Role of the RR - CT Flashcards
Standards of practice, Trauma imaging in CT:
Standards of practice and guidance for trauma radiology in severely injured patients (RCR 2015, 2nd ed.)
Recommendations include:
If there is an early decision to request multi-detector computed tomography (MDCT),
focused abdominal sonography in trauma (FAST) and digital radiography (DR) should not cause any delay.
Whole-body contrast-enhanced MDCT is the default imaging procedure of choice in the severely injured patient (SIP).
On-call consultant radiologists should provide the final report on the SIP within one hour of MDCT image acquisition.
National Institute for Health and Care Excellence (NICE) Guidelines and Standards
Do not use FAST or other diagnostic imaging before immediate CT in patients with major trauma. (Guideline NG39 [major trauma])
Use whole‑body CT (consisting of a vertex‑to‑toes scanogram followed by a CT from vertex to mid‑thigh) in adults (16 or over) with blunt major trauma and suspected multiple injuries. (NG39, NG37 [complex fractures], NG41 [spinal injury])
Use CT for first-line imaging in adults (16 or over) with suspected high‑energy pelvic fractures. (NG37)
The current primary investigation of choice for detecting an acute clinically important traumatic brain injury is CT imaging of the head. (NG232 [head injury])
Make a provisional written radiology report available within 1 hour of a CT scan. (NG232)
People who have had urgent 3D imaging (CT/MRI) for major trauma have a provisional written radiology report within 60 minutes of the scan. (Quality standard QS166)
nutshell:
CT is first line imaging (departmental protocols will identify specific scan parameters, etc.)
Suitably qualified person to report images
Provisional report to be available within 1 hour of image acquisition
What are the demands in CT reporting (statistics):
Increasing and ageing population – increasing demands on imaging service – demand for diagnostics is rising faster than that for healthcare services as a whole, typically rising at between 2-3% per annum (RCR census 2022)
Decrease in reporting capacity (more reporting/less reporters) – 29% shortfall of radiologists identified in RCR census of 2022; predicted to rise to 40% in 5 years without action
Demand for CT imaging is increasing rapidly (>5% annual increase in recent years, as identified in RCR census report of 2022
A definite need for skill mix and reporting radiographers in CT……..
What is the scope of practce for RR in CT?
Limited - head and colon
further limited locally - no paeds, non-con only, brain only (no facial bones)
Ability to refer on for further/repeat imaging (can be to other cross-sectional modalities), but prior discussion with radiologist often required
Can also recommend onward referral to specialist clinical teams for input into the treatment and management of the patient
Can recommend further investigations and refer in some cases depending on departmental protocols
What are the potential benefits and considerations of RR in CT
Improves job satisfaction/R&R
Inclusion in MDT
Respect from staff
Regular audit procedure must be followed
Require post graduate training and on-going CPD
CT reporting, describing the images
When reporting CT trauma images, much of the terminology will be that used in plain image reporting, e.g. comminution, displacement of fracture fragments, etc.
When assessing bleeding, remember fresh blood is bright white on CT
In cases where there are any irregular areas or masses (e.g. non-trauma, or incidental findings), remember to consider the density of the area/lesion in comparison to the surrounding normal tissues:
Hyperdense = more dense = lighter
Isodense = same
Hypodense = less dense = darker
Also remember to consider the lesion content/structure:
Homogeneous – composed of parts or elements that are all the same kind
Heterogeneous – composed of parts of different kinds
Characterisation:
Age of patient - some lesions are pertinent to certain age groups
Location of lesion e.g. articular surface
Periosteal reaction
Size of lesion and zone of transition
Soft tissue involvement or bony involvement/destruction
Marginal sclerosis or not well demarcated
Irregular appearance shape/well rounded shape
Expansile
Lobulation
Patient presentation and clinical signs and symptoms
