Computed Tomography: Advanced Clinical Applications

Description

This edited volume will focus on the advanced elements of computed tomography for an array of audiences, but more specifically, to undergraduate and postgraduate radiographers or CT technologists. This book will draw on the international expertise of advanced topics in CT. Typically, CT practices and approaches differ between hospital sites and workplace environments. As there are currently no universally accepted approaches, the reader can use this book to develop local imaging protocols with adjustments made for patients, the type of scanner and the radiologists’ or physicians’ preferences. Editors anticipate this to remain a key text for undergraduate and postgraduate radiography and CT students as it incorporates a holistic view of the profession whilst identifying advanced knowledge and understanding pertinent to CT practice. This is not a text on CT physics and imaging protocols alone but on the application and potential for such advanced techniques within the computed tomography field. The text, which includes most relevant technical and pathophysiological premises, also articulates learning points and pitfalls. Throughout the text, there is also an emphasis on image evaluation, with guidance on the recognition of normal, benign, and malignant pathologies and clear instruction on learning points and pitfalls. Given the increasing recognition of advanced scope of practice and professional capabilities in the field of medical radiation science, a focus on CT imaging within emergency settings, interventional environments and forensic imaging is portrayed. It is intended that this text will enhance and offer original discussions surrounding the interconnectivity of the technology, sciences research, and patient care in CT. Foreword Acknowledgements Contents Part I: Radiobiology and Patient Care Radiobiology and Radiation Protection 1 Radiobiology and Radiation Protection 1.1 Interactions Between Photons and Matter 1.1.1 Rayleigh Scattering 1.1.2 Compton Scattering 1.1.3 Photoelectric Absorption 1.1.4 Pair Productions 1.2 Effects of Ionizing Radiation 1.2.1 Deterministic Effects 1.2.2 Stochastic Effects 1.2.3 Evidence of Ionizing Radiation Effects 1.3 Linear No-Threshold Model 1.4 Radiation Protection 1.5 Image Quality Optimization and Dose Reduction 2 Radiation Dose in CT Examinations 2.1 Absorbed Dose 2.2 Effective Dose 2.3 Organ Dose 2.4 Exposure 2.5 Dose Distribution in SFOV 2.6 Dose Distribution Along Scan Length 2.7 CT Dose Index 2.8 CTDIFDA 2.9 CTDI100 2.10 CTDIW 2.11 CTDIvol 2.12 Dose-Length Product References Patient Care and Self-Care in CT 1 Introduction 2 Clinical Considerations for Patients Undergoing a CT Examination 2.1 Obtaining Informed Consent 2.1.1 Ionising Radiation 2.1.2 Iodinated Contrast Media 2.1.3 CT-Guided Interventional Procedures 2.2 Preparation and Safety for CT Scans Requiring IV Contrast 2.2.1 Dietary Restriction 2.2.2 Contrast-Induced Nephropathy (CIN) 2.2.3 Hypersensitivity to IV Contrast Some Key Points About Allergic Reactions (Cardarelli and Ulsh 2018) Premedication for Patients with Previous Allergic Reactions to Contrast 2.2.4 Extravasation of Contrast Media 2.2.5 Pregnancy and Breastfeeding in Relation to Iodine Contrast Pregnancy Breastfeeding 3 Patient Interaction and Communication 3.1 Values & Biases in Patient Interaction 3.1.1 Values & Biases of the Healthcare Professional 3.1.2 Values & Biases of the Patient 3.2 Language and Communication 3.2.1 Language Barriers 3.3 Patient Greeting 3.4 Patients with Specific Needs 3.4.1 Anxiety Causes Signs & Symptoms 3.4.2 Physical Limitations/Disabilities 3.4.3 Children 3.4.4 Aggressive & Intoxicated Patients 3.5 Medical History & Referral Review 3.5.1 Common Medical Questions for IV Contrast Administration Include 3.5.2 Common Medical Questions for Interventional Procedures 4 Navigating the CT Department as a Technologist 4.1 Alignment of Values between the Healthcare Professional and the Healthcare Institution 4.2 Roles, Responsibilities & Goals for CT Technologists 4.3 Balancing Workflow in a CT Department 4.3.1 Trilemma of CT Workflow 4.3.2 Empathy vs