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Protcol Neck And Head Powerpoints > Head And Neck > Flashcards

Head And Neck Flashcards

(108 cards)

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1
Q

Algorithms

What is it?

Many used based on?

A

Set of mathematical computations ( rules or direction) used to create an image from acquired raw data from ct scanner. A variety of algorithms can be selected to create optimal images depending on tissue type

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2
Q

Azimuth

  • what is it?
  • 0 degrees? 90 degrees?
A

Aka scout
Direction by which the X-ray tube images a patient during scout. Usually given in degrees . Ex 0 degrees = ap scout and 90 degrees = lateral

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3
Q

Contrast resolution

What is?
- what varies?

A

Ability of a scanner to image as separate object , 2 or more structures vary in density by small amounts

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4
Q

Spatial resolution

  • ?
  • increases with decrease in?
A

Ability of a scanner to display as seperate objects, 2 or more structures are close to each other. Increases with decrease in slice thickness

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5
Q

Ct numbers

  • aka-
  • ?
  • range?
  • air number?
  • bone number?
A

Number used to designate the X-ray absorption in each pixel ( picture element) of the image. Ct numbers expressed in hounsfield units and are set - 1000 to + 1000. Where ct number for air is -1000 and bone is + 1000

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6
Q

Gray scale

  • ?
  • air
  • water
  • bone
A

Shades of grey assigned to pixels with specific with a ct number ( hounsfield unit)

Air - 1000
Water 0
Bone + 1000

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7
Q

Windowing

- ?

A

Adjustment of the gray scale to optimize tissue visualization

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8
Q

Window width

?

A

Range of ct numbers above and below the window level

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9
Q

Window level
Aka
- ?

A

Aka window center

Center of window width

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10
Q

Pitch

?
- thinner slices means?

  • higher ratio is more?
A

In helical scanning it is the ratio of slice thickness to table movement.
How many times the scanner goes around the patient .

Thinner the slices more times around.

Higher ratio- more mas used

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11
Q

Raw data

A

Collection of all data acquired during scan within scan field of view. Can by used to later reconstruct images with a different algorithm, slice thickness or display field of view. Usually not archived.

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12
Q

Scan field of view

A

Field by which the raw data is collected

What is actually used not everything that was scanned

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13
Q

Displayed field of view (dfov)

A

Size of image on monitor

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14
Q

Effective scan data

A

Collection of raw data used to create the display image . Usually archived

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15
Q

Noise

-?

4 reasons?

A

Fluctuation in ct numbers of an object of uniform density. Displayed as graininess. Caused by insufficient photons( not enough mas) , slice thickness, algorithms , and electronic malfunction

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16
Q

Multiplanar reconstruction (mpr)

A

Simple 3-d technique that enables the visualization of data in any plane

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17
Q

Volume rendering (vr)

A

3-d visualization technique that provides a 3-d model of all structures in an imaging data set. Used in cta, urograms

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18
Q

Maximum intensity projection (mip)

A

A volume rendering 3-d technique that displays the voxels with the highest ct number to be displayed. Used in cta to look at vessels

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19
Q

Contrast is out of body in what time frame?

A

24-48 hrs

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20
Q

Why no contrast with a suspected bleed?

A

Blood / contrast have same ct number

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21
Q

Routine ct scan of brain, why no contrast used?(5)

A 
Trauma
Acute cva
Intracranial hemorrhage
Hydrocephalus 
Subdural hematoma less than week
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22
Q

Routine ct brain with contrast

  • first with
  • 5
A

First done without contrast with tumors

Vascular malformations
Abcess 
Headache
Aneurysm
Metastasis
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23
Q

Ct scan brain done intrathecal to evaluate?

