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Procedures Flashcards

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1
Q
  1. Gantry Angle For CT Brain is ______
  2. Is CT Brain Helical or Axial Scan? Why?
  3. What Causes Streak Artifacts in a CT Brain? How is this fixed/prevented?
A
  1. Parallel to Supraorbital Meante Line (SOML)
  2. Axial b/c Gantry can’t be tilted & scan in Helical
  3. Posterior Fossa typically has streak artifacts due to different attenuation between hard skull and soft brain tissue.
    - Adjusted by using different slice thicknesses.
    - Adjust by increasing kVp
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2
Q
  1. How is the Posterior Fossa scanned? Why?
  2. When would you scan a CT Brain in Helical?
  3. Brain Window Width & Level For:
    - Soft Tissue ____ WW & ____ WL
    - Posterior Fossa ____ WW & ____ WL
    - Blood ____ WW & ____ WL
A
  1. 1.25mm thickness to help reduce beam hardening artifacts
  2. Reduce motion artifacts or 3D post processing is needed
  3. Brain Window Width & Level For:
    - ST = 160 WW & 40 WL
    - PF = 100 WW & 30 WL
    - Blood = 200 WW & 60 WL
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3
Q
  1. What type of Window Width is needed for viewing CT Brain? Why?
  2. How will a hemorrhage appear from onset - 3 days?
    - 4-10 days?
    - 11 days - 6 months?
    - Beyond 6 months?
  3. Clinical Indications for Contrast in CT Brain?
A
  1. Narrow Width b/c of slight differences between gray & white matter of brain
  2. Onset -3 = Hyperdense
    - 4-10 days = Hyperdense Center w/ hyper&hypodense surroundings
    - 11 Days- 6mo = Isodense Center w/ Hyperdense surroundings
    - 6mo+ = Hypodense
  3. Infection, Neoplasm, Venous Malformation
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4
Q

CT BRAIN:
Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Gantry to SOML
PREP= NONCON but if CON ~100ml
CLIN= w/o Hematoma, IHA, Infarction, Dementia, Hydrocephalus
- w/ = Infection or Neoplasm
SCAN= Below Skull Base - Above Vertex
ALG.= Soft Tissue & Bone
SLICE= Thin (2-5mm) For Skull Base Through Post. Fossa
- Thick (5mm+) For Post Fossa to Above Vertex
RFMT= SAG, COR, Protocol Dependent

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5
Q

CT FACIAL BONES

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine
PREP= NONCON
CLIN= Facial Trauma
SCAN= Frontal Sinus to below Mandible
ALG.= Soft Tissue & Bone
SLICE= 2mm - 3mm
RFMT= SAG, COR, 3D

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6
Q

CT ORBITS

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Gantry Parallel to IOML
PREP= NONCON, But if ~100ml
CLIN= w/o Trauma, FB
- w/ Mass, Infection, Inflammation
SCAN= Orbital Floors to Orbital Roofs
ALG.= Soft Tissue & Bone
SLICE= 2mm - 3mm
RFMT= COR & SAG
- Oblique maybe for Optic Nerve

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7
Q

CT SINUS’

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= SUPINE
PREP= NONCON, But If ~100ml
CLIN= w/o Sinusitis
- w/ Infection, Mass or Vascular Ab
SCAN= Maxillary & Ethmoidal Sinus through Sphenoid & Frontal
ALG.= Soft Tissue & Bone
SLICE= 2mm - 3mm
RFMT= COR & SAG

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8
Q
  1. When would Oblique Orbits be requested?
  2. Facial Bones may require what? (in regards to patient position)
  3. What reduces need for patient to be prone in CT Sinus’?
A
  1. Optic Nerve is ROI
  2. Open Mouth Scan & Closed Mouth Scan
  3. MPR removed need for prone or dropped head
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9
Q
  1. CTA of Brain images what?
  2. What are the Arteries of Interest in CTA Brain?
  3. What is typically done prior to a CTA Brain?
  4. What phase is CTA Brain scanned at? Why is this important?
A
  1. Arteries of Brain at peak opacification
  2. Basilar Artery, Middle Cerebral Artery, & Circle of Willis (COW)
  3. NONCON Brain CT
  4. Arterial Phase
    - Specific Injection Rate of 4ml/s +
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10
Q

CTA BRAIN

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Antecubital IV
PREP= CON 60-80ml
CLIN= Cerebral Aneurysm, Arterial Stenosis, Malformation
SCAN= C2 to Top of Skull
ALG.= Soft Tissue
SLICE= 1mm-2mm
RFMT= COR, SAG, MIP, 3D

