Emergency Cross-sectional Radiology Daniel Y. F. Chung, Dipanjali Mondal, Erskine J. Holmes, Rakesh R. Misra. New York, NY: Cambridge University Press, 2012, 220 pages, $55.00 (softcover).


Emergency Cross-Sectional Radiology is a brief manual aimed at clinicians who routinely rely on imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) to recognize and manage emergent medical conditions. The stated target audience also includes radiology residents in earlier stages of their training who are increasingly relied upon to recognize important pathology in an expeditious fashion. With the exception of the first section, the book is presented in an outline format and is organized in an anatomic fashion starting at the head. The book finishes with several appendices that include well-established clinical scoring schemes and decision-making algorithms. Overall the book is easy to read and is high-yield.

The book is divided into three main sections. Section 1 is composed of three chapters, each dedicated to a brief technical description of CT, MRI, and US. Section 2 makes up the vast majority of the book and is further divided into four main subsections, beginning with pathology of the head and neck, the chest, abdomen and pelvis, and musculoskeletal pathology. The last section consists of seven brief appendices, includes decision-making algorithms and clinical scoring tools.

In Section 1 the authors attempt to “demystify” the technical aspects of image generation with CT, MRI, and US. The discussion of each imaging modality begins with a brief history of its use, followed by a basic explanation of how images are generated. While this may seem to be of limited expedience to those of us who will never sit for a radiology certification examination, these sections do provide some useful information. For instance, the CT section describes how window levels work and how they relate to imaging different tissues. It also describes the different types of artifact and how to recognize them. Of particular usefulness is the section on MRI that explains the different types of images and how one interprets different tissue types (e.g., T1- vs. T2-weighted images, STIR, FLAIR, proton density, etc.).

Section 2 is divided into subsections of anatomical regions (head and neck, chest, abdomen and pelvis, and the musculoskeletal) to discuss common and unusual abnormal findings seen in different diseases. Each chapter begins with a brief bullet-style description of the subject condition and provides CT, MRI, and US images where relevant. The images are those shown by a radiologist as a “key image” on a radiology report. There is also no shortage of images with “positive arrow signs” highlighting subtle yet important radiographic findings. Some sections include important distinctions made between subtle radiologic findings. For example, the chapter on cervical spine images highlights hard to see distinctions between stable and unstable cervical spine fractures. There are several other useful tables that can be found throughout the book. For example, in the chapter on aortic dissections there is a very succinct table describing the DeBakey classification with example images.

The final section, with the multiple appendices containing clinical guidelines and decision-making algorithms, is where the reader can find clinical prediction guidelines such as the Wells Criteria, the ABCD2 TIA, and the Early Stroke Scoring System. The clinician will find an outline of the Glasgow Coma Scale, as well as the NICE guidelines for head CT in acute head injury. A proposed algorithm for the management of acute stroke and neurosurgical consultation worksheet is also present. Overall, most of the information found in this section is similar to what one would find in any of the multiple quick reference applications or desktop tools.

When I initially read through this book, I felt it provided a good review of the hallmark radiologic findings associated with several disease processes. My original criticisms were that there were not enough images to develop a good sense of pattern recognition, especially with more subtle radiologic findings. Also, I felt the images were a bit small to clearly see the details of the radiologic findings. The book would really benefit from more and larger images, such that the user had the opportunity to develop some rudimentary form of pattern recognition.

I then decided to try the book out as a field guide. For 2 months in the emergency department I used it as a quick reference when waiting for official radiologists readings. To this end I did find it useful, especially in conjunction with some of the classification systems. Aside from the first section, the book's organization really lends itself to this, and if one has some specific pathology in mind, it is quick and easy to use.

For nonradiologists, the book's utility really depends on how you intend to use it. In my scope of practice, it is exceedingly rare that dispositions that hinge upon radiographic studies are decided upon without the official reading by a radiologist. In that vein, the utility of this book as a field guide is limited. However, if the clinician's practice includes the reading of CT scans, MRIs, and ultrasounds without immediate radiologic interpretation, this book may provide a much more valuable service.