A

Ventricles

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24
Q

Ct scan of brain positioning

A 
Head first 
Supine
Remove head jewelry
Head placed into immobilization cradle
Cushion under legs for comfort
Shield
Patient centered midcoronal and midsagital with lasers
Have patient close eyes while lasers on
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25
In ct patient needs be shielded ?
All way around
26
Protocol brain routine - scout - Scout 90 degree azimuth ( lateral) from ______ to top of _____approx ___-____ mm total ____mm slices thru posterior ____. Better spatial resolution. Reduces beam hardening artifact ___-____mm slices from base skull to skull apex Slices angled parallel to ________ Head algorithmn with _____cm display field of view Reconstruct with a bone algorithmn for ____ Brain windows: ___-____ window width and __-___window level and ___ ww and ____wl for bone when trauma is suspected
Scout 90 degree azimuth ( lateral) from base of skull to top of head, approx 250-300 mm total 1mm slices thru posterior fossa. Better spatial resolution. Reduces beam hardening artifact 2-3 mm slices from base skull to skull apex Slices angled parallel to orbitomeatal line( oml) Head algorithmn with 25cm display field of view Reconstruct with a bone algorithmn for trauma Brain windows: 90- 120 window width and 0-50 window level and 2500 ww and 500wl for bone when trauma is suspected
27
______mm throughout entire brain may be used for stereotactic or surgical navigation for tumor localization
1 mm
28
Know head and brain anatomy out wb
Wb
29
Pons
Connects cerebellum to medulla oblongota
30
Vertebral artery merges into ?
Basilar artery
31
Temporalis muscle
Originates in temporal fossa and inserts on the coronoid process of mandible and elevates the mandible
32
Basilar artery
Supplies pons, cerebellum, inferior and medial surfaces of temporal occipital lobes with blood
33
Cerebellum
Coordinates and regulates muscle activity
34
4th ventricle
Diamond shaped cavity located anterior to the cerebellum and posterior to pons
35
Pituitary gland _______ gland connected to the_____.It's located in the ____ . Called the master gland and Controls and regulates the function of other ____glands
Endocrine gland connected to the hypothalamus. It's located in the sella turcica . Called the master gland and Controls and regulates the function of other six glands
36
Internal carotid artery bifurcated at
C4
37
Internal carotid artery
Supply frontal, parietal , and temporal lobes of brain and orbital structures. Arise from bifurcation of carotid artery
38
Parts of circle of Willis
Anterior , middle, posterior cerebral artery
39
Tentorium
Fold of dura mater connects cerebellum and cerebrum
40
Anterior cerebral artery
Supply blood anterior frontal lobe and medial aspect of parietal lobe. Main branches horizontal segment( a1), vertical segment(a2), and distal segment(a3)
41
Middle cerebral artery
Largest of cerebral arteries and considered direct continuation of internal carotid artery . Supplies much of the lateral surface of cerebrum, insula, anterior and lateral aspects of temporal lobe, basal ganglia and anterior and posterior internal capsule Four segments: Insular (m1) Opercular( m3) Cortical ( m4)
42
Septum pellucidum
Seperate anterior horn and lateral ventricle
43
Anterior horn lateral ventricle
Pg 93
44
3rd ventricle
Communicates with 4th ventricle via cerebral aqueduct
45
Quadrigeminal cistern
Lies between splenium of corpus callosum and superior surface of cerellbelum just posterior to coliculi of midbrain
46
Field of view (fov)
Size of the image Ex abdomen 46/48
47
Corpus callosum
White matter separates left / right hemisphere of brain
48
Falx cerebri
Separates cerebral hemispheres
49
Largest and densest bundle white fibers within of cerebrum
Corpus callosum
50
Internal cerebral vein
Drain deep parts of brain
51
Choroid plexus
Can be partially calcified and produce csf in ventricles
52
Fornix
Grey matter both sides hemisphere
53
Ct scan of paranasal sinus non contrast (4)
Acute or chronic sinusitis Headache Trauma Sinus surgery planning
54
Ct scan of paranasal sinus contrast exams
If mass is suspected
55
Ct scan of paranasal sinus intrathecal contrast
In cases of csf leak
56
Ct scan paranasal sinus positions
Axial and coronal positions
57
Best ct scan paranasal sinuses for true air fluid level
Coronal
58
