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Chest CT By: Sara al-lithey, Nora Alanazi. Outline:  Chest CT.  Indications.  Contraindications.  Chest CT protocols. - HRCT protocol. - Pathology.

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Presentation on theme: "Chest CT By: Sara al-lithey, Nora Alanazi. Outline:  Chest CT.  Indications.  Contraindications.  Chest CT protocols. - HRCT protocol. - Pathology."— Presentation transcript:

1 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  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 1. Chest pain. 2. Chest trauma. 3. Infection. 4. Intra-thoracic bleeding 5. Pulmonary embolism. 6. Pneumonia. 7. Suspected tumor or mass. 8. Assessment of interstitial lung disease 9. Minor fibrosis

5 Contraindication 1. Pregnancy. 2. Hypersensitivity to iodinated contrast media( if contrast is used). 3. Renal failure. 4. Heart disorder

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

7  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 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 Recon. Algorithm FOVpitchRecon Slice thick Scan delay MAKVType of scan standard lung Large speed ×5 2.5 × sec Auto M.A 120 Spiral (axial) Inspiration LungLarge__1.25 × secAuto m.A 120 Axial Spiral Expiration & Prone levelwindow Soft tissue35500Standardspiral 1 Lung widow 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 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: 1. Omnipaque 2. Xenetix  Adult : 300  Child: 250

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

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

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18  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 2 nd 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: 1. Smart Prep 2. Bolus timing  Then selected in the computer.

20  In case if: 1. The heart rate abnormal (above ) 2. Obese patient (above 110 Kg).

21 Recon. Alga.FOVpitchRecon.S.Tsec Scan delay MAKV Type of scan - standard - lung large1.375 speed × × sec auto Helical spiral Levelwindow soft tissuespiral lung windowspiral 2

22  In case if the heart rate normal (70-90)  Procedure 1. PA scout (to localize the pulmonary trunk ). 2. 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 1. Smart Prep: Adult: 100 ml – 5 ml/ sec 2. 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 1.Sagittal 2.Coronal 3.Both oblique 4. 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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