Powerpoint

Question 1

Ct chest usually done?

Answer 1

With contrast unless contraindicated

Question 2

Thinner cuts ct (4)

Answer 2

Less artifacts
More mas
Increased patient dose
Better image quality

Question 3

Bigger patient in ct

Answer 3

Delay interscan delay if patient fat moves while table moves or will have motion

Question 4

Patient position for chest

Answer 4

Supine
Feet first
Trauma- head first if doing head w/ neck
Jewelry and clothing containing metal removed. Gown provided
Arms raised over head
Cushion under patients knees for comfort
Immobilization straps placed over patient to prevent motion
Patient centered midcoronal and midsagital with positioning lasers
Clear breathing instructions and explanation of intravenous contrast prior to obtaining a scout view
Patient shielding
Proper patient positioning - positioning at isocenter to minimize radiation dose and optimize image quality

Question 5

Ct chest clinical indication(8)

Answer 5

Pulmonary masses
Hilar lymph nodes and masses
Aortic aneurysm
Metastasis
Pneumonia
Pleural effusion
Pneumothorax
Pericardial effusion

Question 6

Chest protocol

• scout 0 degree azimuth ap from the top of the_____to the ____approx ___-____ mm
• optional: lateral scout to center
• ____mm slices from ____of lungs to ____
• optional: 5-2 mm sections thru the hilum and 5 mm sections superior and inferior to hilum
• no gantry angulation necessary
• _____acquisition
• inject __-___cc of Iv contrast material with a __-___second scan delay at __cc/sec
• instruct patient to suspend breathing after full _____
• reconstruct on a standard algorithm and display field of view in include lateral nborders of the chest
• mediastinal windows ww ____wl ___
• reconstruct lungs with a detail or lung algorithm and lung windows ww ____wl ___
• when trauma is suspected , reconstruct under a nine algorithm and film bone window ww ____wl ____
• Retrospectively, reconstruct axial images as thin as possible and use data to create mips of aorta, coronal, sagital, and 3d

Answer 6

• scout 0 degree azimuth ap from the top of the shoulders to the kidneys approx 300-350mm
• optional: lateral scout to center
• 5 mm slices from apices of lungs to adrenal glands
• optional: 5-2 mm sections thru the hilum and 5 mm sections superior and inferior to hilum
• no gantry angulation necessary
• helical acquisition
• inject 50-120 cc of Iv contrast material with a 45-65 second scan delay at 2cc/sec
• instruct patient to suspend breathing after full inspiration
• reconstruct on a standard algorithm and display field of view in include lateral nborders of the chest
• mediastinal windows ww 350 wl 50
• reconstruct lungs with a detail or lung algorithm and lung windows ww 1500 wl -500
• when trauma is suspected , reconstruct under a nine algorithm and film bone window ww 2500 wl 500
• Retrospectively, reconstruct axial images as thin as possible and use data to create mips of aorta, coronal, sagital, and 3d

Question 7

When aortic aneurysm or dissection is suspected, decrease scan delay to________cta( arterial phase)

Answer 7

20-30 sec

Question 8

Cta increase_____and decreases_____

Answer 8

Volume rate

Decrease scan delay

Question 9

Know heart and arteries

Answer 9

Aorta arteries diagram

Question 10

Carina

Answer 10

Trachea bifurcation

Question 11

Azygos vein

Answer 11

Connects superior vena cava to inferior vena cava down to the thoracic spine

Question 12

Indications for hrct(3)

Answer 12

The indications :

• clinically suspected diffuse lung disease that is incompletely evaluated on standard ct chest and chest X-ray occult
• suspected small airway disease
• quantification of extent of lung disease for evaluating effectiveness of treatment
• guidance for site selection for biopsy of diffuse lung disease

Question 13

High resolution ct chest clinical indications no contrast(4)

Answer 13

Sarcoidosis
Emphysema
Asbestosis
Pulmonary fibrosis

* usually followed by routine chest ct scan*

Question 14

High resolution ct chest protocol

• scout 0 degree azmiuth (ap) from top of shoulders to kidneys
  Approx ___-____ mm
• optional: lateral to center coronally
• ____mm slices with __-___mm increment from lung apices to lung bases( high spatial resolution)
• no gantry angulation
• _____acquisition
• no contrast necessary
• instruct patient to suspend breathing after full ____
• reconstruct on a edge or lung agorithmn and display field of view to include lateral border of lungs
• film lungs only ww ____wl ____
• perform non contrast scan of chest and retrospectively reconstruct high resolution images

Answer 14

• scout 0 degree azmiuth (ap) from top of shoulders to kidneys
  Approx 300-350mm
• optional: lateral to center coronally
• 1 mm slices with 10- 20 mm increment from lung apices to lung bases( high spatial resolution)
• no gantry angulation
• axial acquisition
• no contrast necessary
• instruct patient to suspend breathing after full inspiration
• reconstruct on a edge or lung agorithmn and display field of view to include lateral border of lungs
• film lungs only ww 1500 wl -500
• perform non contrast scan of chest and retrospectively reconstruct high resolution images

