Keywords:
Dosimetry, Thrombolysis, Decision analysis, CT-High Resolution, CT-Angiography, CT, Radioprotection / Radiation dose, Neuroradiology brain, Interventional vascular, Acute, Obstruction / Occlusion, Ischaemia / Infarction
Authors:
N. J. Darcy1, S. Rienecker2, J. Blazak1; 1QLD/AU, 2Sunshine Coast/AU
DOI:
10.26044/ranzcr2019/R-0015
Purpose
Advanced CT techniques have become the standard of care in acute stroke management in many tertiary centers. The two primary treatments available to clinicians in the hyperacute setting of ischaemic stroke are generally recognised to be IV thrombolysis and Endovascular Clot Retrieval (ECR). There is sufficient evidence to suggest advanced imaging predicts response to both treatments in the early phases of management (1-9). The recent EXTEND trial builds a strong case for thrombolysis up to 9 hours in patients with a favourable perfusion scan (1) and the 2018 DEFUSE- 3 trial demonstrated a large benefit for clot retrieval patients up to 16 hours after onset of symptoms (3). However, stroke mimics are common, ranging from between 15-30% of stroke presentations (10-12) and dose related to CT based stroke protocols is not insignificant (13).
This audit aims to review how often advanced CT based stroke imaging is being used, the long term risks associated with this level of radiation exposure, how often it indicates reperfusion techniques and what benefit is associated with these treatments in the total population that is imaged.