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11
Q
  1. What is typically done prior to a CT Perfusion Scan?
  2. What is a Perfusion scan evaluating?
    - Goal of Perfusion?
  3. 3 Key Measurements of Perfusion:
A
  1. NONCON Brain CT
  2. Evaluate blood flow in & out of brain tissue.
    - Determine infarcted brain tissue vs viable brain tissue
  3. Blood Volume, Blood Flow & Mean Transit Time
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12
Q
  1. Define:
    - Cerebral Blood Volume
    - Cerebral Blood Flow
    - Mean Transit Time
  2. Perfusion Contrast:
    - Amount:
    - Rate:
    - Time:
  3. What is crucial in perfusion images? Why?
A
  1. CBV= Quantity of blood in 100g tissue
    - CBF= Quantity blood moves in 100g tissue in 60 seconds
    - MTT= Average time takes blood pass through given area
  2. 50 ml/s
    - 5.0-7.0ml/s
    - For 60 Seconds
  3. Only ROI scanned
    - Higher Dose b/c longer scan time
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13
Q

CT PERFUSION

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Antecubital IV
PREP= CON 50ml,
- Xenon / Xe per protocol
CLIN= Stroke, Vasoplasm, Temporary Occlusion
SCAN= Only ROI (Typically COW)
ALG.= Soft Tissue
SLICE= 3mm - 5mm
RFMT= COR, SAG, 3D, FLOW MAPS

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14
Q
  1. What type of scan is CT Neck scanned in?
  2. CT Neck patient positioning considerations?
  3. Why do you preform Valsalva & “eee” ?
A
  1. Helical
  2. Extend neck up
    - lower shoulder much possible
    - Valsalva or “eee”
  3. Valsalva = Pyriform Sinus
    - eee = Areyepiglottis & Pyriform
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15
Q

CT LARYNX
Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Gantry Parallel Vocal Cords
PREP= CON 80-135ml @45-90sec delay
CLIN= Mass, Cyst, Infection, Vocal Cord Damage
SCAN= Mid Orbits To Clavicles
ALG.= Soft Tissue
SLICE= 1mm - 2mm
RFMT= COR & SAG

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16
Q
  1. How is the gantry positioned in CT Soft Tissue Neck? Why?
  2. What are typical patient instructions during CT Soft Tissue Neck? Why?
  3. What Organ/Anatomy is important consideration in CT STN & Why?
A
  1. Orbits to Hard Palet = Gantry parallel to hard palette
    - Rest of scan = parallel to mandible body
    - This prevents streak artifacts
  2. Stop Swallowing & Breathe Softly
    - Reduce patient motion
  3. Thyroid Gland
    - Hyperdense / important consideration w. contrast
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17
Q

CT SOFT TISSUE NECK

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine
PREP= CON 80-125ml @ 45-90sec delay
CLIN= Mass, Cyst, Infection, Swollen Glands
SCAN= Mid Orbits to Clavicles
ALG.= Soft Tissue
SLICE= 2mm - 3 mm
RFMT= SAG & COR

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18
Q

CTA NECK

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Antecubital Right Arm
PREP= CON 60-80ml @SP 15-18sec
CLIN= Aneurysm, Vascular Injury, Occlusion, Arterial Stenosis
SCAN= Skull Base to Aortic Arch
ALG.= Soft Tissue
SLICE= 1 - 1.5 mm
RFMT= COR, SAG & MIP

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19
Q
  1. What phase is CTA Neck scanned?
    - Why is this important?
  2. What’s done before CTA Neck?
  3. Contrast injection rate, amount & typical delay for CTA Neck?
A
  1. Arterial enhancement of carotid arteries
    - Important for injection rate 4.0+ and time being boils tracked 13-18sec
  2. NONCON Neck
  3. 60-80ml @ 4.0ml/s @ Bolus Tracking but typically 13-18 sec empiric delay
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20
Q
  1. Where is the IV best placed for CTA Neck? Why?
  2. Describe C-Spine Anatomy
  3. Where does the spinal cord begin & end? What is the name of it?
A
  1. Right Antecubital
    - Reduce streak artifact from contrast entering vasculatures
  2. Between C1 & C2 there’s no intervertebral disc space
    - C2 - C7 there is
  3. Medulla of brain to level of L1
    - Tapers off into bundle nerves called Cauda Equina
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21
Q
  1. What does intervertebral disc consist of?
  2. What is
    - Spondylosis
    - Spondylolysis
    - Spondylothesis
  3. What is spinal Stenosis?
A
  1. Nucleus Pulpous - Center of disc
    - Anulus Fibrosis - Outer portion of disc
  2. Losis = Hypertophy of
    - Lolysis = Damage to interarticularis
    - Lothesis = Superior body slips over inferior
  3. Narrowing of spinal cord
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22
Q

CT CERVICAL SPINE
Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Head First,
PREP= NONCON, But if 80-100ml @1-3ml/s (Portal Venous Phase)
CLIN= Herniated Disc, Trauma, Lesion, Degeneration, Infection, Post Op
SCAN= Skull Base to T1
ALG.= Soft Tissue & Bone Window
SLICE= .5 mm - 2.0 mm
RFMT= COR, SAG, 3D

