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Teknik Pemeriksaan CT

Scan
Cervical dan Thoracal

ANATOMI

CT Cervical
What Is a Cervical Spine CT Scan?
A cervical spine CT (computed tomography) scan
is a medical procedure that combines specialized
X-ray equipment with computer imaging to
create a visual model of your cervical spine.
Your doctor may order this test if you have been
in a recent accident or are suffering from neck
pain. The exam can help more accurately
diagnose potential injuries to that area of your
spinal column.

CT scanning is used to investigate


the spine and neck for a number of
different pathologies. The neck is
primarily imaged for soft tissue
structure definition while the spine
needs high resolution bone and soft
tissue images. When imaging the
spine, bone detail is important as
well as adequately demonstrating
the intervertebral discs.

INDIKASI
Evaluation of herniated disk or
trauma
Evaluation of degenative disk
disesase
Detection of neoplasm or infection
Evaluation of spinal infection
Evaluation of spinal stenosis

Hingga 20% dari patah tulang yang tidak


terjawab pada radiografi konvensional. CT
dapat membantu.
CT scan tidak wajib untuk setiap pasien
dengan cedera leher. Kebanyakan cedera
dapat didiagnosis dengan film biasa. Namun,
jika tidak terlihat pada radiograf, CT dari
tulang belakang leher harus dilakukan.
CT scan sangat berguna dalam fraktur yang
mengakibatkan defisit neurologis dan fraktur
elemen posterior kanalis serviks (misalnya
fraktur Jefferson/ Bursting fracture of atlas).

Keuntungan dari CT adalah:


1. CT sangat baik untuk karakterisasi fraktur
dan mengidentifikasi kompromi tulang dari
kanal tulang belakang karena tidak adanya
superimposisi dari pandangan melintang.
Resolusi kontras yang lebih tinggi dari CT
juga memberikan peningkatan visualisasi
patah tulang halus.
2. CT memberikan kenyamanan pasien
dengan mampu merekonstruksi gambar di
aksial, sagital, coronal, dan pesawat miring
dari satu posisi pasien.

Keterbatasan CT adalah:
1. sulit untuk mengidentifikasi patah
tulang berorientasi pada bidang
aksial (misalnya patah tulang dens).
2. tidak dapat menampilkan cedera
ligamen.
3. biaya yang relatif tinggi.

Ketika melakukan pemeriksaan


jaringan lunak leher adalah penting
bahwa pasien menahan napas dan
tidak menelan selama pemeriksaan.
Menelan menyebabkan jaringan
kabur dan dapat meniru patologi
seperti abses.
Jika menggunakan head-dudukan
untuk pemeriksaan leher pastikan
bahwa tidak memiliki logam yang
bisa menimbulkan artefak.

Using an AP and lateral 'scout' is a


good idea. This can help you ensure
that you localise the correct
vertebrae

Patient positioning

Axial
lateral topogram/
scout
(to include entire
neck)

Axial
AP and lateral
topogram/
scout
(to include vertebrae
under
investigation)

axial cervical spine


axial neck

- use head holder


- patient positioned supine, head first
- chin angled down slightly
- arms by patients side or across chest
- use Velcro straps and immobilisation
pads to help the patient keep his/her
head still
- if the patient is likely to jump off table
use thick Velcro straps and strap the
patient down to the table
- get patient to relax shoulders to
decrease artefact
- ensure that patient is comfortable

axial lumbar spine


axial thoracic spine

- use black carbon fibre head holder


(for feet) with pillow placed on it
patient positioned supine, feet first.
- arms raised above patients head
- if patient likely to jump off table use
thick Velcro strap and strap the patient
to the table
- ensure that patient is comfortable

Positioning for cervical spine


examinations

NECK IMAGING
- carcinoma
pathologie - abscess
s
- fracture

- retrosternal thyroid
extension
- difficulty in
indications
swallowing
- hoarse voice
- lymphadenopathy
- trauma

AXIAL NECK
start of range 1

end of range 1

Technic
Standard neck imaging consists of a spiral
range that extends from the base of the
skull/hard palate until the thoracic inlet. If
the pathology investigation revolves
around the thyroid, you must check
whether IV contrast is needed.
IV contrast flow rate and volume is 75-100
ml at 2 ml per second.

