Interventional Neuroradiology unit in National Neuroscience Institure Singapore
Story from Chng Soke Miang, M.D.
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Chng Soke Miang.Interventional Neuroradiology unit in National Neuroscience Institure Singapore.วารสารชมรมรังสีเทคนิคและพยาบาลเฉพาะทางรังสีวิทยาหลอดเลือดและรังสีร่วมรักษาไทย, 2550 ; 1(2) : 15-16
Best practise of role model in interventional radiology is important to learn with each other, National Neuroscience Institute is one of the best interventional neuroradiology unit in south east asia
The angiographic unit in the department is a biplane digital subtraction angiography (DSA) machine specifically designed for optimal imaging of the blood vessels in the brain and spine. It produces fast rotational angiography and is the only unit in this region at present able to perform 3-D angiographic images.
In addition to diagnostic cerebral and spinal angiograms, the department has an active interventional neuroradiology service enhanced by the availability of bi-plane fluoroscopy and accurate road mapping. It is the largest centerof interventional neuroradiology in this region. Embolization of brain and spine arteriovenous malformation, coil packing devascularisation of head and neck tumors are some of the routine procedures carried out in the unit.
The department is also the first in Singapore to offer outpatient cerebral angiogram as a routine service. Compared to the previous 2-day hospital stay required for such a procedure, the patient only needs to report to the department in the morning and is discharged on the evening of the same day.
The unit comprises with 3 doctors, including the head of department, 4 nurses and 4 radiographers (technicians) these doctors, nurses and radiographers are also involved in CT scan and MRI units in the department, so are rotated roung within the service.
We have 2 routine days for embolisation when anaesthetists are rostered to our department. These are on tuesday and thursday. On the other way, and in the night for urgent cases, we need to contact the anaesthetist on call, for cases that need general anaesthesia.
The routine duties of each person in the unit:
Keeping stock of equipment such as catheters, guidewires, embolic materials, medicines, make sure the patient monitoring devices and anaesthetic machine are in order, liase with the ward nurses regarding preparation of patients for angiogram or embolisation, send list of patients to anaesthetist for routine embolisation days (Tues and Thurs), while for urgent cases, the doctor has to contact the anaesthetist.
- nurses also prepare the angiography and intervention sets, and scrub into assist the doctor in angiogram and embolisation. Usually one nurse for angiogram and 2 nurse for embolisation. One nurse circulates.
- for routine non general anaesthesia cases, the nurse monitors the patient.
Incharge of the angiography machine and routine maimtenance of the machine, air-con in the angiography room
- and embolisation, they are in the room to operate and move the angiography biplanes, help in 3D reconstruction, help in measurements of aneurysm, etc.
During the day, all the senior doctors in the department can do routine cerebral angiograms, but only the interventional neuroradiologists in the department do the embolisation procedures
- a neurointerventionist is on call for a whole week, somthimes 1 week sometimes 2 weeks in a month, to cover urgent embolisation procedures at night and during the weekend
- the doctor on call for neurointervention also covers other hospitals in Singapore, including Singapore General, National University, Changi General, Children and Women's Hospitals (we share this on call with a neurointerventionist from Singapore General Hospital)
- the neurointerventionist on call is notified directly about any urgent case, usually by the referring team doctor on call who stays in the hospital
- the on call radiographer and on call nurses are activated by the in house radiographer (there is one in house radiographer every night to cover urgent scans)
- everyone ususlly arrives in the department by 30 minutes, latest one hour
Each doctor who does neurointervention also has an outpatient clinic where we follow up our patients. Most of the time, we share the responsibility with the neurosurgeon.
In our hospitals in Singapore, when there is ruptures aneurysms or other urgent neurovascular cases, there is discussion between the neurosurgeon and neurointerventionist to decide for surgery or embolisation. The decision is the discussed with the patient/ family before procedure is carried out.