Question 15

Pulmonary embolism protocol

• scout 0 degree azmiuth (ap) from the top of ____ to the kidneys approx ___-___mm
• optional: lateral scout to center coronally
• high speed ____ acquisition
• display field of view included the lateral borders of the lungs
• scan ___ to ___
• __-___mm overlapping slices thru the _____arteries
• no gantry angulation
• inject ___-___cc of Iv contrast at rate of____-___cc/sec with a ___-___sec scan delay . Test bolus or contrast tracking software maybe used to get more accurate scan delay
• instruct patient to suspend breathing after full _______
• reconstruct standard or detail algorithm
• mediastinal windows ww ____wl 30 and lung windows ww ____ wl ____
• reconstruct axial images as thin as possible and use data to create mips of aorta, coronal sagittal and 3d

Answer 15

• scout 0 degree azmiuth (ap) from the top of shoulders to the kidneys approx 300-350 mm
• optional: lateral scout to center coronally
• high speed helical acquisition
• display field of view included the lateral borders of the lungs
• scan superior to inferior
• 1-2 mm overlapping slices thru the pulmonary arteries
• no gantry angulation
• inject 80-120 cc of Iv contrast at rate of 3-5 cc/sec with a 10-18 sec scan delay . Test bolus or contrast tracking software maybe used to get more accurate scan delay
• instruct patient to suspend breathing after full inspiration
• reconstruct standard or detail algorithm
• mediastinal windows ww 350 wl 30 and lung windows ww 1500 wl -500
• reconstruct axial images as thin as possible and use data to create mips of aorta, coronal sagittal and 3d

Question 16

Ct trauma or aortic dissection

• scout 0 degrees ( ap) from top of shoulders to the kidneys approx ___-____mm . When aortic dissection is suspected scan down ____
• lateral scout optional center coronally
• high speed _____acquisition
• display field of view includes lateral border of chests
• scan from superior to inferior
• ___-___mm slices from lung apices to the adrenal glands for trauma and from _____to _____arteries for dissection
• no gantry angulation
• inject _____-____ cc of Iv contrast at rate of __-____cc/sec with ___-____sec scan delay. Test bolus or contrast tracking software may be used to get more accurate scan delay time
• instruct patient suspend breathing after full inspiration
• reconstruct a standard or detail algorithm and a bone algorithm for trauma
• mediastinal windows ww ___wl ___and lung windows ww ___wl ___
• add bone windows ww ____wl ____for trauma
• reconstruct axial images thin and use data to create mips of aorta, coronal, sagittal, and 3d
• with or without contrast

Answer 16

• scout 0 degrees ( ap) from top of shoulders to the kidneys approx 300-350 mm . When aortic dissection is suspected scan down pelvis
• lateral scout optional center coronally
• high speed helical acquisition
• display field of view includes lateral border of chests
• scan from superior to inferior
• 2-5 mm slices from lung apices to the adrenal glands for trauma and from aortic arch to iliac arteries for dissection
• no gantry angulation
• inject 80-120 cc of Iv contrast at rate of 3-5 cc/sec with 15-25 sec scan delay. Test bolus or contrast tracking software may be used to get more accurate scan delay time
• instruct patient suspend breathing after full inspiration
• reconstruct a standard or detail algorithm and a bone algorithm for trauma
• mediastinal windows ww 350 wl 30 and lung windows ww 1500 wl - 500
• add bone windows ww 2500 wl 500 for trauma
• reconstruct axial images thin and use data to create mips of aorta, coronal, sagittal, and 3d
• with or without contrast

Question 17

If dissection extends past thoracic aorta continue through ____ to capture it in its entirety

Answer 17

Abdominal

Question 18

Ct cervical spine clinical indications(7)

Answer 18

• trauma
• degenerative disc disease
• neoplasm
• infection
• spinal stenosis
• post Mylographic evaluate intradural or extradural abnormalities
• usually without contrast unless I case of infections or spinal masses

Question 19

Ct cervical spine position

Answer 19

-Head first

• supine
• jewelry removed
• removable dental work
• head placed into cradle
• cushion under legs
• shield
• center midsagittal and midcoronal
• patient close eyes

Question 20

Cervical protocol

Scout 90 degree azimuth ( lateral) from mid ____to mid ___( c1) apporx ___mm total

• ___-___mm slices from skull base to t1
• ___mm slices trauma
• usually no gantry angulation but may be angled parallel to majority of disk spaces
• standard or soft algorithmn with ___-___cm display field of view
• iv contrast indicated, inject ___-___cc iodinated contrast with ___-___second scan delay
• instruct patient not_____during exam
• reconstruct bone algorithm
• soft tissue ____ ww and ____wl and ___ww and ____wl bone
• reconstruct axial images as thin possible and use data create coronal, sagital , 3d
• image both lateral scout with and without cross reference line to aid radiologist in id vertebral bodies

