Category Archives: Imaging Protocols and Techniques
Open letter in response to NYT article from July 31, 2010 “The Radiation Boom After Stroke Scans, Patients Face Serious Health Risks” By WALT BOGDANICH
posted by Michael H. Lev and Max Wintermark
Every year in the United States, more than three quarters of a million people have a stroke, and approximately every 3 minutes someone dies from a stroke. A significant portion of stroke victims are young, and left with a devastating handicap for the rest of their lives. The monetary and societal costs of stroke represent a major economic challenge to the healthcare system. With stroke – as with heart attack – rapid treatment is essential to limit the extent of irreversible brain injury (“time-is-brain”), and rapid determination of the cause and degree … Continue reading >>
Until recently we have been scanning routine CT heads using a sequential technique with 5 mm slices through the posterior fossa and 10 mm slices of the supratentorial compartment. With a change of machines the protocols were revamped and we are now using sequential 5 mm thick slices all the way through.
One of my colleagues has complained about this change, stating that lesion conspicuity will be reduced by using thinner slices above the tent. I personally prefer the uniform and thinner slice thickness but cannot find anything in the literature to support either argument – there is lots about … Continue reading >>
By now most Neuroradiologists are aware of the US Food and Drug Administration notification regarding dangerous levels of radiation exposure produced in one facility while performing CT perfusion. This unfortunate event has been front page material for the media, leading to patient anxiety and, more important, to questions regarding the use of this valuable technique. The facility involved has recently revealed that 260 patients were exposed to high radiation levels; 20% of cases involving the eyes which places these individuals at high risk for cataracts. It should come as no surprise that by the time of this writing, legal action … Continue reading >>
In the recent paper of Kim et al. , the authors attempt for first time to examine the relationship between pharmacokinetic parameters, obtained by dynamic contrast-enhanced (DCE)-MRI, of a metastatic target node and treatment outcome in patients with neck cancer. The paper makes 3 important contributions to the DCE neck imaging: 1) adding to the evidence gained by Cao et al. , Kim et al. derived (based on a two-compartment pharmacokinetic model) quantitative perfusion-associated parameters 2) similarly to the work of Bisdas et al.  microcirculation parameters (other to blood flow, blood volume, and permeability) such as Ktrans (transfer constant), … Continue reading >>
Fall is upon us and so is the lecturing season! Like years before, this Fall I will be giving my brachial plexus lecture several times and the most commonly asked question by the audience is: “where can I get your MRI protocol?” For this reason I am posting it here. Posting of protocols seems to gather considerable attention; Dr. Wiggins post on MRI and CT protocols has been viewed over 1900 times! Caveats regarding this post: our BP protocol was designed to satisfy the needs of our clinicians here at UNC, your referring physicians may be expecting … Continue reading >>
I would like to know how much intrathecal contrast to inject for a CT cisternogram via a lumbar puncture approach. I am not sure.… Continue reading >>
Alisa Gean is doing a great job getting a group together to share and collaborate neuro protocols. This would be a great place from members to share protocols, and open a discussion about the best imaging techniques.