For critically ill patients in the Intensive Care Unit (ICU), timely and accurate diagnostic imaging is paramount. Transporting unstable patients to a fixed radiology suite for a Computed Tomography (CT) scan can be risky and complex. This study investigated the significant role of portable CT scanners, often referred to as Care Scanners in modern medical settings, in addressing these challenges and transforming diagnostic practices within the ICU environment.
This research combined a survey of medical professionals and a retrospective review of radiology records from December 1996 to June 1998. The setting was a Level I trauma center university hospital, encompassing multitrauma, neurotrauma, and neurosurgical ICUs. Participants included critical care attending physicians, fellows across various specialties (anesthesiology, surgery, internal medicine), and neurosurgery residents. The study aimed to understand physician ordering patterns for portable CT scans and the clinical scenarios where they are deemed most beneficial.
The survey achieved a 100% response rate, revealing compelling insights into the utilization of portable CT technology. An overwhelming majority of physicians reported ordering portable head CT scans (97%), highlighting its importance in neurological assessments at the point of care. Chest CT scans followed at 88%, abdominal CT scans at 78%, and pelvic CT scans at 34%, indicating a broad application of portable CT across different anatomical regions within the ICU. These self-reported ordering patterns were strongly supported by the analysis of actual scans performed, with 511 head CTs, 115 chest CTs, 88 abdominal CTs, and 87 pelvic CTs documented.
Alt text: A portable CT scanner, a type of care scanner, being used to image a patient in the ICU.
The primary reason cited for choosing portable CT scans over traditional, fixed CT scans was patient severity of illness (77%). Conditions making patient transport to radiology risky included extracorporeal support (93%), cardiovascular instability (70%), respiratory instability (57%), and neurologic instability (40%). These findings underscore the critical role of care scanners in providing diagnostic capabilities directly at the bedside for the most vulnerable patients.
Interestingly, the study also explored physician behavior when portable CT was unavailable. A significant 67% of physicians indicated they would still order a fixed helical CT scan, and proceed with patient transport to the radiology suite, regardless of the patient’s unstable condition. This highlights the perceived medical necessity of CT imaging, even when the safer, more convenient option of a portable care scanner is not accessible. It also emphasizes the potential risks associated with transporting critically ill patients and the value proposition of having readily available portable imaging solutions within the ICU.
Alt text: Medical professionals utilizing a portable care scanner for diagnostic imaging in a critical care setting.
In conclusion, this study definitively demonstrates that access to portable CT scanners, or care scanners, significantly influences physician ordering practices in the ICU. The high utilization rates and physician preference for portable CT in unstable patient scenarios clearly establish its crucial role in modern critical care. When diagnostic imaging is deemed essential, portable CT offers a safer alternative to patient transport, potentially improving patient outcomes and streamlining workflows within the demanding ICU environment. The availability of care scanner technology not only impacts immediate diagnostic capabilities but also shapes the overall approach to managing critically ill patients requiring advanced imaging.
