الفحوصات الشعاعية الخاصة المرحلة الثالثة اعداد م.م. مرتضى عبد الامير محمد جامعة المستقبل Lecture 7 كلية التقنيات الصحية والطبية قسم تقنيات الاشعة Methods of imaging the respiratory system Methods of imaging the respiratory system 1. Plain
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الفحوصات الشعاعية الخاصة المرحلة الثالثة اعداد
م.م. مرتضى عبد الامير محمد جامعة المستقبل Lecture 7 كلية التقنيات الصحية والطبية
قسم تقنيات الاشعة Methods of imaging the respiratory system<br>
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Methods of imaging the respiratory system 1. Plain films
2. Radionuclide imaging
3. CT
4. US (for pleural disease)
5. MRI
6. Bronchography.<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
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The normal anatomy necessary to the respiratory system angiography<br>
Pulmonary arteriography is the “gold standard” and will detect most pulmonary emboli. 1. Unenhanced scan of thorax - to detect any other clinical
abnormality which might account for symptoms.
2. Enhanced scan of pulmonary arterial system Technique<br>
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Patient preparation Prepare The D-dimer blood test (norm<500)
Blood urea + serum creatinine
patient position supine with their arms above their head
scan extent lunge apices to diaphragm
Remove metals attached to the clothes
Blue canula or pink , test the canula ,<br>
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During exam Use manual method (look at the superior vena cava)
Respiration phase inspiration
monitoring slice (region of interest)
below the carina ( Trachea bifurcation ) at the level of the pulmonary trunk.
Use bolus method
A-IF ROI on the SVC the HU would be approx:175 HU
B- IF the ROI on the pulmonary trunk ,The HU would be 100 HU
Contrast injection (1or 2 ml per kg ), (usually 75-85 ml)
**In the perfect scan, the contrast should not appear in the descending aorta.
** Before the radiation starts make sure the CT scan room door is closed
**During IV administration Look at the patient and your CT screen to make sure that the cannula and the connection line is working properly during the exam<br>
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The normal anatomy necessary to the respiratory system angiography Topogram<br>
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A GUIDE TO CT pulmonary angiogram (CTPA) procedure (manual method) Volume of contrast medium - 80 ml Contrast (and 20 ml of normal saline).
Delay – usually around 15 s (Manual look at the pulmonary trunk or the SVC when the contrast reach press start scanning)
Rate of injection - 4 ml/s
Collimation - 3 mm
Pitch - 1.8
Start point - just above the aortic arch
End point - the lowest hemidiaphragm.<br>
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A GUIDE TO CT pulmonary angiogram (CTPA) procedure (Auto method ) Volume of contrast medium – 80 ml Contrast +20 ml Normal saline
ROI circle
- If on the pulmonary trunk HU = 100
- If on the SVC HU = 175
Rate of injection – 4 - 6 ml/s
Start point - just above the aortic arch
End point - the lowest hemidiaphragm.<br>
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Practical test of the exam Practical CTPA , Toshipa (Canon) 64 slice CT scan Please Watch carefully !!<br>
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References Further reading Klein, J.S. (ed) (2000) Interventional Chest Radiology. Radiol. Clin. N. Am. 38 (2). Macklem P.T. (1998) New methods of imaging the respiratory system. Respirology 3, 101-102.
PIOPED Investigators. (1990) Value of ventilation/perfusion scanning in acute pulmonary embolism. JAMA 263 , 2753-2759. Robinson, P.J. (1989) Lung scintigraphy. Clin. Radiol. 4 0 , 557-560.
Further reading Remy-Jardin, M., Artaud, D., Fribourg, M. & Beragi, J.P. (i 998) Spiral CT of pulmonary emboli: diagnostic approach, interpretative pitfalls and current indications. Eur. Radiol. 8, 1376-1390.<br>
