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By: Sara al-lithey, Nora Alanazi

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1 By: Sara al-lithey, Nora Alanazi
Chest CT By: Sara al-lithey, Nora Alanazi

2 Outline: Chest CT. Indications. Contraindications. Chest CT protocols.
- HRCT protocol. - Pathology protocol. - Pulmonary Embolism. Patient after care .

3 Chest CT scanning is a noninvasive medical test that helps physicians diagnose and treat medical conditions. CT scan is better for chest CT it show many different types of tissue, including the lungs, heart, bones, soft tissues, muscle and blood vessels in short time.

4 Indication Chest pain. Chest trauma. Infection.
Intra-thoracic bleeding Pulmonary embolism. Pneumonia. Suspected tumor or mass. Assessment of interstitial lung disease Minor fibrosis

5 Contraindication Pregnancy. Hypersensitivity to iodinated contrast media( if contrast is used). Renal failure. Heart disorder

6 Technique High Resolution CT HRCT Pathology or Routine C+
Pulmonary Embolism PE

7 1- HRCT Without contrast.
High kV, mAs & thin slices to produces a high spatial resolution and anatomic detail No preparation Sedation if needed.

8 Patient 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 height The arms are above the head. The external laser liner in the chine. Scout Images: PA : plane 180º Lat : plane 90º

9 Procedure Inspiration Expiration Prone
To cover from the apex to the base of the lung Inspiration From the Aorta down to the lower lung Expiration To check the plural effusion Prone

10 Scan parameters: Window level window Soft tissue 35 500 Standard
Recon. Algorithm FOV pitch Recon Slice thick Scan delay MA KV Type of scan standard lung Large 30-40 1.375 speed 27.5 1.25 ×5 2.5 ×2.5 0.7 sec Auto M.A 120 Spiral (axial) Inspiration Lung _ 1.25 ×10 Auto m.A Axial Spiral Expiration & Prone Window level window Soft tissue 35 500 Standard spiral 1 Lung widow - 300 1500 spiral 2 & 3

11 Reformatting: 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).

12 2- Pathology (C+) Preparation: NPO 3-4 hours before the procedure.
Not allergic or asthmatic. Renal function test normal 1 week inpatient. 3 month diabetic patient 6 month non diabetic patient. Canulla in the Rt arm, size 18, 20 Gag. Sedation if needed

13 Procedure Inspiration technique: As HRCT Patient position: As HRCT
IV Contrast media: Omnipaque Xenetix Adult : 300 Child: 250

14 Contrast media The injector machine Hand injection
Adult Child FR 5ml/sec 5ml/sec V 100 ml Weight × 2 Time delay sec C. in the Aorta

15 Axial & Sagittal – Soft window
Scan parameters & Window : as Inspiration HRCT 2nd Reconstruction: ×1.25 Axial & Sagittal – Soft window



18 3- 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.

19 Main thing: calculate the contrast time that start from the injection until it will enter in the
main pulmonary artery Two ways to calculate the timing: Smart Prep Bolus timing Then selected in the computer.

20 A- Smart Prep In case if: The heart rate abnormal (above 110-140)
Obese patient (above 110 Kg).

21 Window Scan parameters Level window 100 800 soft tissue spiral 1 - 300
Recon. Alga. FOV pitch Recon. S.T sec Scan delay MA KV Type of scan standard lung large 1.375 speed 27.5 2.5 × 2.5 1.25 ×0.6 0.7 sec auto Helical spiral Window Level window 100 800 soft tissue spiral 1 - 300 1500 lung window spiral 2

22 b- 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.

23 Select 20 images in the same location
Give 20 ml IV CM (FR 5 ml/ sec) Start the CM in the same time of the exposure wait 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

24 Then 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.

25 I.V. Contrast Smart Prep: Adult: 100 ml – 5 ml/ sec
Bolus timing: Scan time × 5 = volume The bolus timing is Better than the Smart Prep Less C. dose, so there is chance to repeat the scan again if there is any mistake ( the max dose is 100 ml/ day).

26 Reformatting Sagittal Coronal Both oblique
Maximal intensity projection (MIP)

27 After 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.

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