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01-04-2009 | Chest

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

Authors: Thomas Frauenfelder, Philippe Appenzeller, Christoph Karlo, Hans Scheffel, Lotus Desbiolles, Paul Stolzmann, Borut Marincek, Hatem Alkadhi, Thomas Schertler

Published in: European Radiology | Issue 4/2009

Abstract

Triage decisions in patients suffering from acute chest pain remain a challenge. The patient’s history, initial cardiac enzyme levels, or initial electrocardiograms (ECG) often do not allow selecting the patients in whom further tests are needed. Numerous vascular and non-vascular chest problems, such as pulmonary embolism (PE), aortic dissection, or acute coronary syndrome, as well as pulmonary, pleural, or osseous lesions, must be taken into account. Nowadays, contrast-enhanced multi-detector-row computed tomography (CT) has replaced previous invasive diagnostic procedures and currently represents the imaging modality of choice when the clinical suspicion of PE or acute aortic syndrome is raised. At the same time, CT is capable of detecting a multitude of non-vascular causes of acute chest pain, such as pneumonia, pericarditis, or fractures. Recent technical advances in CT technology have also shown great advantages for non-invasive imaging of the coronary arteries. In patients with acute chest pain, the optimization of triage decisions and cost-effectiveness using cardiac CT in the emergency department have been repetitively demonstrated. Triple rule-out CT denominates an ECG-gated protocol that allows for the depiction of the pulmonary arteries, thoracic aorta, and coronary arteries within a single examination. This can be accomplished through the use of a dedicated contrast media administration regimen resulting in a simultaneous attenuation of the three vessel territories. This review is intended to demonstrate CT parameters and contrast media administration protocols for performing a triple rule-out CT and discusses radiation dose issues pertinent to the protocol. Typical life-threatening and non-life-threatening diseases causing acute chest pain are illustrated.

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Title: Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings
Authors: Thomas Frauenfelder
Philippe Appenzeller
Christoph Karlo
Hans Scheffel
Lotus Desbiolles
Paul Stolzmann
Borut Marincek
Hatem Alkadhi
Thomas Schertler
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2009
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-1231-3

At a glance: The STEP trials

Springer Medicine

Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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