Imaging of Chest Pain and the Acute Chest Grand round 4/10/18 Imaging of Chest Pain and the Acute Chest Dr Richard Beese Bsc (Hons ) MRCP FRCR

Dual energy CT Figure 1 - uploaded by Rajiv Gupta Download View publication                                                                                                                                                                                                                                             

Advantages of Dual energy CT Increases contrast of soft tissue leading to better image quality. Improves diagnostic information with contrast excellent for angiography Can determine chemical composition of tissue eg renal stones. Provides a non contrast image and non contrast image in the same data acquisition/ scan. Less scatter with metal implants Radiation dose reduction of 80%

Chest pain 30 % of medical admissions 50% no abnormal findings 3 major pathologies ACS Pulmonary emboli Aortic dissection

Triple rule out Arterial phase; Coronary arteries, aortic angiography Venous phase; Pulmonary arteries

CTA

Triple rule out

Detection of other pathologies causing chest pain.

What is needed to go forward ? Discussion between acute physcians , cardiologists Radiologists Feasability study ? Save money on admission rates. Business plan Protcols for patient selection ‘medium risk patients’ Training of CT staff