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Emergency Department CT Scanner

Karim Brohi karim at trauma.org
Wed Apr 25 13:56:07 BST 2012


At the risk of sounding self-satisfied, we've just put two dedicated
128-slice scanners in our new resus room/ED.  The main trauma one
being a 128 'flash' dual-source scanner.  We have great plans for
these machines!

In relation to previous discussions on CT - yes clinical judgement is
important, yes there's a group of patients who should not get a CT and
yes we need to address issues around radiation, but the new CTs are
not the same as the old CTs and cannot be thought of or used in the
same way.

For example, it makes absolutely no sense with a volumetric multislice
to scan individual body regions like head, neck and abdomen.
Especially if you are then going to do plain X-rays of the thoracic
spine to clear the spine.  The whole-body acquisition is the only
logical choice for patients with potential multiple trauma.  We need
to learn new ways of reading and reporting these images to be sure -
and that's clinicians not only radiologists.  But the new CT
generation must be embraced and researched, not dismissed.

Two papers from the recent trauma supplement of the BJS attached and a
link to the REACT-2 trial:
http://www.biomedcentral.com/1471-227X/12/4/abstract

Karim



On Wed, Apr 18, 2012 at 07:56, Doc Holiday <drydok at hotmail.com> wrote:
>
>
> From: pbjorn at emh.org
>> Who has brought scanners into their ED's, and what has been the practical upshot -- besides quicker (and perhaps more) scans?
>
>
> --> We have. 7 or so years ago (upgraded machine since). CT table is actually under 3m from the trauma bed itself.
>
> Overall, we ALL are happy it's there. As you say, speed is a big bonus. We DO more CTs than before, but we are careful NOT to do one simply because it's easy. Also, our pattern of imaging continues to change over the years in various ways, while the physical set-up has not, e.g. we now do Pan-CT for indicated mechanisms.
>
> FAST is now virtually only done in order to maintain the skill. Cannot recall back to a case when it was THE right thing to do.
>
> Sufficient "stability" for CT - the meaning of this has changed because of proximity (and having the facility to continue work in the CT room). Hen's Teeth Rare to find a patient who is not fit for OUR scanner and is not already being wheeled to the OR (also very near by and with no elevators in the way).
>
> Having the reporting IT suite in the same room as the CT computer itself is also a bonus in terms of the trauma radiologist being right there to get involved in imaging planning, further imaging, show us right there what he/she are seing and we can be with them AS they look at the images coming off the processor and give them the info we have on that body part (e.g. bruis pattern, mechanism, etc.) relevant for interpretation. It has brought radiology INTO our trauma teams - it's no longer "them"! And once this happened ALL our interaction with radiology has much improved, including non-trauma. Proximity is nice!
>
> We do ALL work on preventing over-imaging. Having radiologist there MORE than compensates (and helps to prevent) for any tendency to over-image. Tougher to request stuff you don't need when it's face-2-face...;-)
>
> We have internal evidence to show we have improved our trauma care and we consider the CT location was a big part of why.
>
> It has also helped with imaging for stroke thrombolysis (we use the same area for medical resuscitations, CVAs and trauma - as is typical for the UK).
>
> If I think of more then I will write again. Cannot think of a negative. Ask questions if you wish...
> --
> trauma-list : TRAUMA.ORG
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