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23
Q
  1. Typical rate of contrast for CT Spine studies?
    - What Phase?
  2. What is HNP?
  3. What are clinical indications for CT Spines?
A
  1. 1-3ml/s
    - Portal Venous Phase
  2. Herniated Nucleus Propos. (Herniated disc / nucleus protruding)
  3. HNP, Trauma, Fracture, Post-Op, Degenerative Diseases (Spondies), Lesion, Infections
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24
Q

CT THORACIC SPINE

Patient:
Prep:
Clinical Ind: (w & w/o)
Scan Range:
Algorithm:
Slice Thickness:
Reformats:

A

PT= Supine, Arms Over Head
PREP= NONCON but if 80-100ml @1-3ml/s @ Portal Venous
CLIN= Trauma, Fx, Degenerative, Post Op
SCAN= C7 to L1
ALG.= Soft Tissue & Bone Window
SLICE= 2mm - 5mm
RFMT= COR, SAG, 3D

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25
CT LUMBAR SPINE Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Over Head, Knees Bent PREP= NONCON but if 80-100ml @1-3ml/s @ Portal Venous CLIN= Trauma, Fx, Degenerative, Post Op SCAN= T12 Through L5 ALG.= Soft Tissue & Bone Window SLICE= 2mm - 5mm RFMT= COR, SAG, 3D
26
1. What is different about CT Lumbar positioning vs C & T Spine? 2 Why are Breath Holds used in CT Chest exams? 3. Common site for Metastesses?
1. C & T =. Head First - L = Feet First & Cushion for bent knees to relieve low back pain T & L = Arms Raised 2. Reduce motion artifacts 3. Adrenal Glands
27
1. How is a CT Chest typically scanned? - Why? 2. Contrast rate & amount for CT Chest? 3. Cardiac Exams Ideal HR?
1. Inferior to Superior to reduce contrast artifacts as it is injected 2. 70-120 ml @ 2-4ml/s 3. Below 65 BPM
28
CT CHEST Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised PREP= CON 70-120ml @ 2-4ml/s, Breath Holds CLIN= Mass, Infection, Emphysema, Congenital Thoracic Cond. Abnormal XRays SCAN= Above Apices to below lung base / diaphragm ALG.= Soft Tissue & Lung Window SLICE= 2mm - 5mm RFMT= COR & SAG
29
CT CHEST (HIGH RESOLUTION) Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine or Prone, Arms Raised PREP= NONCON, Breathhold, Insp & Exp CLIN= Asthma, COPD, Cystic Fibrosis, Emphysema, Bronchitis SCAN= Above Apices through Lung Bases ALG.= Soft Tissue & Lung Window SLICE= .5mm - 2mm RFMT= COR, SAG, MIP, MinIP
30
1. What are patient instructions in High Resolution CT Chest? - Why? 2. How is a CT Chest High Res. Scanned? - What are the Recons in & Why? 3. What is patient position in CT Chest High Res? - Why?
1. Inspiration & Expiration - Displace air trapped in patients 2. Axially w/ Thin Slices (.5-2mm) - Recon in 10-15mm to better demonstrate interstanial lung disease 3. Supine & Prone - Demonstrate Edematous Changes
31
1. Describe Steps of Blood Flow Through Heart. - Which Side is Oxygenated?
1. Superior Vena Cava or Inferior Vena Cava -> 2. Right Atrium -> Tricuspid Valve -> Right Ventricle -> Pulmonary Artery -> Lungs -> Left Atrium -> Mitrial/Bicuspid Valve -> Left Ventricle -> Aorta -> Rest of Body - LEFT SIDE = Oxygenated (LOX) RIGHT SIDE = Deoxygenated
32
1. What is commonly used in CT Cardiac Exams? 2. What branches off of the RIGHT Coronary Artery? *How Remember* 3. What about the Left? *How Remember*
1 ECG Gating 2. Conus Artery, Sinus Node Artery, R. Atrial & Ventricle Branches, Posterior Descending Artery **RIGHT C.A.P = Conus, Sinus, Posterior 3. Left Anterior Descending Artery & Left Circumflex Artery ** LEFT LAC = Anterior & Circumflex
33
1. What medications are used in CT Cardiacs? - Why? 2. What advantages do newer CT Scanners have? - Why are they important? 3. What phase of Cardiac Cycle is scanned in CT Cardiacs? - Why?
1. Beta Blockers = Lower HR - Nitroglycerin = Dilate Vessels 2. Higher Temporal & Spatial Resolution Temporal = Clearer images of object in motion Spatial = Differentiation between structures close together 3. Diastolic / Rest - Eliminate Cardiac Motion
34
1. Temporal Resolution = - Spatial Resolution = 2. What helps reduce patient dose in Cardiac Exams? 3. When are images acquired for Cardiacs? - What % ECG Interval is used for Cardiac Scan?
1. Temporal = Ability produce clearer images of objects in Motion - Spatial = Allows differentiation between structures close together 2. Radiation shut off when not in diastolic phase of cycle 3. Images acquire through whole cycle, only portion is used for reconstruction - 55-75% of R-R Interval
35
CT CARDIAC (Coronary Arteries) Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Antecub IV, ECG PREP= CON 80-100ml @ 4-7ml/s, Breathholds & Meds CLIN= Cardiac Abnorm, Calcification, Morphology, Myocardial Perfusion SCAN= Carina through Apex Heart ALG.= Soft Tissue SLICE= 0.4mm - 0.7mm RFMT= COR, SAG, MIP, 3D, VR, SSD
