CT SCAN

ABDOMEN
 Kompetensi Dasar

 Mahasiswa mampu melakukan scanning dasar CT

Abdomen tanpa menggunakan media kontras
PENGERTIAN

 Teknik pemeriksaan CT Scan

abdomen adalah teknik
pemeriksaan secara radiologi untuk
mendapatkan informasi anatomis
irisan atau penampang melintang
dari abdomen
Umum
 - ascites
- post surgical collections
- Crohn's disease
- appendicitis
- bowel obstruction
pathologies/ - diverticulitis
indications - hernias
- ischaemic bowel
- haemorrhage
- neoplasm
- abscess
- aneurysm
 Plain Radiography

• Abdomen AP
• Abdomen Lateral
• LLD
 Review Anatomi

KETERANGAN :

1. Liver
2. Gall bladder
3. Large
intestine
1 4. Small
6
intestine
2 5. Vermiformic
7 appendix
3
6. Stomach
4 7. Spleen
8. Urinary
5 8 bladder
Anatomi Crossectional
1. Liver 13. Splenic vein 25. Spinslis muscle
2. Caudate lobe 14. Pancreas 26. Vert. canal
3. IVC 15. Jejenum 27. Abd. Aorta
4. Hepatic venaporta 16. Transverse colon 28. Herniazygos vein
5. Rectus abdominis 17. Descenden colon 29. Longissmus
muscle 18. Left colic 30. Suprarenal arteri
6. Round ligament 19. Ekt.oblik muscle 31. Left suprarenal
7. Lobus kiri liver 20. Diafragma gland
8. Duodenum 21. Azygos 32. Left kidney
(descenden) 22. IIliocostalis muscle 33. Left lung
9. Linea alba 23. Thoracic duct 34. Latissimus dorsi
10.SMA 24. Thoracit vert muscular
11.Celiak trunk 35. Spleen
12.Stomach
Persiapan
PERSIAPAN PEMERIKSAAN

•PERSIAPAN ALAT
Alat steril : alat-alat suntik, spuit, media
kontras, kasa dan kapas serta
alkohol
Alat non steril : Pesawat CT Scan, injektor, Baju
dan selimut pasien, tabung
oksigen, head holder, body clamp
 Oral Contrast
 Barium suspensi (1% - 2%)
misalnya EZ-CAT
 Campuran Air dan Kontras
Yodium (2% - 4%) (water
soluble agent) mis.
Gastrografin, atau urografin
yang dicampur dengan air
mineral.
 (Air 600 ml - kontras 24 ml,
atau Air 1000 ml - contrast 30
ml = untuk mendapatkan 3%)
 Untuk mengurangi rasa tidak
enak, dapat dicampur dengan
sirup,madu atau gula.
 Air minum saja sebagai
kontras negative
 PEMBERIAN MEDIA KONTRAS
TEKNIK ORAL KONTRAS

Pemeriksaan CT Abdomen Atas :

Minimum 600 ml s/d 750 ml kontras dibagi 3 bagian/gelas (@ 200-250 ml)
- Gelas Pertama : diminum 30 menit sebelum pemeriksaan
- Gelas kedua : diminum 15 menit sebelum pemeriksaan
-- Gelas ketiga : diminum 5 menit sebelum pemeriksaan

Pemeriksaan CT Abdomen-Pelvis
Minimum 800 ml s/d 1000 ml kontras dibagi 4 bagian/gelas (@ 200-250 ml)
- Gelas Pertama : diminum 1 jam sebelum pemeriksaan
- Gelas kedua s/d gelas ke 4 : diminum tiap 15 menit sesudahnya.
- Setelah gelas ke empat (terakhir) 5 menit kemudian pemeriksaan CT dapat
dilakukan
 Teknik Oral Contrast

• Adapun jika pemeriksaan CT Abdomen untuk

melihat adanya batu (Lithiasis) pada
Gallblader/kantung empedu (cholelithiasis),
urolithiasis, atau pun nephrolithiasis, biasanya
cukup digunakan Air saja sebagai kontras
negatif.
• Hal ini untuk menghindari tertutupnya
(superposisi) gambaran batu jika kita
menggunakan kontras positif (Barium atau Water
Soluble)
Intravenous Contrast
 POSISI PASIEN

FEET FIRST OR HEAD FIRST

SPONGE
 TEKNIK PEMERIKSAAN

• Posisi Obyek
 Mengatur pasien sehingga Mid Sagital Plane (MSP)
sejajar dengan lampu indikator longitudinal dan
MCP tubuh sejajar dengan lampu indikator
horisontal.
 Lengan pasien harus berada diatas kepala
 Untuk meminimalisir artefak dari gerakan bisa
digunakan bantalan dan straps
 Memfiksasi lutut dengan menggunakan sponge
 Menjelaskan kepada pasien untuk inspirasi penuh
dan tahan nafas pada saat pemeriksaan
berlangsung.
 Ketinggian meja diatur pada pertengahan tubuh
atau mid axillary line
 Scanogram

