Coming Soon to EDs: The Speedy ‘Triple Rule Out’

2005 ◽  
Vol 38 (20) ◽  
pp. 59
Author(s):  
ROBERT FINN
Keyword(s):  
Triple Rule Out ◽  
Rule Out

scholarly journals The triple rule out CT in acute chest pain: a challenge for emergency radiologists?

2021 ◽  
Author(s):  
Vincenzo Russo ◽  
Camilla Sportoletti ◽  
Giulia Scalas ◽  
Domenico Attinà ◽  
Francesco Buia ◽  
...  
Keyword(s):  
Chest Pain ◽  
Emergency Radiology ◽  
Acute Chest Pain ◽  
Radiology Workflow ◽  
Radiology Department ◽  
Atypical Chest Pain ◽  
Triple Rule Out ◽  
Good Diagnostic Accuracy ◽  
Rule Out ◽  
Ct Studies

Abstract Purpose To evaluate the feasibility of triple rule out computed tomography (TRO-CT) in an emergency radiology workflow by comparing the diagnostic performance of cardiovascular and general radiologists in the interpretation of emergency TRO-CT studies in patients with acute and atypical chest pain. Methods Between July 2017 and December 2019, 350 adult patients underwent TRO-CT studies for the assessment of atypical chest pain. Three radiologists with different fields and years of expertise (a cardioradiologist—CR, an emergency senior radiologist—SER, and an emergency junior radiologist—JER) retrospectively and independently reviewed all TRO-CT studies, by trans-axial and multiplanar reconstruction only. Concordance rates were then calculated using as reference blinded results from a different senior cardioradiologist, who previously evaluated studies using all available analysis software. Results Concordance rate was 100% for acute aortic syndrome (AAS) and pulmonary embolism (PE). About coronary stenosis (CS) for non-obstructive (<50%), CS concordance rates were 97.98%, 90.91%, and 97.18%, respectively, for CR, SER, and JER; for obstructive CS (>50%), concordance rates were respectively 88%, 85.7%, and 71.43%. Moreover, it was globally observed a better performance in the evaluation of last half of examinations compared with the first one. Conclusions Our study confirm the feasibility of the TRO-CT even in an Emergency Radiology department that cannot rely on a 24/7 availability of a dedicated skilled cardiovascular radiologist. The “undedicated” radiologists could exclude with good diagnostic accuracy the presence of obstructive stenosis, those with a clinical impact on patient management, without needing time-consuming software and/or reconstructions.

Triple Rule-Out CT in Patients with Suspicion of Acute Pulmonary Embolism

2009 ◽  
Vol 16 (6) ◽  
pp. 708-717 ◽  
Author(s):  
Thomas Schertler ◽  
Thomas Frauenfelder ◽  
Paul Stolzmann ◽  
Hans Scheffel ◽  
Lotus Desbiolles ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Triple Rule Out ◽  
Rule Out

Comparison of Triple-Rule-Out Prospectively ECG-triggered Systolic and Diastolic Acquisition Protocol in Patients With Acute Chest Pain

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Michele Fusaro ◽  
Damiano Caruso ◽  
Giovanni Tessarin ◽  
Domenico de Santis ◽  
Giovanni Balestriero ◽  
...  
Keyword(s):  
Chest Pain ◽  
Acute Chest Pain ◽  
Acquisition Protocol ◽  
Triple Rule Out ◽  
Rule Out

Triple rule-out CT angiography protocol with restricting field of view for detection of pulmonary thromboembolism and aortic dissection in emergency department patients: simulation of modified CT protocol for reducing radiation dose

2016 ◽  
Vol 58 (5) ◽  
pp. 521-527 ◽  
Author(s):  
Hyun Su Kim ◽  
Sung Mok Kim ◽  
Min Jae Cha ◽  
Yoo Na Kim ◽  
Hae Jin Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Radiation Dose ◽  
Aortic Dissection ◽  
Ct Angiography ◽  
Pulmonary Thromboembolism ◽  
Acute Chest Pain ◽  
Field Of View ◽  
Ct Protocol ◽  
Triple Rule Out ◽  
Rule Out

