Computed Tomography; The how and why of its importance

Transcription

1 Computed Tomography; The how and why of its importance Presented by KENNETH HABLE, MD, BSRT Director of Engineering & Training Technical Prospects, LLC 7/18/2017 1

2 About me (a little shameless self promotion) Who I am Director of Engineering and Training for Technical Prospects o Lead CT and Vascular (Angiography & Cardiac) Instructor A diverse combination of industry training, knowledge and experience What I ve done Certified Radiographic Technologist (RT) Hold degrees in both Radiographic Science and Biology; minor in Human Anatomy Chief Technologist of X-ray and CT Assistant Director of Medical Imaging Certified Network Engineer (Multi-vendor); o Certifications; Microsoft MCSE, Novell CNE, IBM AS400, A+ Hardware Certified Medical Doctorate (MD) degree Independent Consultant in Mass Storage and Distributed Content 7/18/2017 2

3 About me And lastly. I ve been the PATIENT! Isn t that who this is really all about?!? 7/18/2017 3

4 What we ll discuss The How and the Why of CTs importance When and why CT is used How it assists in the diagnosis of illness and disease in our everyday world The impact of the differing departmental personnel s roles and responsibilities How these different roles impact the service personnel Why preventative maintenance and service are so important to a systems uptime A high-level overview of the CT modality o Principles of CT Operation o Historical Development of CT Differential Characteristics of CT vs. X-ray o Chest o AP Skull o Lateral Skull 7/18/2017 4

5 CT A Diagnostic Modality or A Tree in the Forest Modality A therapeutic method or agent, such as medical imaging (CT, X-ray, etc.) or surgery that involves the physical diagnosis and/or treatment of a disease or disorder CT is a single Medical Imaging modality The choice of utilizing CT over other diagnostic modalities is driven by the following; The presenting cause The diagnostic standard or prescribed method of diagnosis The desired (presumed) outcome 7/18/2017 5

6 The Who of CT Scanning The players; The Patients The Technologists The Departmental Directors or Lead Technologist The Physicians The Service Personnel (FSE/CSE) 7/18/2017 6

7 The Patients The reason we re doing the scan, right? They are in pain, scared, worried or worse Our job is to help them! That is to figure out what is wrong and how we can best treat (fix) it 7/18/2017 7

8 The Technologists Their job is to perform the prescribed procedure(s) using the system This results in performing the proper scan protocol(s), generating the correct imaging sequences and final scan images that will be used for a diagnosis They also care for the patient during this time; Keeping them comfortable Monitoring their vitals Comfort family 7/18/2017 8

9 The Departmental Directors or Lead Technologist Are responsible for the overall operation of the department or the sub-department (CT) Maintain adequate staffing and training of personnel Oversee departmental Quality Assurance Programs and accreditation programs (ARC, JACHO, etc.) Develop and monitor departmental budgeting/spending 7/18/2017 9

10 The Physicians The responsible party for ordering or reading the procedure(s) Depending on which part of the process they are involved in will determine their motives and work processes The ordering physician is concerned with identifying/eliminating a cause so a treatment plan can be developed and implemented The reading physician is concerned with identifying ANYTHING seen on the resulting procedural images 7/18/

11 The Service Personnel - FSE It is their job to properly maintain and service the system Must keep the system within OEM specifications for operation and image quality Are under intense pressure based on; The patient s safety and diagnostic outcome The Technologist s need to meet their workflow demands and performance goals The Departmental Director s budgeted performance numbers (efficiency) and earning vs. costs (effectiveness) The physician s need for proper scan protocols and image quality 7/18/

12 The Importance of Preventative Maintenance CT systems are highly complex mechanical systems and require a certain degree of regular preventative maintenance Rotation speeds up to sec/r Monitoring and replacement of consumable parts such as power and data transfer brushes, filters, etc. Require constant tuning or calibrating to maintain consistent image quality Have highly complex safety circuits, it either works correctly or it doesn t work at all! 7/18/

13 Siemens Definition Flash running at.28 Sec/R 7/18/

14 OEM Preventative Maintenance Practices I highly recommend exceeding the OEM PM plan, but meeting it is absolute! Typically broken down into bi-annual or quarterly segments Always replace the recommended parts, even if they don t appear to need it. Brushes are a great example, replace regardless and maintain any lightly used ones as backups General system cleaning; vacuuming out carbon & room dust 7/18/

15 OEM Preventative Maintenance Practices Continued Computer maintenance; Patient database cleanup Image database cleanup HDD defragmentation Fan cleaning Filter replacement or cleaning if non-replaceable Monitor calibration Maintain the necessary on-site service tools; Daily QA Phantom set Special service phantoms and calibration tools 7/18/

16 OEM Preventative Maintenance Practices Continued Performing final system calibration and image quality verification and documentation Performing Final Work ; Utilize the system in the manner the customer would o Perform a Daily QA scan o Perform a simply standard scan protocol; Routine head utilizing the QA phantom set Perform a complete system backup 7/18/

17 Differential Characteristics of CT vs. General X-ray CT: Highly tissue sensitive Provides more anatomical detail and differentiation o Tissue and organ separation Scan data can be manipulated into different views without additional imaging (i.e.: Axial, Sagittal, Coronal & 3D reconstruction) Increased exposure dose Increased examination cost Increased examination time X-ray (General Radiography): Less tissue sensitive Provides less anatomical detail and differentiation o 2-dimensional, superimposing anatomical information Required separate exposures for each unique view (i.e. AP, Lateral & Oblique views) Decreased exposure dose Decreased examination cost Decreased examination time 7/18/

18 CT is an acronym for Computed Tomography CT what does it mean Computed Tomography A radiographic imaging process that uses x-ray photons and computer processing to generate an image of differing tissue density in slices through the patient s body 7/18/

19 So what happened to the CAT Scanner?!? 7/18/

20 Or the CAT Scan?!? Sick Kitty 7/18/

21 So is it CT Scanning or CAT Scanning?!? CAT stood for Computed Axial Tomography which is now outdated since we are no longer limited to imaging in the AXIAL plane So, we dropped the A and ended up with simply CT Scanning 7/18/

22 We Scan in the Axial Plane Think of it like this the patient is like a loaf of bread. As that loaf of bread enters the scanner it is sliced from head and heel The open or end surface from each slice can then be viewed, seeing into the patient s anatomy 7/18/

23 Da Planes We can now reconstruct images in a verity of anatomical planes Axial (Transverse) Plane Creates Head and Foot portions Sagittal (Lateral) Plane Creates Right and Left portions Coronal (Frontal) Plane Creates Front and Back portions 7/18/

24 We Scan and Image in the Axial Plane 7/18/

25 But we can Imagine in the Sagittal Plane 7/18/

26 As well as the Coronal Plane 7/18/

27 3D CT (3-Dimenstional Modeling/Rendering) Examples of multi-plane CT reconstructions of the lower skull and cervical spine. 1 procedure = 1 original set of data (Axial plane) 3 separate image reconstruction planes Composite 3D image constructed from the 3 separate scan planes Sagittal Axial Coronal 7/18/

28 CT Imaging vs. General X-ray Imaging Let s compare and contrast the demonstrated anatomy and diagnostic evaluation between similar CT and General X-ray examinations 7/18/

29 Chest CT Scan vs. Chest X-ray 7/18/

30 Head CT Scan (Coronal Slice) vs. AP Skull X-ray 7/18/

31 Sagittal Head CT Scan (Sagittal Slice) vs. Lateral Skull X-ray 7/18/

32 Training at Technical Prospects 7/18/

33 Questions??? 7/18/

34 The End 7/18/