INTRODUCTION

Computed Tomography has become a very important tool in diagnostic medicine,

opening up a new world in diagnosis and treatment of disease. Computed tomography
uses special detectors to measure the non-absorbed x-rays passing through a given part
of the human anatomy. This information is then sent to a computer to be reconstructed
using mathematical equations called algorithms. An image is then displayed on a cathode
ray tube.

The development of CT occurred during the early 1970s because of the work of
Godfrey N. Hounsfield. Hounsfield, an engineer, worked for Electrical and Musical
Industries (EMI) in London. It was here that he worked on the practical applications of CT
scanners. The first clinically usable CT scanner was a head unit installed in 1971 at
Atkinson-Morley Hospital in Wimbledon, England.

A CT Scan is an x-ray procedure that creates cross-sectional images with the help
of computer processing. CT images are more detailed than conventional x-ray images
and can reveal bones as well as soft tissue and organs. A conventional x-ray uses a fixed
tube that sends x-rays in only one direction while a CT Scanner uses a motorized x-ray
source that shoots narrow beams of x-rays as it rotates around the patient. There are
special digital x-ray detectors located directly opposite the x-ray source. As the x-ray
passes through the patient, they are picked up by the detectors and transmitted to a
computer. Image slices can either be displayed individually in 2-dimensional form or
stacked together to generate a 3-dimensional image that can reveal abnormal structures
or help the physician plan and monitor treatments.

BASIC CT SYSTEM

There are three major sections of the basic CT system: (1) the imaging system
(gantry, x-ray tube, and detectors); (2) the computer system (develops raw data acquired
from detectors and controls the scanner); and (3) display system (operator and viewing
console).

Imaging System

The gantry houses the x-ray tube and detectors. It is built so it accommodates the
patient in the center of the framework. The circular opening through which the patient
moves during scanning is called the gantry aperture.

Tubes used in CT must be able to endure significant stress due to large amounts
of exposure made at consistently high milliamperes and kilovolt peaks. Special
requirements of CT tubes are higher anode heating capacity. The anode heating capacity
in most tubes is typically 1 to 3 million heat units.
 Detectors are a very important part of the CT scanner system, as they gather the
information for reconstruction of the image. Basically, the detector is a device that
converts x-rays into electrical pulses, which are then fed into a computer for processing.

Display System

Computed tomography imaging systems can be equipped with two or three consoles.
One console is used by the CT radiologic technologist to operate the imaging system.
Another console may be available for a technologist to postprocess images to annotate
patient data on the image (e.g., hospital identification, name, patient number, age,
gender) and to provide identification for each image (e.g.,number, technique, couch
position). This second monitor also allows the operator to view the resulting image before
transferring it to the physician’s viewing console.
A third console may be available for the physician to view the images and manipulate
image contrast, size, and general visual appearance. This is in addition to several
remote imaging stations.
The operating console contains meters and controls for selection of proper imaging
technique factors, for proper mechanical movement of the gantry and the patient couch,
and for the use of computer commands that allow image reconstruction and transfer. The
physician’s viewing console accepts the reconstructed image from the operator’s console
and displays it for viewing and diagnosis.

Computer System

Each time the x-ray source completes one full rotation, the CT computer uses
sophisticated mathematical techniques to construct a 2D image slice of the patient. The
thickness of the tissue represented in each image slice can vary depending on the CT
machine used. Image slices can either be displayed individually or stacked together by
the computer to generate a 3D image of the patient that shows the skeleton, organs, and
tissues as well as any abnormalities the physician is trying to identify. This method has
many advantages including the ability to rotate the 3D image in space or to view slices in
succession, making it easier to find the exact place where a problem may be located.

CT PARTS AND FUNCTION

SAMPLE IMAGES

CONTRAST AGENT

The use of a positive

contrast medium plays an
important role in helping
define pathology and in
visualizing vascular structures
in CT.

