ct angiography
DESCRIPTION
CT ANGIOGRAPHY. Dr Mohamed El Safwany, MD. Intended learning outcome. The student should learn at the end of this lecture CT IMAGE OF THE BLOOD VESSEL OPACIFIED BY CONTRAST. CT IMAGE OF THE BLOOD VESSELS OPACIFIED BY CONTRAST. REQUIREMENTS FOR CTA. PATIENT PREPARATION ACQUSITION PARAMETERS - PowerPoint PPT PresentationTRANSCRIPT
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CT ANGIOGRAPHY
Dr Mohamed El Safwany, MD
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Intended learning outcome
• The student should learn at the end of this lecture CT IMAGE OF THE BLOOD VESSEL OPACIFIED BY CONTRAST.
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CT IMAGE OF THE BLOOD VESSELS OPACIFIED BY
CONTRAST
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REQUIREMENTS FOR CTA
• PATIENT PREPARATION
• ACQUSITION PARAMETERS
• CONTRAST MEDIUM ADMINISTRATION
• POSTPROCESSING TECHNIQUES
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PATIENT PREP.
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INFORMED CONSENT
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PATIENT PREP.
• CREAT.- 0.6 –1.2 mg/dl
• IODINE ALLERGY- STEROID THERAPY
• HYPERVENTILATION BEFORE EXAM FOR BETTER BREATHOLD
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UTILIZED
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GAUGE SUITABLE FOR CTA
18 OR 20
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CONTRAST ADMINISTERED WITH POWER INJECTOR
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ACQUSITION PARAMETERS
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PARAMETERS
• USUALLY ROUTINE CT PRECEDES A CTA EXAM. THE ROUTINE EXAM IS USED AS A REFERENCE SCAN HELPING TO DETERMING THE SCANNING RANGE IN CTA.
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SLICE THICKNESS
• SLICE THICKNESS
• SPATIAL RESOLUTION
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• CEREBRAL CTA
• ABDOMINAL CTA
• THORACIC CTA
• 1MM (LOWER mA)
• 3MM
• 3MM
SLICE THICKNESS
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SPIRAL PITCH
• PITCH • SPATIAL RESOLUTION
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SPIRAL PITCH
• UP TO 2
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kVp, mA, TIME
• SIMILAR TO NON- CTA EXAM OF THE SAME BODY PART
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RECONSTRUCTION INTERVAL
• 50% OF OVERLAP
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CONTRAST ADMINISTRATION
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POWER INJECTOR
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POWER INJECTOR PARAMETERS
VOLUME OF CONTRAST-ml
RATE ml/sec
TIME OF INJECTION – sec
SCAN DELAY TIME - sec
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CONTRAST WARMER
WHY???
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RATE OF INJECTION
3-5 ml/sec
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ORAL CONTRAST????
WATER
NEGATIVE CONTRAST
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AUTOMATED CONTRAST ADMINISTRATION
SYSTEMS • SMARTPREP
• CARE
• SURESTART
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CONTRAST ADMINISTRATION AND SCANNING METHODS
• BOLUS TRACKING
• BOLUS TIMING
• MANUAL PRESET TIME
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CARE BOLUS
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SMART PREP
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Bolus tracking- PE
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PE?
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Tracking slice
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Bolus tracking- Carotids and Circle of Willis
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Circle of Willis
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Circle of Willis?!
40 SEC
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Renal arteries 25-30 sec.
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ABDOMINAL AND FEMORAL RUNOFF
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MANUAL DELAYS
• CERBRAL CTA
• CAROTID CTA
• CHEST CTA (PE)
• 15 SEC
• 12 SEC
• 10-20 SEC
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CARDIAC CT
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TWO TECHNIQUES TO REDUCE MOTION ARTIFACTS IN CARDIAC
CT
• PROSPECTIVE TRIGGERING
• RETROSPECTIVE GATING
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Prospectively ECG-Triggered Sequential Scanning
Cardiac CT applications require the synchronization of data acquisition to the cardiac cycle, i.e. to the movement of the heart. For sequential imaging, a prospective trigger is derived from the ECG-trace to initiate the CT-scan with a certain delay time after the R-wave. Usually, the delay is defined such that the scans are acquired during the diastolic phase of the heart
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Retrospectively ECG-Gated Spiral Scanning
For "retrospectively ECG-gated spiral scanning" a continuous spiral scan is acquired with the ECG-signal recorded simultaneously. The acquired scan data is selected for image reconstruction with respect to a pre-defined cardiac phase. Similar to ECG-triggered sequential scanning a certain R-wave delay time defines the start point of data that is used for image reconstruction. ECG-gated spiral scanning has several advantages over ECG-triggered sequential scanning. The continuous acquisition allows for reconstruction of overlapping slices. Due to the retrospective analysis of the ECG, the technique is less sensitive to arrhythmia.
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BOTH METHODS REQUIRE ECG MONITORING
DIASTOLIC PHASE
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SCANNING DURING RR INTERVAL
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Retrospective ECG-Gating
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CARDIAC CT PROCEDURES
• CARDIAC ANGIOGRAM
• CALCIUM SCORING
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CARDIAC ANGIOGRAM
PERFORMED WITH CONTRAST INJECTION
4-5 cc/sec
150 cc total volume
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CALCIUM SCORING
NO IV CONTRAST USED
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CARDIAC ANGIOGRAM
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CALCIUM SCORING
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3-D VISUALIZATION TOOLS IN CTA
• MPR
• MIP
• SSD
• VR
• CINE
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CARDIAC ANGIOGRAM
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CTA - MPR
PLANE?
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MPR
PLANE?
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MIP - CTA
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SSD -CTA
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VR - CTA
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CINE CTA
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MPR
• SIMPLE• FAST• ANY PLANE
VISUALIZATION
• LESS USEFUL IN COMPLEX VESSEL VISUALIZATION
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SSD
• FAST• LITTLE EDITING• LITTLE AXIAL
DATA USAGE• CONTOUR ,
RELATIONSHIP OF VESSELS
• ARTIFACT GENERATION
• INACCURATE
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MIP
• CALCIFICATION DETECTION
• THROMBUS DETECTION
• AILIASING ARTIFACT
• EDITING REQUIRED
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VR
• ACCURATE• ALL DATA USED• GOOD STENOSIS
DETECTION
• COMPLEX COMPUTER PROCESSING (PAST)
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STEREOSCOPIC VIEWING
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Text Book
• David Sutton’s Radiology
• Clark’s Radiographic positioning and techniques
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Assignment
• Two students will be selected for assignment.
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Question
• Define Care bolus technique?
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• Thank You