Ct scan of paranasal sinus may be scanned ______ position and reconstructed ______
Axial Coronally
59
Isocenter
Middle of scan that gives best data to receptor. Further away less data to receptor
60
Ct scan paranasal sinus : coronal position
``` Prone Head first in immobilization cradle Neck hyperextended Cushion under chin Support under legs Jewelry and dental work removed Laser midsagital and midcoronal plane Patient shield ```
61
Ct scan paranasal sinus : axial
``` Supine Head first in immobilization cradle Jewelry and dental work removed Cushion under knees Laser midcoronal and midsagital Patient keeps eyes closed Patient shielded ```
62
Coronal paranasal sinus protocol Scout 90 degree azimuth (lateral) from ________thru _____ ___-____mm slices from posterior sella turcica thru the frontal sinus Slices angled perpendicular to ____ Bone or detail algorithm with ____-____cm dfov Film either or all bone , air, , or soft tissue windows
Scout 90 degree azimuth (lateral) from posterior skull base thru frontal bone 1-2 mm slices from posterior sella turcica thru the frontal sinus Slices angled perpendicular to oml Bone or detail algorithm with 14-20 cm dfov Film either or all bone , air, , or soft tissue windows
63
Axial paranasal sinus protocol Scout 90 degree azimuth ( lateral) from ___thru ____ 1-2 mm slices from below ___sinus thru ____sinus Slices angled parallel ____ Film same as coronal Reconstruct axial images into ____
Scout 90 degree azimuth ( lateral) from chin thru midbrain 1-2 mm slices from below maxillary sinus thru frontal sinus Slices angled parallel oml Film same as coronal Reconstruct axial images into coronal
64
Ct scan orbits and facial bones non contrast(3)
Trauma Graves' disease - extra fluid in back eyes Foreign body
65
Ct scan orbit and facial bones contrast(2)
``` Suspected mass Visual disturbances Scanned axial and coronal Coronal best true fluid levels Scanned axial and reconstructed ```
66
Coronal position orbits and facial bones
``` Prone Head first in immobilization cradle Neck hyperextended Cushion under chin Support under legs Jewelry and dental work removed Laser midsagital and midcoronal plane Patient shield ```
67
Axial position ct scan orbits and facial bones
``` Supine Head first in immobilization cradle Jewelry and dental work removed Cushion under knees Laser midcoronal and midsagital Patient keeps eyes closed Patient shielded ```
68
For orbits have patient ______ reduce rectus muscle motion
Close eyes or stare
69
Orbit and facial bone protocol: coronal Scout 90 degree azimuth( lateral) from _______thru bone 1-2 mm slices from posterior _____ thru _____ Slices angled perpendicular to _____ Bone and detail algorithm with a ___-____cm dfov Film in both bone and soft tissue windows( two different algorithm - bone and soft tissue)
Scout 90 degree azimuth( lateral) from posterior skull base thru bone 1-2 mm slices from posterior sella turcica thru anterior globe of the eye Slices angled perpendicular to oml Bone and detail algorithm with a 14-20 cm dfov Film in both bone and soft tissue windows( two different algorithm - bone and soft tissue)
70
Axial orbit and facial bone protocol Scout 90 degree azimuth (lateral) from ____thru mid ____ __-___mm slices from below maxilla or______ thru ___ Slices angled parallel _____ Film as coronal Reconstruct axial images into coronal
Scout 90 degree azimuth (lateral) from chin thru mid brain 1-2 mm slices from below maxilla or mandible thru superior orbital rim Slices angled parallel oml Film as coronal Reconstruct axial images into coronal
71
Facial /sinus/ orbit anatomy
Do notebook
72
Tmj
Condyle and temporal bone joint
73
Nasal septum
Perpendicular plate of ethmoid and vomer
74
Anterior clinoid process is in?
Sella turcica
75
Crista galli is in?
Ethmoid bone
76
Ct mastoids and internal auditory canals ( iac) non contrast exams(7)
Temporal or petrous bone survey Hearing loss Cholesteatoma Mastoiditis Chronic Ottis media Foreign body Bony destruction
77
Ct mastoids and internal auditory canals ( iac) contrast exams(3)
Acoustic neuroma Coronal best for air fluid levels Scanned axial must be reconstructed
78
Ct mastoids and internal auditory canals ( iac) and temporal bone coronal protocol Scout 90 degree azimuth( lateral) from ____thru ____ 1-2 mm slices from _____ thru ____ Slices angled perpendicular to _____ Bone or detail algorithm with a ___-___cm dfov Film either or all bone , air or soft tissue windows
