Teknik Pemeriksaan CT Scan

Thorax

BAGUS DWI HANDOKO_ JTRR

Dalam melakukan pemeriksaan CT scan, idealnya :
(Dari aspek radiolog)

Tahu riwayat pasien :

Mengenali keluhan dan riwayat penyakitnya

Jelas indikasinya :
Tahu yang akan dicari /diutamakan /diperhatikan.
Kemungkinan ada hubungannya dengan teknik
pemeriksaan (pemberian kontras dan delayed scan)

Melihat foto /USG/ CT Scan sebelumnya akan sangat

membantu dalam memberikan kesimpulan yang lebih
baik
(Dari aspek radiografer)

Penting : ada komunikasi yang baik antara radiolog dan

radiografer.

- Tahu gambar mana yang akan dicetak/ bagian mana

yang dibesarkan, diukur atau dicetak khusus
- Tahu kondisi window wide dan window level yang tepat.
Mis. Kondisi paru, tulang dan soft tissue.
- Radiografer dapat mencetak foto yang baik, mengetahui
kelainan, variasi normal atau partial volume effect
ANATOMI PARU-PARU
interstitial lung disease adalah kelompok penyakit paru-paru yang ditandai oleh
pertumbuhan jaringan parut atau fibrosis pada organ paru-paru. Gejalanya adalah
batuk kering hingga sesak napas yang bisa memburuk seiring waktu
Persiapan Pasien
– Puasa 4-6 jam sebelum pemeriksaan.
– Periksa laboratorium kadar ureum dan creatinin.
– Pasien diberi penjelasan tentang pemeriksaan
yang akan dilakukan
– Cek riwayat asma, alergi dan penyakit lain.
– Cek vital sign
 What are some common uses of the CT Thorax?
Chest CT is used to:
• examine abnormalities found on conventional chest x‐rays.
• help diagnose the causes of clinical signs or symptoms of disease
of the chest, such as shortness of breath, chest pain, or fever.
• detect and evaluate the extent of tumors that arise in the chest,
or tumors that have spread there from other parts of the body.
• evaluate injury to the chest, including the heart, blood vessels,
lungs, ribs and spine.
What are some common uses of the CT Thorax?
Chest CT can demonstrate various lung disorders, such as:
• lung cancer.
• pneumonia.
• tuberculosis.
• bronchiectasis.
• inflammation or other diseases of the pleura, the covering of
the lungs.
• congenital abnormalities.
• A CT angiogram (CTA) may be performed to evaluate the blood
vessels (arteries and veins)
• You should wear comfortable, loose‐fitting clothing to your exam.
You may be given agown to wear during the procedure.
• Metal objects, including jewelry, eyeglasses, dentures and hairpins,
may affect the CT images and should be left at home or removed
prior to your exam. You may also be asked to remove hearing aids
and removable dental work. Women will be asked to remove bra.
• containing metal underwire. You may be asked to remove any
piercings, if possible.
• material will be used in your exam. You should inform your
physician of all medications
• you are taking and if you have any allergies.
Persiapan Alat
– Peralatan CT Scan dalam keadaan Stanby
– Obat kontras non ionik 100-150 cc
– Peralatan injeksi
– Obat-obatan emergency
– Oksigen
– Infus set,needle,abocath, dll
 Scanogram
STANDARD THORAX
start of range 1

end of range 1
Teknik Scanning
• Potongan axial prekontras/ polos dari puncak paru
sampai diafragma, tebal potongan 10mm, slice
thickness in recon 3-5 mm.
• Bolus kontras diberikan mulai dari arkus aortae
sampai hilus inferior, tebal potongan 5-8mm (post
kontras).
• Kondisi dicetak dalam 2 macam: kondisi parenkim
paru dan kondisi mediastinum.
• Spiral/helical imaging is recommended as the entire
lung area can be imaged in one single breath hold.
 Scan Parameter

Slice
Table Rotation IV
Acquisition Thicknes mAs kV algorithm
Movement Time contrast
s

range 1
~100- soft tissue 0.75-1.0
Axial Spiral 8-10 mm 10-15 mm 120 
150 adult body second
pitch = 1.5
 Window Setting
Window Width Centre

