Showing papers in "American Journal of Roentgenology in 1981"
420Â citations
TL;DR: The results of this study indicate that when adequate hydration is maintained, angiography does not pose a "significant hazard" of renal failure as previously reported, even in patients with underlying medical problems.
Abstract: A reported 12% incidence of acute renal failure after angiography prompted this prospective study to substantiate or repudiate this seemingly excessive rate. In 537 consecutive patients undergoing cerebral, abdominal, or peripheral angiography, there was no instance of renal failure following the procedure. The results of this study indicate that when adequate hydration is maintained, angiography does not pose a "significant hazard" of renal failure as previously reported, even in patients with underlying medical problems.
212Â citations
TL;DR: Femoral torsion has been measured in infants and children by computed tomography and appears to have sufficient accuracy for clinical purposes.
Abstract: Femoral torsion has been measured in infants and children by computed tomography. The method requires two scans, one through the femoral neck, another through the femoral condyles. A specially designed device and packing about the knees assures immobilization of the legs. Slight variations in the positions of the sections in the neck and condyles do not alter the measurement significantly. Intraobserver and interobserver errors are low, 2 degrees and 3 degrees mean error, respectively. The radiation required involves small tissue volumes at about 1.7 R (4.4 x 10(-4) C/kg). Measurements are more difficult when the femoral necks are short or vertically oriented. The method appears to have sufficient accuracy for clinical purposes.
206Â citations
TL;DR: Observations indicated that no significant heating should be expected from implanted surgical clips during exposure, and the heating of larger metallic implants should be further investigated.
Abstract: To test if changing magnetic fields and radiofrequency fields used in nuclear magnetic resonance imagers could induce electrical currents capable of causing localized tissue heating in metal surgical clips and prostheses, steel surgical clips, copper wire clips, and hip prostheses were exposed to fields greater than those used in the nuclear magnetic resonance imager. Observations indicated that no significant heating should be expected from implanted surgical clips during exposure. The heating of larger metallic implants should be further investigated.
169Â citations
TL;DR: Twenty cases of avulsion fractures of the apophyses of the pelvis and proximal femur were reviewed, finding that most occurred in male adolescents engaged in active sports and should prompt the radiologist to consider a traumatic etiology.
Abstract: Twenty cases of avulsion fractures of the apophyses of the pelvis and proximal femur were reviewed. Most occurred in male adolescents engaged in active sports. Pain, often with little external evidence of trauma, was the most frequent presenting symptom. Conservative, nonsurgical treatment was successful in all the patients. The radiographic appearance of each type of apophyseal injury is demonstrated. Recognition of the initial deformity and of the patterns of repair is important to avoid unnecessary evaluation (tomography, radionuclide scans) and inappropriate therapy. While productive changes with healing are most likely to occur in the region of the ischium, any of the other sites may heal with abundant bone and may mimic neoplasm. In the proper clinical setting, bony changes at these sites should prompt the radiologist to consider a traumatic etiology.
167Â citations
TL;DR: In this paper, the authors evaluated the clinical value of CT in the management of head and neck tumors, and concluded that CT can accurately detect cancer in cervical lymph nodes and correctly predicted surgically confirmed nonpalpable nodal metastases in six patients.
Abstract: This study seeks to establish whether CT can accurately detect cancer in cervical lymph nodes. Retrospective correlation of CT scans and surgical findings in 51 patients with laryngeal cancer undergoing radical neck dissection suggested that the node-bearing areas in the neck can be usefully evaluated with CT scans. An additional 10 patients studied prospectively with carefully correlated CT scans and radical neck dissections were used to evaluate CT specific criteria for cancer in individual nodes. In 13 patients CT correctly predicted surgically confirmed nonpalpable nodal metastases in six. It suggested false-positive nodes in two. These criteria are now being tested in an ongoing evaluation of the clinical value of CT in the management of head and neck tumors.
155Â citations
TL;DR: An effect of clinical information on interpretation of radiographs has been assumed, and test films were included in the dialy work load of readers who were unaware that a study was being carried out to investigate this effect in a real-life setting.
