On-call Guidance for Trainees in the Radiology hub

 

Requests which we regard as routine (no need to contact us):

 

Lumbar spine for ? Cauda Equina compression

    1. Give contrast if previous discectomy (more than 2 days ago).

    2. No need for contrast if previous posterior decompression.

    3. If giving contrast do a routine lumbar spine with pre and post contrast axial and sag fat sats.  

    4. If trainee has limited experience of post op spines, consider contacting on-call consultant.

    5. Do a sag T2 of thoracic spine if lumbar spine normal.

    6. Requests come from neurosurgery or orthopaedics only. Patient does not have to be in the INS, may be at the QEUH.

    7. Don’t forget to look for cord infarct.

CTA in CT proven or clinically suspected subarachnoid haemorrhage (intracranial)

    1. CT proven (diffuse or perimesencephalic) routinely anytime 24/7, preferably on table/immediately following CT brain or prior to transfer. This is to facilitate early treatment at INS (C6 - vertex if scanning at INS, otherwise C2 - vertex).

    2. Suspected SAH clinically, normal CT brain, typically done within working hours (9-5 including weekends (C6 - vertex if scanning at INS, otherwise C2 - vertex).

    3. GCS is not relevant in deciding whether or not to perform a CTA in suspected or confirmed SAH.  Identifying an aneurysm and facilitating coiling is done to prevent a second often fatal re-bleed, therefore seemingly well patients with suspected SAH in fact have more to lose through waiting longer for treatment than those who are already obtunded.  Please do not refuse patients simply because they are GCS 15.

CTA in acute parenchyma haematoma or subdural (intracranial)

    1. Do in cases where surgical decompression is being considered overnight.

Mri spine in trauma patients who have neurology, where epidural haematoma needs to be excluded.

    1. See trauma spine document in patient under imaging pathways.

CT Venogram

  1. Anyone with suspected VST who has been referred/discussed with stroke, neurology or neurosurgery. 

  2. Be aware of VITT guidance (imaging pathways).

 CT carotid angiogram in acute stroke situation .

    1. Any patient presenting to the QEUH with suspected stroke and is within thrombolysis window, routinely have non-contrast brain, CTA (Arch to vertex) and CT perfusion. CT brain is reported overnight, CTA can wait until next day for reporting. CTP is interpreted with AI software.

    2. Those presenting to the QEUH not being considered for thrombolysis may get CT brain +/- CTA (at discretion of stroke).

    3. No similar agreement in place with other GG&C hospitals.

    4. CTA for ? basilar occlusion must be discussed beforehand and requires immediate overnight report.

    5. All CTA/CTP examinations are performed at the discretion of stroke physicians. Patients should be referred to stroke first.

Requests which are not routine, consider contacting consultant prior to accepting scan request..

 

Mri brain scans are not routinely performed.

    1. Exceptions are tumours which require decompressed overnight.

    2. Ring enhancing lesions/collections on CT, where abscess needs excluded.

 

Mri spine for discitis is not routinely imaged overnight.

    1. Exception is if patient has neurology and neurosurgery have asked for it directly.