smooth, and unambiguous; and the image qual­ity is consistent throughout the text. Broder provides clear direction for how and when to order specific tests, and he systematically describes how to read CTs. Diagnostic Imaging for the Emergency Physiciana differs from other available texts also in that it is targeted to the specific needs of board-certified emergency physicians, emergency medicine residents, and students interested in emergency medicine. This book may also serve providers attending to patients in urgent and emergent settings.



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