36
CT CARDIAC - Calcium Score Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised, ECG PREP= NONCON CLIN= Atherosclerotic Disease SCAN= Carina through Apex Heart ALG.= Soft Tissue SLICE= 2mm - 3mm RFMT= COR, SAG, 3D
37
1. CT Calcium Score evaluates what? 2. Why does Calcium Score use ECG? 3. Is CT Calcium Score High Dose or Low Dose?
1. Calcification of Coronary Arteries 2. Monitor Cardiac Cycle for Diastolic phase - reduce patient dose & limit motion artifacts 3. Lower Rad Dose
38
1. What defines “Calcification” of Coronary Arteries? 2. What’s the Calcium Score Measurement System Called? 3. What Are The Ranges for Calcification?
1. 1mm^2 with HU above 130 2. Agatston Scoring System 3. 1-10 Minimal 11-100 Mild 101-400 Moderate 400+ Excessive
39
1. What Breathing Is Used for CT Pulmonary Angiography? - Why? 2. How is CT Pulmonary Angiography scanned? - Why? 3. Goal of CT Pulmonary Angiography? - How is it done? 4. Why is Saline Flush after CTA Pulm good?
1. Shallow Breathing or Hold Breath Shallow Better b/c hold can trap non-opacified blood in arteries and dilute contrast 2. Caudicranial - Reduce motion artifacts from patient breathing & reduce artifacts from contrast as it’s being administered 3. Image Pulmonary Arteries at Peak Opacification - By Bolus Tracking and Rate of 4.0+ 4. Saline Flush after to help reduce streak artifacts in Superior Vena Cava
40
CT PULMONARY ANGIOGRAPHY Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Above PREP= CON 80-130ml @4.0+, Breathhold or Shallow Breathing CLIN= Pulmonary Embolism SCAN= Above Apices to below Lung Bases ALG.= Soft Tissue & Lung Window SLICE= .5mm - 2mm RFMT= COR, SAG, MIP, 3D
41
CTA AORTA Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Right Antecubital IV, (CAN be gated) PREP= CON 80-130ml @4.0+ CLIN= Trauma, Aneurism, Dissection, Vascular Abnormal, Arterial Disease SCAN= Above Clavicles to Below Celiac Arteries ALG.= Soft Tissue SLICE= .5mm - 2mm RFMT= COR, SAG, MIP, 3D, VR
42
1. Goal of CTA Aorta? - How is it done? 2. Why should ECG be used in CTA Aorta? 3. Where is IV best placed for CTA Aorta? - Why?
1. Imaging peak opacification of Thoracic Aorta - Rate of 4.0+ 2. Reduce motion artifacts in aorta 3. Right Antecubital - Reduce streak artifacts appearing in branches of aortic arch
43
1. What are the types of Dissection? - Explain difference 2. What is a “Triple Rule Out” for CTA?
1. A Type Dissection = Ascending Aorta - B Type = Descending Aorta 2. Asses Coronary Arteries, Aorta & Pulmonary Artery
44
1. GI Tract Consists of: 2. Where is the Appendix located? 3. How is the intestine wall imaged? - Examples of?
1. Esophagus, Intestine & S/L Intestine 2. Extends from Cecum by ileocecal Valve 3. Oral Contrast - Water, Barium & Water Soluble Iodine
45
1. First Part of GI Tract is: - Connects to: 2. Why is imaging intestine wall important? 3. Typical Oral Contrast for CT Abdomen?
1 Esophagus - To Stomach 2. Most pathology contained there 3. 750-1500ml
46
1. What determines how long after oral contrast is consumed to scan? (Delay Time) - Common Ranges: 2. The Stomach Connects to ______ via ______ 3. Common Indications for CT of esophagus & stomach?
1. Region of Interest & Department Protocol - Immediate - 3 Hours 2. Small Intestine via Pyloric Sphincter & Duodbulb 3. FB, Esophageal Varies, Hiatal Hernia, Cancer
47
1. The Small Intestine consist of: 2. Most Distal Part of Small Intestine is ______ - Why is this important? 3. Common Small Intestine Indications:
1. Duodenum, Jejunum & Illeum 2. Illeum - Where connects to Large Intestine via Ileocecal Valve 3. Hernia, Obstruction, Intussception, Ileus, Chrohns & Cancer
48
1. The Large intestine consist of: 2. Clinical Indications for CT Large Intestine: 3. What is the patient prep instructions for CT Abdomen & Pelvis?
1. Cecum, Ascending Colon, Transverse Colon, Descending Colon, Sigmoid Colon & Rectum 2. Diverticulitis, Inflammatory Bowel, Colitis, Appendicitis 3. Some may need NPO 2-8 Hours Prior (Department Based)
49
1. What indicates Appendicitis? 2. Four Types of Hernia In Abdomen: - What Region of Interest for Each 3. Why do patients fast before CT Abdomen/Pelvis with contrast?
1. Inflamed & Thickened Appendix Wall or Presence of Appendicolith 2. Hiatal = Esophagus - Inguinal, Umbilical & Incisional = Small Intestine 3. Better evaluation of proximal GI & minimize risk of aspiration
50