Contrast materials help distinguish or "contrast" selected areas of the body from
surrounding tissue. By improving the visibility of specific organs, blood vessels or tissues,
contrast materials help physicians diagnose medical conditions.

Contrast materials enter the body in one of three ways. They can be:

• swallowed (taken by mouth or orally)

• administered by enema (given rectally)
• injected into a blood vessel (vein or artery; also called given intravenously or intra-
arterially)

Oral Contrast Materials

 Barium-sulfate contrast materials that are swallowed or administered by mouth
(orally) are used to enhance x-ray and CT images of the gastrointestinal (GI) tract,
including:
• Pharynx
• Esophagus
• Stomach
• The small intestine
• The large intestine (colon)
In some situations, iodine-based contrast materials are substituted for barium-sulfate
contrast materials for oral administration.

Rectal Contrast Materials

Barium-sulfate contrast materials that are administered by enema (rectally) are used
to enhance x-ray and CT images of the lower gastrointestinal (GI) tract (colon and
rectum). In some situations, iodine-based contrast materials are substituted for barium-
sulfate contrast materials for rectal administration.

Intravenous Contrast Materials Iodine-based and Gadolinium-based

Iodine-based contrast materials injected into a vein (intravenously) are used to
enhance x-ray and CT images. Gadolinium injected into a vein (intravenously) is used to
enhance MR images. Typically they are used to enhance the:
• internal organs, including the heart, lungs, liver, adrenal glands, kidneys, pancreas,
gallbladder, spleen, uterus, and bladder
• gastrointestinal tract, including the stomach, small intestine and large intestine
• arteries and veins of the body, including vessels in the brain, neck, chest,
abdomen, pelvis and legs
• soft tissues of the body, including the muscles, fat and skin
• brain
• breast

INDICATION
Computed tomography is a useful and accurate cross-sectional imaging test
ideally suited for investigating possible pathology in body cavities where the organs of
interest may not be accessible to superficial imaging techniques (e.g. ultrasound). These
cavities include the skull, thorax, abdomen and pelvis.

CT is a good examination in a variety of conditions including:

• acute head injury;

• suspected subarachnoid hemorrhage;
• ureteric calculus;
• acute cervical spine trauma where there is a higher than average likelihood of
fracture or dislocation;
• suspected acute appendicitis in a non-pregnant patient.
 It has excellent capabilities to differentiate various soft tissue structures and can
provide excellent bone detail. Compared to other cross-sectional techniques, such as
magnetic resonance imaging, it can be done so rapidly that it is minimally affected by
patient movement.

PATIENT PREPARATION

General Instructions

• Patients, who do not have congestive heart failure or are not on dialysis, are asked
to drink 64 ounces of water before the exam, especially if the exam is performed
with oral or intravenous contrast. If possible, they should start drinking 12 hours
before their scheduled appointment time.
• If patient is receiving IV or contrast, they should not eat or drink 4 hours prior to
exam.
• Patients will be asked to remove jewelry and other metallic objects that might
interfere with the scan. We ask patients to leave jewelry at home when possible.
• Patients who are breastfeeding should be given an opportunity to make an
informed decision about whether to continue breastfeeding after receiving
intravascularly administered iodinated contrast media or to temporarily abstain. A
very small percentage of iodinated contrast medium can be excreted into the
breast milk and absorbed by the infant’s gut. We believe that the available data
suggests that is safe for the mother and infant to continue breastfeeding after
receiving such an agent.
• The patient can choose to temporarily abstain from breastfeeding for 24 hours with
the active expression and discarding of breast milk from both breast during that
period. If so, the patient may wish to use a breast pump to obtain milk beforehand
to use during the 24 hour period following the administration of contrast media.
Please inform the patient of this option when the exam is scheduled.

