Automated vs. Traditional Reconstruction Workflows for Head and Neck CTA: Effects on Exam Duration and Variability

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Background and Purpose Rapid and reliable stroke imaging is critical for timely diagnosis and intervention. Traditional workflows for head and neck CT angiography (CTA) involve manual image reconstruction steps that can prolong exam completion times and increase variability. This study aimed to evaluate whether an automated, software-driven reconstruction workflow could reduce stroke CTA exam duration and improve efficiency without compromising image quality. Materials and Methods This HIPAA-compliant, retrospective study included 100 consecutive stroke CTA examinations performed on a single emergency department scanner (Siemens SOMATOM Force, Forchheim, Germany) between August and November 2022. Fifty scans were obtained immediately prior to implementation of the automated workflow and 50 scans after a one-month technologist training period post-implementation. Exclusion criteria included repeat imaging due to motion, exams adjacent to other CT angiograms or trauma panscans, and post-intervention cases with technologist adjustments to the automated sequence. All scans were acquired at 100 kVp with intravenous iohexol 350 (50 mL) at 4–5 mL/s, followed by bolus tracking. The primary outcome was total exam completion time; secondary outcomes included technologist active time and variability measures. Results Implementation of the automated workflow resulted in a significant reduction in median exam completion time compared with the traditional workflow. Automated processing decreased median exam time by approximately 8.5 minutes and reduced technologist active time by 14.1 minutes, with narrower standard deviations for both metrics. These improvements were achieved without changes in image acquisition parameters or diagnostic quality. The streamlined process eliminated repetitive manual reconstruction tasks, allowing technologists to focus on patient care and other critical responsibilities. Conclusions Transitioning to an automated reconstruction workflow for stroke CTA substantially improves efficiency by reducing exam duration and technologist workload. In practice settings where radiologists review images after full exam completion, this approach accelerates image availability in PACS, enabling faster detection and communication of critical findings. While immediate clinical impact may vary depending on real-time interpretation practices, earlier availability of reformatted images can facilitate prompt identification of large vessel occlusions and other emergent conditions. Adoption of automated workflows represents a practical strategy to optimize imaging operations amid increasing imaging volumes and technologist shortages.