Name: SYED NAQI ABBAS

SAP ID: 70058547

SUBMITTED TO: SIR AHMED

BRAIN CT SCAN INDICATION:

bleeding,
brain injury and skull fractures in patients with head injuries
• bleeding caused by a ruptured or leaking aneurysm in a patient with a sudden severe headache. •
a blood clot or bleeding within the brain shortly after a patient exhibits symptoms of a stroke. • a
stroke, especially with a new technique called Perfusion CT.
• brain tumors.
• enlarged brain cavities (ventricles) in patients with hydrocephalus.
• diseases or malformations of the skull.
• diagnose diseases of the temporal bone on the side of the skull, which may be causing hearing
problems.
• guide the passage of a needle used to obtain a tissue sample (biopsy) from the brain.
• assess aneurysms or arteriovenous malformations through a technique called CT angiography.

CONTRAINDICATION:
Radiation exposure to a fetus can cause developmental problems.
PRE-PROCEDURAL PREPRATION
Are or might be pregnant
• Are allergic to any medicines, including iodine dyes•
Have a heart condition, such as heart failure.
• Have had kidney problems. • Have asthma.
• Have a medical device, such as a pacemaker or an insulin pump.
You should wear comfortable,loose-fitting clothing to your exam. You may be given a gown to wear
during the procedure. evaluate the extent of bone and soft tissue damage in patients with facial
trauma, and planning surgical reconstruction
• determine whether inflammation or other changes are present in the paranasal sinuses. • plan
radiotherapy for cancer of the brain or other tissues. But due to the relatively high radiation dose
involved in CT scans, it is important to avoid scanning patients who are pregnant. Thus, CT should
only be performed for pregnant patients in critical situations and only after discussion of
the potential risks.
• Patients who have an allergy to the IV contrast media (IVCM) used in CT scans. • Renal impairment
may also prohibit your patient from having IVCM.
• Have diabetes or take metformin (Glucophage) for your diabetes. You may have to adjust your
medicine for a day before and after the test.
• Become very nervous in small spaces. You need to lie still inside the CT scanner, so you may need
a medicine (sedative) to help you relax.
• Metal objects, including jewelry, eyeglasses, dentures and hairpins, may affect the CT images and
should be left at home or removed prior to your exam. You may also be asked to remove hearing
aids and removable dental work. Women will be asked to
remove bras containing metal underwire. You may be asked to remove any piercings, if possible.
If your procedure involves the use of contrast dye,
you will be asked to sign a consent form that gives permission to do the procedure. Read the form
carefully and ask questions if something is not clear
• Generally, there is no fasting requirement prior to a CT scan, unless a contrast dye is to be used.
Procedure with contrast:
• Kidney function test (BUN and Creatinine) must be done 72 hrs. before the procedure. • NPO (4
hours) before the procedure.
• You may drink clear liquids up until the time of your scan.
Clear liquids include water, black coffee or tea, apple juice, clear soda or clear broth. • Secure a
consent form.

CONTRAST MEDIA
• (Iopamiro/Ultravist) >300 mg I/mL and 370 mg I/mL
DURING THE PROCEDURE Your doctor will give you special instructions ahead of time if contrast is to
be used and if you will need to withhold food and drink.
You will lie on a scan table that slides into a large, circular opening of the scanning machine. Your
head may be immobilized to prevent movement during the procedure.
• The technologist will be in another room where the scanner controls are located. However, you
will be in constant sight of the technologist through a window. Speakers inside the scanner will
enable the technologist to communicate with and hear you.
You may have a call button so that you can let the technologist know if you have any problems
during the procedure. The technologist will be watching you at all times and will be in constant
communication.
• As the scanner begins to rotate around you, X-rays will pass through the body for short amounts
of time. You will hear clicking sounds, which are normal.
The X-rays absorbed by the body's tissues will be detected by the scanner and transmitted to the
computer. The computer will transform the information into an image to be interpreted by the
radiologist.
• It will be very important for you to remain very still during the procedure. You may be asked to
hold your breath at various times during the procedure.
• If contrast dye is used for your procedure, you will be removed from the scanner after the first set
of scans has been completed. A second set of scans will be taken after the contrast dye has been
administered.
If contrast dye is used for your procedure, you may feel some effects when the dye is injected into
the IV line.
• When the procedure has been completed, you will be removed from the scanner. If an IV line was
inserted for contrast administration, the line will be removed.
These effects include a flushing sensation, a salty or metallic taste in the mouth, a brief headache,
or nausea and/or vomiting. These effects usually last for a few moments.
• You should notify the technologist if you feel any breathing difficulties, sweating, numbness, or
heart palpitations.
• You may be asked to wait for a short period of time while the radiologist examines the scans to
make sure they are clear.

POST PROCEDURAL
If contrast dye was used during your procedure, you may be monitored for a period of time for any
side effects or reactions to the contrast dye, such as itching, swelling, rash, or difficulty breathing.

