CT an Important Diagnostic Tool for ED Patient Management

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1 CT an Important Diagnostic Tool for ED Patient Management Dr. Nicolas Grenier In recent years, the volume of CT examinations conducted in Emergency Departments (ED) has dramatically increased. CT is now an important diagnostic imaging modality for patient management. In response to this development, GE Healthcare designed the Optima* CT660 to meet specific challenges in major applications such as trauma, chest and abdominal pain, and stroke. The ED at Bordeaux s Pellegrin University Hospital in Bordeaux, France considered one of the most active in France is a perfect example of high-volume CT imaging for patient diagnosis. During the first quarter of 2012, 6,000 CT exams were performed in the hospital s ED with the. Dr. Patrice Menegon Dr. Nicolas Poussange The allows us to handle our large patient volumes while taking advantage of its dose reduction features. Dr. Nicolas Grenier 8 A GE Healthcare CT publication

2 customer spotlight Figure 1. in the Emergency Department of Pellegrin University Hospital of Bordeaux, France. Last year, 21,000 CT procedures were performed and this year, we will easily reach 24,000, explains Professor Nicolas Grenier, MD, Chief of Diagnostic and Adult Therapeutic Imaging. He adds that two factors account for this growth: First, it s due to the centralization of emergency care, and second, it s because of our desire to reduce the time it takes to evaluate patients. He highlights the fact that major traumatic and neurological emergencies are sent to Pellegrin University Hospital, since it is the only stroke center in the region. According to Professor Grenier, the is able to meet this high demand and he states it has transformed the management of his ED. He notes that, This 64-slice CT system is very well-suited to emergencies. He adds, The allows us to handle our large patient volumes while taking advantage of its dose reduction features. He sees this as an essential benefit in many cases of trauma or stroke. Additionally, the gantry display offers the possibility for radiologic technologists to reassure the patient in the scan room while performing the pre-scanning functions. Poly-trauma application As the head of patient management who is responsible for establishing emergency acquisition protocols on the, Nicolas Poussange, MD, explains, A main benefit is the time reduction in patient management for poly-trauma cases, due to the system ergonomics, fast acquisition, and wide coverage. Dr. Poussange has found the useful for scanning difficult patients, such as those who are non-cooperative or intubated; it provides the information he needs for a timely and confident diagnosis in life-threatening situations. He emphasizes a key advantage in a poly-trauma study is the ability to scan quickly from the Circle of Willis (COW) to the lower limbs in one pass with high image performance. Regarding the post-processing, he attests that it is fast and allows images to be processed in a very short time frame an important capability in situations where every second counts. July

3 A B E C D Figure 2. Swelling of soft tissues with significant premaxillary bone loss associated (A); bi-pediculare fracture of C2 (B); compression of T9 and T12 vertebrae (C); fractures of the inferior pubic ramus and the posterior pillars of acetabulum (D); 3D rendering of CT exam from head-to-pelvis including the whole aorta, carotids, and COW with a single injection (E). Case 1 An elderly person who was injured in a multiple story fall. A CT scan of the head-neck-chest-abdomen-pelvis including the whole aorta, carotids, and COW was performed with a single contrast injection. With a high helical pitch of 1.531, the enabled the radiologist to scan from the head to the pelvis in 6.7 sec with 40 mm beam width at 0.5 sec rotation speed. The DLP was 747 mgy cm (10.3 msv) using ASiR^ while maintaining a high imaging performance with mm slice thickness. In this case, these scanning parameters enabled the detection of a thin fracture near the metallic hip prosthesis and the patient was quickly transferred to surgery. Stroke application According to Patrice Menegon, MD, a neuroradiologist in the Emergency Department, presents two main advantages for cerebral perfusion a very good coverage of 80 mm using VolumeShuttle* and the generation of a cerebral blood volume (CBV) map to aid in prompt diagnosis. He also emphasizes that dose can be significantly reduced in perfusion studies on the thanks to ASiR. Indeed, has the capacity to provide whole brain perfusion studies that can help a clinician quickly detect infarction ischemic signs. It also provides high-quality CT angiography studies to help identify vessel occlusion, stenosis, or ventricular thrombus from the arch to the COW, notes Dr. Menegon. ^In clinical practice the use of ASiR may reduce patient CT dose depending on the clinical task, patient size, anatomical location and clinical practice. A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task. 10 A GE Healthcare CT publication

