Upfront vascular imaging in acute stroke: Impact on thrombectomy transfer time at a primary stroke center.

OBJECTIVES: Early cerebral arterial imaging is currently only recommended in the subgroup of acute ischemic stroke (AIS) patients suspected of having large vessel occlusion (LVO). There is limited data on the impact of early cerebrovascular imaging in all suspected AIS patients presenting within 24 h of symptom onset and the impact on door in-door out (DIDO) time. MATERIALS AND METHODS: In January 2020, our Primary Stroke Center implemented a protocol to perform upfront head and neck CT angiography (CTA) with initial non-contrast CT head for all suspected ischemic stroke patients screening positive for BE-FAST stroke symptoms within 24 h from last known normal time. We retrospectively reviewed IV alteplase and thrombectomy-eligible patients before (January 1-December 31, 2019) and after protocol implementation (January 1, 2020-June 30, 2022). RESULTS: Of 86 patients meeting study criteria, up-front CTA was associated with significant reductions in door-to-CTA start (median 37 vs 15 min, p = 0.003), door-to-CTA result (median 83 vs 52 min, p = 0.023) and DIDO times (median 150 vs 106 min, p = 0.023). There was no significant difference in door-to-needle time before and after protocol implementation (median 48 vs 43 min, p = 0.450). CONCLUSION: Up-front cerebrovascular imaging with CTA in suspected AIS patients presenting within 24 h resulted in shorter DIDO times without delaying door-to-needle times. Primary Stroke Centers should consider this approach to detect LVO early and expedite patient transport to thrombectomy capable centers.

Neuroimaging of Adults with Headache: Appropriateness, Utilization, and an Economical Overview.

One of the most common reasons that a patient seeks out a health care provider for a neuroscience-related issue is headache. Not all patients can, or probably should, be imaged with headache. We must use an approach that attends to scientific evidence, accepted guidelines, and available resources. This approach should focus on quality, safety, appropriateness, and utilization. This article reviews and discusses the consideration of imaging adult patients with headache.

Increasing utilization of emergency department neuroimaging in Medicare beneficiaries from 1994 to 2015.

OBJECTIVE: To assess for changes in emergency department (ED) utilization of neuroimaging in Medicare fee-for-service beneficiaries from 1994 to 2015. METHODS: Using Medicare Physician Supplier Procedure Summary Master Files, annual ED volumes of head computed tomography (CT), magnetic resonance (MR), and carotid duplex ultrasound (CDUS) were assessed from 1994 through 2015. Annual volumes of head CT angiography (CTA), neck CTA, head MR angiography (MRA), and neck MRA studies were assessed from 2001 (first year of unique reporting codes) through 2015. Longitudinal population-based utilization rates were calculated using annual Medicare Part B enrollment, and utilization rates were normalized annually per 1000 ED visits. RESULTS: From 1994 through 2015, ED neuroimaging utilization rates per 1000 ED visits increased 660% overall (compound annual growth rate [CAGR] 9%); 529% for head CT (CAGR 9%); 1451% for head MRI (CAGR 14%); and by 104% for CDUS (CAGR 3%). From 2001 to 2015, rates increased 14,600% (CAGR 43%) and 17,781% (CAGR 45%) for head and neck CTA, respectively, and 525% (CAGR 14%) and 667% (CAGR 16%) for head and neck MRA, respectively. Trends were similar when volumes were normalized for annual Medicare fee-for-service enrollment. Non-contrast head CT was the most common imaging modality throughout the study period (86% of annual neuroimaging volume in 1994; 89% in 2015). CONCLUSIONS: In Medicare beneficiaries, neuroimaging utilization in the ED grew unabated from 1994 through 2015, with growth of head and neck CTA far outpacing other modalities. Non-contrast head CT remains by far the dominant ED neuroimaging examination.

Unexpected intrathecal haemorrhage following uncomplicated placement and removal of an epidural catheter.

We report a case of intrathecal and epidural haemorrhage 2 weeks after uncomplicated placement and removal of an epidural catheter in a patient that was initially scheduled for surgical repair of an aortic dissection and aneurysm. Included in this case report is a literature review and discussion of similar entities, differential diagnoses, and high yield learning points.

Change Management for Radiologists.

Change management refers to the research, science, and tools that prepare, equip, and enable individuals to adopt transformation successfully. Implementation of this discipline involves familiarity with an organization's culture, people, and structure. Several frameworks exist within which radiologists can successfully apply these concepts. With changes occurring within health care and within the field of radiology itself, it will be increasingly important for radiologists to familiarize themselves with and adopt the principles of change management in their practices.

Professional Social Networking in Radiology: Who Is There and What Are They Doing?

RATIONALE AND OBJECTIVES: Although it is perceived that the use of social media professionally is increasing among radiologists, little is known about the habits and demographics of this subspecialty. This study aims to compare radiologists who use social networking for professional purposes to those who do not with regard to their characteristics, habits, and attitudes. MATERIALS AND METHODS: Radiologists were invited by e-mail and through posts on social networks to participate in a survey on the use of social media platforms. Questions included type of user, pattern of use, and benefits and barriers. Professional users and professional nonusers were compared. RESULTS: One hundred eighty-six radiologists responded. One hundred ten (59.1%) used social networking for professional purposes, 34 (18.2%) for personal-use only, and 42 (22.6%) denied using social media. LinkedIn was the most common platform among all professional users, and Twitter was the most commonly used platform among highly active professional users. Trainees comprised 52 out of 110 (47.3%) professional social networking users compared to 18 out of 76 (23.7%) nonusers (P < 0.01). A subgroup analysis on Twitter use for professional purposes revealed a significant gender difference: 15 out of 66 (22.7%) professional Twitter users were female compared to 48 out of 120 (40.0%) non-Twitter users (P < 0.05). The greatest barrier to professional social media use for nonusers was confidentiality. CONCLUSION: Nearly 60% of radiologist respondents use social networking for professional purposes. Radiology is likely to see growth in the role of social networking in the coming years as nearly half of professional users are radiology trainees. Twitter use for professional purposes among radiologists was disproportionately male. It is important to be cognizant of gender imbalance and to improve visibility of female leaders on social networking.