Scout 90 degree azimuth( lateral) from posterior skull base thru frontal bone 1-2 mm slices from posterior mastoid air cells thru sella turcica Slices angled perpendicular to oml Bone or detail algorithm with a 14-20 cm dfov Film either or all bone , air or soft tissue windows
79
Ct mastoids and internal auditory canals ( iac) and temporal bone Axial protocol Scout 90 degree azimuth ( lateral) from ___ thru _____ 1-2 mm slices from ______ thru ______ Slices angled parallel to _____ Bone or detail algorithm with a ___-____cm dfov Film same as coronal Reconstruct axial images into _____
Scout 90 degree azimuth ( lateral) from chin thru mid brain 1-2 mm slices from inferior mastoids thru petrous ridges Slices angled parallel to oml Bone or detail algorithm with a 14-20 cm dfov Film same as coronal Reconstruct axial images into coronal
80
Mallelus
Hammer like structure in ear
81
Pituitary and sella turcica scan done with ?
Iv contrast and without delayed due to blood brain barrier
82
Infendibulum
Pituitary gland hangs on it and connects to hypothalamus
83
Coronal position best sees ____ and ______
Pituitary | Sella turcica
84
Pituitary gland sits on_____
Sella turcica
85
Pituitary and sella turcica coronal protocol Scout 90 degree azimuth ( lateral) from______thru ______ _____mm slices from posterior sella turcica thru the anterior sella turcica Slices angled perpendicular to ____ Bone or detail algorithm with a ___-___cm dfov Film in both and soft tissue windows
Scout 90 degree azimuth ( lateral) from posterior skull base thru frontal bone 1 mm slices from posterior sella turcica thru the anterior sella turcica Slices angled perpendicular to oml Bone or detail algorithm with a 10-14 cm dfov Film in both and soft tissue windows
86
Pituitary and sella turcica protocol axial Scout 90 degree azimuth ( lateral) from ____thru ___ 1mm slices from ____ sella thru ____ sella Slices angled parallel to _____ Film as coronal Reconstruct axial images into _____image
Scout 90 degree azimuth ( lateral) from chin thru mid brain 1mm slices from inferior sella thru superior sella Slices angled parallel to oml Film as coronal Reconstruct axial images into coronal
87
Ct scan soft tissue neck non contrast
Parotid calculi ( gland - salivary gland)
88
Ct scan soft tissue neck with contrast(6)
``` Lymphadenopathy Tumors Abcess Vascular pathology Tracheal stenosis or fracture Trauma ```
89
Ct scan soft tissue neck positioning
``` Head first Supine Head jewelry removed Remove dental work Head placed into immobilization cradle Cushion under legs Shield Patient centered midcoronal and midsagital with positioning lasers Patient closes eyes with laser ```
90
Soft tissue neck protocol Scout 90 degree azimuth (lateral) from____to midbrain approx___mm ___-____mm slices _______ to _____ ____ mm slices for ct angiography of carotid arteries Usually no gantry angulation but may be angled ______ to neck Standard or soft algorithm with a ___-____cm Display field of view ( neck size)
Scout 90 degree azimuth (lateral) fromT-2 to midbrain approx 350mm 1-3 mm slices superior base of tongue to lung apices 1mm slices for ct angiography of carotid arteries Usually no gantry angulation but may be angled parallel to neck Standard or soft algorithm with a 20-25 cm Display field of view ( neck size)
91
Soft tissue neck scanning procedure Inject ___-___ cc of iodinated contrast material with a ___-___second scan delay ___-___sec delay for carotid Instruct patient not ____ during exam Evaluate vocal cord motility instruct to phonate the letter ______while scanning Reconstruct with bone algorithm for trauma- can see ______ Film soft tissue ___-___ window width and ___-___window level and _____ww and ___wl for bone when trauma is suspected Air windows of ____ww and ____wl may helpful evaluate tracheal leaks
Inject 60-120 cc of iodinated contrast material with a 60-65 second scan delay 10-15 sec delay for carotid Instruct patient not swallow during exam Evaluate vocal cord motility instruct to phonate the letter "e" while scanning Reconstruct with bone algorithm for trauma- can see free air Film soft tissue 90-120 window width and 0-50 window level and 2500 ww and 500wl for bone when trauma is suspected Air windows of 1500ww and -500 wl may helpful evaluate tracheal leaks
92
Parotid
Largest salivary gland
93
External carotid artery
