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CT > Procedures > Flashcards

Procedures Flashcards

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
Q

CT LUMBAR SPINE

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

A

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

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26
Q
  1. What is different about CT Lumbar positioning vs C & T Spine?

2 Why are Breath Holds used in CT Chest exams?

  1. Common site for Metastesses?
A
  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
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27
Q
  1. How is a CT Chest typically scanned?
    - Why?
  2. Contrast rate & amount for CT Chest?
  3. Cardiac Exams Ideal HR?
A
  1. Inferior to Superior to reduce contrast artifacts as it is injected
  2. 70-120 ml @ 2-4ml/s
  3. Below 65 BPM
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28
Q

CT CHEST

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

A

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

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29
Q

CT CHEST (HIGH RESOLUTION)

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

A

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

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30
Q
  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?
A
  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
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31
Q
  1. Describe Steps of Blood Flow Through Heart.
  • Which Side is Oxygenated?
A
  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
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32
Q
  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
A

1 ECG Gating

  1. Conus Artery, Sinus Node Artery, R. Atrial & Ventricle Branches, Posterior Descending Artery
    **RIGHT C.A.P = Conus, Sinus, Posterior
  2. Left Anterior Descending Artery & Left Circumflex Artery
    ** LEFT LAC = Anterior & Circumflex
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33
Q
  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?
A
  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
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34
Q
  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?
A
  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
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35
Q

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

A

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

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36
Q

CT CARDIAC - Calcium Score

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

A

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

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37
Q
  1. CT Calcium Score evaluates what?
  2. Why does Calcium Score use ECG?
  3. Is CT Calcium Score High Dose or Low Dose?
A
  1. Calcification of Coronary Arteries
  2. Monitor Cardiac Cycle for Diastolic phase
    - reduce patient dose & limit motion artifacts
  3. Lower Rad Dose
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38
Q
  1. What defines “Calcification” of Coronary Arteries?
  2. What’s the Calcium Score Measurement System Called?
  3. What Are The Ranges for Calcification?
A
  1. 1mm^2 with HU above 130
  2. Agatston Scoring System
  3. 1-10 Minimal
    11-100 Mild
    101-400 Moderate
    400+ Excessive
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39
Q
  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?
A
  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
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40
Q

CT PULMONARY ANGIOGRAPHY

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

A

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
Q

CTA AORTA

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

A

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
Q
  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?
A
  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
Q
  1. What are the types of Dissection?
    - Explain difference
  2. What is a “Triple Rule Out” for CTA?
A
  1. A Type Dissection = Ascending Aorta
    - B Type = Descending Aorta
  2. Asses Coronary Arteries, Aorta & Pulmonary Artery
44
Q
  1. GI Tract Consists of:
  2. Where is the Appendix located?
  3. How is the intestine wall imaged?
    - Examples of?
A
  1. Esophagus, Intestine & S/L Intestine
  2. Extends from Cecum by ileocecal Valve
  3. Oral Contrast
    - Water, Barium & Water Soluble Iodine
45
Q
  1. First Part of GI Tract is:
    - Connects to:
  2. Why is imaging intestine wall important?
  3. Typical Oral Contrast for CT Abdomen?
A

1 Esophagus
- To Stomach

  1. Most pathology contained there
  2. 750-1500ml
46
Q
  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?
A
  1. Region of Interest & Department Protocol
    - Immediate - 3 Hours
  2. Small Intestine via Pyloric Sphincter & Duodbulb
  3. FB, Esophageal Varies, Hiatal Hernia, Cancer
47
Q
  1. The Small Intestine consist of:
  2. Most Distal Part of Small Intestine is ______
    - Why is this important?
  3. Common Small Intestine Indications:
A
  1. Duodenum, Jejunum & Illeum
  2. Illeum
    - Where connects to Large Intestine via Ileocecal Valve
  3. Hernia, Obstruction, Intussception, Ileus, Chrohns & Cancer
48
Q
  1. The Large intestine consist of:
  2. Clinical Indications for CT Large Intestine:
  3. What is the patient prep instructions for CT Abdomen & Pelvis?
A
  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
Q
  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?
A
  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
Q
  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?
A
  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
Q

CT ABDOMEN / PELVIS

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

A

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
Q

CT ADRENAL GLANDS

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

A

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
Q
  1. How is CT Adrenal Gland Typically Scanned?
  2. Where are Adrenal glands found?
  3. Why is IV Contrast important in CT Adrenal Glands?
A
  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

  1. Differentiate between metastatic & benign masses
54
Q
  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?
A
  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
Q
  1. Common Pathology & Tumors of Liver Consist of:
  2. How is blood supplied to liver?
  3. Typical CT Liver rate of injection?
A
  1. Hepatic Cyst, Hepato Carcinoma, Hemagomia, Fatty Liver, Cirrohos
  2. Dual Source - 75% Portal & 25% Arterial
  3. 4.0 ml/s
56
Q
  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?
A
  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
Q
  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?
A
  1. Pre
    - Early / Arterial Contrast
    - Portal Venous
    - Delay
  2. Common Hepatic Duct, Common Bile Duct, Intrahepatic Bile Duct
  3. Gallbladder
    - Gallstones & Cholecystitis
58
Q

