Themed imaging suites

November 15, 2010

Any radiographer can tell how challenging is to image children. X-ray, CT or MR imaging scans require patient’s cooperation in order to get good images.This is not always easy. Children are specially difficult, mainly because they are scared of the whole procedure. Therefore different pediatric hospitals in the UK have started a new concept: the themed imaging suites.
According to Dana Etzel-Hardman, an advanced practice nurse in Children’s Hospital’s radiology department, a thematic room adds to the distraction techniques employed to try to increase productivity of the CT scanner and decrease the number of sedations required for the patients having CT exams. The number of children requiring sedation for a CT scan has declined and the waiting lists too.
Imaging vendors are now working together with children’s hospitals to create themed imaging suites. For more information, check the article aunt minnie

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The American Academy of Neurology has weighed in heavily on the side of MR as opposed to noncontrast CT for the diagnosis of stroke patients in its newly published practice guidelines. However, the practice may not be feasible in the real world.

According to the president of AHA, it is clear that MR has more diagnostic accuracy than a CT scan for stroke assessment. The latest studies reviewed in the article demonstrate the superiority of MRI for detecting a stroke at an early stadium. However, considering the current situation in most hospitals, it is always faster to do a CT than an MR scan on an acute stroke patient. There are always extra arrangements to be made before the patient can get into the MR scanner and many places do not have more than one MR scanner, which is fully booked the whole day.
As a conclusion, if hospitals are going to implement these guidelines, they probably need to get themselves an MR scanner at the emergency department.

Having your patients hold their breath properly during a MR or CT scan is always a challenge, especially when your patients are infants. Mueller et al. have come up with a simple volume-monitored (VM) method for performing reproducible, motion-free full inspiratory and end expiratory chest CT examinations in children. They tested the method on
fifty-two children with cystic fibrosis (mean age 8.8 ± 2.2 years). They underwent pulmonary function tests and inspiratory and expiratory VM-CT scans (1.25-mm slices, 80–120 kVp, 16–40 mAs) according to an IRB-approved protocol. The VM-CT technique utilizes instruction from a respiratory therapist, a portable spirometer and real-time documentation of lung volume on a computer. CT image quality was evaluated for achievement of targeted lung-volume levels and for respiratory motion. Overall, 94% of scans were performed at optimal volumes without respiratory motion. This method is applicable to children older than 4 years-old.
A drawback of the method, though, is the fact that the respiratory therapist has to stay in the room while the scan is being performed, with all the risks of radiation.

For more information you can read the whole article, published online in Pediatric Radiology (May 28, 2010): Volume-monitored chest CT: a simplified method for obtaining motion-free images near full inspiratory and end expiratory lung volumes

A multi-institutional research team found that the app yielded 100% sensitivity, 78% specificity, and 100% negative predictive value in predicting stenosis greater than 50%, comparable to previous multicenter studies employing 3D workstation software. The group also found that heart rate and heart rate variability were the factors most likely to affect diagnostic performance of the technique. Want to know more? Read the following article: http://www.auntminnie.com/index.asp?Sec=sup&Sub=car&Pag=dis&ItemId=90081&wf=3663

Stroke imaging by CT perfusion has exposed more than 200 patients to radiation poisoning in Cedars-Sinai Medical Center in Los Angeles only. But this is just an example of a problem emerging in many medical centers. This has led the FDA authorities to issue a set of preemptive recommendations for the use of CT perfusion. The rapid developments of CT imaging in the last couple of years has led to a significant increase in CT scans, sometimes without taking into account the risks associated to radiation. For more information, take a look at the following links:
http://www.diagnosticimaging.com/display/article/113619/1491688
http://www.diagnosticimaging.com/display/article/113619/1475485
http://www.diagnosticimaging.com/display/article/113619/1491848

MRI patient throughput and CT dose reduction is not just a matter of improving the scan speed and technique. The new advanced image processing algorithms could also play a very important role.
A collaborative study between ContextVision AB, SharpView AB, Massachusetts General Hospital (MGH) and the Center for Medical Image Science and Visualization (CMIV) will investigate advanced 3D image filtering as a means of increasing patient throughput and improving image quality in MRI and further enabling dose reduction in CT. Researchers will compare state-of-the-art 3D techniques with 2D filters. For more information, please visit http://www.imagingeconomics.com/news/2009-11-11_01.asp

The American Medical Association (AMA) recently released the 2010 CPT codes that will take effect January 1, 2010. There are 4 new Category 1 codes to report cardiac computed tomography and cardiac computed tomography angiography (CCT/CCTA).
These Category 1 codes represent a significant step forward to achieve broader patient access to this proven technology.
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