Blood supply face
94
Internal carotid artery
Blood supply brain
95
Epiglottis
Flap over esophagus
96
Sternocleidomastoid muscle
Rotates head to opposite side and flexion of neck
97
Parotid gland
Secretes saliva through parotid duct into mouth to facilitate mastification and swallowing
98
Sublingual gland
Smallest salivary gland
99
Veins vs artery
Veins more outside Veins larger
100
Ct angiography of carotids and circle of Willis Clinical indication (7)
``` Aneurysm Stenosis Trauma Dissection Atherosclerosis Vascular malformations Subarachnoid hemorrhage ```
101
Ct carotids and circle Willis positioning
``` Head first Supine Head jewelry removed Remove dental work Head placed into immobilization cradle Cushion under legs Shield Patient centered midcoronal and midsagital with positioning lasers Patient closes eyes with laser ```
102
Cta carotid protocol Scout 90 degree azimuth ( lateral) from ______to _____ _-_mm slices from aortic arch to temporal region Usually no gantry angulation but may be angled _____to neck Standard or soft algorithm with a ___-___cm display filed of view (dfov) Inject ___-___cc iodinated contrast material at __-___cc/sec with ___-___sec scan delay. Optional use of test bolus 20 cc injection at level of ____or manual start scan bolus timing software to avoid venous contamination Faster injection brighter image will look. Need larger needle lumen Instruct not swallow during exam Reconstruct overlapping slices ``` Post process with maximum intensity projection ( mip) Volume rendered(vr), multiplanner reconstruction( mpr) ```
Scout 90 degree azimuth ( lateral) from aortic arch to midbrain 1-2 mm slices from aortic arch to temporal region Usually no gantry angulation but may be angled parallel to neck Standard or soft algorithm with a 15-20 cm display filed of view (dfov) Inject 90-120cc iodinated contrast material at 3-5 cc/sec with 12-20 sec scan delay. Optional use of test bolus 20 cc injection at level of c6 or manual start scan bolus timing software to avoid venous contamination Faster injection brighter image will look. Need larger needle lumen Instruct not swallow during exam Reconstruct overlapping slices ``` Post process with maximum intensity projection ( mip) Volume rendered(vr), multiplanner reconstruction( mpr) ```
103
Cta circle of willis (cow) protcol Scout 90 degree azimuth ( lateral) from ___-thru _____ ___mm slices from foremen magnum to _____ or thru ___ no gantry angulation Brain algorithm with a ___-___cm display field of view Inject ___-___cc iodinated contrast material at ___-___cc/sec with _____sec scan delay. Optional use of test bolus ___cc injection at level of circle of Willis or manual start scan bolus timing software to avoid venous contamination _____injection brighter image will look. Need ____ needle lumen Instruct not ______during exam Reconstruct overlapping slices( take away _____and ____if just wanna see carotids ``` Post process with maximum intensity projection ( mip) Volume rendered(vr), multiplanner reconstruction( mpr) ```
Scout 90 degree azimuth ( lateral) from t2-thru skull apex 1mm slices from foremen magnum to skull apex or thru mid brain no gantry angulation Brain algorithm with a 20-25 cm display field of view Inject 90-120cc iodinated contrast material at 3-5 cc/sec with 12-20 sec scan delay. Optional use of test bolus 20 cc injection at level of circle of Willis or manual start scan bolus timing software to avoid venous contamination Faster injection brighter image will look. Need larger needle lumen Instruct not swallow during exam Reconstruct overlapping slices( take away skin/ bone if just wanna see carotids ``` Post process with maximum intensity projection ( mip) Volume rendered(vr), multiplanner reconstruction( mpr) ```
104
Anterior cerebral artery
Blood supply midline to portions of frontal lobe and superior medial parietal lobes
105
Anterior communicating artery
Connects left and right anterior cerebral arteries
106
Middle cerebral arteries
One three major arteries supplying blood cerebellum. Supplies blood also to anterior temporal lobes and insular cortices
107
Posterior communicating artery
Connects between posterior the cerebral artery and internal artery
108
Posterior cerebral artery
Supply oxygen blood supply to posterior portion of brain

Protcol Neck And Head Powerpoints (1 decks)

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