Reduce Exposure Eyes. CT Imaging Procedures. Head Positioning. Head Pathology 5/16/2008. CT Head & Posterior Fossa
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1 CT Head & Posterior Fossa CT Imaging Procedures Scoutview = Lateral OML ( 10 to 20 degrees) 15 degrees ( above OML) Time (fastest obtain info) Slide # 1 Slide # 2 2 CT Head & Posterior Fossa Reduce Exposure Eyes Head Positioning PF Region Scan Extent Foreman magnum Region Tentorium Cerebelli comes together 5mm ST, 5mm CI Slide # 3 3 Slide # 4 4 Head Positioning Head Pathology 8-10 mm ST, 8-10mm CI Vertex Hypo, Iso, Hyper (chronic) Syncope hydrocephalus and the ventricles Glioma (glial cells) Cholesteatoma (inner ear) Hematoma Hydrocephalus 4 to 6 hrs (METS)?? Pituitary Gland Slide # 5 5 Slide # 6 6 1
2 Windowing A Jefferson fracture consists of a fracture of the C1 ring. This results from an axial loading injury to the head with compression force to C1 (typically from diving). The fracture consists of unilateral or bilateral fractures of the anterior and posterior arches of C1. This is an unstable injury. Other burst type fractures are possible in the spine. Posterior Fossa Soft Tissue Windows 120 WW, 50 WL 170 WW, 40 WL These also result from axial loading injuries (compression) and result in severe comminution of a vertebral body. Posterior element displacement into the spinal canal is common Slide # 7 7 Slide # 8 8 Windowing Other... Brain 80 WW, 40 WL 100 WW, 30 WL etc WW WL BONE Inner ear Sinuses Facial Bones, Temporal bone Orbit, Blow-out fx s Imaging planes Which is the best for visualization? Slide # 9 9 Slide # CHEST CHEST 7-10 secs immediate opacification Aortic Dissection / Bolus injection Dynamic scanning Mediastinal structures Scoutview = AP Start = Supraclavicular region Apices End = Adrenal Glands Lung CA mets to Adrenals Slide # Slide #
3 CHEST Respiration Inconsistent Respiration 8-10mm ST 8-10mm CI many modifications CT CHEST WW mediastinal WL Lung Windows 1600 WW (-) 600 WL Slide # Slide # Chest HRCT Optimizes spatial resolution Lung structures and airways Asbestosis, Pneumoconiosis High Pass or Frequency ALG. Small ST / Targeting Slide # Scout view = AP Xiphoid Process Lung bases top of liver Illiac Crest 8-10 mm ST 8-10 mm CI Slide # Respirations same for each section Suspended common choice practice breathing Barium Sulfate 1 to 3 % Streak Artifacts Water Soluble 2 to 5 % inflammatory bowel ml protocols vary Slide # Slide #
4 Right Decub position fill C-loop 3 to 5 min or scan in Decub position oral contrast 1/2 hr. Abd scans appears to be an abscess Drip infusion = worst way to image the liver CM administration Delays depend on speed of machine and power injector Dynamic scanning = hemangiomas Delayed enhancement Slide # Slide # Abdomen Abdomen Misc. Soft Tissue Windows WW WL Liver Windows WW, WL Head of the Pancreas Liver = pre-equilibrium phase Also known as bolus phase You have approx secs Ave. Bolus inj delay secs Helical sec delays Slide # Slide # PELVIS Pelvis Scoutview = AP 8-10 mm ST, 8-10 mm CI Illiac Crests Symphysis Pubis Allow contrast to reach bladder CO 2 negative contrast bladder wall ml barium A & P Slide # Slide #
5 Pelvis Tampon anatomical localization of the vagina IV,Oral, Rectal Contrast Soft tissue windows Bone windows (invasion) Endomeatrial CA Spine Flex hips and knees Scoutview = Lateral 3-5mmST ST, 35mmCI 3-5 most common overlapping / reconstruction Slide # Slide # Spine Spine Pedicle to Pedicle Gantry angulation = section plane parallel to the vertebral disk spaces L4-L5 HNP Intrathecal Contrast Intravenous Contrast inherent subject contrast enhances dura by way of dural veins Slide # Slide # SPINE MISC. Lumbar spine Evaluation osteoporosis Bone density, Lumbar spine Spondylolithesis Saggital Cushing s disease = microadenomas Pituitary adenomas Seminal Vessicles CT scans with CM Nuc Med Thyroid scans Therapy planning markers, table Aqueduct of Sylvius Slide # Slide #
6 MISC. Retroperitoneal structures Jefferson fracture Prone spine scanning Post myelogram Pulmonary calcifications Bone length measurement Circle of Willis Caudate Nucleus Ventricles Optic Nerve Rectus muscles (All in the orbit) Slide # Slide # IAC s Vestibule Cochlea Incus, Malleus EAM Mandibular Condyles Sinuses Submandibular Glands Parotid Glands Hyoid bone Thyroid Slide # Slide # Sternocleidomastoid Common carotid Internal & External Carotid Internal & External Jugular Vertebral Arteries Trachea & Esophagus Brachiocephalic viens Brachiocephalic arteries Common Carotid Arteries Subclavian Arteries Ascending & Descending Aorta Slide # Slide #
7 Pulmonary Trunk Main Pulmonary Artery Superior Vena Cava Azygos Vein The Heart ( divisions ) Liver Falciform Ligament Crux of the Diaphragm Aorta Adrenal Glands Spleen Slide # Slide # Kidneys Stomach ( Fundus ) GB Pancreas Superior Mesenteric Artery IVC Cecum Ureters Portal Vein Femoral Artery & Vein Psoas muscles Acetabular Fossa Slide # Slide # Ilium bone Ischium ( the whole bone ) Femoral head Gluteus maximus Bladder Rectum Seminal Vesicles Prostate Uterus Vagina Int & Ext Obturators Slide # Slide #
8 Dural Sac Lumbar Nerve Roots Ligamentum Flavum Apophyseal Joints Shoulder, Foot, Wrist Slide #
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