Abstract: An effect of clinical information on interpretation of radiographs has been assumed, on the basis of experimental studies. To investigate this effect in a real-life setting, test films were included in the dialy work load of readers who were unaware that a study was being carried out. Eight subtle but unambiguous abnormalities (three lung nodules, lobar collapse, lung cyst, rib destruction, dilated esophagus, congestive heart failure) were included on the test films. For each abnormality there were four readings with a suggestive and four with a nonsuggestive clinical history. The readers were radiology residents and all interpretations were reviewed an sometimes altered by staff radiologists. There was a statistically significant (p less than 0.01) increase in the rate of true-positive readings in the presence of a suggestive as compared to nonsuggestive history: 16%-72% for residents' readings, 38%-84% for combined resident-staff readings. There was some concomitant increase in false positives.
155Â citations
TL;DR: Twelve patients with arterial occlusions demonstrated by angiography were treated using intraarterial "low dose" streptokinase delivered to the site of occlusion via a 5 French catheter, extremely promising as a method of treatment of thromboses of recent origin, especially in the poor operative candidate, and for angioplasty-related thromBoses.
Abstract: Twelve patients with arterial occlusions demonstrated by angiography were treated using intraarterial "low dose" streptokinase delivered to the site of occlusion via a 5 French catheter. The catheter was embedded at the site of arterial occlusion if possible, but if not, was placed immediately proximal to the occlusion. Streptokinase was infused at 5,000 U/hr in a volume of about 50 ml using an arterial infusion pump. The technique was applied to vessels of the upper and lower extremities as well as the renal arteries. Of 12 patients infused, 11 had successful thrombolysis. No hemorrhagic complications were encountered. This technique is extremely promising as a method of treatment of thromboses of recent origin, especially in the poor operative candidate, and for angioplasty-related thromboses.
153Â citations
TL;DR: The clinical presentations ranged from occasional cough to severe respiratory difficulties and radiologic manifestations varied from a solitary lipoid granuloma and larger consolidations simulating carcinoma to extensive subacute bronchopneumonia.
Abstract: Eleven patients with exogenous lipoid pneumonia are reported. A history of usage of oil was obtained in all, but in five only retrospectively after thoracotomy. The clinical presentations ranged from occasional cough to severe respiratory difficulties. The radiologic manifestations varied from a solitary lipoid granuloma and larger consolidations simulating carcinoma to extensive subacute bronchopneumonia. The definitive diagnosis was made by history and radiographic findings in three, by history and analysis of sputum or bronchial washings in two, and after thoracotomy in six.
149Â citations
TL;DR: CT staging of esophageal carcinoma correlated closely with surgical findings and that local extension, regional adenopathy, and size of tumor mass were better evaluated by computed tomography than by other methods.
Abstract: Fifty-two patients with proven esophageal malignancy underwent esophagography, computed tomography (CT). esophagoscopy, and/or surgical exploration and resection. On the basis of CT findings, esophageal carcinoma was classified into four stages: stage I, intraluminal mass without esophageal wall thickening; stage II, esophageal wall thickening (greater than 5 mm); stage III, esophageal wall thickening and contiguous spread of tumor into adjacent mediastinal structures such as the trachea, bronchi, aorta, or atrium; and stage IV, any stage with evidence of distant metastatic disease. The stage of esophageal malignancy as determined by CT was correlated with symptoms, location of tumor, esophagography, and surgical findings. Results indicated that CT staging of esophageal carcinoma correlated closely with surgical findings and that local extension, regional adenopathy, and size of tumor mass were better evaluated by computed tomography than by other methods. CT is an accurate method of preoperatively stagin...
143Â citations
TL;DR: In the patients in whom the colloid scan shows decreased or absent uptake, angiography may show findings diagnostic of focal nodular hyperplasia in up to 75% of cases, thus avoiding the need need for liver biopsy or surgery.
