Dr. H. Declercq Az St Blasius Dendermonde

Transcription

1 Dr. H. Declercq Az St Blasius Dendermonde

2 Before 16 slice scanner Introduction ict augustus 2010 Cardiac CT course (level 2 cardiac ct) Start cardiac CT in november 2010 More than 600 cardiac CT patients in 1 year

3 Preparation & Setting Scanning Reviewing & Reporting

4 Proper preparation & adequat setting crucial importance Patient seen on outdoor basis by cardiologist Referal only by cardiologist Premedication is strictly applied, given at the time of consultation (60-70 bpm : 100 mg metoprolol/seloken po) (70-75 bpm : 150 mg metoprolol/seloken po) ( + 75 bpm : 200mg metoprolol/seloken po)

5 Appointments are given 2 /week ( from jan /week ) Limited to 8 patients per session from 13h30 to 17 h CT is reserved for cardiac-ct Cardiologist & radiologist are present

6 Patient admitted at least 30 before scanning Dedicated cardiac nurse Dedicated space & positioned on stretcher BP, HR, Questionary & data form is filled in IV line 18 gauge (pref right side) Proper position of the ecg electrodes!! Quick check by cardiologist

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8 Beeld formulier cardio

9 If HR < 70 : ok If HR > 70 : additional B-blockers IV : max 30 mg Seloken IV If anxious or extreem nervous (and if driver availabel) : Temesta 1mg No scanning if > 75 bpm

10 Patient is taken over by the radiology technician Installed on scan Proper instructions are given ( breath hold, heat sensation) Nitroglycerine 0,4 mg (Nitrolingual) sublinguaal just prior to scanning

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12 We always start with Ca++ score 1. determination of scan field (dose reduction) 2. breathhold test (effect on heart rate) 3. if ca++ score is too high : stop ( > 700)

13 Double scout Step & Shoot (2 steps) 120 Kv 55 Mas

14 If < 70 bpm : Step & Shoot If > 70 bpm : prospective scanning ( %) More than 90% Step & Shoot!

15 S&S advantages 1. simple 2. quick (acquisition, reconstruction and reviewing) 3. lower dose

16 SS standard settings : 256 slice( 128x0,625X2) 8 cm coverage 0,27 sec rotation time 0,8 mm slices 50% overlap 2 steps (FOV 250 mm effective Z coverage 7,2 cm/step) 75 % ( no tolerance)

17 Introduction idose 4 in may 2011 BMI adapted protocols Differentation between male & female BMI<20 BMI BMI BMI BMI > 30 Male 80 kv mas 100 kv mas 100 kv mas 100 kv 200 mas 120 kv 200 mas Female BMI<20 BMI BMI BMI > kv mas 100 kv 150 mas 100 kv 200 mas 120 kv 210 mas

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19 Using BMI adapted protocols Shift in kv use : lowered by 20 kv & no decrease in image quality. Results dose reduction with idose 4 : before average 2-3 msv after average 1-2 msv

20 Contrast injection -Bolus type : double bolus and saline flush -Bolus timing : automatic bolus detection -Roi position : aorta descendens -Injector: Nemoto double head injector -Contrast : Iomeron 400

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23 2 reconstruction options are used 1 S&S without Edge correction sharp kernel 2 S&S with Edge correction standard kernel

24 W/O edge correction With edge correction

25 Revieuwing : Philips Workstation Reporting : PACS and EMR Cardiologist and radiologist together in the same room Radiologist is on the workstation, makes the reconstructions and shows the lesions to the cardiologist Cardiologist makes the report on the spot in the medical file Conclusion and proposition for further managment in same report

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27 Very high learning curve (radiologist for cardiac pathology and cardiologist for imaging tools) Motivates the cardiologist to use cardiac CT (is involved in the exam) & to premedicate Weekly joint session: comparison of CT results with Cathlab results Reviewing in a systematic way :

28 Post processing Part 1 Post processing Part 2 Post processing Part 3 Loading series Cardiac views : (valves, septum, auriculum) Lung & mediastinal window Reviewing with swiffel RCA LAD, LCX Heart segmentation Curved MPR coronaries Adjustment curved mpr Batch curved mpr 3D batch, analyse Stenose measurement Total post processing time 10 min

29 Choice for Philips ICT because of Large coverage High temporal resolution due to fast rotation SS up to 70 bpm Premedication & setting is crucial Collaboration of the radiologist with the cardiologist ( diagnostic and therapeutic upgrade of the exam)