NECK AND ELBOW CT PROTOCOLS group 10.pptx

Neck and elbow

1. NECK AND ELBOW CT PROTOCOLS

2. GROUP 10 MEMBERS BIZO LYDIA HOPE URRI U/2203132/DMR YANANI LYDIA U/2108109/DMR NANTEZA SALAMA U/2203061/DMR KESENTE MILIA U/2203255/DMR RWOTBER MODESTA LOISEA U/2203025/DMR KASUMBA GEOFREY U/2203143/DMR YIKI BENARD U/2203114/DMR NAKYANZI FLORENCE U/2203189/DMR NAMPIJJA CHARLOTE U/2103110/DMR KUKUNDAKWE ESTHER U/2203049/DMR

3. CONTENTS INDICATION CONTRAINDICATATIONS PATIENT PREPARATION IMAGING TECHNIQUES Patient after care REFERENCE BOOKS

4. INTRODUCTION OF THE NECK The neck is part of the human body that separates the head from the torso or part of the body that attaches the head to the rest of the body. It contains nerves and blood vessels that supplies structures in the head to the body.

5. Boundaries of the neck Anterior superiorly mylohyoid muscles and inferior border of the mandible Antero inferiorly Superior b order of the clavicles Postero superiorly The base of the skull Postero inferiorly The scapulae Centrally in the inferior aspect Thoracic inlet

6. Spaces of the neck The neck spaces concept is commonly used in radiology in organizing the neck and establishing an appropriate differential diagnosis for pathology discovered within a specific space of the neck. The space may limit to some degree the spread of most infectious diseases and some tumors. The spaces are described in relation to hyoid bone. They include-suprahyoid and infrahyoid spaces.

7. INDICATIONS Screening for inflammatory, tumoral diseases Trauma Pharyngeal diseases Confirmation of lesions Rule out vascular abnormalities Preoperative baseline Postoperative follow ups

8. CONTRAINDICATIONS Pregnancy Renal diseases Hypersensitivity to contrast Thyroid diseases

9. PATIENT PREPARATIONS Explain the procedure to the patient Clear patient history should be taken along with report of any previous investigations Advise patient to do some lab tests eg RFTs,HCG NPO for 4-5 hours prior to the test Obtain patient consent Patient removes radiopaque materials from the field of view Irritable or uncooperative and pediatric patients be sedated Neck should be in neutral position Patient should be instructed to avoid swallowing movements

10. IMAGING TECHNIQUE FOR NECK PATIENT POSITIONING Head first ,supine with arms by the sides of the trunk with hands tucked under the hips and slightly extend neck Head support can be applied to restrict the neck movements SCOUTS ; AP and LATERAL MODE OF SCANNING Helical with single breath take technique SCANNING ORIENTATION ; Cranio-caudal STARTING LOCATION ; base of the skull ENDING LOCATION ; clavicula heads

11. NECK PROTOCOL soft tissue Examples of clinical indication, neck mass,vascular abnormality Iv contrast;125ml at 1.5ml/s it’s a spilt bolus-1 st injection 50ml,2-minute delay,2 nd injection 75ml, scans initiated 25seconds after the start of the second injection Oral contrast; none DFOV;18CM SFOV; large body Algorithm; standard

12. Window settings; 350ww/50wl 16 detector protocol 64 detector protocol Gantry rotation time 0.8s 0.8s Acquistition .detector width x number of detector row equals 0.625mm x 16 equals 10mm 0.625mm x 32 equals 20mm Reconstruction.slice thickness/interval 2.5mm/1.25mm 2.5mm/1.25mm pitch 0.562 0.531 Kvp /auto mAs Reconstruction 2 Algorithm.bone Window setting .4000ww/400wl DFOV. 18CM Slice thickness/interval 2.5/1.25mm 120/150-800 120/150-800

13. Mpr Sagittal images –its aligned through the center of the vertebral body and the chin Coronal images-aligned to the transverse processes and the mandibular Axial images-its perpendicular the head –neck axis's

14. CT-IMAGES OF NECK

15. Vrt -image

16. Patient after care If contrast injection was used during the exam encourage patient to drink enough water within 24hrs to eliminate the contrast from the body. Diabetic patients who are on metformin should resume medication after 48 hours from the time of the examination. Monitor the patient for sometime for any reactions to contrast.

17. ELBOW CT- PROTOCOL The CT-elbow protocol serves as an examination for the bone assessment of the elbow and is usually performed as a non-contrast study.it can also be combined with CT-arthrogram INTRODUCTION TO ELBOW JOINT ANATOMY The elbow is a hinged joint made up of three bones , humerus, ulna and the radius The ends of the bones are covered by cartilage which a rubbery consistency that allows the joints to slide easily against each other and absorb shock.

18. INDICATIONS Elbow trauma Elbow stiffness Inflammatory or infectious diseases Bone and soft tissue tumors Post-operative follow-up , implants and there complications Interventions e.g. CT guided biopsy CONTRAINDICATION Pregnancy Allergy Renal impairment

19. IMAGING TECHNIQUE Patent preparation Explain the procedure to the patient Obtain consent Remove radiopaque materials from area of interest Patient position Supine position/prone The arm in question is raised above the head The affected elbow should be closed to the center of the scanning table If possible elbow extended palm facing upwards Upper body and head bent to the contralateral side The contralateral arm next to the body

20. CONT Scout; AP and LATERAL Scan type; Helical Start location; Above the elbow joint Ending location; Below the radial tuberosity DFOV; 15cm SFOV; large body Algorithm; bone Window width; 2000HU Window level; 500HU

21. 16-detectors 64-detectors Gantry rotation time 0.8s 0.8s Acquisition (detector width x number of detector rows)=coverage 0.625mm x 16 =10mm 0.625mm x 32 =20mm Slice thickness/interval 1.25mm/0.625mm 1.25mm/0.625mm pitch 0.562 0.531 Kvp / mAs 140/300 140/300

22. cont Reconstruction 2 Algorithm; standard Window setting; 350ww/50wl Slice thickness/interval ; 2mm/2mm PLANES Axial(A)-MPR can be programmed from the scout and should be parallel to the radial head Oblique-coronal(B) –MPR can be programmed from an axial image from the level of humeral epicondyles and the olecranon Oblique sagittal(C)-MPR can be programmed from an axial image and be perpendicular to the plane of the oblique coronal MPR

23. Mpr -images

24. VRT TECHNIQUE It’s a complicated reconstruction process .A two dimensional representation from 3-dimensional data set is achieved by assigning color and opacity values to every voxel of the data set. Brightness an reflection are also part this complicated reconstruction process By using color lookup table ( clut ) which is common in all VRT software color and opacity are assigned to various tissues based on their CT-numbers In the CLUT , a number of trapezoids can be chosen representing the attenuation ranges of relevant tissues/materials ie air,fat,bone,parachymal organs, the contrast enhanced vessels etc These trapezoids can be color-coded, and the tussues /materials they represent will appear in the same colour in the final images

25. VRT-IMAGE OF THE ELBOW

26. REFERENCE BOOKS Step by step Radiopaedia Ct for radiologists Thanks for listening .