CT SCAN OF THORAX AND SPINE
Out line
CT scan of Thorax
CT scan of Spine
Objective
Atthe end of this session students will be able
to Understand :-
Common indication for CT scan of Thorax and Spine
Common Procedure, technique and parameter of thoracic
and vertebral CT scan
CT scan of Thorax
Introduction
Ingeneral, Thoracic CT is obtained for the
following two basic reason
An abnormality visible on plain radiographs
In a patient with normal chest radiographs
and a clinical suspicion of mediastinal
disease.
Thoracic CT
Indication
Screening
Infection or Inflammation
Masses of lung, pleura and mediastinum
Stagging lymphoma
Lesion of chest wall and esophagus
Follow ups
Pulmonary Embolism
Vascular and air way abnormality
Trauma
Count.....
Contrast
Most of the above procedure done with contrast except
trauma
IV contrast is typically requested by the radiologist to
differentiate vascular from nonvascular structures,
particularly lymph nodes, to evaluate cardiovascular
structures by seeing the inside of these structures, and to
further characterize lesions by observing their pattern of
enhancement.
Count.....
Basically we use three window
they are automatically
programed in our
machine
Bone window
Soft tisse window
Lung window
Technique
Positioning
Feet first Supine with arm above the head
Topographic land mark
AP and lateral,1 inch bellow the level of the chin to umbilicus
Mode of scanning
Helical
Scan orientation; Craniocaudal
Starting location;1 cm above the apex of the lung
End location; Imaginary line Joining the two costophrenic
angle
Count…..
KVp- 120
Slice thikness;3-5 cm
Slice Interval;1.5-2.5 mm
Field of view;just fitting to thoracic cavity including soft
tissue of chest wall
DFOV:;~38 cm (optimize for individual
Contrast ;intervenous,oral air/positive contrast for esophageal
evalution
Contrast volume =60-100ml
Using the shortest scan time possible helps to reduce artifacts
created by respiratory motion.
CT cervical spine
• The CT cervical spine or C-spine protocol serves as
an examination for the assessment of the cervical
spine.
• It is usually performed as a non-contrast study.
• In certain situations, it might be combined or
simultaneously acquired with a CT angiography of
the cerebral arteries or a CT of the neck.
• It also forms a part of a polytrauma CT or might
rarely be done as a CT myelogram in situations where
MRI is contraindicated.
Count.....
Indications
cervical spine injury
cervical spine fractures
disco ligamentous injuries
cervical spine implants and complications
spinal tumors and/or vertebral metastasis
congenital anomalies
Count.....
If MRI is contraindicated
inflammatory arthritis or spondylodiscitis
degenerative disk disease
image guidance (e.g. cervical spinal epidural injections)
CT myelography
spinal cord compression
Technique
patient position ;supine position with both arms next to
the body, shoulders pulled down
Tube voltage; ≤120 kVp
Tube current; as suggested by the automated current
adjustment mode
scout ;Lateral, from above the temporal bone to the
manubrium of sternum
scan extent; should include the base of the skull and the
first thoracic vertebrae
scan orientation; craniocaudal
Count….
field of view (FOV): 120-200
mm (should be adjusted to
increase in-plane resolution)
slice thickness: ≤1.5 mm
interval: ≤0.75 mm
CT thoracic spine
The CT thoracic spine or T-spine protocol serves as
an examination for the assessment of the thoracic
spine.
As a separate examination, it is often performed as a
non-contrast study.
It might be combined or simultaneously acquired
with a CT chest or CT chest-abdomen-pelvis as part
of a trauma or staging protocol and also forms a part
of a polytrauma CT.
It might be acquired as dual-energy CT or rarely
done as a CT myelogram in situations where MRI is
contraindicated.
Indication
thoracic or thoracolumbar injury
thoracic spine fracture-dislocation
thoracolumbar spine fracture
thoracic spine implants and complications
congenital anomalies
spinal tumors and/or vertebral metastasis
Count….
If MRI is contraindicated
Inflammatory arthritis or spondylodiscitis
degenerative disk disease
thoracic spine interventions (e.g. CT guided
biopsy)
CT myelography
spinal cord compression
Technique
patient position ;supine position both arms elevated
tube voltage; ≤120 (140) kVp
tube current; as suggested by the automated current adjustment
mode
scout; Lateral lower neck to the iliac crest
scan extent; varies with regard to the clinical question, and might
be more limited or more extensive
the whole thoracic spine includes the area from C7 to L1
scan direction;craniocaudal
Count…
scan geometry; field of view (FOV): 120-200 mm
(should be adjusted to increase in-plane resolution)
slice thickness: ≤0.625 mm, interval: ≤0.5 mm
contrast injection considerations; usually non-
contrast, optionally with contrast
Count…
contrast volume: 70-100ml (0.1 mL/kg) with 30-40
mL saline chaser at 2-3 mL/s
sagittal images: sagittal aligned through the center of
the vertebral bodies and spinal processes
coronal images; coronal aligned to the transverse
processes
axial images: perpendicular to the thoracic spine with
the separate reconstruction of several blocks
slicethickness: bone ≤2 mm, soft tissue ≤3 mm,
overlap 50%
CT lumbar spine (protocol)
The CT lumbar spine or L-spine protocol serves as an
examination for the assessment of the lumbar spine.
As a separate examination, it is most often performed
as a non-contrast study. It might be combined or
simultaneously acquired with a CT abdomen.
Italso forms a part of a polytrauma CT or might
rarely be done as a CT myelogram in situations where
MRI is contraindicated.
Indication
lumbar spine fractures
seat belt injury
lumbar spine implants and complications
if MRI is contraindicated
spinal tumors and/or vertebral metastasis
spondylodiscitis or inflammatory arthritis
Count…..
degenerative disk disease
spondylolisthesis/spondylolysis
lumbar spine interventions (e.g. lumbar spinal
epidural injections)
CT myelography (if MRI is contraindicated or
metallic implants are present)
cauda equina syndrome
Technique
patient position; supine position both arms elevated
tube voltage; 120 (140) kVp
tube current; as suggested by the automated current
adjustment mode
scout; diaphragm to hip
scan extent; might vary with regard to the clinical
question and should include TH12 and S1
scan direction; craniocaudal
Count…
field of view (FOV): 120-200 mm (should be
adjusted to increase in-plane resolution)
slice thickness: ≤0.625 mm, interval: ≤0.5 mm
contrast injection considerations; usually non-
contrast, optionally with contrast
contrast volume: 70-100ml (0.1 mL/kg) at 2-3
mL/s
scan delay: 65-80 seconds
Count…..
sagittal images: sagittal aligned through the center
of the vertebral bodies and spinal processes
coronal images: coronal aligned to the transverse
processes
axial images: perpendicular to the lumbar spine
with a separate reconstruction of several blocks
curved reformats might be helpful
slice thickness: bone ≤2 mm, soft tissue ≤3
mm, overlap 50%