Patient Screening Prior to Administration of Iodinated Contrast

Prior to the administration of iodinated contrast, patients are screened for the following:

• Previous reactions to iodinated contrast media

• All severe allergies and reactions (both medications and food)
• History of diabetes, kidney disease, pheochromocytoma, solitary kidney, kidney or
other transplant, or myeloma
• Current use of any metformin-containing medications
• Pregnant or breast-feeding (in women of child-bearing age).

The UCSF Department of Radiology routinely screens patients undergoing CT

examinations to identify those individuals with chronic kidney disease and thus at
potential risk of acute kidney injury and recommends volume expansion therapy to
mitigate the risk in this subgroup.
First, the patient’s electronic medical record is searched to determine whether a serum
creatinine and an estimated glomerular filtration rate (eGFR) acquired within the past 6
weeks are available for outpatients and within the last 7 days for inpatients.

If this information is not available, the information from the patient’s screening form is
reviewed, focusing on four key questions to identify patients who are most likely to have
underlying chronic kidney disease:

1. What is your current age?

2. Do you have diabetes?
3. Do you have hypertension requiring medication?
4. Do you have ANY problems with your kidneys (such as transplant, single
kidney, kidney cancer, kidney surgery, dialysis)?
• If patient is less than 60 years of age and answers NO to questions 2-4, IV
contrast will be administered.
• If a patient is older than 60 years of age and/or answers YES to any of these
questions, an assessment of renal function will be performed before
administering IV contrast.

Cranial Plain
1. Ask patient history.
2. Ask patient to remove any metal like earrings, hair clips, dentures.
3. Prepare the exposure area for the said procedure.
4. Instruct patient not to move the head while scanning.
5. Scan patient with optimal/acceptable dose.

Cranial with contrast

1. Ask patient where his/her request and BUN & Creatinine must be done within 72
hours of the scan.
2. Interview the patient. Ask medical history if he/she has any food and drug allergies.
If the patient is diabetic, any previous surgery, any cardiovascular condition, any blood
condition and any previous procedure using contrast media.
3. Ask patient to drink 3/4 for water in his/her 1liter of water for full bladder purposes.
4. Prepare patient before undergo the said procedure. Skin test and IV lines for
contrast media.
5. Instruct patient to remove any metal
6. Introduce certain contrast. Oral contrast, rectal contrast and IV contrast (IV contrast
is introduce while scanning the patient).
7. Scan patient with optimal or acceptable dose.

Whole abdomen without contrast

Before evaluating an abdominal CT, you should first carefully study the case
history. The patient’s medical history is always important. See if previous abdominal CTs
have been made, which you could use for comparison. It would be a waste of your time
to focus on abnormalities which have been analyzed before.

If your doctor ordered a CT scan without contrast, you can eat, drink and take your
prescribed medications prior to your exam. You are encouraged to drink clear liquids.

Whole abdomen with contrast

A day before procedure, the patient should undergo this preparation

1. Light evening meal/soft diet

2. 1hour after dinner take laxative (surelax, phosphosoda or castor oil)
3. After taking laxative drink water
4. Fasting starting 12 midnight no food no water intake except if patient has oral
medical (only sip water is recommended).

ADVANTAGES AND DISADVANTAGES OF COMPUTED TOMOGRAPHY

Advantages

• Rapid acquisition of images

• CT images allow radiologists and other physicians to identify internal structures
and see their shape, size, density and texture.
• A major advantage is its ability to image bone, soft tissue and blood vessels all at
the same time.
• CT scan can be performed if you have an implanted medical device of any kind.
• A diagnosis determined by CT scanning may eliminate the need for exploratory
surgery and surgical biopsy.
• CT Scanning is painless, accurate, noninvasive and fast

Disadvantages

• CT scan delivers relatively high dose of radiation to the patients. However, the
benefit of an accurate diagnosis will generally outweigh the risk.
• CT scans use iodine to scan patients. This can be associated with an allergic
reaction to the contrast agent.
• CT scan can sometimes give misinterpretations to the doctors. It can report
problems in the patient’s body when there is nothing wrong.
• CT scan is not recommended for pregnant women.