Presentation on theme: "By: Sara al-lithey, Nora Alanazi"— Presentation transcript:
1By: Sara al-lithey, Nora Alanazi Chest CTBy: Sara al-lithey, Nora Alanazi
2Outline: Chest CT. Indications. Contraindications. Chest CT protocols. - HRCT protocol.- Pathology protocol.- Pulmonary Embolism.Patient after care .
3Chest CT scanningis a noninvasive medical test that helps physicians diagnose and treat medical conditions.CT scan is better for chestCT it show many different types of tissue, including the lungs, heart, bones, soft tissues, muscle and blood vessels in short time.
4Indication Chest pain. Chest trauma. Infection. Intra-thoracic bleedingPulmonary embolism.Pneumonia.Suspected tumor or mass.Assessment of interstitial lung diseaseMinor fibrosis
5ContraindicationPregnancy.Hypersensitivity to iodinated contrast media( if contrast is used).Renal failure.Heart disorder
6Technique High Resolution CT HRCT Pathology or Routine C+ Pulmonary EmbolismPE
71- HRCT Without contrast. High kV, mAs & thin slices to produces a high spatial resolution and anatomic detailNo preparationSedation if needed.
8Patient position Supine, in the center of the table Feet first in the gantry (child, head first to see the chest movement during the breathing after the sedation).Table heightThe arms are above the head.The external laser liner in the chine.Scout Images:PA : plane 180ºLat : plane 90º
9Procedure Inspiration Expiration Prone To cover from the apex to the base of the lungInspirationFrom the Aorta down to the lower lungExpirationTo check the plural effusionProne
11Reformatting: sagittal & coronal Note:FOV is as small as possible while still including all of the soft tissue and the upper abdominal part (to check the metastasis).
122- Pathology (C+) Preparation: NPO 3-4 hours before the procedure. Not allergic or asthmatic.Renal function test normal1 week inpatient.3 month diabetic patient6 month non diabetic patient.Canulla in the Rt arm, size 18, 20 Gag.Sedation if needed
13Procedure Inspiration technique: As HRCT Patient position: As HRCT IV Contrast media:OmnipaqueXenetixAdult : 300Child: 250
14Contrast media The injector machine Hand injection Adult Child FR 5ml/sec 5ml/sec V 100 ml Weight × 2Time delaysecC. in the Aorta
183- Pulmonary Embolism scan Fast helical CT scanning to visualization of the pulmonary vessels and lung parenchyma during the injection of a CM to detect any obstruction.Optimal contrast should be in the pulmonary arteries, but not in the pulmonary veins.Patient Preparation & position: As 2nd tech.
19Main thing: calculate the contrast time that start from the injection until it will enter in the main pulmonary arteryTwo ways to calculate the timing:Smart PrepBolus timingThen selected in the computer.
20A- Smart Prep In case if: The heart rate abnormal (above 110-140) Obese patient (above 110 Kg).
22b- Bolus Timing In case if the heart rate normal (70-90) Procedure PA scout (to localize the pulmonary trunk).FOV only in the bifurcation of the trachea and take CT images.
23Select 20 images in the same location Give 20 ml IV CM (FR 5 ml/ sec)Start the CM in the same time of the exposurewait the image to review.From the 20 images, select the good image with the good contrast in the Main Pulmonary artery.Time delayed calculation:image number × 2 = sec
24Then do the normal image from down- up with same before and fixed the scan time manually. This graph shows that the contrast injected into the vein reached the pulmonary trunk in 8 seconds.
25I.V. Contrast Smart Prep: Adult: 100 ml – 5 ml/ sec Bolus timing: Scan time × 5 = volumeThe bolus timing is Better than the Smart PrepLess C. dose, so there is chance to repeat the scan again if there is any mistake ( the max dose is 100 ml/ day).
26Reformatting Sagittal Coronal Both oblique Maximal intensity projection (MIP)
27After care Pt. can eat or drink as normal. Drink fluids to flush the contrast.Bandaged contrast injection site.Watch the patient for adverse contrast reactions.