Background Triple rule-out computed tomography (TRO CT) is a CT protocol designed to simultaneously evaluate the coronary, aorta, and pulmonary arteries. Purpose To evaluate potential diagnostic performance of TRO CT with restricted volume coverage for detection of pulmonary thromboembolism (PTE) and aortic dissection (AD). Material and Methods This study included 1224 consecutive patients with acute chest pain who visited the emergency department and underwent TRO CT using a 128-slice dual-source CT. Image data were reconstructed according to the display field of view (DFOV) of coronary CT angiography (CCTA) and TRO CT protocols in each patient. The presence of PTE and AD was evaluated by independent observers in each DFOV. The radiation dose was calculated to evaluate the potential benefits by restricting z-axis coverage to cardiac scan range instead of the whole thorax. Results Among all patients, 22 cases with PTE (1.9%) and nine cases with AD (0.8%) were found. Except for one PTE case, all cases were detected on both DFOV of TRO CT and CCTA. Mean effective dose for evaluation of entire thorax and cardiac scan coverage were 5.9 ± 1.1 mSv and 3.5 ± 0.7 mSv, respectively. Conclusion Isolated PTE and AD outside the CCTA DFOV rarely occur. Therefore, modified TRO CT protocol using cardiac scan coverage can be adopted to detect PTE and AD with reduced radiation dose.

Triple Rule-Out-CT: Wann und Wie?

2009 ◽  
pp. 67-73
Author(s):  
Thomas Schertler
Keyword(s):  
Triple Rule Out ◽  
Rule Out

scholarly journals Coronary computed tomography angiography (CCTA): effect of bolus-tracking ROI positioning on image quality

2020 ◽  
Author(s):  
Heiner Nebelung ◽  
Thomas Brauer ◽  
Danilo Seppelt ◽  
Ralf-Thorsten Hoffmann ◽  
Ivan Platzek
Keyword(s):  
Image Quality ◽  
Left Atrium ◽  
Coronary Arteries ◽  
Coronary Computed Tomography Angiography ◽  
Pulmonary Arteries ◽  
Ascending Aorta ◽  
Triple Rule Out ◽  
Comparable Image Quality ◽  
Rule Out

Abstract Objectives The aim of the study was to evaluate the effect of bolus-tracking ROI positioning on coronary computed tomography angiography (CCTA) image quality. Methods In this retrospective monocentric study, all patients had undergone CCTA by step-and-shoot mode to rule out coronary artery disease within a cohort at intermediate risk. Two groups were formed, depending on ROI positioning (left atrium (LA) or ascending aorta (AA)). Each group contained 96 patients. To select pairs of patients, propensity score matching was used. Image quality with regard to coronary arteries as well as pulmonary arteries was evaluated using quantitative and qualitative scores. Results In terms of the coronary arteries, there was no significant difference between both groups using quantitative (SNR AA 14.92 vs. 15.46; p = 0.619 | SNR LM 19.80 vs. 20.30; p = 0.661 | SNR RCA 24.34 vs. 24.30; p = 0.767) or qualitative scores (4.25 vs. 4.29; p = 0.672), respectively. With regard to pulmonary arteries, we found significantly higher quantitative (SNR RPA 8.70 vs. 5.89; p < 0.001 | SNR LPA 9.06 vs. 6.25; p < 0.001) and qualitative scores (3.97 vs. 2.24; p < 0.001) for ROI positioning in the LA than for ROI positioning in the AA. Conclusions ROI positioning in the LA or the AA results in comparable image quality of CT coronary arteriography, while positioning in the LA leads to significantly higher image quality of the pulmonary arteries. These results support ROI positioning in the LA, which also facilitates triple-rule-out CT scanning. Key Points • ROI positioning in the left atrium or the ascending aorta leads to comparable image quality of the coronary arteries. • ROI positioning in the left atrium results in significantly higher image quality of the pulmonary arteries. • ROI positioning in the left atrium is feasible to perform triple-rule-out CTA.

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