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CTScanoftheChest
WhatisCTScanningoftheChest? WhataresomecommonusesofCTScanningoftheChest? HowshouldIprepareformyCTScanoftheChest? HowdoestheCTScanoftheChestprocedurework? HowistheCTScanoftheChestperformed? WhatwillIexperienceduringmyCTScanoftheChest? Whatarethebenefitsvs.risksofCTScanningoftheChest? WhatarethelimitationsofCTScanningoftheChest?

WhatisCTScanningoftheChest? Computedtomography(alsoknownasCTorCATscanning)ofthechest usesspecialequipmenttoobtainmultiplecrosssectionalimagesofthe organsandtissuesofthechest.CTproducesimagesthatarefarmore detailedthanaconventionalchestxray.CTisespeciallyusefulbecauseit cansimultaneouslyshowmanydifferenttypesoftissue,includingthelungs, heart,bones,softtissues,muscleandbloodvessels.ModernCTscans utilizeamethodcalledspiral(orhelical)CTthatcapturesimagesofthe chestfrommanyanglesand,withtheaidofacomputer,processesthe imagestocreatecrosssectionalpicturesor"slices"oftheareaofinterest. Theimagescanthenbeprintedoutorexaminedonamonitor. CTscanningisconsideredtobea"patientfriendly"procedurebecauseit involvesrelativelylowradiationexposureandisnotinvasive.Contrast materialissometimesinjectedthroughaveintomakethebloodvesselsand softtissuemassesstandout.DuringtheCTexaminationpatientsusuallylie flatontheirback,butoccasionallytheymaybeaskedtolieontheirsideor ontheirstomach.Patientsareperiodicallyaskedtoholdtheirbreath.No preparationisrequiredpriortotheexam.Patientsgenerallydonotrequirea sedativetoremaincalm.

WhataresomecommonusesofCTScanningoftheChest? CTofthechestisusedtotakeacloserlookatfindingsdetectedon conventionalchestxraysormaybeusedtoinvestigateandtrytoexplain

clinicalsignsorsymptomsofdiseaseofthechest.TheCTexaminationmay providemorespecificinformationregardingthenatureandextentofthe findingsor,insomecases,determinethatthechestisnormal. CTmaybeusedtodetectandevaluatetheextentoftumorsthatariseinthe lungandmediastinum,ortumorsthathavespreadtherefromotherpartsof thebody.CTisroutinelyusedtoassesswhethertumorsarerespondingto treatment. Youmayhaveheardthat,inrecentyears,somepeoplehavechosento haveachestCTscantoscreenforlungcancer.Thismakesthemostsense forthosewhoareformerorcurrentcigarettesmokers,astheyareatmuch greaterriskofcancerthanarenonsmokers.Thebesthopeofcuringlung canceristofinditasearlyaspossible,makingiteasiertotreat.CTisableto detectevenverysmallabnormalitiesthatcouldbeearlylungcancer,which wouldnotbevisibleonaconventionalchestxray.AspeciallowdoseCT techniqueisusedforlungcancerscreening.CTofthechestisnotableto detecteverycancer.

CTofthelungs,windowlevelsettodemonstrate thevesselsandairways.

WhensomeonehasabnormalCTfindingsbutthecauseisuncertain,a percutaneousneedlebiopsymaybeneededtodirectlyexaminethetissue. CTcanbeusedtohelpguidethebiopsyneedletotheareainquestion. ChestCTalsocandemonstrateotherlungdisorders,suchasoldornew pneumonia,tuberculosis,emphysema,bronchiectasis,anddiffuseinterstitial lungdisease.Whentheclinicalfindingsandregularchestxrayare inconclusive,CTmayclarifythesituation.Inflammationorotherdiseasesof thepleura,themembranecoveringthelungs,canbeseeninCTimages. HighresolutionCT(HRCT)maybeusedforfurtherevaluation.Thisuses thinnersliceswithpossibleexpirationandproneviews.

ACTangiogram(CTA)maybeperformedtoevaluatethebloodvessels (arteriesandveins)inthechest.Thisinvolvesinjectingtheiodineintoavein alittlefaster,andalso,morenumerousandthinnerslicesareobtained throughthechestinordertoseethearteriestobetteradvantage.Seethe CTAngiography(CTA)pageformoreinformation.

HowshouldIprepareformyCTScanoftheChest? Youshoulddresscomfortablybutavoidanyclothinginthechestareathat hasazipper,snapsorjewelry,sincemetalobjectsmayaffecttheCT images.Womenshouldalwaysinformtheirphysicianorthexray technologistifthereisanypossibilitythattheyarepregnant.

HowdoestheCTScanoftheChestprocedurework? Xraysemittedfromarotatingxraytubepassthroughthepatient'sbody. Differenttissuesabsorbthisradiationindifferentamounts.Radiationleaving thebodyisrecordedbyanarrayofdetectorsthataremountedonthe gantry,alongwiththexraytube.Duringeachrotation,about1,000images arerecordedwiththexraybeam.Theseimagesarethenreconstructedbya computerintoaverydetailedtwodimensionalviewoftheinteriorofthe body.Asthexraysourcerotatesand,atthesametime,thepatientlyingon theexaminationtableadvancesthroughthescannerataconstantrate,the xraybeamfollowsaspiralpathhence,theterm"spiral"CTscanning. ThemostrecentspiralCTunitsproducehigherqualityimagesinashorter time.Thisisanespeciallyimportantfeatureforchildrenandforpatientswho areelderlyorcriticallyill,aswellasthosewhocannotholdtheirbreathfora longtime.Modernscannersareabletoimagelargeregionsofthebody, suchasthelungs,duringasinglebreathholdofabout20secondsorless.If asuspiciousnoduleisfound,additionalscansmaybedonetoobtaingreater detail.ItnowispossibletocombinemultipleCTimagestoproduceathree dimensionaldisplaythatprovidesadditionalinformation.

