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ISRRT | Book Of Abstracts

6 1. ACUTE STROKE 1.1. CT imaging of acute ischemic stroke Presenter: Ulla Nikupaavo, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland Author: Ulla Nikupaavo Introduction: Stroke is the most common cause of disability in adults and the second leading cause of death in Finland. In the next two decades ageing population will double the amount of strokes. Recanalizing the occluded artery and thus limiting the duration of ischemia is the only clinically verified method to minimize the infarct. Fast recanalization lowers the mortality rate and gives a better outcome for the patient. The most significant treatment for acute ischemic stroke is intra-venous thrombolysis (Actilyse) administered no later than 4,5 hours after the symptoms have started. The 4,5 hour time window has raised a demand for better detection and evaluation of an acute ischemic stroke. The imaging choice is generally non-contrast computed tomography (NCCT), since computed tomography (CT) is fast and widely available here. CT protocol for acute ischemic stroke patient includes three phases: NCCT, perfusion CT and CTangiography (CTA). This protocol provides quantitative and qualitative information of cerebral vasculature. For this type of analysis, multidetector CT (MDCT) and an advanced workstation with proper options is needed. Fast recanalization predicts a better outcome for the patient. The duration of symptoms is therefore vital. By locating, organizing and training the CT emergency department correctly, the time from stroke onset to CT imaging and thrombolysis can be shortened significantly. For years, this has been a priority in Meilahti hospital, Helsinki. After the CT emergency department is notified, patient is brought straight from the ambulance into the CT scan room. Methods: The most important role of NCCT is to rule out contraindications such as haemorrhage before the iv-thrombolysis. Perfusion CT provides information of tissue at risk and tissue already destroyed via functional maps: cerebral blood flow, blood volume and mean transit time. CTA shows the location of possible vessel occlusion and verifies its ethiology. If intra-arterial thrombolysis or a mechanical thrombectomy is planned, CTA provides information about arterial anatomy. Conclusion/results: When iv-thrombolysis is considered for a patient with acute ischemic stroke, CT scan is the basic imaging method in Finland. A fast, trained system to treat the patient is vital for minimal ischemic damage to the brain. Imaging is an important part of this chain and the radiographer has an important role to ensure fast imaging with all the right imaging protocols. 1.2. Magnetic resonance imaging in acute stroke Presenter: David Ricardo Danger, HUS Medical Imaging Center, Mobile Imaging, Helsinki University Central Hospital, Finland Author: David Ricardo Danger Background: The diagnostic tool of acute ischemic stroke is computed tomography with non-contrast (CT). Recently MRI has been used in young patients; MRI has made great progress recently. Imaging times have shortened, resolution and signal-to-noise ratios have improved, and new imaging sequences have been developed. In the acute ischemic stroke, CT images are often normal or show subtle changes only. On the contrary, diffusion-weighted MRI (DWI) can reveal the ischemic lesion in its full extent within minutes; our department have been using DWI procedure as a primary series on the acute ischemic diagnostic follow by PWI and MRA in some cases. However access to MRI scanners is limited both during daytime (overbooked) and, also a few percent of all patients cannot be imaged with MRI because of claustrophobia. Furthermore, some patients have pacemakers (Patients using Pacemaker can be screening in our department, but should be inspected by a cardiologist and physics specialist previous the examination.), aneurysm clips, or other ferromagnetic material in their bodies and cannot be safely imaged with MRI. Teaching points: The objective of this clinical presentation is review the use of the DWI and PWI in the acute stroke patients as well as issues concerning the patient and staff safety in our department, underline the radiographer role on the this process, to obtain as soon as possible and on a very safe environment quality images. Methods: Our method was based on the monitoring of patients during the onset-door-needle process in our institution. Over a period of one year. Summary: In conclusion, MRI is increasingly used in the imaging of acute stroke patients, and this trend is welcome. Overall, MRI is diagnostically superior to CT for cerebrovascular indications, but is contraindicated in ≈10% of patients, has limited availability at many hospitals, and can be costly and time-consuming, however the use of PWI and DWI has shown high positive results in the diagnostic evaluation of suspected stroke patients and that is why the radiographer should recognize the use and misuse of these techniques to obtain quality imaging and thus accurate diagnostic. 1.3. Mechanical thrombectomy with acute ischemic stroke patients in the angio suite Presenter: Raisa Simula, HUS Medical Imaging Center, Helsinki University Central Hospital, Finland Authors: Raisa Simula, Marjut Tenhola, HUS-Medical Imaging Center Introduction: In Meilahti hospital Helsinki, around 50 mechanical thrombectomies (MET) are performed yearly on acute ischemic stroke patients. Working in this procedure can be demanding: it requires efficiency, precision and good interpersonal skills from the radiographer. MET is performed in an angiography suite (Meilahti has 3), where the patient is brought right after a CT-scan. This procedure is prioritized: one angio suite will be kept vacant or an ongoing procedure will be aborted for this. Quick and efficient recanalization can predict good recovery for the patient. As the patient arrives, at least 2 radiographers are needed: one in sterile outfit assisting the radiologist performing MET by preparing and handling the instruments and one who documents the procedure and brings in more equipment. Patient arriving will have at least a nurse and a neurologist arriving with them, also an anaesthesia team if required. It's the radiographer's responsibility to ensure everyone is properly protected from radiation. Also, flow of information between everyone is highly important. The procedure starts as the radiologist uses local anaesthesia on the patient's groin area, then punctures the a. femoralis communis. Through this puncture patient's a. carotis interna or a. vertebralis will be catetherized. Next, a Digital Subtraction Angiography (DSA) is performed to locate the the thrombosis. In Meilahti, removing of the thrombosis will be done with a stent-type device. Instruments and devices used in MET are very long and often difficult to handle. Preparing them requires skill from the radiographer. Methods: This presentation shows how important a radiographer's role is when performing MET. Key points are efficiency, precision, collaboration with other professionals as well as in-depth understanding of a radiographers role. Conclusion/results: In the future more MET will be performed on acute ischemic stroke patients and more radiographers will be working in this procedure. MET requires collaboration between different professionals. A radiographer is responsible for radiation protection and co-ordinating the medical staff together with the radiologist. Radiographers also perform the DSA-imaging instructed by the radiologist as well as gather and handle the instruments needed. 2. BREAST IMAGING 2.1. A Nigerian Hospital Experience in Breast Imaging Presenter: Mosunmola Oyinade Okedayo, Radiology Department, University of Maiduguri Teaching Hospital, Maiduguri, Borno state, Nigeria Authors: Mosunmola Oyinade Okedayo, Z. Mustapha, M. Ameadaji, M. Yusuf Introduction: Over the past few decades, in many developed countries, the use of evidence from well conducted, reproducible research studies has been encouraged as basis on which clinical decisions and interventional procedures in healthcare are based. This is termed evidence based practice (EBP). However, Nigeria, like most developing countries, is unable to implement full scale EBP due to inaccessibility to good research evidence, lack of adequate government funding, appropriate staff and patient enlightenment deficit. Globally, breast cancer is the second most common cause of deaths in females. Although its incidence is on the increase among Nigeria women, breast care awareness and interventions are still left to non- governmental organizations and the management


ISRRT | Book Of Abstracts
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