CT LIVER

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

A

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
Q
  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?
A
  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
60
Q

CT PANCREAS

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

A

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

61
Q
  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?
A
  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
62
Q
  1. Describe Uterus location & anatomy:
  2. Which part(s) of uterus are affected by contrast?
    - why?
  3. What is the “Adnexa” of Uterus?
A
  1. Between Rectum & Bladder
    - 3 Layers: Outer (Perimetrium), Middle (Myometeium) & Inner (Endmetrium)
  2. Myometrium & Cervix
    - b/c Vascular nature
  3. Ovaries & Fallopian Tubes
63
Q

CT PELVIS

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

A

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

64
Q
  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?
A
  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
65
Q
  1. What Phase is CT Spleen Scanned?
  2. Urinary Tract Consist of:
  3. What is Gerota Fascia?
A
  1. Portal Venous
  2. Kidney, Ureter & Bladder
  3. Connective tissue around kidney
66
Q

CT Spleen

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

A

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

67
Q
  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?
A
  1. Calculi
  2. NONCONTRAST
  3. Hydrate before exam
    - Minimize chance of hyperintensities to appear in renal pyramids
68
Q
  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?
A
  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
69
Q
  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?
A
  1. Help differentiate stones in urinary tract
  2. Dual Collecting System, Obstructions, Tumors & Filing Defects
  3. Pre Con, Arterial, Corticomedullary, Nephrographic & Excretory
70
Q

CT URINARY TRACT

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

A

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

71
Q
  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?
A
  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

  1. Coats stool, fluid & polyps
    - Helps differentiate between above 3
72
Q
  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?
A
  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
73
Q

CT COLONOGRAPHY

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

A

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”

74
Q
  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?
A
  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
75
Q

CT ENTERCOLYSIS

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

A

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

76
Q

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

A

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

77
Q
  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?
A
  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
78
Q
  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
A
  1. Image Aorta @ Peak Opacification
    - Aorta & its branches though abdomen & pelvis
  2. 4.0 + Bolus Tracking
  3. Pre Contrast, Arterial & Venous
79
Q

CTA ABDOMEN & PELVIS
1. Renal Arteries images for:
2. Superior & Inferior Mesenteric Arteries & Veins for:
3. Other organs imaged:

A
  1. Stenosis, Aneurism & Transplant
  2. Mesenteric Ischemia or GI Bleed
  3. Left Gastric, Common Hepatic, & Splenic Arteries
80
Q

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

A

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

81
Q
  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?
A
  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
82
Q
  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?
A
  1. Start @ 4.0 but go lower to increase arterial phase imaging
  2. Thin
    - Greatest details possible
  3. R&L Common Iliac Arteries @ L4
83
Q
  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?
A
  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
84
Q
  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?
A
  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
85
Q
  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?
A
  1. 50% overlap
    - Maximize quality of 3D Recons
  2. 3ml/s - Portal Venous Phase
    - IV in arm not of interest
86
Q

CT UPPER EXTREMITY

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

A

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

87
Q
  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?
A
  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
88
Q
  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
A
  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
89
Q
  1. Slices for CT Lower Extremity?
    - Why?
  2. Scan direction of CT Lower?
    - Why?
  3. How are Recons for above done?
    - Why?
A
  1. Thin
    - Best Detail
  2. Perp long axis
    - Ensure entire ROI & best detail
  3. At least 50% overlap
    - Most accurate
90
Q

CT LOWER EXTREMITY

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

A

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

91
Q

CT ARTHOGTAM

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

A

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

92
Q
  1. What is CT Arthogtam?
  2. How is it performed?
  3. What is this injection called?
A
  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
93
Q

CT MYELOGRAM

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

A

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

94
Q
  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?
A

1 Can be C, T &/or L Spine

  1. Injected into subarachnoid space surrounding spinal cord
    - intraethecal injection
  2. Needle Guided procedures
95
Q
  1. Intraethical vs Intrarticular injection?
  2. How to reduce exposure during CT Fluroscopy?
  3. Typical CT IR cases?
A
  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
96
Q
  1. What determines patient positioning in CT IR cases?
  2. Why is a small ROI important in CT IR?
  3. CT PET stands for:
A
  1. What procedure, Anatomical ROI, Patient Condition
  2. Due to high exposure, small ROI limits dose and exposure
  3. CT Positron Emission Tomography
97
Q
  1. CT PET utilizes what?
    - What does it show?
  2. Where are these typically done?
  3. What’s typical dose for CT PET?
A
  1. Uses Fludeoxyglucose F18 Radiopharmacuetical
    - To measure amount of FDG uptake by body’s cells
  2. Nuclear Medicine
  3. FDG is 10-15 cm
98
Q
  1. In CT PET, Malignant cells will have what type uptake?
  2. Typical PET exams?
  3. How can CT aide in Radiation Therapy?
A
  1. increased
  2. Head Neck Lungs Breast & GI
  3. Determine beam arrangement to be used during

CT (7 decks)

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