Soft Tissue range

300-500 30-60
1&2

Soft Tissue Lung

Parenchyma 800-1800 -300 - -700
range 1
 Kriteria
- entire thoracic wall
visualisation imaging - entire thoracic aorta and vena cava
criteria - entire lung parenchyma
- vessels after intravenous contrast media

- visually sharp reproduction of the thoracic aorta

- visually sharp reproduction of the anterior mediastinal
structures, including thymic residue (if present)
- visually sharp reproduction of the trachea and main bronchi
- visually sharp reproduction of the paratracheal tissue
- visually sharp reproduction of the carina and lymph node area
image reproduction - visually sharp reproduction of the oesophagus
criteria - visually sharp reproduction of the pleuromediastinal border
- visually sharp reproduction of large and medium sized
pulmonary vessels
- visually sharp reproduction of segmental bronchi
- visually sharp reproduction of the lung parenchyma
- visually sharp reproduction of the border between the pleura
and the thoracic wall

anatomy covered - from the apex of the lungs to the inferior border of the liver
Benefits
• CT is fast, which is important for patients who have trouble holding their breath.
• CT scanning is painless, noninvasive and accurate.
• A major advantage of CT is its ability to image bone, soft tissue and blood vessels all at the same
time.
• Unlike conventional x‐rays, CT scanning provides very detailed images of many types of tissue as
well as the lungs, bones, and blood vessels.
• CT examinations are fast and simple; in emergency cases, they can reveal internal injuries and
bleeding quickly enough to help save lives.
• CT has been shown to be a cost‐effective imaging tool for a wide range of clinical problems.
• CT is less sensitive to patient movement than MRI.
• CT can be performed if you have an implanted medical device of any kind, unlike MRI.
• CT imaging provides real‐time imaging, making it a good tool for guiding minimally
• invasive procedures such as needle biopsies and needle aspirations of many areas of the body,
particularly the lungs, abdomen, pelvis and bones.
• A diagnosis determined by CT scanning may eliminate the need for exploratorysurgery and surgical
biopsy.
• No radiation remains in a patient's body after a CT examination.
Risks
• There is always a slight chance of cancer from excessive exposure to
radiation. However, the benefit of an accurate diagnosis far
outweighs the risk.
• The effective radiation dose for this procedure varies.
• Women should always inform their physician and x‐ray or CT
technologist if there is any possibility that they are pregnant.
• The risk of serious allergic reaction to contrast materials that
contain iodine is extremely rare, and radiology departments are
well‐equipped to deal with them.
• In some patients with reduced kidney function, the dye used in CT
scanning may worsen kidney function.
• Because children are more sensitive to radiation, they should have
a CT exam only if it is essential for making a diagnosis and should
not have repeated CT exams with lowdose technique.
Teknik Pemasukan Media Kontras
• Pemberian kontras sebanyak 60-80 ml , 300 – 370 mg/ml di
suntikan dengan flow rendah 1,5 -2,5 ml/dtk , untuk
memastikan didapatnya fase kontras saat scan berlangsung
pada daerah pembuluh darah thorax. Pemberian flushing
(NaCl) disarankan untuk mengurangi artifact dari perivena ,
selain itu disarankan pula untuk melakukan scanning dengan
arah caudo-cranial.
• Tingkat injeksi 2 ml per detik digunakan. Volume kontras yang
diperlukan untuk pemeriksaan toraks standar dapat bervariasi
75-100 ml , (300-370 mg iodin per ml) IV kontras.
Penentuan Dosis, Flow Rate dan Scan Delay
Berdasar Berat Badan
Flow
Berat Badan Dosis Scan Delay (s)
Rate

(kg) (cc) (cc/s) Thorax Th+Abd

> 118 160 3,3 55 42

98 - 117 140 3,1 53 40

78 - 97 120 2,8 51 38

64 - 77 100 2,6 49 36

48 - 63 80 2,4 46 34

38 - 47 70 2,2 46 34

*) 31 - 37 60 2 46 34

* for pediatrics : Dose= kg*2.0, Rate= kg*0.04 + 0.4

pitfalls
• Hal yang paling mendasar dari CT Scan thorax adalah
contrast timing. Sangat penting untuk mendapatkan
arterial enhancement ketika IV contrast digunakan.
• Artefact from a 'hyperdense' right brachiocephalic/
superior vena cava can cause problems when
imaging a thoracic dissection. The 'beam hardening'
artefact
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