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Audit of post processing of CT brain scans  performed for dementia workup
EP34317
Poster Title: Audit of post processing of CT brain scans performed for dementia workup
Submitted on 29 Oct 2020
Author(s): Weiken Tan, Helena Birch, Helen Cliffe, Mark Igra
Affiliations: Leeds Teaching Hospitals NHS Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 44
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Poster Information
Abstract: Aims and Background:
Alzheimer’s disease (AD) is the commonest dementia subtype and hippocampal atrophy is a radiologically assessable marker of AD.(1-4) NICE recommends brain imaging to assess clinically equivocal dementia presentations.(5) In our institution, CT is the first-line investigation.
Research suggests hippocampal volume is reliably assessed using coronal images oriented perpendicular to the long axis of the hippocampus.(6,7)

We evaluated the percentage of dementia CT head studies with coronal images saved to the picture archiving and communication system (PACS) and the percentage of coronal reformats appropriately oriented, with the target of 100% respectively.

Methodology:
Consecutive outpatients CT studies requested for assessment of cognitive impairment and protocolled as a dementia study (5mm axial slices and 3mm coronal reformats) in January 2019 were identified using the radiology information system. Coronal reformats are performed by the CT radiographers prior to sending to PACS.

Data collected included patient demographics and request details.
Imaging was reviewed on PACS. The presence of stored coronal images and the plane of coronal reconstruction were assessed.

Results:
149 patients (84 Female: 65 Male) with a mean age of 79 years (range 60-96) were analysed.
99% had coronal reconstructions.
75% of coronal reconstructions were correctly orientated.
74% of scans overall had appropriately orientated coronal reconstructions.

Action plan:
1) Presentation of audit background and results to radiography team.
2) Update of CT protocol book explaining how to correctly construct coronal reformats.
3) Poster in CT scan room to highlight correct protocol.
4) Re-audit in 12 months.
Summary: An audit to assess the post-processing of CT head studies performed for the assessment of dementia.
References: 1. Prince, M. et al. Dementia UK : Second edition. (2014).
2. Whitwell, J. L. et al. Temporoparietal atrophy: a marker of AD pathology independent of clinical diagnosis. Neurobiol. Aging 32, 1531–41 (2011).
3. Scheltens, P. et al. Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: interobserver reliability. J Neurol 242, (1995).
4. Wattjes, M. P. et al. Diagnostic imaging of patients in a memory clinic: Comparison of MR imaging and 64-detector row CT. Radiology 253, 174–183 (2009).
5. National Institute for Health and Care Excellence. Dementia: assessment, management and support for people living with dementia and their carers. NICE guideline [NG97] (2018). Available at: https://www.nice.org.uk/guidance/ng97.
6. Scheltens, P. et al. Atrophy of medial temporal lobes on MRI in ‘probable’ Alzheimer’s disease and normal ageing: diagnostic value and neuropsychological correlates Imaging D Huglo M Steinling. Neurosurgery, and Psychiatry 55,
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