Abstract: Eleven patients with focal nodular hyperplasia of the liver underwent a combination of radiologic procedures, including sonography, computed tomography (CT), hepatic scintigraphy, and angiography. This paper describes the radiologic findings in this group of patients and reviews the current literature. In the present series, sonography was the most sensitive (100%) method for detection of focal nodular hyperplasia, while CT was able to detect only seven (78%) of nine cases. Arteriographic findings were felt to be characteristic in nine (82%) of 11 cases. Hepatic scintigraphy demonstrated normal colloid uptake in six (55%) of 11 lesions. In this series, an accurate radiologic diagnosis of focal nodular hyperplasia was made in 73% of cases. Hepatic scintigraphy is the pivotal examination. Normal colloid uptake by a focal hepatic mass is virtually diagnostic. However, in the patients in whom the colloid scan shows decreased or absent uptake, angiography may show findings diagnostic of focal nodular hyperplas...
TL;DR: Stenoses within the renal artery responded very well to angioplasty, with 83% of patients showing either an excellent or good result, whereas when aortic plaques were responsible for inflow obstruction, 76% of Patients responded poorly or not at all to balloon dilatation.
Abstract: Most lesions that decrease renal blood flow originate within the renal artery; however; large, aortic, atherosclerotic plaques can overhang the renal ostium producing a functional renal artery stenosis. At the Hospital of the University of Pennsylvania, 45 consecutive percutaneous transluminal angioplasties were examined retrospectively and classified as to site of the obstructing lesions and clinical outcome. Stenoses within the renal artery responded very well to angioplasty, with 83% of patients showing either an excellent or good result. Conversely, when aortic plaques were responsible for inflow obstruction, 76% of patients responded poorly or not at all to balloon dilatation. It is proposed that this disparity of response reflects the anatomic differences in the orientation of elastic and collagen fibers of the muscularis and advential layers of the renal artery and the aorta.
TL;DR: Hematoma almost exclusively manifested at C1-C4 and proved to be closely related to fractures of anterior elements of the spine, with relatively small hematomas encountered in odontoid fractures and compression fractures of vertebral bodies.
Abstract: In a consecutive series of 30 hospitalized cervical injury patients, 18 proved to have widening of the prevertebral soft tissue space due to hematoma. The upper limit of normal width in 50 noninjury patients was used as a reference. Hematoma almost exclusively manifested at C1-C4 and proved to be closely related to fractures of anterior elements of the spine. Relatively small hematomas were encountered in odontoid fractures and compression fractures of vertebral bodies; relatively large hematoma in disruptive hyperextension injury. Large hematomas are explained by extensive anterior ligamentous damage with rupture of larger blood vessels. As a rule, most hematomas disappeared within 2 weeks after the injury.
TL;DR: The data derived from this study may enable the sonographic distinction of abnormally thickened bowel wall from normal bowel segments in the collapsed and distended state.
Abstract: The thickness and regularity of the bowel wall can often be assessed by sonographic imaging. In 26 normal patients, the bowel wall averaged 3 mm in thickness when distended and 5 mm when nondistended. In contrast, in 12 patients with an abnormally thickened bowel wall, bowel wall thickness averaged 23 mm and the affected bowel segment exhibited decreased or absent peristalsis on real-time scanning. The data derived from this study may enable the sonographic distinction of abnormally thickened bowel wall from normal bowel segments in the collapsed and distended state.
TL;DR: A prospective study using sonography and computed tomography was performed on 102 patients consecutively identified as having acute pancreatitis to see which method provided the most information.
Abstract: A prospective study using sonography and computed tomography (CT) was performed on 102 patients consecutively identified as having acute pancreatitis to see which method provided the most information. Each examination was graded for visualization of the pancreas, extent of disease, and the detection of complications. CT was found to be of significantly greater value than sonography due to the high percentage (38%) of nondiagnostic studies with the latter method. Of the 102 patients, 70% had abnormal CT studies, including 18% with extrapancreatic phlegmons, 10% with pseudocysts, 5% with acute hemorrhage, and 3% with pancreatic abscesses.
TL;DR: Twenty cases of sonographically visualized thickening of the gallbladder wall were reviewed and the clinical diagnoses compiled, but in only eight of these patients was cholecystitis considered responsible for the finding.
Abstract: Twenty cases of sonographically visualized thickening of the gallbladder wall were reviewed and the clinical diagnoses compiled. In only eight of these patients was cholecystitis considered responsible for the finding. The rest had hepatitis, alcoholic liver disease with hypoproteinemia, heart failure, renal disease, and multiple myeloma; however, all lacked clinical evidence of gallbladder disease. Because of these findings, caution is urged in making the diagnosis of cholecystitis on the basis of wall thickening alone.
