1. 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

2. Dual energy CT Figure 1 - uploaded by Rajiv Gupta Download
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3. 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%

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

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

6. CTA

9. Triple rule out

10. Detection of other pathologies causing chest pain.

11. 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