Notify the radiologist or your doctor if you experience any of these symptoms
. • If you notice any pain, redness, and/or swelling at the IV site after you return home following
your procedure, you should notify your doctor as this could indicate an infection or other type of
reaction.
Otherwise, there is no special type of care required after a CT scan of the brain. You may resume
your usual diet and activities unless your doctor advises you differently.
• Your doctor may give you additional or alternate instructions after the procedure, depending on
your particular situation.
• If you are a diabetic who takes any medication that contains metformin, you must have a blood
test to check your kidney function before you can start taking metformin again
. Call your doctor for the results of the blood test and for instructions about resuming metformin.

PT POSITION
ROUTINE ADULT HEAD (BRAIN) PATIENT POSITIONING:
• Patient should be supine, head first into the gantry, with the head in the head-holder whenever
possible. • Center the table height such that the external auditory meatus (EAM) is at the center of
the gantry.
• SCAN RANGE: Top of C1 lamina through top of calvarium.
CONTRAST
• Oral: None.
• Intravenous contrast administration should be performed as directed by the supervising radiologist
•
A typical amount would be 100 cc at 300 mg/cc strength, injected at 1 cc/sec.
A delay of 4 minutes between contrast injection and the start of scanning is typical.
AXIAL VERSUS HELICAL SCAN MODE (both are provided in the following sample protocols):
• medical physicist to assist in determining which mode to use.
• To reduce or avoid ocular lens exposure, the scan angle should be parallel to a line created by
the supraorbital ridge and the inner table of the posterior margin of the foramen magnum.
• This may be accomplished by either tilting the patient’s chin toward the chest (“tucked” position)
or tilting the gantry.
• While there may be some situations where this is not possible due to scanner or patient
positioning limitations, it is considered good practice to perform one or both of these maneuvers
whenever possible.
• Injected: Some indications require injection of intravenous or intrathecal contrast media during
imaging of the brain.using appropriate injection protocols and in accordance with the ACR Practice
Guideline for the Use of Intravascular Contrast Media.
• There are advantages and disadvantages to using either axial or helical scans for routine head CT
exams.
The decision as to whether to use axial or helical should be influenced by the specific patient
indication, scanner capabilities, and image quality requirements.
• Users of this document should consider the information in the following table and consult with
both the manufacturer and a medical physicist to assist in determining which mode to use.

CT BIPHASIC AND TRIPHASIC

A three phase CT scan usually of the liver, that requires an injection of contrast medium, this
injection helps outline the vessels of your body by giving the x-rays something to be absorbed by
besides blood which has a very low absorption rate. The phases are
Arterial Phase Scan during injection: arterial phase, this will highlight lesions in or around the artery
leading into the liver.
The arterial phase of scanning is performed approximately 30 seconds after the contrast injection is
initiated and is most accurately determined by using bolus tracking software (eg Smart Prep) to
monitor the level of contrast enhancement in the aorta and automatically triggering the scan when
it reaches a pre- determined level of enhancement (eg 120HU).
Hyper vascular lesions enhance during the arterial phase and appear hyperdense. Arterial phase
images are also used for pre operative evaluation of the arterial vasculature through the use of MIPs
and 3D reconstructions.
1. Scan Method 5 mm – post contrast – top to bottom of liver for arterial phase, 2.5 mm recon
Arterial phase – “SMART PREP” Aorta (170HU baseline) (usual delay 30 sec) Ideally obtain excellent
hepatic arterial opacification with minimal contrast in portal vein
2. CT of the abdomen. Arterial phase images of dynamic computed topography scan showed a highly
necrotic tumor compressing the renal parenchyma without either invasion to surrounding tissues or
local lymphadenopathy.

Portal Vein Phase

Scan during injection or shortly after: portal vein phase, this will show lesions in or around the
portal vein. The portal venous phase is performed 70-90 seconds post contrast and hypo vascular
lesions appear hypodense and hyper vascular lesions appear isodense (same density as surrounding
liver).
1. Scan
2. Method Portal venous phase – 5mm with 2.5 mm recon at 80 sec delays. Scan the entire abdomen
in this acquisition (top of the liver to spleen)
3. Portal venous phase image of an axial CT cut showing a large heterogeneous cystic mass within
the right lobe of the liver

Delayed Phase
Delayed scan after injection: this will allow the soft tissue to absorb the contrast and may highlight
changes in tissue.
Delayed scans thru kidneys at 3 minutes
The delayed phase is performed 5-10 minutes post contrast and is used to further characterize
lesions. Hemangiomas are slow to enhance and some HCC can appear hypodense due to rapid
washout and CCC can appear hyperdense due to delayed washout.
Scan Method
Delay Phase – 5 mm with 2.5 mm recon 3 minutes from injection (top of liver to bottom of kidneys).
TRIPLE PHASE LIVER - HCC (Non contrast, arterial, portal venous, equilibrium) This scan is performed
in cases of surveillance or follow up for hepatocellular carcinoma in patients with chronic liver
disease/cirrhosis.