This is an education resource only. Ordering of all procedure codes on this website are subject to the Canberra Health Services guidelines for imaging orders.
INDICATIONS (1-4)
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Thunderclap headache with possible associated nausea, vomiting, photophobia & meningism.
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Subarachnoid haemorrhage to assess aneurysmal origin
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Vascular malformation within the brain
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Transient ischaemic attack
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Cerebral parenchymal haemorrhage, to assess for the presence of a vascular malformation or ongoing bleeding (spot sign)
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Known Aneurysm within Circle of Willis
PATHOLOGY DEMONSTRATED (5)
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Intracranial haemorrhage (ICH), subdural haemorrhage (SDH), extradural haemorrhage, subarachnoid haemorrhage (SAH)
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Brain contusion
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Ischaemic infarct (hyperdense artery sign), established infarct, subacute infarct
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Brain mass lesions (best visualised on a post contrast brain not angio)
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Mass effect due to associated pathology e.g. mass, ICH
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Skull # or lesion
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Brain inflammation secondary to infection, abscess (often a post contrast scan is indicated also)
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Cerebral oedema
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Cerebral atrophy (age related and pathological)
PATIENT PREPARATION
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Patient able to lie still for ten minutes
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Not claustrophobic (sedation may be given)
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Cognitively capable of following basic instructions
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Metal artefacts removed from the region of interest
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No respiratory distress when lying supine
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Not allergic to Iodine based Contrast
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No known kidney disease (EGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function
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No hyperthyroidism, may induce thyroid storm
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Patient to have 18G cannula in anterior cubital fossa to allow a 7ml/s flow rate(20G cannula acceptable if flushing to 5ml/s)
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Preferably patient fasted for 4 hours
ANATOMY INCLUDED
CT Brain - Non Contrast (Axial)
CT COW Angio (Axial)
CT Brain - Non Contrast (Coronal)
CT COW Angio (Coronal)
CT Brain - Non Contrast (Sagittal)
CT COW Angio (Sagittal)
REFERENCES
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Radiopaedia. CT Head. [Internet]. 2010 [updated 01 Dec 2021, cited 23 Nov 2021]. Available from https://radiopaedia.org/articles/ct-head
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American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2021, cited 23 Nov 2021]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria
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Radiopaedia. Brain tumours. [Internet]. 2008. [updated 18 Dec 2019, accessed 23 Nov 21]. Available from https://radiopaedia.org/articles/brain-tumours
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Radiopaedia. CT Angiography of the Cerebral Arteries (technique). [Internet]. 2018. [Updated 01 Jul 2021, cited 29/12/2021]. Available from https://radiopaedia.org/articles/ct-angiography-of-the-cerebral-arteries-technique
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Eisenberg RL., Johnson NM. Comprehensive Radiographic Pathology. 5th Edition. Elsevier Mosby, 2012.