Continued
Thinly collimated scans made be needed if
the tumour under investigation involves
the vocal cords. These fine slices help
determine exactly where the tumour lies
and what anatomy it encompasses.
Contrast monitoring software is useful in
evaluating the neck. Scan acquisition can
be triggered when there is carotid artery
opacification.
WW:250-500, WC:30-60

Scanogram -trauma
TRAUMA CERVICAL
SPINE
pathologies

- disc and joint


degeneration
- fracture
- spinal canal stenosis
- disc herniation
- tumours
- cysts

indications

- trauma
- paresthesia
- sciatica
- back/neck pain

start of range 1

end of range 1

TECHNIC
Cervical spine trauma protocol is used to evaluate
the stability of a patient's neck in a post trauma
situation. Thinly collimated scans are used to
minimise the risk of missing small fractures.
In the acute stage of investigation the entire
cervical spine should be imaged from the base of
the skull to the end of the first thoracic vertebrae.
If only specific areas are imaged, post-traumatic
fractures can and will be missed.
Speed of examination is important if the patient is
severely ill or uncooperative.

CONTINUED
After the examination is completed
sagittal MPR images must be
produced.
These sagittal images are important
in demonstrating compression
fractures of the vertebrae.
These are very useful, especially in
very large patients where axial scans
can be of poor quality.

Scan Parameters
visualisation imaging
criteria

- the entire area of the suspected pathology


- vessels after intravenous contrast media

image reproduction
criteria

- visually sharp reproduction of the cortical and trabecular bone


- visually sharp reproduction of the intervertebral joints
- visually sharp reproduction of the intervertebral disk profiles
- visually sharp reproduction of the intervertebral radicular canals
- reproduction of the thecal sac
- visually sharp reproduction of the spinal cord (CT myelography)
- visually sharp reproduction of the paravertebral muscles
- reproduction of the main vessels and perithecal venous plexuses
after intravenous contrast media

anatomy covered

- base of skull to the inferior portion of the first thoracic vertebrae


- or pedicle above to pedicle below area of investigation

gantry scan plane

- axial no gantry tilt for trauma studies - axially through the vertebrae and
disks for disk study examination

Scan parameter-trauma
Acquisitio
n

range 1
Axial
Spiral
pitch =
1.5

Slice
Thi
ckn
ess

2 mm

Table
Mov
eme
nt

3 mm

mAs

~100-150

kV

algorith
m

Rotatio
n
Tim
e

IV
cont
rast

140

bone +
soft
tissu
e
adul
t
head

0.75-1.5
seco
nd

CERVICAL DISC
Cervical disc scans are performed infrequently
these days as the majority of cervical pathology is
investigated by MRI. These scans are usually
performed because of patient MRI
contraindications or unavailability.
Sequence scans are obtained through the body of
each cervical vertebrae.
The discs that are scanned are usually from the
base of the skull to the C3-C4 intervertebral disc.
It is very important that the patient does not
move. If the patient moves it usually means that
the topogram has to be repeated and scanning
recommenced.
A stack acquisition from the top of C4 is adequate
in demonstrating the rest of the cervical
vertebrae in a disc series examination.

CERVICAL SPINE
CERVICAL SPINE
DISC SERIES

CERVICAL SPINE
DISC SERIES

start of stack acquisition

end of stack acquisition

CERVICAL SPINE
DISC SERIES

Scan parameter-cervical
disc
Acquisition

Scan series
1&2
Axial
Sequence

range 3
Axial Spiral
pitch =
1.5

Slice
Thic
kne
ss

3 mm

2 mm

Table
Moveme
nt

3 mm

3 mm

mAs

~100-150

~100-150

IV
contra
st

kV

algorithm

Rotation
Time

140

bone + soft
tissue
adult
head

0.75-1.5
secon
d

140

bone + soft
tissue
adult
head

0.75-1.5
secon
d

windowing
Window

Width

Centre

Bone range 1 - 3

2000-3000

200-500

Soft Tissue range 1 3

150-450

30-50

Scan Parameters thoracic


spine
visualisation imaging
criteria

image reproduction
criteria

- the entire area of the suspected pathology


- vessels after intravenous contrast media

- visually sharp reproduction of the cortical and trabecular bone


- visually sharp reproduction of the intervertebral joints
- visually sharp reproduction of the intervertebral disk profiles
- visually sharp reproduction of the intervertebral radicular canals
- reproduction of the thecal sac
- visually sharp reproduction of the spinal cord (CT myelography)
- visually sharp reproduction of the paravertebral muscles

anatomy covered

-- or pedicle above to pedicle below area of investigation

gantry scan plane

- axial no gantry tilt

Thoracic Spine Spiral


Protocol
Acquisition

range 1
Axial Spiral
pitch =
1.5

Slice
Thi
ckn
ess

3 mm

Table
Move
ment

4.5 mm

mAs

~200-250

kV

algorithm

Rotation
Tim
e

140

bone +
soft
tissue
adult
body

0.75-1.5
seco
nd

IV
cont
rast

windowing
Window

Width

Centre

Bone range 1

2000-3000

200-500

Soft Tissue range 1

150-450

30-50