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Singh BR, Ahmed KA, Virador MG, Idrissi AY, Bhatt AA, Lakhani AD, Oei WM, Gopal N, Overfield C, Rowell C, Rao D, Vibhute P, Watson ER, Sandhu JSS. Exploring the role of CT scouts in expediting MRI in acute stroke. Emerg Radiol 2024:10.1007/s10140-024-02282-6. [PMID: 39304569 DOI: 10.1007/s10140-024-02282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE For acute stroke patients requiring MR examination and unable to provide a reliable history, screening for potentially MRI-incompatible objects (PMIOs) typically necessitates the use of plain-film radiographs (PFRs). However, using a whole body CT scout at the time of non-contrast head CT scans can preclude critical delays. Here, we aim to compare the effectiveness of PFRs and CT scouts in detecting PMIOs. METHODS A case-control study was conducted at a tertiary care institution, involving 408 imaging studies from 200 patients, half of which contained PMIOs. The diagnostic performances of CT scouts and PFRs were evaluated by six blinded readers, including two board-certified neuroradiologists, one neuroradiology fellow, and three radiology residents. RESULTS 2448 interpretations from the 6 readers were analyzed. The diagnostic performance of combined CT scout images (full-body and regional) was not significantly different from that of PFRs for all six readers (p = 0.06). However, PFRs outperformed full-body CT scouts in PMIO detection (p = 0.01), with no significant differences observed between PFRs and regional CT scouts (p = 0.4). Notably, the diagnostic accuracy of the radiology residents was found to be equivalent to radiologists across all imaging techniques. CONCLUSION Integrating CT scouts in acute stroke protocols may help expedite MRI screening. The scouts should include the head, neck, chest, upper arms, abdomen, pelvis, and thighs. Including radiology residents in the screening process for PMIOs may be an avenue for resource optimization in acute care settings.
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Affiliation(s)
- B Rahul Singh
- Department of Internal Medicine, New York City Health and Hospitals, South Brooklyn Health, Brooklyn, NY, USA
| | - K Ahmed Ahmed
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - M Gabriel Virador
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA, USA
| | - A Yassine Idrissi
- Department of Radiology, UPMC Hillman Cancer Center, Pittsburg, PA, USA
| | - A Alok Bhatt
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - A Dhairya Lakhani
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - W Merrie Oei
- Great Lakes Medical Imaging, Williamsville, NY, USA
| | - Neethu Gopal
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Cameron Overfield
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Colin Rowell
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Dinesh Rao
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | - Prasanna Vibhute
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA
| | | | - J S Sukhwinder Sandhu
- Radiology Department, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
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Watson RE, Yu L. Safety Considerations in MRI and CT. Continuum (Minneap Minn) 2023; 29:27-53. [PMID: 36795872 DOI: 10.1212/con.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE MRI and CT are indispensable imaging modalities for the evaluation of patients with neurologic disease, and each is particularly well suited to address specific clinical questions. Although both of these imaging modalities have excellent safety profiles in clinical use as a result of concerted and dedicated efforts, each has potential physical and procedural risks that the practitioner should be aware of, which are described in this article. LATEST DEVELOPMENTS Recent advancements have been made in understanding and reducing safety risks with MR and CT. The magnetic fields in MRI create risks for dangerous projectile accidents, radiofrequency burns, and deleterious interactions with implanted devices, and serious patient injuries and deaths have occurred. Ionizing radiation in CT may be associated with shorter-term deterministic effects on biological tissues at extremely high doses and longer-term stochastic effects related to mutagenesis and carcinogenesis at low doses. The cancer risk of radiation exposure in diagnostic CT is considered extremely low, and the benefit of an appropriately indicated CT examination far outweighs the potential risk. Continuing major efforts are centered on improving image quality and the diagnostic power of CT while concurrently keeping radiation doses as low as reasonably achievable. ESSENTIAL POINTS An understanding of these MRI and CT safety issues that are central to contemporary radiology practice is essential for the safe and effective treatment of patients with neurologic disease.
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Kimbrell V. Elements of Effective Patient Screening to Improve Safety in MRI. Magn Reson Imaging Clin N Am 2020; 28:489-496. [PMID: 33040990 DOI: 10.1016/j.mric.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Conducting magnetic resonance imaging (MRI) safety screening is not a new idea and has developed as a proved method in efforts to ensure patient safety and prevent accidents in the magnetic resonance (MR) environment. A growing number of surgical procedures with implanted medical devices have complicated MR screening and added to the workload of Level 2 personnel. Level 2 staff members are trained to understand and implement screening procedures and should be consulted by all individuals requiring access to the MR environment. All the steps have potential gaps, but as a whole offer efficient and effective tools to alleviate MR-related accidents.
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Affiliation(s)
- Vera Kimbrell
- Brigham and Women's Hospital, Boston, MA, USA; SMRT Safety Committee 2020, 66 Bellingham Street, Mendon, MA 01756, USA.
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Abstract
New implanted medical devices continue to be made available for treatment of medical conditions. Many recipients can benefit from the diagnostic power of MR imaging. Provisions must be made to determine if these patients can be safely scanned. Metal-containing devices can be considered either MR unsafe or conditional. It is essential that all components of an implanted system are completely and accurately identified, with the most restrictive MR safety condition dictating the scanning approach. MR safety considerations for major classes of implanted devices are discussed, recognizing that there have been reports of serious device-related MR safety incidents.
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Affiliation(s)
- Robert E Watson
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Heidi A Edmonson
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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