Teknik Pemeriksaan CT Scan

Thorax

Oleh: Elly P
Thoraxic Anatomi
 Plain Radiography
• Thorax PA/AP (erect/supine)
• Thorax Lateral (left)
• Dorsal Decubitus
• Lordotic Position (apex)
 pitfalls
• The only major one is contrast timing. It is
extremely important to achieve adequate arterial
enhancement when IV contrast media is used.
• Artefact from a 'hyperdense' right
brachiocephalic/ superior vena cava can cause
problems when imaging a thoracic dissection.
The 'beam hardening' artefact that this causes
can mimic 'type A' thoracic dissections.
• Window levels may need to be varied to help
decrease the affect of this 'hyperdense' artefact.
 Continued..
• Caution must be used when turning the patient from the
supine to prone position. Orientation must be changed
so that the side markers present on the CT images are
correct.
• If the examination is performed on a cardiac monitored
patient the leads of the ECG (electrocardiogram) need to
be positioned so that they cause minimal artefact on the
resultant images.
• When the patient has lots of intravenous infusions and
other paraphernalia it must be made sure that when the
table moves for the 'planning radiograph' that none of
these infusions etc. are accidentally disconnected from
the patient.
 Jenis-jenis Pemeriksaan:
Umumnya pemeriksaan CT Scan thorax
terdiri dari :

• Standard Chest
• Mediastinal structure & vessels
• High Resolution CT (HRCT)
 Indikasi Standard Chest
• suspected or known pulmonary masses
• pleural or lymph node disease, including
metastatic neoplasms
• infection
• traumatic lesions
• focal diseases
Posisioning Axial
 Scanogram
STANDARD THORAX
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 Technics
• The standard thoracic examination must be performed in
arterial phase to outline the borders of the heart and
major blood vessels
• It must include the adrenal glands to determine if a
neoplastic lesion found in the lungs has its primary in the
adrenals. To ensure adequate arterial opacification
occurs a pressure injector must be used.
• An injection rate of 2 ml per second is used. The volume
of contrast that is needed for a standard thoracic
examination can vary from 75-100 ml of 300-370
strength (300-370 mg iodine per ml) IV contrast. As the
patient’s size and weight increases a greater volume of
IV contrast and a faster injection rate needs to be used.
 Continued…
• Scan technique involves a 10 mm slice acquisition using
a pitch of 1.5. Spiral/helical imaging is recommended as
the entire lung area can be imaged in one single breath
hold. FOV is to skin edge.
• Tube voltage only needs to be minimal because the
structures imaged are mainly air filled lungs. If the mA is
increased too dramatically it can have an adverse affect
on IV contrast density (i.e. increasing the mA will
decrease the apparent image density of the IV contrast
media). Rotation time should be as fast as possible to
decrease the amount of time that the patient has to hold
his/her breath.
 Scan Parameter

Slice Table IV
Acquisitio Rotation
Thicknes Movemen mAs kV algorithm contras
n Time
s t t

range 1
~100 soft tissue 0.75-1.0
Axial Spiral 8-10 mm 10-15 mm 120 
-150 adult body second
pitch = 1.5
 Window Setting

Window Width Centre

Soft Tissue range

300-500 30-60
1&2

Soft Tissue Lung

Parenchyma 800-1800 -300 - -700
range 1
 Kriteria
- entire thoracic wall
visualisation imaging - entire thoracic aorta and vena cava
criteria - entire lung parenchyma
- vessels after intravenous contrast media

- visually sharp reproduction of the thoracic aorta

- visually sharp reproduction of the anterior mediastinal
structures, including thymic residue (if present)
- visually sharp reproduction of the trachea and main bronchi
- visually sharp reproduction of the paratracheal tissue
- visually sharp reproduction of the carina and lymph node area
image reproduction - visually sharp reproduction of the oesophagus
criteria - visually sharp reproduction of the pleuromediastinal border
- visually sharp reproduction of large and medium sized
pulmonary vessels
- visually sharp reproduction of segmental bronchi
- visually sharp reproduction of the lung parenchyma
- visually sharp reproduction of the border between the pleura
and the thoracic wall

