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Chest CT
Protocols

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Educational Objectives
By the end of this lecture you should be able to:
Explain patient preparation for chest CT examinations Explain the CT protocol for :

Routine chest

High resolution Chest State the common indications for each protocol Identify the contrast volume and route of administration for each protocol Identify the standard windowing for each protocol Explain how to modify the technique according to patient condition

References
1. 2. 3. Protocols for Multislice Helical Computed Tomography, The fundamentals. by Peter Dawson Body CT protocols state of the Art , Rogalla P., Mutze S., Hamm B. Text book of radiographic positioning and related anatomy; by Kenneth L.Bontrager,6th edition.

Websites
http://www.ctisus.org/ http://www.halls.md/ct/ct.htm http://www.slaney.org/pct/

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Advantages of spiral CT chest

Allows major portions or entire chest to be scanned during a single breath hold Eliminates motion artifacts High quality multiplanar, three dimensional image display Basis of virtual bronchoscope

Advantages of spiral CT chest

Virtual bronchoscopy Virtual bronchoscopy combines multidetector helical CT with computer-assisted image processing to generate high quality intra- and extra-luminal views of the airways. The use of novel, automated reconstruction algorithms can help assess the extent of an airway abnormality, detect subtle areas of stenosis, and define complex anatomical relationships prior to bronchoscopy or surgical intervention. In addition, this technology improves the ability of radiologists to assess airway disease noninvasively.
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Some Indications of Chest CT

1. 2. 3. 4. 5. 6. 7. 8. 9.
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Evaluation of mediastinal or pleural mass Detection of pulmonary metastasis Emphysema (COPD) Patient with Hemoptysis Abscesses or cysts Lung fibrosis Atelectasis Bronchitis (COPD) Guidance FNA

COPD
Chronic Obstructive Pulmonary Disease

Chronic Emphysema Bronchitis

Asthma

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Patient Preparation and contrast

Patient preparation:
Fasting for 3-4 Hours before the examination

Contrast:
The use of contrast media which injected intravenously is important for visualization of structures within the mediastinum. Department protocols/radiologist preferences determine the specific type, volume and site of injection. ( Average dose 100ml) For children 2 ml per kilogram body weight.

The advantage of contrast media :

1. To detect lesions 2. To distinguish vessels from lesions 3. To demonstrate displacement of vessels by masses 4. To demonstrate the enhancement of pathologies
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CT Chest -Slice spacing

Adequate assessment of patient 10 mm interval Improved spatial resolution allows better assessment of normal and abnormal findings Pulmonary metastasis requires spiral CT with 5 to 7mm thick sections Trachea and central bronchi 3 to 5mm thick spiral CT Pulmonary parenchyma and peripheral bronchi requires 1 to 2 mm sections

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Image display settings

Mediastinum ,Hilum
WW 350 to 500HU WL 30 to 50HU

lungs:
WW 1000 to 1500HU WL -600 to -700HU

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Normal Anatomy
1. Coracoid. 2. Right clavicle. 3. Right common carotid artery. 4. Thyroid. 5. Internal jugular vein. 6. Left clavicle. 7. Left Subclavian vein. 8. Left humeral head. 9. Scapular spine. 10. Spinous process.

Axial cut. Mediastinal Window

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Normal Anatomy
1. 2. 3. 4. 5. 6. Right humeral head. Esophagus. Trachea. Left Subclavian vein. Scapular spine. Glena

Axial cut. Mediastinal Window

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Normal Anatomy
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Right lung. Rib. Esophagus. Trachea. Left brachiocephalic vein . Left common carotid artery. Left Axillary vein. Left Lung. Transverse process. Scapula.

Axial cut. Mediastinal Window

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Normal Anatomy
1. 2. 3. 4. 5. 6. 7. 8. 9. Axial cut. Mediastinal Window Right lung. Rib. Trachea. Left brachiocephalic vein . Brachiocephalic artery. Left common carotid artery. Left Subclavian artery. Scapula. Esophagus. Spinous process.

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Normal Anatomy

1. 2. 3. 4. 5. 6. 7. 8.

Right lung. Trachea. Superior vena cava. Aortic arch. Left Lung. Scapula Vertebral body. Rib.