1. How much contrast is used if distal large colon is area of interest? - Type & Route? 2. What can IV Contrast show in intestinal walls? 3. Common injection Rate for CT Abdomen/Pelvis? - Amount & Phase?
1. 200ml Positive Contrast (Barium) via Enema 2. Wall Thickening, Lesions, Inflammation & Ischemia 3. 1.5 ml - 4.0 ml - 80-120ml - Portal Venous Phase
51
CT ABDOMEN / PELVIS Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised PREP= CON 80-120ml IV &/or 750-1500ml Oral, Breathholds CLIN= Trauma, Mass, Infection, Abscess, Inflammation, RLQ Pain SCAN= Above Diaphragm through Public Symphysis ALG.= Soft Tissue SLICE= 2mm - 5mm RFMT= COR, SAG, 3D
52
CT ADRENAL GLANDS Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised PREP= CON 80-120ml via IV, Breathhold CLIN= Mass, Lesion, Cancer Staging SCAN= Slightly Above Diaphragm to slightly below Kidneys ALG.= Soft Tissue SLICE= 2mm-5mm RFMT= COR & SAG
53
1. How is CT Adrenal Gland Typically Scanned? 2. Where are Adrenal glands found? 3. Why is IV Contrast important in CT Adrenal Glands?
1. 2 Aquisitions @ 2 Phases - Portal Venous Phase - Delay Phase (10-15 Min) 2 Superior to each kidney / can be seen on routine A/P 3. Differentiate between metastatic & benign masses
54
1. Is contrast used in CT Liver? - Why or Why Not? 2. How Does Tumor Appear in Liver? - How does contrast affect this? 3. How is a CT Liver scanned? - Why?
1. Usually, Based on Department Protocol - Aids in Diagnosis & Helps Classify Tumors in Liver 2. Hypo or Hyper dense compared to surroundings. - Makes them appear isodense 3. Triple Phase -1. Early Arterial (15-18sec post Contrast) -2. Arterial (25-35sec post) -3. Portal Venous (60-70sec post) - Properly identify pathology and tumor
55
1. Common Pathology & Tumors of Liver Consist of: 2. How is blood supplied to liver? 3. Typical CT Liver rate of injection?
1. Hepatic Cyst, Hepato Carcinoma, Hemagomia, Fatty Liver, Cirrohos 2. Dual Source - 75% Portal & 25% Arterial 3. 4.0 ml/s
56
1. Four Phases of CT Liver, There Typical Timing & What is Imaged: 2. What Determines CT Liver Delay Timing? 3. How Long For Liver Reach Equilibrium?
1. Early Arterial - 15 - 20 sec post inj. - Parenchyma minimally enhanced - Arterial - 25-30sec post inj. - - Portal Venous - 60-70sec post - Hypovascular Lesions b/c contrast has distributed - Delayed - 5-15 Min Post - Show Hemogina becoming Isodense 2. Patient Cardiac Output, Rate Injection, Iodine Concentration 3. 2-3 Minutes Post Inj.
57
1. Typical CT Liver Protocol Includes: 2. Billary Tract Consist of: 3. What other Organ Can Be Seen on CT Liver? - What would be diagnosed here?
1. Pre - Early / Arterial Contrast - Portal Venous - Delay 2. Common Hepatic Duct, Common Bile Duct, Intrahepatic Bile Duct 3. Gallbladder - Gallstones & Cholecystitis
58
CT LIVER Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= SUPINE, Arms Raised PREP= CON 750-1500ml Oral &/or 80-135ml IV, Breathhold CLIN= Cirrhosis, Infection, Mass, Cyst, Cancer Staging, Pre-Transplant SCAN= Top of Diaphragm to Illiac Crest ALG.= Soft Tissue SLICE= 2mm - 5mm RFMT= COR, SAG, 3D
59
1. Typical Phase of CT Pancreas? - Why 2. What are the steps of CT Pancreas? 3. What may occur if CT Pancreas is positive for Pancreatic Cancer?
1. Delayed Arterial (35-45sec) - Parenchyma @ Peak Enhanced - Allows Pancreas’s neoplasms be identified 2. Pre Con, Delayed Arterial & Portal Venous *TRIPLE PHASE STUDY* 3. Whipple Reconstruction of Pancreas and Duodum
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CT PANCREAS Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised, Antecubital IV PREP= CON 80-125 ml CLIN= Pancreatitis, Cyst, Masses/Tumor SCAN= Diaphragm to Illiac Crest ALG.= Soft Tissue SLICE= 1mm - 3mm RFMT= COR & SAG
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1. Structures Evaluated in CT Pelvis? 2. Is CT best imaging for male & female reproductive organs? - why/why not? - What is shown for each? 3. How does Uterus appear on CT?
1. Colon, Bladder, Reproductive Organs 2. Not for men b/c they are external but CT can show prostate cancer - Women yes - Fallopian, Ovaries & Uterus imaged 3. Homogenous mass between rectum & Bladder
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1. Describe Uterus location & anatomy: 2. Which part(s) of uterus are affected by contrast? - why? 3. What is the “Adnexa” of Uterus?
1. Between Rectum & Bladder - 3 Layers: Outer (Perimetrium), Middle (Myometeium) & Inner (Endmetrium) 2. Myometrium & Cervix - b/c Vascular nature 3. Ovaries & Fallopian Tubes
