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Protcol Neck And Head Powerpoints > Head And Neck > Flashcards

Head And Neck Flashcards

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
Q

In ct patient needs be shielded ?

A

All way around

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26
Q

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

A

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

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27
Q

______mm throughout entire brain may be used for stereotactic or surgical navigation for tumor localization

A

1 mm

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28
Q

Know head and brain anatomy out wb

A

Wb

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29
Q

Pons

A

Connects cerebellum to medulla oblongota

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30
Q

Vertebral artery merges into ?

A

Basilar artery

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31
Q

Temporalis muscle

A

Originates in temporal fossa and inserts on the coronoid process of mandible and elevates the mandible

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32
Q

Basilar artery

A

Supplies pons, cerebellum, inferior and medial surfaces of temporal occipital lobes with blood

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33
Q

Cerebellum

A

Coordinates and regulates muscle activity

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34
Q

4th ventricle

A

Diamond shaped cavity located anterior to the cerebellum and posterior to pons

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35
Q

Pituitary gland

_______ gland connected to the_____.Itā€™s located in the ____ . Called the master gland and Controls and regulates the function of other ____glands

A

Endocrine gland connected to the hypothalamus. Itā€™s located in the sella turcica . Called the master gland and Controls and regulates the function of other six glands

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36
Q

Internal carotid artery bifurcated at

A

C4

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37
Q

Internal carotid artery

A

Supply frontal, parietal , and temporal lobes of brain and orbital structures. Arise from bifurcation of carotid artery

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38
Q

Parts of circle of Willis

A

Anterior , middle, posterior cerebral artery

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39
Q

Tentorium

A

Fold of dura mater connects cerebellum and cerebrum

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40
Q

Anterior cerebral artery

A

Supply blood anterior frontal lobe and medial aspect of parietal lobe. Main branches horizontal segment( a1), vertical segment(a2), and distal segment(a3)

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41
Q

Middle cerebral artery

A

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)

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42
Q

Septum pellucidum

A

Seperate anterior horn and lateral ventricle

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43
Q

Anterior horn lateral ventricle

A

Pg 93

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44
Q

3rd ventricle

A

Communicates with 4th ventricle via cerebral aqueduct

45
Q

Quadrigeminal cistern

A

Lies between splenium of corpus callosum and superior surface of cerellbelum just posterior to coliculi of midbrain

46
Q

Field of view (fov)

A

Size of the image

Ex abdomen 46/48

47
Q

Corpus callosum

A

White matter separates left / right hemisphere of brain

48
Q

Falx cerebri

A

Separates cerebral hemispheres

49
Q

Largest and densest bundle white fibers within of cerebrum

A

Corpus callosum

50
Q

Internal cerebral vein

A

Drain deep parts of brain

51
Q

Choroid plexus

A

Can be partially calcified and produce csf in ventricles

52
Q

Fornix

A

Grey matter both sides hemisphere

53
Q

Ct scan of paranasal sinus non contrast (4)

A

Acute or chronic sinusitis
Headache
Trauma
Sinus surgery planning

54
Q

Ct scan of paranasal sinus contrast exams

A

If mass is suspected

55
Q

Ct scan of paranasal sinus intrathecal contrast

A

In cases of csf leak

56
Q

Ct scan paranasal sinus positions

A

Axial and coronal positions

57
Q

Best ct scan paranasal sinuses for true air fluid level

A

Coronal

58
Q

Ct scan of paranasal sinus may be scanned ______ position and reconstructed ______

A

Axial

Coronally

59
Q

Isocenter

A

Middle of scan that gives best data to receptor. Further away less data to receptor

60
Q

Ct scan paranasal sinus : coronal position

A 
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
Q

Ct scan paranasal sinus : axial

A 
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
Q

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

A

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
Q

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 ____

A

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
Q

Ct scan orbits and facial bones non contrast(3)

A

Trauma
Gravesā€™ disease - extra fluid in back eyes
Foreign body

65
Q

Ct scan orbit and facial bones contrast(2)

A 
Suspected mass
Visual disturbances
    Scanned axial and coronal 
    Coronal best true fluid levels
     Scanned axial and reconstructed
66
Q

Coronal position orbits and facial bones

A 
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
Q

Axial position ct scan orbits and facial bones

A 
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
Q

For orbits have patient ______ reduce rectus muscle motion

A

Close eyes or stare

69
Q

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)

A

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
Q

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

A

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
Q

Facial /sinus/ orbit anatomy

A

Do notebook

72
Q

Tmj

A

Condyle and temporal bone joint

73
Q

Nasal septum

A

Perpendicular plate of ethmoid and vomer

74
Q

Anterior clinoid process is in?

A

Sella turcica

75
Q

Crista galli is in?

A

Ethmoid bone

76
Q

Ct mastoids and internal auditory canals ( iac) non contrast exams(7)

A

Temporal or petrous bone survey

Hearing loss

Cholesteatoma

Mastoiditis

Chronic Ottis media

Foreign body

Bony destruction

77
Q

Ct mastoids and internal auditory canals ( iac) contrast exams(3)

A

Acoustic neuroma

Coronal best for air fluid levels

Scanned axial must be reconstructed

78
Q

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

A

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
Q

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 _____

A

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
Q

Mallelus

A

Hammer like structure in ear

81
Q

Pituitary and sella turcica scan done with ?

A

Iv contrast and without delayed due to blood brain barrier

82
Q

Infendibulum

A

Pituitary gland hangs on it and connects to hypothalamus

83
Q

Coronal position best sees ____ and ______

A

Pituitary

Sella turcica

84
Q

Pituitary gland sits on_____

A

Sella turcica

85
Q

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

A

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
Q

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

A

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
Q

Ct scan soft tissue neck non contrast

A

Parotid calculi ( gland - salivary gland)

88
Q

Ct scan soft tissue neck with contrast(6)

A 
Lymphadenopathy
Tumors
Abcess 
Vascular pathology
Tracheal stenosis or fracture
Trauma
89
Q

Ct scan soft tissue neck positioning

A 
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
Q

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)

A

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
Q

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

A

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 ā€œeā€ 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
Q

Parotid

A

Largest salivary gland

93
Q

External carotid artery

A

Blood supply face

94
Q

Internal carotid artery

A

Blood supply brain

95
Q

Epiglottis

A

Flap over esophagus

96
Q

Sternocleidomastoid muscle

A

Rotates head to opposite side and flexion of neck

97
Q

Parotid gland

A

Secretes saliva through parotid duct into mouth to facilitate mastification and swallowing

98
Q

Sublingual gland

A

Smallest salivary gland

99
Q

Veins vs artery

A

Veins more outside

Veins larger

100
Q

Ct angiography of carotids and circle of Willis

Clinical indication (7)

A 
Aneurysm
Stenosis
Trauma
Dissection
Atherosclerosis 
Vascular malformations
Subarachnoid hemorrhage
101
Q

Ct carotids and circle Willis positioning

A 
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
Q

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)
A

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
Q

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)
A

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
Q

Anterior cerebral artery

A

Blood supply midline to portions of frontal lobe and superior medial parietal lobes

105
Q

Anterior communicating artery

A

Connects left and right anterior cerebral arteries

106
Q

Middle cerebral arteries

A

One three major arteries supplying blood cerebellum. Supplies blood also to anterior temporal lobes and insular cortices

107
Q

Posterior communicating artery

A

Connects between posterior the cerebral artery and internal artery

108
Q

Posterior cerebral artery

A

Supply oxygen blood supply to posterior portion of brain

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