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         CT Perfusion Imaging in acute stroke neuroimaging PDF

  • CT Perfusion Imaging in acute stroke case review PPT
  • HFW Stroke Protocol Policy 
     Stroke Protocol Policy

     
     
    There has been recent discussion concerning the reading of Level I Stroke studies from HFW which involve CTA and particularly CT Perfusion.  The HFW protocol for Level I stoke patients with a NIH Stroke Scale above 12  is to get CTA and CTP in addition to noncontrast head CT.  Select patients with NIH Scale < 12 with aphasia may also get CTA and CTP.  The original policy was for the telerad doc to read the studies.  The head without should be read immediately (ie prior to completion of the CTP and CTA) and results called to the ER physician so that IV TPA can be given without delay. The CTA and CTP are read immediately upon their completion and results called to the ER physician. 

     
    This policy has not changed. The telerad doc should read the CT, CTA and CTP.

     
     These are time critical studies and the most efficient way to handle them is via the telerad doc. Ideally I would have liked the NeuroIR rad handle these cases but three issues make this untenable; 1/3 of NeuroIR coverage is by an interventional neurosurgeon who can't read the studies for contractual reasons; NeuroIR have inordinate amount of beeper call and the majority of the studies are not positive. The night box call people should be competent to read these.  I read these and those that cover my shift ( 10-7 box) who are not comfortable with them have access to Harr, Chandler, Gerstle or a night box person for back up almost all the time.  Same is true for weekend box now that we have weekend neuro coverage at Harris there should almost always be a back up.  Hopefully in the not to distant future we can have extended hour neuro coverage and/or a dedicated group of ER rads that can handle these cases.

     Remember prior to this Stroke Protocol "going live" a presentation on CTP was given at one of our Interesting Case Conferences. Pertinent articles and a powerpoint presentation were circulated via email and were also placed on the Wiki for constant availability.

    There is one caveat to this.  If the NeuroIR radiologist has opened the case and is reviewing it before the telerad doc has read it he should read the study, both CTA and CTP for purposes of continuity of care.  If for some reason he can't dictate the exams he at minimum needs to call and discuss with the telerad doc so they are on the same page about the findings.

 

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Viewing 1 of 3 comments: view all
David, I use:

https://docnet.radntx.com/wpg_directories.htm

You have to use your RANT login but this page has most of the numbers.
Posted 13:02, 25 Apr 2013
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