anatomy covered - from the apex of the lungs to the inferior border of the liver
 Teknik modifikasi
• Prone position may be used to elucidate
pleural lesions or focal spaces
• The examination may be confined to a
specific area of interest -4 mm slices may
be used for specific examination of hilar
pathology and subtle pulmonary lesi
 Indikasi-mediastinal & vessels
• Suspected or know major vessel
aneurysm
• Dissection or conginital anomaly
 technics
• Range 1 consists of a non contrast scan from the
superior portion of the aortic arch to the aortic root. This
non contrast scan demonstrates calcification in the arch
and surrounding vessels which can be missed on a post
IV contrast scan only. Thinly collimated slices are used
to decrease partial voluming and increase image quality.
• The second range repeats the first range in arterial
phase and extends the acquisition until the aortic
bifurcation. Some thoracic dissections can extend for
the arch down to the iliac arteries. A delayed repeat
scan of range 2 can also be important to show contrast
media pooling in the dissected aorta.
 Continued…
• A large amount of IV contrast is used for
dissections studies. The volume is generally
between 100-150 ml of 300-370 strength
contrast, injected at 3 ml per second. A bi-
phasic injection rate can be used, which
increases the arterial phase temporal resolution.
The IV contrast can be diluted with sterile saline
to decrease the always apparent right
brachiocephalic/superior vena cava hyperdense
artefact
 Scan Parameter
• Patient position:supine, arms above the head
• Volume of investigation:may be limited to area of
radiographic abnormality or clinically suspected lesion
• Nominal slice thickness:4-5 mm serial or preferably
helical
• a pitch = 1.0; 2-4 mm or a pitch up to 1.2 - 1.5 for large
lesions
• FOV:limited to area of the heart and major vessels
• Gantry tilt:none
• X-ray tube voltage (kV):standard, Tube current and
exposure time product (mAs):should be as low as
consistent with required image quality
• Reconstruction algorithm:soft tissue/standard
• WW=150-500HU, WL=20-150
 Scanogram

DISSECTION DISSECTION

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 Clinical condition
• Motion-movement artefact deteriorates the
image quality. This is prevented by a
standard breath-hold technique;
alternatively if this is not possible scan
during quiet respiration
 Problems and pitfalls
• artefact from the cardiac outline may cross
the aorta and mimic dissection flap
• inhomogeneities in luminal opacification
due to inconstant blood flow
• inappropriate administration of contrast
media may mimic thrombus
 HRCT
• A HRCT (high resolution computed tomography) thoracic
examination is usually performed prone and supine.
Prone scans help to demonstrate atelectasis in the
mobile lower lungs. Scans can also be performed on
expiration, which can help show trapped air pockets in
the lung parenchyma. IV contrast is not indicated for
HRCT imaging.
• It is recommended that a high kV is used and mA needs
to be increased as slice thickness is decreased
significantly when compared to standard thoracic CT
imaging. The patient must be able to hold his/her breath
to get adequate scans without blurring.
 Continued…
• Scan technique involves 1-2 mm sequence slices with a
slice inter-scan distance of 10-20 mm. Fine slices are
used to increase the spatial resolution of the resultant
lung images. The FOV is smaller than a standard
thoracic examination and should be limited to the lung
parenchyma. Images can also be filmed on a 12 format
instead of the normal 20. Filming on a 12 format helps
to magnify the HRCT images. A non contrast spiral
range may also be completed to demonstrate the
mediastinal vessels and heart to determine if there is any
lymphadenopathy.
 Indikasi HRCT
• Detection and characterization of diffuse
parenchymal lung disease
• Emphysema
• Bronchiectasis
• Asbestosis
 Scanogram

150
HRCT PRONE THORAX
HRCT SUPINE THORAX
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 Scan Parameter
• Patient position:supine, arms above the head
• Volume of investigation:from lung apex to the base of the
lungs (survey) or corresponding to radiographically
defined abnormality (localised disease)
• Nominal slice thickness:1-2 mm
• Inter-slice distance/pitch:10-20 mm
• FOV:adjusted to the minimum which will demonstrate the
whole lung field
• Gantry tilt:none
• X-ray tube voltage (kV):high kV or standard
• Tube current and exposure time product (mAs):should
be as low as consistent with required image quality
• Reconstruction algorithm:high resolution
• Window width:1000-1600 HU3.11Window level:-400 - -
700 HU
 Clinical Condition
• Motion-movement artefact deteriorates the
image quality and breath-hold technique is
mandatory
• Intravenous contrast media-not required
 Modification to Technique

• sections with smaller inter-slice distance

for evaluation of very small areas of
disease
• sections with a cranio-caudal -25 to -30°
gantry tilt for detection of bronchiectasies
Prone position