Axial cut. Mediastinal Window

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Normal Anatomy
1. 2. 3. 4. 5. 6. 7. 8. 9. Right lung. Right pulmonary artery. Superior vena cava. Thoracic ascending aorta. Pulmonary artery root. Left pulmonary vein. Left pulmonary artery. Rib. Thoracic descending aorta

Axial cut. Mediastinal Window

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Normal Anatomy

1. 2. 3. 4. 5.

Right atrium. Aortic root. Right ventricle. Left atrium. Thoracic descending aorta.

Axial cut. Mediastinal Window

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Normal Anatomy

1. 2. 3. 4. 5. 6.

Right lung. Right atrium. Right ventricle. Left ventricle. Left Lung. Thoracic descending aorta.

Axial cut. Mediastinal Window

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Normal Anatomy
1. 2. 3. 4. 5. 6. 7. 8. Right lung. Inferior vena cava. Right ventricle. Left ventricle. Esophagus. Left Lung. Thoracic descending aorta. Spinal canal.

Axial cut. Mediastinal Window

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Normal Anatomy
1. 2. 3. 4. 5. 6. 7. 8. 9. Right lung. Liver. Inferior vena cava. Right ventricle. Left ventricle. Esophagus. Left Lung. Thoracic descending aorta. Vertebral body.

Axial cut. Mediastinal Window

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Normal Anatomy

1, Inferior lobe of right lung. 2, Liver. 3, Inferior vena cava. 4, Esophagus. 5, Left Lung 6, Aorta.

Axial cut. Mediastinal Window

22

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Normal Anatomy

1. 2. 3. 4. 5.

Inferior lobe of right lung. Liver. Inferior vena cava. Inferior lobe of left lung. Aorta.

Axial cut. Mediastinal Window

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Normal Anatomy
Axial cut. Lung Window

1. 2. 3. 4.
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Apical segment bronchus upper lobe (Right lung). Division of Trachea. Superior lobe of the left lung. Inferior lobe of left lung. Red arrow, Major fissure.

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Normal Anatomy
Axial cut. Lung Window

1. 2. 3. 4. 5. 6.
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Posterior segmental bronchus upper lobe (right lung). Anterior segmental bronchus upper lobe (right lung). Right main bronchus. Left main bronchus. Superior lobe of the left lung. Inferior lobe of left lung. Red arrow, Major fissure.

Normal Anatomy
Axial cut. Lung Window

1. 2. 3. 4. 5. 6.
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Right lower lobe bronchus. Inferior lobe of the right lung. Right middle-lobe bronchus. Right middle lobe. 5, Superior lobe of the right lung. Superior lobe of the left lung. Inferior lobe of left lung.

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Normal Anatomy
Coronal Reconstruction Image 1. 2. 3. 4. Trachea. Left main bronchus. Right main bronchus. Apical segmental bronchus upper lobe (Right lung). 5. Right lower lobe bronchus. Red arrow, Major fissure.

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Protocols
Reminder
Variables Plain or contrast enhanced Slice positioning Slice thickness Slice orientation Slice spacing and overlap Timing of imaging and contrast administration Reconstruction algorithm Radiation dosimetry
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Protocols ( Routine/ HRCT) Note

Optimization of the CT examination requires the supervising physician and Technologist to develop an appropriate CT protocol based on careful review of relevant patient history and clinical indications as well as all prior available imaging studies.

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CHEST ( Lungs and Mediastinum)

Indications Patient Position Topogram Breathing Contrast Technical Parameters Filming Parameters Comments General screening of Pathology Supine arms elevated above head From lung apices to below diaphragm Breath hold in inspiration ( single breath hold) I.V : 100 ml at 3ml/s. Imaging timing about 30-40 s. Pitch : 1 mm Slice thickness : 7-10mm ( 3-5 mm for small lesions) Soft tissue widow and Lung widow ( Refer to slice No.26) Bone window if needed For the demonstration of lung nodules or inflammation low dose protocol with out contrast enhancement is recommended. 30

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CHEST ( HRCT)
Thin section and high spatial algorithm makes structures sharper
Indications lung diseases e.g. : Bronchiectasis Pulmonary Fibrosis Emphysema Supine arms elevated above head From lung apices to below diaphragm Breath hold in inspiration ( single breath hold) N/A Pitch : 1 Suggested collimation 64x0,6 mm Slice thickness : 2-3 mm Lung widow Expiration sequence if required

Patient Position Topogram Breathing Contrast Technical Parameters Filming Parameters Comments

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HRCT

Routine CT

HRCT - bronchial dilatation

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THANK YOU

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