Emergency departments have always been prepared to deal with difficult cases, but today they are better armed with imaging.

Marianne Matthews

I made my first visit to a hospital emergency room some 35 years ago. It was the middle of the night and I’d woken with a terrible headache. Apparently, I was speaking gibberish to my terrified mother. Then I had a seizure. An ambulance rushed me to the ED. When I regained consciousness, there were a bevy of nurses and physicians hovering over me. But there was very little imaging equipment to help diagnose my problem.

What I recall instead was a lot of uncertain faces and a few too many invasive tests, like that very memorable spinal tap. At the time, there was no MRI. It was a few years later, during routine follow-up visits, when my physician told me about MRI, saying, “We can now take a picture of your brain.”

Flash forward 30 years. I stepped off a curb on Madison Avenue in New York City and was hit by a van delivering cheese to some fancy French restaurants. Turns out this scenario (minus the cheese) happens frequently in big cities. The ambulance personnel told me, “You’re our third one today.” And the ED physician noted that one of the most common cases he treats is “pedestrian struck by motor vehicle.”

My experience in the ED three decades later was quite different than the first time around. After my collision with the cheese van, ED physicians immediately took x-rays and used ultrasound on me, too?right there in the ED. They considered doing a CT scan of my head, but I knew I hadn’t hit my head so we passed on that test. In short, the ED team was armed with imaging equipment and it helped them quickly assess the damage to my person?which, surprisingly, wasn’t all that bad.

ED visits are on the rise, and imaging is making a positive difference in the swift assessment of cases and, ultimately, in patient outcomes. From 1996 through 2006, the overall population-based ED utilization rate nationwide increased by 18%, from 34.2 to 40.5 visits per 100 persons. Morever, imaging exams were ordered at 44.2% of ED visits.

In this issue, we bring you a special section on Imaging in the ED. In our cover story, you’ll learn how hospitals are managing to ensure their EDs have access to imaging equipment and PACS?in spite of tight capital budgets. In addition, in her story writer Ann H. Carlson looks at imaging in the ED from the perspective of addressing the special needs of pediatric patients. Finally, there is an exciting new educational tool available that can help ED physicians and others keep current with ultrasound. We’ve covered that story as well with the article “New and Noteworthy.”

I hope I never have to visit the ED again. But if I do, it’s nice to know that imaging equipment is at the ready?whether in the ED or very nearby.

Marianne Matthews