Page 152 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
35 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
MRI:
MRI has a limited role in trauma imaging owing to the inherent dangers of undiagnosed metallic foreign bodies, cost and availability. The use of MRI is mainly restricted to non-emergent spinal cord, brain and joint injuries on request of appropriate specialists.
Clinical Urgency: as noted above
The ‘Choosing Wisely’ recommendations include:
Avoid the routine use of “whole-body” diagnostic CT scanning minor or single system trauma.
Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated clinical decision rule
Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (localised bone tenderness or inability to weight-bear as defined in the Rules)
Vascular Imaging in Stroke and TIA
Carotid Doppler ultrasound is the preferred modality we use for assessing for carotid stenosis after TIA or stroke to determine the suitability for surgery. MRA (or CTA) may occasionally be indicated to clarify the degree of stenosis. Discuss cases with Vascular Surgery.
CT angiography (CTA) may provide important information on large artery atheroma in the aetiology of the stroke or TIA. CTA can be used in very selected cases, if findings would alter management, to:
• differentiate between high risk large artery atheroma and low risk lacunar cases
• assess the severity of stenosis of calcified intracranial vessels
The request for CTA should always be endorsed by a SMO.
The ‘Choosing Wisely’ recommendations include:
Don’t screen for carotid artery stenosis in asymptomatic adult patients.
Don’t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.
Don’t initiate routine evaluation of carotid artery disease prior to cardiac surgery in the absence of symptoms or other high-risk criteria.
Clinical Urgency: CTA in suspected dissection should be done at the time of the CT which will be done according to the guidelines above. MRA, if indicated, will not usually be done overnight.
Disclaimer: This document has been developed by Waikato District Health Board specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at their own risk and Waikato District Health Board assumes no responsibility whatsoever.