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CT - Gated Cardiac CT Scans for Congenital and Acquired Heart Disease

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Background

The diagnostic work up for congenital and acquired heart disease is complex and often requires a number of imaging modalities. The common advanced modalities routinely employed are echocardiography, MRI and cardiac CT. Echo is invariably the first line investigation with excellent imaging of intra-cardiac structures and vessels close to heart. Questions that cannot be answered with this modality are referred for either a CT or MRI. The modality chosen will be as a consequence of the question being asked and patient safety. The majority of the studies performed on patients under the age of 10 years will be under general anaesthetic. This is especially true when the structures being imaged are small such as coronary arteries.

The requesting physician needs to:

  • Justify why the investigations needs to be done
  • Address what question needs to be answered
  • Assess what impact the investigation will have on the patient's management

The information required needs to be clearly stated as this will influence how the study is performed and it may not be possible answer query retrospectively if the scan has not been set up to optimise imaging of specific anatomy or answering a question.

Booking procedure

(All queries can be discussed with booking personnel at ext 23619)

Routine bookings

There are two routine lists for cardiac CT under GA per week. They take place on Monday afternoon and Wednesday afternoon on alternate weeks ensuring availability of cardiac CT every week. A cardiac anaesthetist is rostered for these lists.

Requirements:

  • Bookings will need to be in place a month before the required date.
  • A booking form needs to be filled in on both sides and specifically it needs to be identified if the patient needs either a clinical review or additional investigations and who will be performing this and reviewing the results.
  • A ROERS needs to be complete and attached to the booking form and returned to the booking personnel in cardiology office
  • If the patient is considered high risk the high risk guideline needs to be followed.

Urgent bookings:

In most instances urgent cases can be accommodated on the routine lists. Availability needs to be ascertained from the booking personnel at ext 23618. If the patient cannot be accommodated on either of the existing lists, the following steps need to be taken:

  • An imaging consultant needs to be contacted to ascertain availability to perform the scan. ( Either Chris Occleshaw or John Stirling)
  • If it is a Tuesday or Thursday, contact the cath lab consultant to ascertain if there is flexibility of accommodating the patient on the cath lists: if there is the booking staff at ext 23618 must be contacted to add the patient to the existing list as directed by cath cardiologist. If this is not an option then:
  • A cardiac anaesthetist must be contacted via the Starship anaesthetic co-ordinator on 021 334344
  • The anaesthetist will indicate if the patient can be accommodated on an existing cardiac surgical list or if a SCOPE needs to be completed. The cardiology requesting team needs to specifically ask if this is a requirement.
  • If the patient is identified as High Risk, the High Risk protocol needs to be followed with requesting cardiology team ensuring availability of PICU beds should that be a requirement.
  • The MRT co-ordinating CT scans must be contacted on ext 25133, 25132 or if no reply at either of these numbers 23181 to ascertain availability of CT time.
  • A ROERS must be completed.

Is the patient high risk of an adverse event occurring during anaesthesia?

Follow the Guideline for the Management of High Risk Paediatric Cardiac Patients for Investigation under General Anaesthesia. If uncertain, discuss with the anaesthetist.

Points to bear in mind

  • The imaging consultant is not taking over the management of the patient.
  • If the information is required urgently, the requesting cardiology team needs to request that they be contacted with the result as reports will take a number of days to appear on the system. The images will however be immediately available for review.

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Document Control

  • Date last published: 07 October 2018
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology
  • Owner: John Stirling
  • Editor: Marion Hamer
  • Review frequency: 2 years