8th Baltic Congress of Radiology

Neuroradiology

oral abstract

Brain death is the permanent cessation of all the functions of the brain and brainstem. Due to the development of the intensive care and transplantology industries, one person after death can save many others by donating their organs, at the same time it’s necessary to perform additional examinations in the diagnosis of brain death and computed tomography angiography (CTA) is one of options. The actuality of the topic is determined by the fact that currently in Latvian hospitals is missing unified protocol in computed tomography (CT) examination method, this relatively rare investigation can cause difficulties for radiographers. Development and implementation of a common protocol would facilitate work for radiographers in examinations for diagnosis of brain death. CTA is “gold standard” for additional tests in diagnostics of brain death because of availability and speed. The hypothesis of work is: CT protocol for confirming brain death in each institution is different. Aim of work: To find out the use of computed tomography protocol in brain death confirmation.

The research tool is a research protocol. Research method is qualitative research - comparative analysis of: • CT protocols in the diagnosis of brain death in different countries guidelines and investigations; • CT protocols in the diagnosis of brain death in different hospitals in Latvia.

In different countries are used different CT protocols for diagnosis of brain death, and In different hospitals of Latvia are used different protocols for diagnosis of brain death. Various examination protocols and guidelines are reviewed and analyzed, a summary is obtained, which is then described in the research part of work, the most important sections: • Positioning: before examination patient's head is placed in a special pad, secured with positioning pads and fixation tapes to prevent possible movement artifacts. • Topogram: is obtained as a radiographic image in the AP and LL planes. • Zone of examination: In the literature, several lengths of the study area are selected. For the evaluation of intracranial blood vessels, the beginning of the scan is planned starting from the base of the skull or from the neck to the 1st. vertebra. If cervical blood vessels are included in the examination, scanning area is extended until the 5th-6th cervical vertebrae, or until the bifurcation of the pulmonary arteries in the middle of the chest. In three hospitals of Latvia, where this protocol is used, scanning area may be differ. • Scanning type: CT head – axial, CTA – spiral. • Slice thickness (mm): Axial - 2,5/5.0, Spiral – 0,625, in literature information varies (0,625; 1,0; 2,0; 3,0mm). • SFOV – small (25cm). • FOV – includes area of examination. • Reconstruction algorithm: standard. • Window width/level: Native 100/30, CTA 500-600/100-200 • Exposition factors: kW/mAs 120-140/120-540 • Scanning phases and interval between them – in literature and in almost all hospitals included in research is used native phase, 1st phase with contrast media (20 seconds after injection), 2nd phase (50 or 60 seconds after contrast media). In one hospital in Latvia don’t use native head examination and venous phase. • Contrast media volume and rate: 65-120 ml/ 3-5 ml/s • Contrast media monitoring-localization: A. carotis or ascending aorta.

Full-fledged cerebral blood circulation and brain function provide optimal maintenance of vital functions. ‘Brain death’ implies irreversible changes in blood circulation and the brain, it can be caused by various types of brain damage. Brain death is a clinical diagnosis – death is defined as permanent loss of brain function, clarification of diagnosis requires imaging tests. CTA is a minimally invasive, fast, and accessible method, applied to detect reduced or absent blood flow for the brain, it’s effective if an appropriate examination protocol is used. Full-fledged cerebral circulation and brain function provide optimal maintenance of vital functions. ‘Brain death’ implies irreversible changes in blood circulation and the brain, it can be caused by various types of brain damage. Brain death is a clinical diagnosis – death is defined as permanent loss of brain function. Clarification of diagnosis requires imaging tests that are different but have a common denominator and the detection and demonstration of cerebral blood flow insufficiency. CT is a minimally invasive, fast, and accessible method, applied to detect reduced or absent blood flow for the brain, it’s effective if an appropriate examination protocol is used. The CT protocol for confirming brain death, based on guidelines and literature, provides for its application in sequential steps, providing the radiologist with a qualitatively interpretable test result. The CT protocol for confirming brain death is used differently in three hospitals of Latvia. Development and implementation of a common protocol would facilitate the use of computed tomography to confirm brain death. The CT protocol for confirming brain death is used differently in three hospitals of Latvia. Development and implementation of a common protocol would facilitate the use of computed tomography to confirm brain death.

CT is a minimally invasive, fast, and accessible method, applied to detect reduced or absent blood flow of the brain, it’s effective if an appropriate examination protocol is used. In different countries and even hospitals, are used different CT protocols for examination in diagnosis of brain death. Development and implementation of a common protocol would facilitate work for radiographers in examinations for diagnosis of brain death.

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