TL;DR: Preliminary experience indicates that a cephalic index greater than 1 SD from the mean may be associated with a significant alteration in the BPD measurement expected for a given gestational age, and that the head circumference can be used effectively as an alternative means of establishing Gestational age.
Abstract: Several recent obstetrical sonographic examinations in this department demonstrated that variations in the shape of the fetal skull (e.g., dolichocephaly, brachycephaly) may adversely affect the accuracy of the biparietal diameter (BPD) measurement in estimating fetal age. In each case the cephalic index of the fetal skull (short axis/long axis x 100) was in either the dolichocephalic or brachycephalic range based on established postnatal criteria. Consequently, normal values were determined (mean, 78.3) for the cephalic index in utero based on 316 obstetrical sonographic studies performed at 14--40 weeks. Preliminary experience indicates that a cephalic index greater than 1 SD from the mean (less than 74, greater than 83) may be associated with a significant alteration in the BPD measurement expected for a given gestational age, and that the head circumference can be used effectively as an alternative means of establishing gestational age.
TL;DR: CT scans usually demonstrate a large fatty mass intermixed with areas of tissue density which may represent nonfatty parts of the tumor or areas of hemorrhage, and are useful in identifying perinephric extension and hemorrhage.
Abstract: The angiomyolipoma is a benign renal tumor composed of fat, smooth muscle, and abnormal blood vessels. The tumor often extends into the perinephric space and often is complicated by intratumoral or perinephric hemorrhage. The CT findings of 17 cases of angiomyolipoma were correlated with their pathologic findings and are described. CT scans usually demonstrate a large fatty mass intermixed with areas of tissue density which may represent nonfatty parts of the tumor or areas of hemorrhage. CT is more sensitive than plain films at detecting the fat within the angiomyolipoma. CT is also useful in identifying perinephric extension and hemorrhage. In those angiomyolipomas composed primarily of smooth muscle or in which intratumoral hemorrhage has obscured the fatty part of the tumor, the CT appearance is indistinguishable from other solid renal tumors.
TL;DR: Using standard B scans, renal cortical echogenicity was graded by comparing the amplitude of echoes in the renal cortex with that of the adjacent liver, spleen, and renal sinus as discussed by the authors.
Abstract: Using standard B scans, renal cortical echogenicity was graded by comparing the amplitude of echoes in the renal cortex with that of the adjacent liver, spleen, and renal sinus. Twenty-five consecutive patients were studied immediately before percutaneous renal biopsies. There was no correlation between the nature and severity of the glomerular lesion on renal biopsy and the sonographic findings. While the pyramids could be identified on sonography in all cases, the clarity of corticomedullary definition also did not correspond to any histopathologic finding. There was a definite relation, however, between the nature and severity of interstitial changes on biopsy and the echointensity of the cortex at sonography. Focal interstitial disease produced a minimal increase in cortical echogenicity. A greater increase was produced by diffuse scarring, and the most intense echogenicity of the cortex was seen in patients with active interstitial changes.
TL;DR: Nine patients with cystic or necrotic hepatic neoplasms had findings on computed tomography (CT) that strongly suggested benign cystic disease of the liver, and sonographic findings virtually excluded uncomplicated hepatic cyst as a diagnosis.
Abstract: Nine patients with cystic or necrotic hepatic neoplasms had findings on computed tomography (CT) that strongly suggested benign cystic disease of the liver. Sonography depicted the true morphology of these cystic lesions more clearly than CT, and the sonographic findings virtually excluded uncomplicated hepatic cyst as a diagnosis. Important observations were wall thickness, mural nodules, septations, and fluid-fluid levels. The potential danger in over reliance on CT attenuation values and the complementary role of sonography and CT in such cases are stressed.
TL;DR: Fifty patients with radiographic pleural or pleural-based opacities were examined with high resolution real-time sonographic sector scanning and, in 90% of cases selected for thoracentesis, fluid sufficient for diagnosis was obtained.