HowistheCTScanoftheChestperformed? Thefirststepisforthetechnologisttomakecertainthatyouarecorrectly positionedontheCTtable.Pillowsmaybeusedtohelpmaintainthecorrect positionduringtheexamination.Fortheinitialscans,thetablewillmove rapidlythroughthescannertodeterminethecorrectstartingposition.The restofthescansaremadeasthetablemovesmoreslowlythroughthe

cavityinthescanner.ThebestchestCTscansareobtainedwhenyouare abletoholdyourbreath.Ifthisisnotpossible,youwillbeaskedtobreathe quietlyandregularly. Undercertaincircumstances,aswhenevaluatingbloodvessels,youwill havecontrastmaterialinjectedintoaveinshortlybeforescanningbegins.If thisisnecessary,youwillbeaskedwhetheryouhaveanyallergiesto medicationsoriodine(whichisapartofmanycontrastmaterials)and whetheryouhaveahistoryofasthma,diabetes,aheartdisorder,multiple myelomaorkidneydisease.Theseconditionsmayindicateagreaterriskof anadversereactiontocontrastmaterial.Kidneydiseasemakesitharderto eliminatecontrastmaterialfromthebloodstream. AftertheCTexaminationiscompleted,youmayhavetowaitashorttime whiletheradiologistchecksthescanstomakesurethequalityisgood enoughtobecorrectlyinterpreted.Ifnecessary,afewadditionalscanswill beobtained.

CTofthechest

WhatwillIexperienceduringmyCTScanoftheChest? CTscanningisapainfreeprocedure.Ifcontrastmaterialisinjected,you mayfeelaflushofheatorametallictasteinyourmouth,usuallylastingno morethanaminuteortwo.Youalsomaynoticemilditching.Ifthispersists orhivesdevelop,effectivemedicationisavailable.Veryrarelyapatient becomesshortofbreathorhasswellinginthethroatoranotherpartofthe body,indicatingamoreseriousreactiontocontrastmaterialthatmustbe promptlytreated.Ifyouexperienceanyofthesesymptoms,informthe technologistimmediately. Youwillbealoneduringthescan,butthetechnologistcanseeandhearyou andcanspeaktoyouatanytimefromtheadjacentcontrolroom.The

examinationusuallytakes15to30minutes,includingpreparationtime.The actualscantimeislessthan30seconds.

Whatarethebenefitsvs.risksofCTScanningoftheChest? Benefits Unlikeconventionalxrays,CTscanningprovidesverydetailed imagesofawiderangeofbodyorgansandtissues. CTisfast.Thisisespeciallyimportantforpatientswithchest injury,becauseinternaldamageorbleedingcanbediagnosedin timetogivelifesavingtreatment. ThereisnopainfromCT.Apartfromanintravenousinjectionif needed,theprocedureisnoninvasive. CTcanshowlungtumorswhentheyaresmallerinsizethanwill bevisiblewithconventionalxraysandareeasiertotreat. Becauseitshowsbothnormalandabnormaltissues,CTscanning isaconvenientwayofguidingneedlebiopsies. CTcanhelpinplanningradiotherapy. ACTdiagnosismayeliminatetheneedforexploratorysurgery.

Risks ChestCTrequiresexposuretoradiation,buttheriskisconsidered solowthatitisfaroutweighedbythebenefitofmakingan accuratediagnosis.Radiologistsusethesmallestradiationdose thatwillprovideaccurateresults.Theeffectiveradiationdosefrom thisprocedureisabout8mSv,whichisaboutthesameasan averagepersonreceivesfrombackgroundradiationin3years. SeetheSafetypageformoreinformationaboutradiationdose. Specialcareistakenduringxrayexaminationstoensure maximumsafetyforthepatientbyshieldingtheabdomenand pelviswithaleadapron,withtheexceptionofthoseexaminations inwhichtheabdomenandpelvisarebeingimaged.Women shouldalwaysinformtheirdoctororxraytechnologistifthereis anypossibilitythattheyarepregnant.

Ifyouareanursingmotherandreceivedcontrastmaterialforyour CTexam,youshouldwait24hoursbeforeresumingbreast feedingtoallowyourbodytimetoeliminatethematerial. Thereisaverysmallbutrealriskofhavingaseriousallergic reactiontocontrastmaterialthatcontainsiodine,butCTstaffwill beabletodealwithit.

WhatarethelimitationsofCTScanningoftheChest? MotioncanlessenthequalityofaCTstudy. CTscanningisgenerallynotrecommendedforpregnantwomen. Magneticresonanceimaging(MRI)maybebetterthanCTfor showingveryfinesofttissuedetail.