4 customer spotlight A B E C D Figure 3. Tissue classification (BV-Tmax) showing necrosis (A); interactive volumetric map demonstrating left MCA territory infarcts with necrosis (B); cerebral blood flow (C); CBV (D); CTA showing TSA without visible thrombus (E). Case 2 A 57-year-old man with a suspected stroke in the middle cerebral artery (MCA) territory within the scope of a thrombolysis protocol. A CT Perfusion 4D with VolumeShuttle was utilized for stroke assessment. Scans performed included: unenhanced CT, CT Perfusion, and CTA of the carotid arteries and COW. In this case, the allowed an extended coverage of 80 mm with VolumeShuttle at low dose (1.65 msv) with a single contrast injection compared to traditional 40 mm perfusion. CT Perfusion 4D software, thanks to a workflow centric and automated perfusion post-processing, enabled the clinicians at Pellegrin University Hospital to obtain the necessary images in a few seconds. With these capabilities, the radiologist was able to diagnose ischemic accident being formed in the left superficial MCA territory with necrosis in zones M1, M4, M6, without visible thrombus at the supra-aortic arteries. July

5 Case of Abdominal Pelvis CT Case of Thoracic CT Figure 4. Abdominal pelvis CT on patient with a left kidney hemorrhage achieved with low dose 9.7 msv (obtained by EUR EN, using an adult abdomen factor of x DLP & pelvis factor of x DLP). High helical pitch of enabled an abdomen and pelvis scan (445 mm) in 5.0 sec. Conclusion Figure 5. Coronal images of the thoracic showing pulmonary emboli. enabled an entire chest scan (327 mm) in 3.5 sec and delivered to the patient a low dose of 9.8 msv (Obtained by EUR EN, using an adult chest factor of x DLP). The helps clinicians in the ED at Pellegrin University Hospital improve patient management. With a powerful array of clinical tools and high image quality, the can address the key clinical questions presented to ED physicians, such as trauma, stroke, Triple RuleOut*, and chest or abdominal pain. Plus, with both the one-stop scanning mode and emergency-patient mode, radiologic technologists have the ability to quickly scan patients and enable a more rapid diagnosis, which is critical to patient management in any ED. Nicolas Grenier, MD, is a Professor of Radiology and Chief of Diagnostic and Adult Therapeutic Imaging at Pellegrin University Hospital (Bordeaux, France). He has contributed to numerous scientific publications and participates in several scientific councils, including the Journal of Medical Imaging, the Journal of Radiology, and European Society of Radiology. Professor Grenier is a recognized expert as a result of his work in the field of radiology, where he has led pilot studies and clinical investigations. Nicolas Poussange, MD, is a radiologist in the Department of Diagnostic and Adult Therapeutic Imaging at Pellegrin University Hospital (Bordeaux, France). Dr. Poussange performed his Internship at Fort de France University Hospital (French Guiana) where he also earned his degree in Radiodiagnostic and Medical Imaging. In the ED at Pellegrin, Dr. Poussange is responsible for the organization of patient management and management of the acquisition protocols on the. Patrice Menegon, MD, is a radiologist in the Neuroradiology Diagnostic and Therapeutic Department at Pellegrin University Hospital, Bordeaux. In the emergency department at Pellegrin, Dr. Menegon specializes in neurological emergencies. He obtained his medical degree at Bordeaux with several certifications in radiodiagnostic, medical imaging, neurovascular, and neuroradiology. He also has participated in numerous publications in the field of neuroradiology. Pellegrin University Hospital is one of the largest hospitals in France with 1,519 beds and more than 63,800 admissions. The main specialties are surgery, maternity, pediatrics, and emergency. The Hospital provides the following surgical specialties: ENT, maxillofacial surgery, ophthalmology, plastic and reconstructive surgery, burn unit, and hand surgery. 12 A GE Healthcare CT publication

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