Abstract: Fifty patients with radiographic pleural or pleural-based opacities were examined with high resolution real-time sonographic sector scanning. In 90% of cases selected for thoracentesis, fluid sufficient for diagnosis was obtained. Complex, septated pleural loculations contained an exudative effusion in 74% of the patients, while anechoic areas yielded exudative and transudative effusions with almost equal frequency. The use of real-time scanning is stressed because of greater flexibility and shorter examination time compared to compound scanning, and its utility for portable scanning on critically ill patients.
TL;DR: Twenty patients with pathologically confirmed extraparenchymal intraabdominal lipomatous tumors, including two lipomas, two cases of diffuse infiltratinglipomatosis, and 16 liposarcomas, were examined by computed tomography (CT).
Abstract: Twenty patients with pathologically confirmed extraparenchymal intraabdominal lipomatous tumors, including two lipomas, two cases of diffuse infiltrating lipomatosis, and 16 liposarcomas, were examined by computed tomography (CT). The CT appearance of these tumors closely correlated with their gross and microscopic pathologic anatomy. Distinctive CT features differentiated simple lipomas from diffuse infiltrating lipomatosis and from liposarcomas. The densities of these tumors, including the variable densities of liposarcomas, were explained by their tissue composition. Lipomas, diffuse infiltrating lipomatosis, and lipogenic liposarcomas were predominantly of fat density, whereas myxoid liposarcomas were of a higher range of densities. Liposarcomas often contained more than one type of tumor tissue, resulting in masses of distinctly different densities coexisting within the same tumor. CT accurately depicted the presence, location, and size of the tumors and provided information about their relation to a...
TL;DR: The authors have reviewed the experimental literature about the different agents used for endovascular embolization: clots, tissues, duramater, Gelfoam, oxydized cellulose, Ivalon, beads, microspheres, cyanoacrylates, silicone, barium.
Abstract: The authors have reviewed the experimental literature about the different agents used for endovascular embolization: clots, tissues, duramater, Gelfoam, oxydized cellulose, Ivalon, beads, microspheres, cyanoacrylates, silicone, barium. Each occlusive agent was studied in regard to its physical properties, injection methods, characteristics of obstruction, vascular reaction, and toxicity. The level and quality of obstruction obtained depend on many factors which are discussed.
TL;DR: 99mTc red blood cells may be used effectively in patients with melena as well as with bright red blood per rectum, and thus would seem to be the preferred radiopharmaceutical for imaging.
Abstract: Imaging was done in 80 patients with gastrointestinal hemorrhage using red blood cells labeled with 99mTc by a modified in vivo technique. Bleeding was detected in 65% of 40 patients with bright red blood per rectum, 71% of 35 patients with melena, and in none of the five patients with occult bleeding and chronic anemia. No clinical evidence of further gastrointestinal hemorrhage occurred in 26 of the 29 patients who were negative on imaging. The imaging study could be carried out for over 24 hr which increased the sensitivity of the test, since only 16% of the studies were abnormal on the initial images. Neither the need for blood replacement nor the presence of bright red blood per rectum correlated strongly with early image positivity, supporting the contention that patients with gastrointestinal hemorrhage do not necessarily bleed continuously. Labeled red cell imaging was more sensitive in the detection of bleeding than angiography. It corresponded to the overall angiographic findings in 23 of 31 cases and in 17 of the 18 patients who had demonstrable extravasation. 99mTc red blood cells may be used effectively in patients with melena as well as with bright red blood per rectum, and thus would seem to be the preferred radiopharmaceutical for imaging.
TL;DR: In three patients the diagnosis of osteomyelitis was made when computed tomography demonstrated gas within the medullary cavity of the involved bone when CT detection of intraosseous gas resulted in significant alteration of patient management.
Abstract: In three patients the diagnosis of osteomyelitis was made when computed tomography (CT) demonstrated gas within the medullary cavity of the involved bone. The diagnosis was clinically unsuspected in two of the patients before the CT examination, and none showed bone abnormalities on plain radiographs. Two patients had evidence of infection of the deep soft tissues adjacent to bone, and the third developed the lesion in an allograft. In all three patients CT detection of intraosseous gas resulted in significant alteration of patient management.