• Gambaran yang pertama kali dibuat adalah scout

potongan coronal.
• Dengan tujuan untuk mengetahui apakah MSP
pasien tepat atau tidak ditengah meja
pemeriksaan. Kemudian dibuat irisan mulai dari
diafragma sampai rektum.
• Gunakan FOV yang luas agar mencakup
keseluruhan abdomen.
• Tak ada penyudutan dari gantry karena irisan
axial dibuat harus tegak lurus dengan MSP
pasien
 Scanogram

start of range 1

AXIAL STANDARD
ABDOMEN

start of range 2
end of range 1

AXIAL STANDARD
ABDOMEN end of range 2
Range 1
Range 2
 Windowing

Window Width Centre

Soft Tissue range 1 & 2 300-500 30-60

Soft Tissue Liver

150-250 0-80
Parenchyma range 1

Soft Tissue Lung

800-1800 -300--700
Parenchyma range 1
 Scan Parameter

Slice Table IV
Rotation
Acquisition Thick Move mAs kV algorithm contr
Time
ness ment ast

range 1
soft tissue
Axial Spiral ~200- 0.75-1.0
8-10 mm 10-15 mm 120 adult OK
pitch = 250 second
body
1.5

range 2
soft tissue
Axial Spiral ~180- 0.75-1.0
8-10 mm 10-15 mm 140 adult OK
pitch = 220 second
body
1.5
No Parameter Nilai / Ukuran
1. Scanogram Abdomen AP (coronal view)
Diatur agar MSP pasien berada pada long axis

2. Range Range I : diafragma sampai kirsta iliaca

Range II: Krista iliaca sampai simphisis pubis

3. Slice thickness 5-10 mm

4. FOV Diatur sampai batas lateral kanan dan kiri
abdomen
5. Gantry tilt 0 derajat
6. Kv 120
7. MAs 150
8. Rekonstruksi algorithma Smooth
9. Window Width 150-250 (soft tissue)
800-1800 (Lung)

10. Window Level 0-80 HU (soft tissue)

-300- -700 HU (lung)
 Quality criteria for standard thoracic examinations
(European guidelines on quality criteria for computed tomography)

- diaphragm
- entire liver and spleen
- retroperitoneal parenchymal organs (pancreas
kidneys)
- abdominal aorta and the proximal part of the
common iliac
visualisation arteries
imaging criteria - abdominal wall including all herniations
- entire iliac bones
- entire ischial bones
- entire pubic symphysis
- entire urinary bladder
- all peripelvic muscles
- vessels after the intravenous contrast media
 - visually sharp reproduction of the liver parenchyma and
intrahepatic vessels
- visually sharp reproduction of the splenic parenchyma
- visually sharp reproduction of the intestine
- visually sharp reproduction of the perivascular retroperitoneal
space
- visually sharp reproduction of the pancreatic contours
- visually sharp reproduction of the duodenum
- visually sharp reproduction of the kidneys and proximal ureters
- visually sharp reproduction of the aorta
- visually sharp reproduction of the aortic bifurcation and
common iliac arteries
image reproduction
- reproduction of lymph nodes smaller than 15 mm in diameter
criteria
- reproduction of branches of the abdominal aorta
- visually sharp reproduction of the vena cava
- reproduction of tributaries to the vena cava in particular the
renal veins
- visually sharp reproduction of the bladder wall
- visually sharp reproduction of the rectum
- visually sharp reproduction of the uterus
- visually sharp reproduction of the parametrical tissues or
seminal vesicles
- visually sharp reproduction of the prostate
- visually sharp differentiation of the perirectal space
- reproduction of the distal portion of the ureters
anatomy covered - from just above diaphragm to inferior border of the pubic ramus
gantry scan plane - axial no gantry tilt
 APLIKASI CT ABDOMEN

3/14/22 30
 ABDOMEN STANDARD

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: Spiral

I.V. CONTRAST: 1.5-2 ml/sec, 100-150 ML

SCAN DELAY: 75-80 sec

ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN,

200 ML JUST BEFORE SCAN

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 8-10 MM

START LOCATION: LUNG BASES

ROUTINE
END LOCATION: ILIAC CREST

FILMING: STANDARD, LUNGS, LIVER + BONE FOR

TRAUMA & CANCER
 ABDOMEN-KIDNEY STONE

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: Spiral

NO ORAL CONTRAST
NO IV CONTRAST

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 5MM

START LOCATION: ABOVE KIDNEYS

END LOCATION: S. PUBIS

FILMING: STANDARD
 ABDOMEN LIVER MASS-3 PHASE

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: SPIRAL

I.V. CONTRAST: 4-5 ml/sec, 100-150 ML

SCAN DELAY: 1. NON-CONTRAST, 2. ARTERIAL 30 SEC.

