Benefits

CT FOR EMERGENCY

In recent years, CT-scan has become an important diagnostic imaging modality for patient management in Emergency Department. In response at this development, GE Healthcare has designed scanners with high flexibility, speed and accuracy diagnostic capabilities enabling doctors to deliver a fast therapeutic strategy. 

SPECIFIC NEEDS IN THE EMERGENCY DEPARTMENT  

In the Emergency Department, patients come in with various sorts of diseases, like chest pains, multiple fractures, hemorrhages or ischemia, that need to be quickly imaged, rapidly diagnosed and routed towards the right departments for the most serious cases. Depending on pathologies, the challenges can be different and specific for each indication.

Trauma

Trauma 

Management of polytrauma patient in the emergency department 



Clinical case 

Patient history 

Young female on bicycle crashed into open car door. Patient found unconscious and referred to CT for a multi-trauma study. Exam included skull, facial bones/c-spine, whole body angiography 

Acquisition 

Whole body angiography: 

  • Helical acquisition 
  • 80 mm collimation 
  • 0.992 pitch 
  • 100 kV 
  • 150 mA 
  • ASiR™-V 50% 
  • 0.5 sec rotation 
  • Coverage of 656 mm in 4 sec 
  • Soft kernel 
  • 120 cc of contrast media (350 mgI/ml) 
  • DLP 276.6 mGy-cm 

Results 



Conclusion  

This case demonstrates the protocol optimization done at the Karolinska University Hospital where they have added a whole body angiography to their standard multi-trauma protocol after installing Revolution CT. The entire 4-series examination was performed with a DLP of only 1331 mGy-cm. By using ASiR-V, the dose of this entire study, with all 4 series, is even less than the previous protocol that didn’t include the whole body CT angiography. By adding a whole body angiography to the standard multi-trauma protocol, carotid dissections are found at an earlier stage even though the patient was scanned with arms up. As a result, the patient could start treatment earlier.


Chest

Chest pain

CT angiography revealed an acute pulmonary embolism in the lower left pulmonary artery with partial lung infarction of the lower lobe and noticed a contrast ground-glass opacity representing the acute alveolar hemorrhage.  



Clinical case : Jena University Hospital 

We established in our ER department certain algorithms for how we use the scanner.

We want the right patient in the CT scanner.

Professor Teichgräber says. In a department that sees an average of 33,000 patients each year, proper CT utilization is a key factor



At Jena University Hospital in Thuringia, Germany, Professor Ulf Teichgräber, MD, MBA, Institute Director at the Institute for Interventional and Diagnostic Radiology (IDIR), has worked with his colleagues to develop clinical algorithms for determining the appropriate use of CT across a multitude of patient conditions. The most common cases where CT is employed in Jena’s ER/trauma unit are trauma, chest pain, and stroke. Chest pain, caused by cardiac, aortic, and pulmonary disease, represents 12% and suspicion of stroke represents 3% of the yearly ER/trauma visits.

“We know that using CT in the ER has a clinical impact in decision making,” explains Dr. Lehmkuhl. “With an immediate diagnosis, we have a clear decision for patient care and also for discharge. With Revolution CT, there is the ability to image higher heart rates and still have sharp images of the aorta.” “The best way to prevent overutilization of CT in the ER is to clearly establish clinical CT protocols dedicated to the underlying disease and based on established guidelines for every major condition that presents to the ER. Then, the clinician can decide if CT is appropriate or not,” Professor Teichgräber says.





The new protocol is called the Big Five. “It’s a combination of the ECG gated heart CTA, combined angiography of the thoracic aorta and cerebral arteries, and CT brain perfusion,” says Lucas Lehmkuhl, MD, PhD, Modality Manager for CT at Jena University Hospital.


Stroke

FastStroke

Simplifies and organizes the display for fast, efficient evaluation of patients scanned for stroke evaluation 

  • Integrated workflow, display and review of multiple series acquired for ischemic stroke evaluation
  • Dynamically evaluate vascular enhancement of multi-phase CTA acquisitions (mCTA)
  • Sophisticated fused view with color visualization of mCTA data to identify vascular flow
  • Integrated with automated CT Perfusion 4D* Stroke protocol

* CT Perfusion 4D license sold separately

Clinical case: Ziekenhuis Brussels University Emergency 

Patient history

A female in her early 30s presented with right-side hemi-paresis and aphasia after a wake-up stroke, with an NIHSS of 12. She had a history of migraine.

All data was loaded into FastStroke and reviewed using the different steps, including ColorViz, for clinical interpretation.

Note: CT Perfusion can be acquired before or after mCTA depending on site preferences. Exam included skull, facial bones/c-spine, whole body angiography followed by a venous phase abdomen.

Procedure – Control

Successful thrombectomy procedure, the patient recovered well. The NIHSS dropped from 12 to 7 directly after the thrombectomy procedure. On day 3 the NIHSS dropped further to a score of 2.



Patient Setup

Performance and dose

Post-processing


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Disclaimer

*Availability based on local regulatory approval