RCR statement on cerebral perfusion CT requesting and reporting for Radiology departments

The development of mechanical thrombectomy for patients with stroke due to large vessel occlusion and extension of the time window for IV thrombolysis has increased the demand for advanced imaging for ischaemic stroke, both in and out of normal working hours. Radiology departments will continue to prioritise these patients due to the time critical nature of the condition and its treatment. 

Brain perfusion CT can be used as an adjunct to non-contrast CT brain imaging and CT angiography in some cases, particularly to help select eligible patients with delayed presentations. Source imaging for cerebral perfusion CT should only be requested and acquired where there is a locally agreed arrangement for image review and contemporary documentation of image interpretation that guides emergency clinical management.

The interpretation of CT perfusion imaging may be delegated to the referring clinical team by local Trust/Health Board agreement, particularly outside of normal working hours, provided the reviewing physician is appropriately trained in interpreting these images. A record of the CT perfusion image interpretation and the subsequent management plan must be documented in the medical notes and accessible for review; this will be subject to audit at local and national level. Arrangements and timelines for any subsequent formal CT perfusion Radiology reporting are by local Trust/Health Board agreement. 

Artificial intelligence stroke software can be used for decision support in acute ischaemic stroke care pathways. All MDT team members working in clinical services that have implemented AI software should be aware of the diagnostic limitations of AI and should not rely on AI alone for image interpretation.

Appropriate local arrangements to cover regulatory compliance (IRMER), discrepancies and complaints should be in place before the advice in this statement is implemented.