TL;DR: In this paper, the authors used three different NMR scanning sequences: saturation-recovery, spin-echo and spin-lattice relaxation time (T1) to obtain images with a dependence on the spin-spin relaxation time.
Abstract: Posterior fossa scans were performed on five healthy volunteers using a nuclear magnetic resonance (NMR) machine constructed by Thorn-EMI Ltd. Three different NMR scanning sequences were used. In the first, a type of saturation-recovery technique was used to produce images strongly dependent on the density of hydrogen nuclei, but with some dependence on the spin-lattice relaxation time (T1). In the second, an inversion-recovery technique was used to produce images with a stronger dependence on the spin-lattice relaxation time. In the third, a spin-echo technique was used to obtain images with a dependence on the spin-spin relaxation time (T2). All three types of NMR image were unaffected by bone artifact. Visualization of brain adjacent to the skull base was obtained without loss of detail due to partial-volume effect from bone. The saturation-recovery images highlighted arteries and veins that were clearly visible without the use of contrast agents. The inversion-recovery images showed remarkable gray-wh...
TL;DR: The mainly perceptive nature of the errors indicates the need for more careful viewing of double contrast barium enemas, and familiarity with the different appearances of colorectal carcinoma on double contrast study, together with double-reading by the same or different observers, should reduce the incidence of missed lesions.
Abstract: A total of 31 cases of primary colorectal carcinoma missed on double contrast barium enema studies over a 5 year period (1976-1980) were collected from six institutions, and the causes of error reviewed. The errors were purely perceptive in 52%, due to a combination of perceptive and technical factors in 32%, and interpretative in 6%. The most common perceptive mistakes were failure to recognize a filling defect in the barium pool and failure to detect the tumor en face in double contrast study. Five cases were only detected at the time of the study as a result of double reading. Ten percent of the lesions could not be seen in retrospect, and therefore can be attributed to failure of the technique itself. At four of the institutions, the double contrast barium enema study missed 11 (6%) of 197 primary colorectal carcinomas. The lesion was invisible in retrospect in only two (1%) of these 197 studies, indicating that the double contrast examination is potentially highly sensitive for detecting colorectal c...
TL;DR: This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding and the sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators.
Abstract: Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding.
TL;DR: CT of the upper urinary tract may obviate the need for more invasive procedures such as retrograde pyelography when nonopaque filling defects require differentiation.
Abstract: Computed tomography (CT) was used in the evaluation of nine patients with nonopaque calculi in the upper urinary tract. In each case the calculus was identified as a very high density object (370-586 Hounsfield units) with calcium oxalate and cystine stones having somewhat higher attenuation values than uric acid or xanthine stones. The differentiation between calculi and other "radiolucent" filling defects was readily made since calculi had much higher attenuation values than blood clot or neoplasm. CT of the upper urinary tract may obviate the need for more invasive procedures such as retrograde pyelography when nonopaque filling defects require differentiation.
TL;DR: CT provided more information than plain films in all patients admitted for spine trauma in an 8 month period due to its superior imaging of bony detail and its ability to assess soft-tissue damage.
Abstract: Fifteen patients admitted for spine trauma in an 8 month period were studied with computed tomography (CT). All the patients had initial routine plain film screening, and 10 of 15 were also examined with conventional tomography. Five patients sustained vertical fall, axial-load injuries in the thoracolumbar junction region; two others suffered missile injury to the spine. CT provided more information than plain films in all these patients due to its superior imaging of bony detail and its ability to assess soft-tissue damage. In four of these patients, conventional tomography was done but contributed no additional information. Eight other patients sustained complex fractures of the cervical spine. In all but one, the combination of plain films and CT allowed complete evaluation of the injury. In one patient, conventional tomography showed an additional linear fracture one vertebral level below the main region of injury. Plain films and CT allow complete, safe, rapid, easily interpretable evaluation of spine trauma patients in the acute setting. Conventional tomography yields no additional clinically vital information in the acute evaluation of spine trauma, when plain films are abnormal. Its current ability to show finer bony detail than CT can be reserved for evaluating equivocal plain film and CT findings or more complete evaluation (if indicated) after the patient is clinically stable.