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CT PELVIS Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised PREP= CON Oral (750-1500ml) &/or IV (80-120ml), Breathhold CLIN= Trauma, Mass, Cancer Staging, Infection, Fibrosis, Cystic SCAN= Top Iliac Crest Through Pubis Symph ALG.= Soft Tissue & Bone Window SLICE= 2mm - 3mm RFMT= COR, SAG, 3D
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1. How do ovaries appear on CT Pelvis? 2. Is Oral or IV Contrast used for CT Pelvis? - Amount? 3. Most common organ affected from Abdomen Trauma?
1. Soft Tissue or Cyst- Like Density 2. Oral &/or IV or Dry depending rule out Oral = 750-1500 ml IV = 80-125ml 3. Spleen
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1. What Phase is CT Spleen Scanned? 2. Urinary Tract Consist of: 3. What is Gerota Fascia?
1. Portal Venous 2. Kidney, Ureter & Bladder 3. Connective tissue around kidney
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CT Spleen Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised PREP= ORAL 750-1500ml &/OR IV 80-125, Breathhold CLIN= Trauma, Mass SCAN= Top Diaphragm to Below Pubic Symph ALG.= Soft Tissue SLICE= 2mm - 5mm RFMT= COR & SAG
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1. Where is a common place for infection/mass/trauma in CT Urinary Tract? 2. CT For Kidney Stones is Typically Contrast or No Contrast? 3. What might you instruct patient to do prior to CT Urinary Tract exam?
1. Calculi 2. NONCONTRAST 3. Hydrate before exam - Minimize chance of hyperintensities to appear in renal pyramids
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1. Contrast in CT Urinary Tract is best for what pathology? 2. What 3 phases can be imaged for a CT Urinary Tract exam? - Timing / Delay? - What Does Each Show?
1. Renal Cyst, Polystic Kidney Disease, Lesions, Carcinomas & Metastasis 2. Corticomedullary - 30-40sec post IV, Best for Renal Cortex & Renal Veins - Nephrographi - 70-90sec post IV, Best for Parenychema & Liver - Excretory - Min. 3min post IV, Best for Renal Pelvis, Ureters & Bladder
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1. Why may a prone scan be needed for CT Urinary Tract? 2. Multiphase Scanning of Urinary Tact show pathologies such as: 3. Based on protocol, what could be the 5 phases of a CT Urinary Tract exam?
1. Help differentiate stones in urinary tract 2. Dual Collecting System, Obstructions, Tumors & Filing Defects 3. Pre Con, Arterial, Corticomedullary, Nephrographic & Excretory
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CT URINARY TRACT Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised, May Need Prone PREP= CON 80-120ml, Oral (Water), Breathhold CLIN= Kidney Stones, Carcinoma, Cysts, Hydronephrosis, Hematuria, Cancer Staging SCAN= Above Diaphragm to Below Pubic Symp ALG.= Soft Tissue SLICE= 1mm - 3mm RFMT= COR, SAG, MIP, 3D
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1. What is a CT Colonography? - Why are the done? 2. What is patient prep for CT Colonography? 3. Why do patients receive oral Barium& Oral Iodine contrast for CT Colonography?
1. Screening Exam for polyps or malignancy, or failed colonoscopy 2.Liquid Only Diet for Days prior, Bowel Emptying Medications, Oral Barium&Oral IV contrast ingested - MAY need CO2 or Room Air 3. Coats stool, fluid & polyps - Helps differentiate between above 3
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1. Why is Room Air &/or CO2 Administered for CT Colonography 2. How is it Administered? - Best Way to / Why? 3. How is patient laying for CT Colonography scan? - why?
1. Allows for better distention 2. Through catheter manually or automatic, While patient is in lateral decubitus position - Automatic = Allows better distention & less chance for perf 3. Typically supine, but can be prone. - Helps differentiate between polyps, stool & fluids. - Prone Promotes Distention
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CT COLONOGRAPHY Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine &/or Prone PREP= ORAL CONTRAST, Rectal via Catheter, Breathhold CLIN= Polyps, Cancer Staging, Failed Colonoscopy SCAN= Diaphragm to Below Pubic Symph ALG.= Lung Window SLICE= 1mm - 2mm RFMT= COR, SAG, 3D, “FLY THROUGH”
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1. What is CT Entercolysis? 2. In CT Entercolysis, What’s the Type of Contrast Used, Amount & Route? 3. What Phase is scanned for CT Entercolysis?
1. Nasogastric Catheter placed in Duodenum using fluoro guidance to evaluate small bowels 2. 1-2 liters of Enteral or Neutral Contrast, Via Nasogastric Catheter into Small Intestine - IV Contrast, 4.0+ ml/s, 40-50 Emperic Delay 3. Portal Venous via IV of 4.0+ Rate & 40-50 Emperic Delay
