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|Year : 2016 | Volume
| Issue : 1 | Page : 12-13
Bedside computed tomography in traumatic brain injury
Vengalathur Ganesan Ramesh
Department of Neurosurgery, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu, India
|Date of Web Publication||11-Jan-2016|
Vengalathur Ganesan Ramesh
Department of Neurosurgery, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ramesh VG. Bedside computed tomography in traumatic brain injury. Neurol India 2016;64:12-3
The advances in technology have added one more important tool to the armamentarium of (neuro) imaging, that is, the portable computerized tomographic (CT) scanner. This has become a very important value added equipment contributing to patient services in emergency and intensive care departments. Obviation of the need to shift the critically ill patients to the site of the CT scan in the radiology department has reduced the risk of transportation to a great extent. Various types of portable CT scanners are becoming available in the market and more and more centers are in the process of acquiring them. The Department of Neurosurgery at the Jai Prakash Narayan Apex (JPNA) Trauma Center of the All India Institute of Medical Sciences, New Delhi, is one of the earliest departments to acquire the equipment and has reported one of the largest experiences with the portable CT scanner.,
Traumatic brain injury (TBI) occurs in a polytrauma setting in a significant percentage of road accidents and such patients have hemodynamic instability and require ventilatory support. These patients also have in place multiple intravenous infusion lines and monitoring devices. Transporting such patients to the CT scan room that is situated within the hospital premises may be a daunting task and carries the risk of deterioration ranging from 15% in the best of settings to nearly 70% in the worst case scenario in some hospitals. Moreover, the time taken for performance of a CT scan and the results being available to the treating neurosurgeon takes up to 50 minutes by the conventional transport to the Radiology department where the CT scanner is housed. It takes less than 20 minutes (12 minutes in the present series) to perform the scan and make the image available with the use of a portable CT scanner., More importantly, a portable CT scanner is economical compared to the fixed CT machines (The per-capita cost works to about Rs. 1340 in the present series). The portable CT scanner also takes the burden of emergency scans off the fixed CT scanner, which may be more effectively utilized in elective imaging.
As with any other equipment, there is also a flip side to the portable CT scanner. The image quality is one of them. Although the image quality may not match the high quality of a 64-slice or 128-slice CT machine, the images provided by the presently available 8-slice portable CT (CereTom, NeuroLogica) have an adequate diagnostic accuracy and reliability required for the emergency management setting. The arrival of the 32-slice wider bore portable CT scanners (BodyTom, NeuroLogica), may further bridge the gap. The other major concern is the radiation hazard. This is taken care of in most of the available portable CT machines and the radiation levels are kept to a bare minimum. The small bore of the CT scan gantry in the initially available portable CT scans made CT imaging of other parts of the body impossible. This may be taken care of by the newer wide bore portable CT scanners. The other major points of concern are the cost of the machine, its frequent maintenance, as well as the cost and feasibility of replacement of the radiation source. These concerns may be addressed more effectively in the near future.
Apart from the CereTom (NeuroLogica), the other portable CT scan systems including the Tomoscan (Philips Medical Systems), the xCAT ENT (Xoran Technologies) and the OTOscan (NeuroLogica) are available in the market and many more are in the offing. The Tomoscan is a portable head CT scanner while xCAT ENT and OTOscan are mainly meant for intraoperative ENT imaging. A wide bore whole body portable CT scanner is also becoming available with the arrival of BodyTom (NeuroLogica).
Apart from their usage in brain trauma, portable CT scanners have other applications also. It has a major application in acute stroke management. Apart from diagnosing acute subarachnoid hemorrhage and intracerebral hemorrhage, perfusion CT scans can be performed at the bedside to assess the ischemic penumbra prior to thrombolysis in ischemic stroke. Portable CT scanners can also be used in the operating room for planning the incision, to assess the completeness of tumor excision and to evaluate the presence of a postoperative hematoma, before the patient is moved out of the operating room. This may reduce the need for a post-operative imaging and a subsequent second surgery. Portable CT scanners are also incorporated in the special “Stroke Ambulances” in some countries. The portable CT scanners are also deployed in the sports arena in football and boxing stadia in some countries, for a quick scanning in case of accidental head or spine trauma during the matches. The images from a portable CT scanner may be effectively utilized in updating the intraoperative neuronavigation images after tumor resection to compensate for the brain shift during surgery.
The ability to perform a CT scan of the brain as a bedside investigation using a portable CT scan machine has become a reality. It is very valuable in the management of severe traumatic brain injury, acute stroke in both emergency room and intensive care wards, and also for an intra-operative imaging in the operating room.,, With the availability of more portable CT scanners with improved design, the cost is also likely to come down and portable CT will soon find widespread usage.
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