Sympathy 4.3.3 Patient-Centred Care 5 Self-Care as a CT Radiographer 5.1 Healthy Lifestyle and Work Habits 5.1.1 Scheduled Breaks 5.1.2 Breath and Body Awareness 5.1.3 Mindfulness and Other Self-Care Tools Journaling Physical Exercise Meditation and Breathwork 5.1.4 Managing Stressful or Traumatic Situations in a CT Department References Part II: CT in an Emergency Setting CT in an Emergency Setting 1 Introduction 2 Traumatic brain injury 2.1 TBI imaging Protocols 2.1.1 General Protocol for NCCT 3 Stroke (nTBI) 3.1 Stroke (nTBI) imaging Protocols 3.1.1 Non-contrast CT (NCCT) for Stroke 3.1.2 Contrast Media (CM) Considerations 3.1.3 CT Perfusion (CTP) 3.1.4 CT Angiography (CTA) 4 General Considerations of Findings on CT Scan TBI and nTBI 5 Common Primary Findings for TBI and nTBI Explained 5.1 Epidural Hematoma 5.2 Subdural Hematoma 5.3 Subarachnoid/Intraventricular hematoma 5.4 Intra-Axial Hemorrhage 5.5 Intraparenchymal Hematoma (IPH) 5.6 Cortical Contusions 5.7 Skull Fractures 6 Common Secondary Findings in CT TBI and nTBI 6.1 Hemorrhagic Stroke 6.2 Transient Ischemic Attack (TIA) 6.3 Traumatic Brain Herniation 6.4 Ischemic Stroke 6.5 Infarction 7 Emerging Protocols: (MSCT) 8 Standardizing CT Protocols 9 Responses to Trauma, Stroke, and/or Intensive Care Patients References Trauma Imaging Protocols and Image Evaluations 1 Introduction 2 Head and Spine Injuries 3 Thorax, Abdomen & Pelvis 4 Penetrating and Vascular Injuries 5 Extremities 6 CT Imaging of Trauma References Stroke Imaging Protocols 1 Introduction References Responses to Trauma and Stroke 1 Introduction References Bibliography Whole-Body CT 1 Background & History 2 Time 3 Radiation Dose 4 Overdiagnosis and Incidental Findings 5 Cost 6 Tips for CT Radiographer When Resuscitation Room Calls 7 Protocols 7.1 Patient Preparation 7.2 Dual Intravenous Contrast Bolus 7.3 Single Intravenous Contrast Phase with Two Scan Ranges 7.4 Image Reconstruction (Table 1): 8 Conclusion References Part III: CT Guided Interventions Indications, Technique and Pitfalls 1 Indications 1.1 Technique 1.2 Patient Preparation 1.3 Consent 1.4 Positioning the Patient 1.5 Pre-Planning CT Scan 1.6 Procedure 1.7 Acquisition Option 1: Injection/Biopsy Mode (I.E. Intermittent CT Fluoro) 1.8 Acquisition Option 2: Scanning a Range 1.9 Acquisition Option 3: CT Fluoroscopy 1.10 Summary of Technique for CT Radiographer 1.11 Lumbar Spine Injections 1.12 Cervical Spine Injections 1.13 Shoulder Hydrodilatation ± Injection ± Arthrogram 1.14 Hip Injection 1.15 Knee Injection 1.16 Lung Biopsy 2 Pitfalls References Tips, Tricks, Radiation Dose and Protection 1 Tips and Tricks 2 Radiation Dose and Radiation Protection 2.1 Clinical Example of Dose Reduction for CT-Guided Lumbar Spine Injections 2.2 Radiation Protection of Staff 2.3 Methods to Reduce Occupational Radiation Dose References Part IV: CT Forensic Imaging CT Forensic Imaging 1 Introduction 2 History of Forensic Imaging 3 Future of Forensic Imaging 4 Living Versus Deceased Cases 5 Advantages and Disadvantages of Post-Mortem CT (PMCT) 5.1 Strengths of PMCT 5.2 Limitations of PMCT 6 PMCT Protocol Considerations 6.1 Equipment 6.2 Reconstruction Considerations 6.3 Scanning Approaches 6.3.1 General Considerations 6.3.2 Study Approaches Head, Neck and Torso Whole-Body Approach No 1 Whole-Body Approach No 2 (Recommended) 6.3.3 Dental Acquisition 6.3.4 Choice of Scan Approach 7 Image Storage, Retrieval & Archiving 7.1 Discussion of Medico-Legal Concepts 8 Radiographer Review/Impressions in PMCT 8.1 Background 8.2 What Is a Radiographer Review/Impression? 8.3 The Structure and Approach for Radiographer Reviewing/Impressions 8.3.1 Head and Neck 8.3.2 Chest 8.3.3 Abdomen 8.3.4 Limbs 9 Education and Training 10 Conclusion References Part V: CT Education Education in CT 1 Introduction 2 Andragogy: Adult Learning 3 Pedagogy: Method and Practice of Teaching 3.1 Interactional Practice 3.2 Dynamic Practice 3.3 Contextual Practice 4 Assessment of the Learning CT Radiographer 4.1 Competence and Capability 4.2 Assessment for Learning and Assessment of Learning 4.3 Professional Judgement 4.4 Application to Assessment of CT Capability 5 Conclusion References