Answer 20

Scout 90 degree azimuth ( lateral) from mid t2 to mid brain( c1) apporx 350 mm total

• 1-2 mm slices from skull base to t1
• 1 mm slices trauma
• usually no gantry angulation but may be angled parallel to majority of disk spaces
• standard or soft algorithmn with 12-16 cm display field of view
• iv contrast indicated, inject 60-120 cc iodinated contrast with 55-65 second scan delay
• instruct patient not swallow during exam
• reconstruct bone algorithm
• soft tissue 350 ww and 40 wl and 2500 ww and 500 wl bone
• reconstruct axial images as thin possible and use data create coronal, sagital , 3d
• image both lateral scout with and without cross reference line to aid radiologist in id vertebral bodies

Question 21

Ct thoracic spine(7)

Answer 21

Trauma

• degenerative disk disease
• xneoplasm
• infection
• spinal stenosis
• post myleographic evaluate intradural and extradural abnormalities
• done with iv contrast except case of infections or spinal masses

Question 22

Thoracic patient position

Answer 22

Head or feet first

• supine
• arms over head
• cushion under patient legs comfort
• shield
• center midcoronal/ midsagittal
• close eyes

Question 23

Thoracic spine protocol

• dual scout ap and lateral from either base of skull to _____or ___to s1
• ___-___mm slices thru entire thoracic spine and specific level
• ____mm slices for trauma
• usually no gantry angulation but may be angles parallel to disc spaces
• standard of soft algorithmn with ___–___cm display field of view
• if if indicated inject ___-____cc of iodinated contrast material with___-___second scan delay
• acquire images of full ______
• reconstruct with bone algorithm
• soft tissue ___ww and ___wl and ____ww and ___wl for bone
• reconstruct axial images as thin as possible and use data to create mips of aorta, coronal , sagital and 3d
• image lateral scout with and without cross reference line to aid radiologist in identifying specific vertebral bodies

Answer 23

• dual scout ap and lateral from either base of skull to l1 or c7 to s1
• 1-2 mm slices thru entire thoracic spine and specific level
• 1 mm slices for trauma
• usually no gantry angulation but may be angles parallel to disc spaces
• standard of soft algorithmn with 12-16 cm display field of view
• if if indicated inject 60-120 cc of iodinated contrast material with 55-65 second scan delay
• acquire images of full inspiration
• reconstruct with bone algorithm
• soft tissue 350ww and 40wl and 2500 ww and 500 we for bone
• reconstruct axial images as thin as possible and use data to create mips of aorta, coronal , sagital and 3d
• image lateral scout with and without cross reference line to aid radiologist in identifying specific vertebral bodies

Question 24

Cat scan of lumbar clinical indications

Answer 24

• trauma
• degenerative disc disease
• neoplasm
• infection
• spinal stenosis
• post Mylographic evaluate intradural or extradural abnormalities
• usually without contrast unless I case of infections or spinal masses

Question 25

Ct scan lumbar patient position

Answer 25

Head or feet first - supine - arms over head - cushion under patient legs comfort - shield - center midcoronal/ midsagittal - close eyes

Question 26

Lumbar ct protocol - dual scout ap and lateral from ___ thru ____approx ____mm - ___-___mm slices from _____thru ____ - usually no gantry angulation but may be angled parallel to majority of disc spaces - standard or soft algorithm with a ___-___cm display field of view - if iv contrast is indicated , inject ___-___cc iodinated contrast material with a ___-___second scan delay - acquire images on quiet respiration - reconstruct with bone algorithm - soft tissue ___ww and ___wl and _____ww and _____wl - retrospectively reconstruct axial images as thin as possible and use data to create mips of aorta , coronal, sagital and 3d - image lateral scout both with and without cross reference line to aid radiologist in identifying specific vertebral bodies

Answer 26

- dual scout ap and lateral from xiphoid thru sacrum approx 400 mm - 1-3 mm slices from t12 thru s1 - usually no gantry angulation but may be angled parallel to majority of disc spaces - standard or soft algorithm with a 12-16 cm display field of view - if iv contrast is indicated , inject 60-120 cc iodinated contrast material with a 55-65 second scan delay - acquire images on quiet respiration - reconstruct with bone algorithm - soft tissue 350 ww and 40 wl and 2500 ww and 500 wl - retrospectively reconstruct axial images as thin as possible and use data to create mips of aorta , coronal, sagital and 3d - image lateral scout both with and without cross reference line to aid radiologist in identifying specific vertebral bodies

Question 27

Post myleographic ct lumbar

Answer 27

Imaging is generally the same as the normal spine except for the admisinitration of intrathecal contrast - patients head should remain slightly elevated to prevent headaches - scan should be completed 2-4 hours after the administration of contrast - patient should completely roll over prior to scanning to prevent layering of contrast - images should be acquired as thin as possible for for increased resolution - film with bone and soft tissue windows - images should be reformatted sagitally and coronally