Feature | June 22, 2006| Cristen Bolan

ER Imaging: Don’t Rule Out Multislice CT in the ED

Emergency departments use multislice CT to triage trauma patients. Excerpted from an article appearing in the June 2006 issue of Imaging Technology News magazine.

Northwestern Memorial Hospital installed a Siemens SOMATOM Sensation 64 CT scanner in its ED.

Chest pain is a common complaint among ED patients, yet failure to diagnose acute myocardial infarction in the trauma unit occurs in as many as 20 percent of cases, according to some estimates.
Serious conditions that are occasionally misdiagnosed in the ED include: acute myocardial infarction, stroke, pulmonary embolism, meningitis and appendicitis. Standard protocol for chest pain is an echocardiogram (ECG); however, physicians may rely too heavily on this test, which does not rule out a heart attack if results are normal.
In a recent study presented at the 2006 American College of Cardiology (ACC), physicians compared patients with acute chest pain who were immediately examined on a 64-slice CTA with those who received a standard of care evaluation, including serial cardiac enzymes, ECGs and sestamibi rest-stress nuclear scanning. The results showed that CT angiography (CTA) rapidly and definitely excluded coronary artery disease as the cause of acute chest pain in less time, and at a lower cost, than stress imaging.
“The emergency room is an area where CTA could be used to its advantage,” said James Carr, M.D., Northwestern Memorial Hospital (NMH), radiology, located in Chicago. “Many patients come in without obvious symptoms or with chest pain. The first thing we try to exclude is coronary disease. If you could do a CTA on that group of patients and exclude coronary disease, you could send those patients home early.”
A year ago, NMH installed a 64-slice CT scanner, Siemens’ SOMATOM Sensation 64; however, Dr. Carr explained that the hospital does not routinely use it for cardiac patients in the ED.
“One of the advantages of 64-slice CTA is its ability to visualize coronary arteries, and if the coronaries are normal, that effectively excludes coronary disease,” said Dr. Carr.
Accordingly, he believes CTA will give a very high specificity for disease, meaning that if the study is normal, nearly 98 times out of 100 the patient definitely does not have coronary artery disease.
“That same scan, however, does not rule out aortic dissection and pulmonary embolus because the technique is different,” noted Dr. Carr. “To be able to rule out all three on the same scan can be challenging because there are slightly different techniques. It is known as the ‘triple rule out’ study. We are going to investigate the triple rule out study in the context of the ER, so we’re working closely with ER physicians and cardiology physicians. We will do CTA to rule out coronary disease.”
To do that, NMH will install a new 64-slice scanner in the ED in the next few months.
Carr anticipates that CT, as well as MR, will become increasingly important in the ED for ruling out coronary disease.
“It’s a huge financial savings if you can discharge patients immediately and free up space in the ER,” said Dr. Carr.
Multislice CT dedicated to the ED may be just what the doctor ordered.
Cristen Bolan is the editor of Imaging Technology News magazine. She can be reached at [email protected]

Related Content

CT Shows Enlarged Aortas in Former Pro Football Players

3-D rendering from a cardiac CT dataset demonstrating mild dilation of the ascending aorta. Image courtesy of Christopher Maroules, M.D.

News | Computed Tomography (CT)| January 12, 2018
Former National Football League (NFL) players are more likely to have enlarged aortas, a condition that may put them at...
Siemens Healthineers Strengthens CT Portfolio With Four New Systems at RSNA 2017

The Somatom Force with the new FAST 3D Camera

Technology | Computed Tomography (CT)| December 14, 2017
December 14, 2017 — Siemens Healthineers introduced four new...
Toshiba Medical Introduces Aquilion Prime SP CT System at RSNA 2017
Technology | Computed Tomography (CT)| December 13, 2017
December 13, 2017 — Toshiba Medical, a Canon Group company, introduced its new Aquilion Prime SP...
Philips Debuts IQon Elite Spectral CT Scanner at RSNA 2017
Technology | Computed Tomography (CT)| December 11, 2017
At the 2017 Radiological Society of North America (RSNA) Annual Meeting, Philips unveiled the IQon Elite Spectral CT,...
Toshiba Highlights Ultra-High Resolution CT at RSNA 2017
News | Computed Tomography (CT)| December 06, 2017
Toshiba Medical, a Canon Group company, showcased the Aquilion Precision, what it calls the world’s first ultra-high...
Samsung Unveils Mobile CT OmniTom at RSNA 2017
Technology | Computed Tomography (CT)| November 26, 2017
Samsung Electronics debuted its OmniTom mobile 16-slice computed tomography (CT) scanner at the Radiological Society of...
Siemens Healthineers Announces First U.S. Installs of Somatom go.Up CT System
News | Computed Tomography (CT)| November 15, 2017
November 15, 2017 — Center for Diagnostic Imaging (CDI), one of the nation’s largest providers of diagnostic imaging
Medis Releases QAngio CT v3.1
Technology | Computed Tomography (CT)| October 09, 2017
Medis has released a new version of its QAngio CT (computed tomography), which can now be launched from the Medis Suite...
Hitachi Supria True64 CT Receives FDA Clearance
Technology | Computed Tomography (CT)| September 15, 2017
Hitachi Healthcare Americas Inc. announced it has attained U.S. Food and Drug Administration (FDA) 510(k) clearance to...
Orange County, Calif. Hospital Adopts Siemens Somatom Force CT for Cardiac Imaging
News | Computed Tomography (CT)| September 12, 2017
Hoag Memorial Hospital Presbyterian recently became the first hospital in Orange County, Calif., to install the Siemens...
Overlay Init