Computed Tomography

CT combines the use of a digital computer with a rotating x-ray device to create detailed cross-sectional images (also known as slices or sections) of different organs and body parts such as the lungs, liver, kidneys, pancreas, pelvis, extremities, brain, spine, and blood vessels. A CT scan produces sequential views of the body that is analogous to slices of bread.

The x-ray tube and detectors are constantly rotating around the body; for every 360° rotation, one cross-sectional image is created. During the examination, hundreds of images are obtained, and the computer later combines these to make the final image. Each original image represents an area of the body that is only a few millimeters wide.

The computer then analyzes the information on the basis of the differences in tissue density, and it produces a reconstructed image of a thin cross-section, or slice, of the body.

On CT scans, bone appears white, gases and most liquids appear black, and other tissue can have varying shades of gray depending on its density.

If a contrast material (a special x-ray dye) is being used or if the use of sedatives is anticipated, you may need to fast for 4-6 hours before the procedure.

In general, you may take prescription medications with a small amount of water. However, you should check with the radiologist first.

You may be asked to sign a consent form.

All jewelry, dentures, glasses, and metal objects that may interfere with the examination must be removed before you enter the CT unit.

Women are asked if they are pregnant. If you are or believe that you might be pregnant, you should tell the technologist before the examination.

You should tell the physician or technologist if you have had any of the following: asthma, life-threatening event in the past, or any allergies to medicines, especially iodinated contrast material.

You should check with your healthcare provider, hospital radiology department, or radiologist prior to the day of the examination to see if any other preparation is needed.

X-rays are painless. The primary discomfort may be caused by the need to lie still on the table. During the test, it is very important for you to remain still because motion can result in blurring images. If you are restless or anxious, sedatives may be given.

If the doctor orders an examination with contrast, you may experience some discomfort when the intravenous line is inserted. The contrast agent may be given orally, intravenously, or both. For instance, if better contrast between different tissues or organs is needed, the dye is administered as an injection into a vein. An oral contrast agent may be required for CT examinations of the abdomen and pelvis. The contrast material allows the radiologist to more clearly see a certain area or structure of the body.

The moveable table raises and lowers you and moves you in and out of the scanner. You are gently secured on the table with a loose strap. The table advances slightly (by 1/4 to 1/2 inch) between each scanning session to properly align your body for the next image. The portion of your body that is being studied is moved into the gantry, and this is the only part of your body that is exposed to the x-ray beam. A technologist specially trained in the use of CT equipment performs the examination by operating a computer in an adjoining room. The technologist will tell you when to hold your breath and when to breathe normally. A sound system is built into the machine to allow the technologist to communicate with you during the test. You are also able to communicate with the technologist during the examination if needed. However, it is important for you not to move during the examination.

With brain CT, your head is placed in a holder with a loose strap across the forehead to gently secure the position of the head.

Following review of your symptoms and examination, a physician may order a CT scan in the following situations:

• +Acute traumatic injury
• +Acute stroke
• +Suspected hemorrhage in the brain
• +Headache
• +Abnormal development of the head or neck

CT imaging of the head can be use to detect brain tumors, blood clots and blood vessel defects, enlarged ventricles (caused by a build up of cerebrospinal fluid), and image other abnormalities such as those of the nerves or muscles of the eye.

CT is the method of choice for imaging patients with acute trauma. CT examinations are fast and simple, and they provide the physician with a quick overview of possibly life-threatening pathology. CT also helps the treatment team to rapidly determine if surgery is needed.

With the advent of spiral (or helical) CT, the continuous acquisition of complete CT volumes can be used for the diagnosis of blood vessels. Techniques for this include CT angiography (CTA). For instance, the carotid arteries and the intracranial vasculature can be imaged with CTA by using only an intravenous injection of contrast material and not a more invasive catheter, as in previous techniques.

During pregnancy, abdominal CT scanning is usually not recommended unless the patient has an emergency situation, because the radiation exposure may pose a risk to the developing fetus.

The true incidence of adverse effects after the administration of intravascular contrast material is not known precisely; however, most adverse effects are mild to moderate (eg, hives, headache, warm sensations). Adverse effects range from hives to more severe allergic reactions. The latter may be of increased incidence in patients with food allergies, asthma, or other allergic conditions. You should alert the technologist of any past allergic reactions before the examination.The injection may cause a cool or warm sensation, as well as a metallic taste in the mouth that lasts for a few seconds. These effects usually do not require treatment, and they occur in only 5-12% of all patients receiving ionic, high-osmolality contrast media. Serious reactions are rare and occur in only 0.1-0.2% of patients receiving high-osmolality contrast media and in only 0.016% of those receiving low-osmolality contrast media. These effects occur in the first few minutes after the contrast is given, and you should immediately report any unusual sensation or discomfort to the technologist and/or physician.

When a contrast medium is given, the contrast is eliminated through the kidneys into the urine.