Advantages of Physiology No false positives Treat only those with viable tissue Use as triage: a tool to spare the expert in stroke?
Radiology will enthusiastically support acute stroke Give us the tools to do it Help us with the out of hours reporting Bear in mind we have other responsibilities too: Most radiologists cover all emergencies, not just neuro And there are not many of us! BUT
1. Plain scan only Who reports? Fear of onerous on call duty Consultant radiologists ideal In each hospital? Network in Wales, or wider UK - local/extended? Network outside Wales? Radiographer or stroke team report??
2. ASPECT score More radiologist experience needed Greater physician input Give drug or not? No longer a yes/no, now a maybe Further need for experienced clinician Use of the Alberta Stroke Program Early CT Score (ASPECTS) for Assessing CT Scans in Patients with Acute Stroke AJNR Am J Neuroradiol 22:1534 ﾐ 1542, September 2001. Alternatively, what percentage of the MCA territory is low density?
2. ASPECTS score reporting Need consultant radiologist In house local network outsource
3.Assess other pathology Need consultant radiologist As before
4. Perfusion data Need Neuroradiologist or highly specialised other person this may change in the future, but not yet Similar issues with location
Suggestion: All hospitals support IST3 Start slowly, learn where the problems are Build resources based on local experience Radiologist, radiographer, stroke team Look to develop perfusion scanning, 24/7 services over time