3. PORTAL 70 SEC.

ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN,

200 ML JUST BEFORE SCAN

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 4-5 MM

START LOCATION: LUNG BASES

END LOCATION: ILIAC CREST

FILMING: STANDARD + LIVER

 LIVER SINGLE PHASE

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: Spiral

I.V. CONTRAST: 1.5-2 ml/sec, 100-150 ML

SCAN DELAY: 45 SEC

ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN,
200 ML JUST BEFORE SCAN

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 8-10 MM

START LOCATION: LUNG BASES

END LOCATION: ILIAC CREST

FILMING: STANDARD + LIVER + BONE FOR

TRAUMA & CANCER
 ABDOMEN- PANCREAS

SCOUT: AP

LANDMARK: XIPHOID TIP

SCANNING MODE: SPIRAL

I.V. CONTRAST: 2-4 ml/sec, 100-150 ML

SCAN DELAY: 30-35 sec

ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN,

200 ml 15 MINUTES BEFORE SCAN

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 3-5 MM THROUGH

PANCREAS

START LOCATION: LUNG BASES

END LOCATION: ILIAC CREST

FILMING: STANDARD + LIVER + BONE FOR

TRAUMA & CANCER
 ABDOMEN- KIDNEYS

SCOUT: AP

LANDMARK: XIPHOID TIP

SCANNING MODE: SPIRAL

I.V. CONTRAST: 2-4 ml/sec

SCAN DELAY:1. NONCONTRAST: 2. ARTERIAL 30 SEC.

3. NEPHROGRAM 90 SEC.:
4. PYELOGRAM 3-5 MIN.

ORAL CONTRAST: 400 ml 45 MINUTES BEFORE SCAN,

200 ml JUST BEFORE SCAN

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 8-10 MM , 5 MM THROUGH

KIDNEYS

START LOCATION: LUNG BASES

END LOCATION: ILIAC CREST

FILMING: STANDARD
 CTA OF THE ABDOMEN

SCOUT: AP

LANDMARK: XIPHOID TIP

SCAN MODE: Spiral

I.V. CONTRAST: 4-5 ml/sec, 100-150 ML

SCAN DELAY: 25 sec

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 3 MM

START LOCATION: ABOVE AORTIC ARCH

END LOCATION: BELOW ILIAC CREST

FILMING: STANDARD + 3D + MPR

 ABDOMEN + PELVIS
APPENDICITIS OR DIVERTICULITIS
SCOUT: AP
SCOUT: AP

LANDMARK: XIPHOID XIPHOID

LANDMARK: TIP TIP

8 MM SCAN MODE:
SCANSpiral
MODE: Spiral

I.V. CONTRAST: 1.5-2 ml/sec,

I.V. CONTRAST: 1.5-2100-150
ml/sec,ML
100-150 ML

SCAN DELAY:
SCAN75-80 sec
DELAY: 75-80 sec

ORAL CONTRAST: 500 cc 60-120

ORAL CONTRAST: 400 mlMINUTES BEFORE
45 MINUTES SCAN,
BEFORE SCAN,
5 MM 200 ML JUST BEFORE SCAN
200 ML JUST BEFORE SCAN

BREATH BREATH
HOLD: SUSPENDED EXPIRATION
HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 8 MM + 3-5MM

SLICE THICKNESS: LOWER
8-10 MM UPPER + 5 MM LOWER

START LOCATION: LUNG BASES

START LOCATION: LUNG BASES

END LOCATION: S.PUBIS S. PUBIS

END LOCATION:

FILMING:FILMING:
STANDARDSTANDARD
CTA ABDOMEN
 PELVIS

SCOUT: AP

LANDMARK: ILIAC CREST

SLICE PLANE: AXIAL OR SPIRAL

I.V. CONTRAST: 1.5-2 ml/sec, 100-120 ml

SCAN DELAY: 120-180 sec (FULL BLADDER)

ORAL CONTRAST: 300-500 ml 1-2 HOURS BEFORE SCAN

500 cc NIGHT BEFORE

BREATH HOLD: SUSPENDED EXPIRATION

SLICE THICKNESS: 8-10 MM,

3-5 MM IF AP OR DIVERTICULITIS

START LOCATION: ILIAC CREST

END LOCATION: SYMPHYSIS PUBIS

FILMING: STANDARD