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CT ENTERCOLYSIS Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised PREP= CON 80-120 IV & Oral via Nasogastric Catheter CLIN= Mass, Obstruction, Chrohns SCAN= Diaphragm to Below Pubic Symph ALG.= Soft Tissue SLICE= 2mm - 5mm RFMT= COR & SAG
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CT ENTEROGRAPHY Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised, Antecubital IV PREP= Oral - 1500ml Low Density Barium & 80-120ml IV, Breathhold CLIN= Mass, Obstruction, Chrohns SCAN= Above Diaphragm to Below Pubic Symph ALG.= Soft Tissue SLICE= 2mm - 5mm RFMT= COR & SAG
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1. Difference between CT Enterography & CT Entercolysis? 2. How much Oral contrast is used in CT Enterography? - Type & Delay? 3. How much IV Contrast used for CT Entrrography? - Rate & Delay?
1. Enterography = Oral Entercolysis = NG TUBE 2. 1500ml Low Density Barium 60-90 min before scan 3. 80-120 ml IV @ Rate of 4.0+ - 40-50 sec Emperic Delay for Portal Venous Phase
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1. Goal of CTA Abdomen & Pelvis? - What is images 2. Rate & Delay for CTA Abdomen & Pelvis 3. What Phase(s) are scanned in CTA ABDOMEN & PELVIS
1. Image Aorta @ Peak Opacification - Aorta & its branches though abdomen & pelvis 2. 4.0 + Bolus Tracking 3. Pre Contrast, Arterial & Venous
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CTA ABDOMEN & PELVIS 1. Renal Arteries images for: 2. Superior & Inferior Mesenteric Arteries & Veins for: 3. Other organs imaged:
1. Stenosis, Aneurism & Transplant 2. Mesenteric Ischemia or GI Bleed 3. Left Gastric, Common Hepatic, & Splenic Arteries
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CTA ABDOMEN & PELVIS Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, Arms Raised, Antecub IV PREP= COM 80-120ml @4.0 Rate, Breathhold CLIN= Anyuerism, Dissection, GI Bleed SCAN= Above Diaphragm to below Pubic Symph ALG.= Soft Tissue SLICE= 1.5mm or less RFMT= COR, SAG, 3D, MIP, VR
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1. Purpose of CTA RUNOFF? 2. What are the area(s) of bifurcation important in CTA RUNOFF? - Locations? 3. Major acquisition concern for CTA Runoff?
1. Image Abdominal Aorta & Peripheral Arteries through feet during arterial phase 2. Abdominal Aorta bifurcates into R&L Iliac Arteries @ L4 - R&L Iliac Arteries each bifurcate into internal & external iliac arteries @ L5-S1 joint 3. Exam will be scanned / completed before contrast reaches patients feet
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1. What is the rate of CTA Runoff? - Why? 2. What type of slices for CTA RUNOFF? - Why? 3. The Abdominal Aprta bifurcates where & into what?
1. Start @ 4.0 but go lower to increase arterial phase imaging 2. Thin - Greatest details possible 3. R&L Common Iliac Arteries @ L4
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1. Positional Goal for CT Upper Extremity? - Ideal Position if Tolerable? 2. Name of Ideal position? - What is best imaged? 3. If patient can’t tolerate above position, What can be done? - Why isn’t this ideal?
1. Area of interest positioned away from rest of body - “Superman” Position. = Patient Prone, Arm of Interest Raised over head & hand supinated 2. Superman - Hand, Wrist, Forearm, Elbow without Head being imaged 3. Supine with arm neutral at side - Streak artifact may occur from pt body
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1. for CT Upper Extremity, What is positioning for Shoulder, Clavicle &/or Humerus? 2. Slices for CT Upper Extremity? - Why? 3. Scanning axis of CT Upper Extremity? - Why?
1. Patient supine with arm at side w/ arm not of interest raised over head 2. Thin - Image best details 3. Perpendicular long axis of ROI - Ensure entire ROI scanned & best detail
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1. How should CT Upper Extremity Reconstruction be done? - Why? 2. If CT Upper Extremity use IV contrast, where is IV & What’s rate? - Which phase scanned?
1. 50% overlap - Maximize quality of 3D Recons 2. 3ml/s - Portal Venous Phase - IV in arm not of interest
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CT UPPER EXTREMITY Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Lower Arm = Superman (Prone, ROI Arm Raised over head & hand supinated) Upper Arm = Supine, Arm Neutral at side & non ROI arm raised. ** Most important is ROI away from body** PREP= NONCON, but if 3.0ml/s @ 80-120ml CLIN= Trauma, Cellulitis, Neoplasms, Arthritis, Multiple Myeloma, Infection, Abcess SCAN= Entire ROI from joint above to joint below ALG.= Soft Tissue & Bone Window SLICE= Thin, Less than 2mm RFMT= COR, SAG, 3D
