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The role of the radiographer

Radiographers undertaking this work not only have highly specialist skills in imaging modalities, but are experienced in the care and techniques required for scanning acutely ill patients who require urgent assessment during a critical period of the care pathway. Additionally, they may also have the advanced practitioner skills to review and report the images obtained to help facilitate rapid access to thrombolytic therapy by the stroke care team, or neurosurgical review, within the short timescale required. They may also be able to undertake the further imaging techniques such as CT Angiography and CT perfusion imaging. There will also be a need for MR scanning, specifically for TIA including Diffusion Weighted Imaging (DWI), MR perfusion, and, in addition, Magnetic Resonance Angiography (MRA), Contrast Enhanced MRA (CEMRA) if appropriate, and Carotid  Imaging.

Imaging overview

The Department of Health document Implementing the National Stroke Strategy: an imaging guide4 advises that Imaging Services Managers will need to be able to provide the following services:

TIA

  • MRI/MRA brain scans available seven days per week for those patients who require it. Scanners will be required to have appropriate software for gradient echo and diffusion weighted imaging.

  • provision for Contrast Enhanced MRA (CEMRA) for first line carotid imaging with facilities for pump injection

  • carotid imaging available seven days per  week, which will ideally include CEMRA and duplex ultrasound, and CT angiography, although this would depend on local protocol.

The Department of Health (DH) Stroke Policy Team recognises that this will be difficult to deliver. If MR is available, patients may have CEMRA at the same time. However, if MR is not available, but Carotid Doppler is, then that should be the pathway. The DH Stroke Policy Team advice is not prescriptive and a patient should only need one pathway.

Stroke

  • 24 hour access to CT with patients who may be suitable for thrombolysis being scanned within as short a timescale as possible, but within the next (appropriately triaged) slot in normal working hours and within 60 minutes outside normal working hours

  • rapidly accessible MRI, with the features described above for those patients who require it

  • the ability to undertake more complex imaging examinations for stroke subtypes as described.

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