Multislice CT scan is a necessity

With more than 30 years of experience in medical practice and managing a multi-specialty hospital, I appreciate the importance of good diagnostics. Any hospital is incomplete without a dedicated imaging department with the right kind of equipment. 20 years back, having a CT scan was not common even in big hospitals, but these days it is an absolute necessity.

At SSB Heart and Multispecialty Hospital, Faridabad, a 250-bedded hospital, we have 128-slice (500 slice for chest and abdomen equivalent) digital CT scan machine. It is the next-generation volume CT with clarity imaging chain that delivers high-resolution images, which are very helpful in real clinical scenarios. It is also designed to reduce heat generation and thus less electric noise, which makes the patient less anxious. As the chairman and managing director of the hospital, I look at how a machine can support a clinician in making quick and accurate diagnosis as well as how satisfied the patient is with the overall experience. Our CT scan also has a high helical pitch and rotation speed up to 0.35 seconds, which allows for faster scan time, lesser breath-hold time, and less patient movement artefacts, thus avoiding need for sedation.

I would like to highlight certain case scenarios where the features of CT scan are very useful and lifesaving for the patient. When a patient with chest pain comes to the emergency with normal ECG, our CT scan can do triple rule-out angiography to scan the coronaries, pulmonary circulation, and aorta to rule out life-threatening cause like acute coronary syndrome, pulmonary embolism, aortic dissection, with a single dye injection. It can also rule out other life-threatening causes of chest pain like tension pneumothorax, mediastinitis, and pneumonia. If all of these are ruled out, then the patient can be sent home safely without need for admission in the hospital or need for any other tests. Similarly, angiography of abdominal aorta and lower limbs can also be done in a single dye injection to assess for aneurysms and the extent of stenosis, which is now almost mandatory for assessment of peripheral arterial disease. This allows proper planning of interventions like angioplasty, stenting, or bypass surgery of the diseased peripheral vessels. It is also a very useful tool for checking the status of bypass grafts, which are accurately delineated on CT angiography and for planning angioplasty in patients with chronic total occlusion of the coronary artery. No other modality can give such insights into the degree of calcification at the site of occlusion. Thus, as an interventional cardiologist, I feel it is absolutely necessary to have such a CT scan in a good cardiac center for correct diagnosis and planned intervention.

It also has Neuro3DDSA with single click extraction of the whole vessel tree as well as Neuro4DDSA, making it very useful in neurology patients who come with intracranial bleed as it gives whole-brain vessel imaging on a single click to rule out aneurysm or A-V malformation, thus allowing for appropriate intervention. In patients of stroke, it helps in quickly ruling out hemorrhage so that the patient can undergo timely thrombolytic therapy where every minute saved is crucial for the patient’s stroke recovery.

For patients with intra-peritoneal bleed, this is the best modality to find the bleeding branch very precisely, out of a network of thousands of small blood vessels in the abdomen, which then helps in sealing that branch by peripheral intervention. This is far superior to the traditional exploratory laparotomy to search for bleeder and saves the patient from extensive and time consuming surgery with high chances of failure.

In my experience, I have seen many patients whose life was saved by interventional treatments after detecting the source of bleeding in abdomen and chest with the help of CT angiography on a good 128-slice machine.

Nowadays, having a good multi-slice CT scan is a necessity for all good hospitals.