Radiographic screening for ECT: use and usefulness

Area of Science:

• Neurology
• Psychiatry
• Radiology

Background:

• Electroconvulsive therapy (ECT) is a medical treatment most often used for patients with severe major depression or other psychiatric disorders that have not responded to other treatments.
• The use of muscle relaxants and radiologic studies in ECT is a practice that varies among clinicians.

Purpose of the Study:

• To survey the Association for Convulsive Therapy members regarding their practices of using muscle relaxants and radiologic studies for ECT.
• To evaluate the clinical significance of pre- and post-ECT radiologic findings.

Main Methods:

• A mail survey was sent to members of the Association for Convulsive Therapy.
• One hundred eleven completed responses were analyzed, with 40% reporting routine use of pre-ECT spine and skull radiographs.
• 57 pre- and post-ECT film pairs were reviewed by a radiologist, and pre-ECT reports were assessed by a psychiatrist.

Main Results:

• 40% of respondents routinely obtained pre-ECT spine and skull radiographs, using 1 to 10 films per patient.
• Radiologic evaluation of 57 pre- and post-ECT film pairs revealed few clinically significant findings.
• Psychiatric review of pre-ECT reports indicated that changes in routine ECT procedures were rarely required due to radiographic findings.

Conclusions:

• The routine acquisition of pre- and post-ECT radiologic studies appears to yield few clinically significant findings.
• This suggests a potential for overuse of routine imaging in the context of electroconvulsive therapy.
• Further investigation into evidence-based guidelines for radiologic imaging in ECT is warranted.