Gierhake D, Weber J E, Villringer K, Ebinger M, Audebert H J, Fiebach J B
Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin.
Rofo. 2013 Jan;185(1):55-9. doi: 10.1055/s-0032-1325399. Epub 2012 Oct 11.
To reduce the time from symptom onset to treatment with tissue plasminogen activator (tPA) in ischemic stroke, an ambulance was equipped with a CT scanner. We analyzed process and image quality of CT scanning during the pilot study regarding image quality and safety issues.
The pilot study of a stroke emergency mobile unit (STEMO) ran over a period of 12 weeks on 5 weekdays from 7a.m. to 6:30 p.m. A teleradiological service for the justifying indication and reporting was established. The radiographer was responsible for the performance of the CT scan on the ambulance. 64 cranial CT scans and 1 intracranial CT angiography were performed. We compared times from ambulance alarm to treatment decision (time of last brain scan) with a cohort of 50 consecutive tPA treatments before implementation of STEMO.
62 (95%) of the 65 scans performed had sufficient quality for reading. Technical quality was not optimal in 45 cases (69%) mainly caused by suboptimal positioning of patient or eye lens protection. Motion artefacts were observed in 8 exams (12%). No safety issues occurred for team or patients. 23 patients were treated with thrombolysis. Time from alarm to last CT scan was 18 minutes shorter than in the tPA cohort before STEMO implementation.
A teleradiological support for primary stroke imaging by CT on-site is feasible, quality-wise of diagnostic value and has not raised safety issues.
为了缩短缺血性卒中患者从症状出现到接受组织型纤溶酶原激活剂（tPA）治疗的时间，一辆救护车配备了CT扫描仪。我们在关于图像质量和安全问题的初步研究中分析了CT扫描的过程和图像质量。
卒中急救移动单元（STEMO）的初步研究在5个工作日上午7点至下午6点30分进行，为期12周。建立了用于确定适应症和报告的远程放射学服务。放射技师负责在救护车上进行CT扫描。共进行了64次头颅CT扫描和1次颅内CT血管造影。我们将从救护车警报响起至治疗决策（最后一次脑部扫描时间）的时长与STEMO实施前连续50例接受tPA治疗的队列进行了比较。
所进行的65次扫描中有62次（95%）图像质量足以用于解读。45例（69%）的技术质量并非最佳，主要原因是患者体位欠佳或晶状体防护不当。8次检查（12%）中观察到运动伪影。团队或患者均未出现安全问题。23例患者接受了溶栓治疗。从警报响起至最后一次CT扫描的时间比STEMO实施前tPA治疗队列缩短了18分钟。
通过现场CT对原发性卒中成像进行远程放射学支持是可行的，在诊断价值方面质量良好，且未引发安全问题。
