CT Clinicals Update

I had no idea I would have something for everyone so soon! We had an interesting case that I got to follow through on beginning with the planning of the patient with the Radiologist's portion of the exam to the CT exam at the end. This patient was in the ICU and intubated and a request came down for a cervical myelogram. Most Radiologists perform their lumbar punctures with the patient prone so he wanted to have some senior tech involvement and the Team Leader for the area was off. So, I assisted. Below is a brief case study of the patient:


We received a 61 y/o male through the emergency room for a CT cervical spine among everything else ordered. He was alert and orientated and was responding to questions. However, he had tingling sensation to the nipple line, but was unable to feel anything from that point down. He suffered a 4 foot fall from a truck bed.

The exam was performed and it was noted that he had a significant C-3 fracture with significant offset. All other imaging studies were negative. After a short time in the emergency room, the patient's respiratory effort declined significantly and had to be intubated.

The following day a CT cervical myelogram was ordered. An attempt by the Radiologist was made, but due to equipment and patient condition a blind stick by the Neurosurgeon in the ICU was performed. The patient then returned to the CT suite to have post images performed.

I've attached the reformats performed and it shows a moderate to severe disc bulge. This certainly can be causing his paralysis.

Neurosurgeon re-evaluated patient and states he is ineligible for MRI due to pain stimulator implant. He will give the patient another day to recover and see him again to evaluate stability with flexion and extension movements. He also states that he has cord contusion that can resolve with some time.

Due to the numbness/tingling and inability to feel past that point the ED physician felt certain that there was a spine injury. These injuries can resolve on their own, with medications, or often require surgery to assist healing.

Update from Deaconess!

Well, things are very busy for me lately. Our new EMR has been implemented and like all new systems...there have been a few bumps in the road. I've had to spear-head collection of issues and assist in getting information out to staff. Lots of issues surrounding availability of reports in a timely manner.

Things are very busy in our CT and MRI departments after a brief lull. We are seeing flu symptoms of course, but have had a influx of trauma and broken bones as well. We have a new traumatologist at Deaconess and he is having us do lots of 3d images via our Tera Recon workstation now. So, we've been training everyone on those. Here is an example...

This was scanned at 2mm increments on our VCT 64 slice scanner. We then reformat an AP pelvis, and inlet and outlet views on every trauma for sure, but he'd like them for all ER pelvis exams. They are just a little time consuming so we haven't gotten that far yet. This particular patient had IV contrast for an abdomen as well and had a catheter in. It showed that really well! It's unbelievable the detail we get from our workstation.

I hope everyone has a great Thanksgiving!

Update from Clinicals at Deaconess

Hello all! We are speeding right along to a new Electronic Medical Record here at Deaconess and all Deaconess sites. We've gone through training and been able to log in to play with the system. But, to be honest, I am just very ready to do it. I have been rotating around trying to help refresh staff, but I am also replacing people so they can go to class or the open labs. This past weekend I went to Gateway.

I am attaching a couple of images from scans that I performed. One was a worsening small bowel obstruction. We scanned her routinely and the reformatted in coronal and sagittal images. Our main radiologist who works with our contrast and protocols just changed everything and we are back to giving 100 cc's of Omnipaque. So, we'll see how things look.

The next picture is an axial image of a probable hemangioma. It was scanned as a routine abdomen/pelvis from the ER. So, if this is something clinically needing follow up we will do a dedicated hemangioma protocol on her. This gives us a without and then arterial and venous phases of contrast enhancement.

Wish me luck this weekend! I will be living at Deaconess for the next two weeks!

Susan

Update 2 on CT clinical experiences

I hope everyone is doing well so far this semester! Deaconess is currently going through the process of implementing an electronic medical records system. So, there are lots of training activities going on throughout our department across all campuses. I am helping in the training, but I am also assisting in the CT and Diagnostic areas to make things a little easier while others are gone to class. I worked Friday at the Main Campus in CT. We had alot going on through the ER and also just general OP work. I worked on our 16 slice scanner and did most Emergency Room work. I had an elderly lady with a severe headache with a history of hypertension. The patient had no history of CVA, although looking at her images she definitely had a CVA in the past. The next patient was a patient who'd fallen from a ladder. We scanned her head and cervical spine with sagittal and coronal reformats. By the time I'd gotten back there, we'd finished our biopsy for the day. When our main interventionalist is gone our special procedure work tends to wane. We typically do a minimum of 2 procedures per day, but many days may do up to 5. Our latest addition that has become a little more routine for us is a CT guided liver ablation. I will try to get back there for the next one and scan for it so I can post a picture for you guys. They are extremely involved procedures that includes anesthesia and our cardiovascular short stay unit.

Susan Brumley

Update on Clinicals 1

Hello all!

I hope your clinical time has been going well. I actually have a bit of a different role in my department. I am a supervisor, so I don't scan all day anymore. So, I take opportunities to actually schedule myself back in CT at either Deaconess Main Campus or Deaconess Gateway. This past weekend I worked at Gateway. It was actually a pretty routine shift. Lots of abdominal pains and stone protocols. The only thing that was of any major difficulty was a PE study on a mid-50's gentleman with stage IV lung cancer. He was not in good shape and it was a modified exam, to say the least. I've included a couple of images that might be of interest to someone. I scanned a gentleman who had a history of DVT/PE. He had an IVC filter placed. This picture is at the top of the blog. You can see the "white" around the inferior vena cava. This is one image showing the filter. Since we retro back at such thin intervals, you can get a great idea what this filter looks like. The second picture denotes a renal stone in a young female that caused a mild to moderate obstruction.

Susan Brumley