NCCT& CECT Pelvis for radiology students

Ncct & cect pelvis

1. NCCT& CECT PELVIS Made by- RAVI(220528033) NISHA(220528037) BHARTI (220528051) Course- Bsc.RIT 5 th sem. Submitted to- Mrs. Ashita Mam

2. CONTENT Anatomy Difference between NCCT& CECT Indication/ Contraindications Contrast-media Patient Preparation Patient Positioning Protocol After-Care Complication

3. Anatomy Pelvis bone is also called “ Pelvic- Girdle”. It is basin-shaped and connected to trunk and legs. It support and balance the trunk. Pelvis Bones- ( Ilium, Ischium, Pubis) Sacrum, Coccyx , Acetabulum and hip-joints. Organs– Bladder, Rectum, Reproductive organs. Function--- It carries entire weight of upper-body Stabilize the body, sitting and standing. Bony pelvis provide the comfortable environment for fetus during pregnancy.

4. Difference B/W NCCT & CECT NCCT stands for Non-Contrast Computed Tomography. Contrast is not used. NCCT is typically used for evaluate calcifications, fractures, bone structures and stones- kidney stone or bladder stone. Less detailed images of blood vessels and soft-tissue. CECT stands for Contrast enhanced Computed Tomography . Iodinated contrast is used. CECT is typically used for visualization of soft-tissues, blood vessels, tumors , inflammation or infection. More detailed images and better contrast between different soft-tissue .

5. Indication Pain in pelvis Masses and fluid collection in pelvis Tumor Complex fractures Suspected occult fracture( suddenly fall) Congenital abnormalities Pre-operative baseline evaluation Post-surgical evaluation

6. Contraindications Pregnancy Sensitivity to contrast-media Serum creatinine reports (0.7-1.3 mg/dl) Kidney failure Severe claustrophobia

7. Contrast-Media Through IV- Non-Ionic , Iodinated contrast-media( Omnipaque ) Volume- 40-60ml Rate- 1ml to 3ml/sec. Administration- Through IV, Orally & Rectally.

8. Contrast Administration Through Rectally 500-750ml of 1-2% Diluted Iodinated Contrast-media. Contrast is injected at the time of scan. Dilution with Plain water. Through Orally 750- 1000ml of 1-2% Barium or Water soluble Contrast-media. 30-60 min. before the scan. Diluted with Plain water. Contra-indication = Perforation

9. Patient- Preparation Identify the patient name, Patient-ID. Collect the previous history. Obtain the consent form. Remove all metallic object from an investigating area & wear the hospital gown. Explain whole procedure to the patient. FOR CONTRAST-- Fasting for 4-6hrs. Before the procedure. Put an IV cannula for administration of contrast-media.

10. Patient Positioning Patient should be in supine position on the CT-couch. Arms by the side or above the head. Legs should be slightly extended with a slight inward rotation of the feet. Centering – pubic symphysis. .

11. Phases of contrast enhancement 1)Arterial phase: Timing:25-30 sec. after the start of contrast injection. Purpose: To assess arterial structures (e.g., iliac arteries ) 2) Venous phase: Timing:60-70 sec. after the start of contrast injection. Purpose: To evaluate venous structures, soft tissues and organs. 3) Delayed phase(if required): Timing:5-10 min. after contrast administration . Purpose: For assessing lesions that may enhance slowly or to evaluate the urinary tract.

12. Protocol Topogram- AP ( Level of umbilicus) Scan extent- Highest point of iliac crest to inter-trochanteric region bilaterally. Slice- thickness- 2-3mm Slice- interval- 1- 1.5mm Reconstruction algorithm- Sharp for bone & medium for soft-tissue. Scan direction- Cranio-Caudal Scan delay-5-10 min . Pre- contrast series- Axial images are acquired covering from highest point of iliac crest to inter-trochanteric region bilaterally. Post- contrast- Axial images are acquired covering from the highest point of iliac crest to inter-trochanteric region bilaterally.

13. Scanning Technique Scout-scan : Anteroposterior(AP) and lateral scout images from the iliac crest to below the pubic symphysis. Helical/Spiral-scan: Continuous helical scanning during the venous phase is typically used for optimal visualization. Breathing instructions: The patient should hold the breath during the scan to reduce motion artifacts.

14. Post- Processing Soft -Tissue window: For the evaluation of pelvic organ (window width=350 HU , window level=50HU ) Bone window : optional for assessing bones if pathology likes a fracture suspected (Window width =2000HU , Window level =400HU ) Multiplanar Reconstruction ( MPR): Axial, Coronal and Sagittal image to thoroughly examine the entire pelvic area 3D-Reconstruction( if required ):useful in cases of trauma , vascular abnormalities or surgical planning .

15. After Care Patient is brought out from the gantry. Bring the patient down from the scanner-table. Ask the patient to dress-up. Patient should be observed at least 30min. For any allergic reaction to contrast-media. IV cannula is removed from the patient hand gently. Take more water adequately for easily removal of contrast-media. Ensure that the patient is stable before leaving the department. Inform patient time and where to collect the report.

16. Complications Allergy to contrast-media Vomiting Headache Fatigue