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Abstract Details

Expediting emergent MRI in acute ischemic stroke by extending CT scout image: a simple intervention to decrease time to treatment
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (11:45 AM-12:45 PM)
6-010
We revised our acute stroke CT protocol to reduce time to MRI in acute ischemic stroke.
“Time is brain” in acute stroke. Patients requiring emergent MR imaging in the emergency department prior to thrombolytic treatment (e.g. wake-up strokes, iodinated contrast allergy, assessment of DWI/FLAIR mismatch) must undergo the MRI safety screen for implantable devices and foreign metallic bodies. Patient factors including neurologic deficits, language barrier, or lack of information on implantable devices make the screening process time-consuming. If patients cannot complete the safety checklist, radiographic clearance with chest and abdomen x-rays is pursued which delays time to treatment. 
We revised our CT acute stroke radiology protocol to include scout images from the head to the femur to screen for foreign bodies, implantable devices or metallic objects. Standard CTA head and neck scout images previously only extended to the mid-chest. The new protocol obviates need for MRI screening checklist in emergent situations and allows to proceed directly from CT to MRI with the assistance of the radiologist interpreting the scout image.
Our multidisciplinary stroke team has implemented this change in our emergency department CT acute stroke protocol. The difference in additional radiation exposure is minimal to non-significant; the estimated total radiation dose of the topogram for the head, neck, chest, abdomen, and pelvic regions is approximately 0.24mSv (of which only the abdomen and pelvis are additional in this protocol). In comparison, the radiation dose of a standard abdomen/pelvis radiograph is 0.7mSv. Data collection is ongoing to measure impact on door to needle time.
Revision of the CT stroke protocol to extend the CT scout from the head to the femur can expedite clearance for emergent MRI in patients who are candidates for thrombolysis or thrombectomy at no significant expense or radiation. This has potential to reduce time to acute stroke treatment.
Authors/Disclosures
Yasmin Aghajan, MD
PRESENTER 		Dr. Aghajan has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
Michael H. Lev, MD (Mass General Hospital) Michael H. Lev, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Takeda, Roche-Genetech. The institution of Michael H. Lev, MD has received research support from GE. Michael H. Lev, MD has received publishing royalties from a publication relating to health care.
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.