Clinical Emergency Radiology, 2nd Edition

Fox JC, ed. Clinical Emergency Radiology. 2nd ed. Cambridge Medicine; 2017; 650 pp; 1271 ill; $165.00

Cover of Fox

Emergency radiology encompasses a wide array of topics across various subspecialties and imaging modalities, providing a challenge to any author or editor putting together a text on the topic. Choices regarding depth and scope have to be made, and the editors and authors of Clinical Emergency Radiology have made a clear decision to provide a heavily image-based discussion of the topic. The book is best summarized as a pictorial review of the radiologic presentations of common pathologies presenting to the emergency department.

The book as a whole is well-organized, divided roughly into thirds by modality, with each chapter within a modality devoted to a particular body part. The first third covers conventional radiography, the second third covers point-of-care ultrasound, and the final third is devoted to CT and MRI. Each chapter has roughly the same format, giving the book a nice rhythm. Each chapter starts with concise text providing an overview of imaging indications, capabilities, and pitfalls, followed by clinical images. While constituting the majority of each chapter, the clinical images are essentially limited to the most common presentations of the most common diagnoses. Allowing for the inherent difficulties all books seem to have reproducing conventional radiographs, the images are of high quality. Notably, many sections, especially those covering the more advanced imaging modalities, include images of normal anatomy before covering pathology. Most images are bread-and-butter, classic presentations of cases that would be used to teach radiology residents at their earlier stages. The images are comprehensively annotated, and the vast majority are accurately so. This reviewer found some errors in image captions, mostly confined to the more advanced imaging modalities.

The section on ultrasound is the book’s best, likely reflecting the interests of the editor and a large percentage of the authors, who are involved with point-of-care ultrasound applications in the emergency department. These chapters contain discussions on how to perform point-of-care ultrasound, limited to answering specific questions. The section contains only the briefest, most rudimentary of discussions on ultrasound physics.

The chapters in the CT and MRI sections are particularly brief and cover a small percentage of the pathologies encountered by a dedicated ER radiologist at a tertiary care center. The CT chapters get a little repetitive, with each chapter covering issues regarding radiation and IV contrast risks, and would have benefited from an opening chapter covering the topic one time, much like the ultrasound and MRI sections have opening physics chapters.

For the neuroradiologist, there are only a few chapters that could be considered relevant (approximately 5 out of 43), including 2 in the conventional radiography section and 3 in the CT/MRI section. As previously discussed, these chapters, like the book as a whole, cover the most basic of topics and offer little for the neuroradiologist within their own specialty.

Clinical Emergency Radiology states in its introduction that it is intended to be a heavily image-based review useful for experienced physicians, midlevel providers, residents, and medical students. Regarding the former, it is clearly successful. The majority of each chapter is devoted to images—a welcome sight for any radiology textbook. Regarding the latter, it is challenged and would benefit from explicitly stating a more narrow audience. It is a book that is predominantly written by emergency medicine physicians for emergency medicine physicians, midlevel providers, residents, and students, and the authors should more explicitly state that. Only 2 of the 73 contributing authors are radiologists, with the remainder primarily being emergency medicine physicians.

In my experience, this text would mostly be review for experienced ER physicians, with the exception of those not doing point-of-care ultrasound. But even for the latter subset, I doubt the text would be enough to replace a dedicated training course. I expect less-experienced ER physicians and midlevel providers would make use of this book, as would emergency medicine residents and medical students.

As for the radiology community, outside of first- or second-year residents, I do not believe this text has much use, and for them there are more useful books that provide a much more comprehensive and solid foundation for their future. The book is likely too basic for even a subspecialty radiologist who will be new to taking general calls for an emergency department.

While succeeding in being a well-organized, image-based, pictorial review of common imaging in the ED and useful for the point-of-care medical provider, this book’s limited scope detracts from its usefulness for radiologists as a whole, and particularly the neuroradiology community.

Clinical Emergency Radiology, 2nd Edition
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