Portable brain scanner saves time, neurons in ICU
By Ross Tomlin
The improved safety and the time saved by a new mobile brain scanner may translate into vastly improved outcomes for patients with severe traumatic brain injuries, say Baylor College of Medicine neurosurgeons who treat patients at the Harris County Hospital District's Ben Taub General Hospital in Houston.
A mobile version of computed tomography (CT), sometimes called CAT scan, is capable of generating high-quality images on par with conventional flat-bed CT scanners. The technology uses special x-ray equipment to obtain image data from different angles and then processes the information through a computer to show a cross-section of body tissues and organs.
Too sick for transport
"Patients in critical condition are really too sick to be transported to radiology when they need a scan because they're ventilated and receiving various intravenous fluids and medications that cannot be safely interrupted," said Claudia Robertson, M.D., professor of neurosurgery at BCM and medical director of the Neurosurgery Intensive Care Unit at Ben Taub General Hospital. "We can now perform the scan at their bedside without taking them out of a setting where they're being monitored very closely by ICU doctors and nurses."
Time is of the essence in cases of traumatic head injuries, where prompt detection of the swelling or bleeding in the brain is critical. For every minute that swelling or bleeding interferes with normal blood flow to the brain, hundreds of thousands of neurons, billions of synapses, and miles of axonal fibers are irreparably damaged. Robertson estimates that the portable scanner can save the ICU staff up to an hour, enabling a doctor to take appropriate measures more quickly.
"Transporting a critically ill patient to the radiology section of a hospital to be scanned with conventional CT requires a doctor, a nurse, a respiratory therapist, and someone to push the bed – four people that have to leave the ICU," said Robertson. "With this new technology, a CT technical assistant just has to come upstairs for a few minutes."
Keeping patients stable also limits the number of complications that can result from having to move them out of the ICU. During transport to radiology, mechanical ventilators are not available, and breathing must be assisted by manual "handbagging."
Avoiding disruptions
"If not performed properly, 'handbagging' can disrupt the pressure system inside the brain," said Shankar Gopinath, M.D., assistant professor of neurosurgery at BCM and chief of the neurosurgery service at Ben Taub General Hospital. "Also, when these patients have to move, the nurses taking care of them have to go with them, so other ICU staff members would need to cover additional patients. So from a nurse's point of view, the new scanner is also very useful."
Ben Taub General Hospital is one of the first six hospitals to use the mobile CT scanner, which is manufactured by Massachusetts-based NeuroLogica. Robertson and Gopinath foresee its use expanding not only to other hospitals in the near future but also to ambulances, where diagnoses and treatments could be made even sooner.