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1. CT Lower Extremity general positioning? - Why? 2. For Pelvis, Hip, Femur & Tib Fib, what positioning is important? 3. What about knee positioning? - Why is it different?
1. Non area interest away as much possible. - Minimize scatter in ROI 2. Leg straight as possible w/ unaffected side bent or out of way 3. Knee bent varying degrees of flexion - Better visualization of patella
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1. In regard to CT Lower Extremity of Foot, What are the regions of the foot? - What do they each consist of 2. Positioning considerations for CT of Foot? 3. Four imaging planes for CT Foot: - How is each scanned
1. Forefoot (Phalanges & metatarsals) - Midfoot (Navicular, Cuneforms & Cuboid) - Hindfoot (Talus & Calcaneus) 2. Midfoot = Foot interest flat on table - Hindfoot or ankle = flat/toes up 3. Direct Axial = Toes pointing up - Oblique Axial = Parallel to metatarsals - Sagital = Medial to Lateral - Coronal = Post to Ant
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1. Slices for CT Lower Extremity? - Why? 2. Scan direction of CT Lower? - Why? 3. How are Recons for above done? - Why?
1. Thin - Best Detail 2. Perp long axis - Ensure entire ROI & best detail 3. At least 50% overlap - Most accurate
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CT LOWER EXTREMITY Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine, ** Most important is ROI away from body** PREP= NONCON, but if 3.0ml/s @ 80-120ml CLIN= Trauma, Cellulitis, Neoplasms, Arthritis, Multiple Myeloma, Infection, Abcess SCAN= Entire ROI from joint above to joint below ALG.= Soft Tissue & Bone Window SLICE= Thin, Less than 2mm RFMT= COR, SAG, 3D
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CT ARTHOGTAM Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= Supine PREP= Iodinated Contrast direct into Joint, May also inject room air CLIN= Degenerative Disease, Athletic Induced Trauma SCAN= Entire Joint of Interest ALG.= Soft Tissue & Bone Window SLICE= Thin, Less than 2 mm RFMT= COR, SAG, 3D
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1. What is CT Arthogtam? 2. How is it performed? 3. What is this injection called?
1. Contrast injected into joint space & then imaged 2. Contrast diluted with Saline before injected into joint space - Room air may also be injected 3. Intra Articular Inejctopn
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CT MYELOGRAM Patient: Prep: Clinical Ind: (w & w/o) Scan Range: Algorithm: Slice Thickness: Reformats:
PT= SUPINE PREP= CON via Intraethically CLIN= Degenerative Disease, Post Op SCAN= Entire ROI ALG.= Soft Tissue & Bone Window SLICE= Less than 2mm RFMT= COR, SAG
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1. What part of the spine can be performed in a CT Myelography? 2. Where is contrast injected? - Name for this? 3. What is CT Fluoroscopy typically used for?
1 Can be C, T &/or L Spine 2. Injected into subarachnoid space surrounding spinal cord - intraethecal injection 3. Needle Guided procedures
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1. Intraethical vs Intrarticular injection? 2. How to reduce exposure during CT Fluroscopy? 3. Typical CT IR cases?
1. Intraethical = mylogram, subarachnoid space - Intrarticular = Arthogram, intra articular joint space 2. Shields Staff, Shield non ROI, Limit technical parameters to reduce dose 3. Biopsy, Drain Placement, RF Ablation, Aspiration
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1. What determines patient positioning in CT IR cases? 2. Why is a small ROI important in CT IR? 3. CT PET stands for:
1. What procedure, Anatomical ROI, Patient Condition 2. Due to high exposure, small ROI limits dose and exposure 3. CT Positron Emission Tomography
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1. CT PET utilizes what? - What does it show? 2. Where are these typically done? 3. What’s typical dose for CT PET?
1. Uses Fludeoxyglucose F18 Radiopharmacuetical - To measure amount of FDG uptake by body’s cells 2. Nuclear Medicine 3. FDG is 10-15 cm
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1. In CT PET, Malignant cells will have what type uptake? 2. Typical PET exams? 3. How can CT aide in Radiation Therapy?
1. increased 2. Head Neck Lungs Breast & GI 3. Determine beam arrangement to be used during

CT (6 decks)

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