Ct pulmonary angiogram


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  • Hi Mr Yasar, Thanks for the slides. Really informative. You should have masked the patient identifiable information on the scans. Sorry if this won't apply to your institute.
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Ct pulmonary angiogram

  1. 1. CT PULMONARY ANGIOGRAM<br />Mr. M. Kartheeswaran<br />Radiographer<br />SRMC Chennai<br />
  2. 2. INTRODUCTION<br />CTPA was introduced in the 1990s as an alternative to ventilation/perfusion scanning, which relies on radionuclide imaging of the blood vessels of the lung. It is regarded as a highly<br />sensitive and specific test for pulmonary embolism.<br />
  3. 3. ANGIOGRAPHY<br />Angiography is the visualization of blood vessel by injecting contrast media using invasive or non invasive technique.<br />
  4. 4. ANATOMY<br />The pulmonary arteries carry blood from the heart to the lungs. They are the only arteries that carry deoxygenated blood.<br />
  5. 5. ANATOMY<br /><ul><li> Pulmonary artery begins at the base of the right ventricle.
  6. 6. It is short and wide approximately 5 cm (2 inches) in length and 3 cm (1.2 inches) in diameter.
  7. 7. It then branches into two pulmonary arteries (left and right), which deliver de-oxygenated blood to the corresponding lung.</li></li></ul><li>
  8. 8. INDICATION<br /><ul><li> Pulmonary embolism
  9. 9. Aortic dissection
  10. 10. Aortic overloading
  11. 11. Left ventricular stress
  12. 12. Teratology of Fallot</li></li></ul><li>CONTRAINDICATION<br /><ul><li> Renal failure
  13. 13. Severe diabetes
  14. 14. Allergic to contrast reactions
  15. 15. Pregnant patients </li></li></ul><li>PREPERATION<br /><ul><li> Enquire about pregnancy from females.
  16. 16. Renal parameters are to be checked.
  17. 17. Nil oral preparation for 4-6 hours
  18. 18. Informed consent is to be got from patient
  19. 19. All metal objects are to be removed from the region of interest
  20. 20. Patient is changed into hospital’s cotton apron.
  21. 21. Enquire about allergic history
  22. 22. A prominent vein in patients upper limb is catheterised with 18-20 guagevenflon.</li></li></ul><li>CONTRAST DOSAGE<br /><ul><li> 1.2ml /kg (body weight) of non-ionic iodinated contrast medium is injected intravenously into the patient using a pressure injector.
  23. 23. Rate of injection being 4-5 ml /sec
  24. 24. Pressure 325 ppm</li></li></ul><li>PATIENT POSITIONING<br /><ul><li> Patient is positioned feet first with the help of laser localizers at the level of sternal notch with coronal beam at mid-axillary line
  25. 25. Proper immobilization should be done</li></li></ul><li>PATIENT POSITIONING<br /><ul><li>Proper breath hold instructions should be given
  26. 26. Ensure the patient connected IV lines, are long enough to allow full travel of the couch without being pulled or entangled while undergoing a CT</li></li></ul><li>PATIENT POSITIONING<br /><ul><li> Test dose of about 2 – 5 ml of contrast is injected and patient is observed for any reaction associated
  27. 27. Patency should be checked before starting the scan</li></li></ul><li>SCAN PARAMETERS<br />
  28. 28.
  29. 29. SMART PREP TECHNIQUE<br /><ul><li>It is a software, that allows real-time monitoring of IVContrast enhancement in the area ofinterest.</li></li></ul><li>
  30. 30.
  31. 31. SCANNING PROCEDURE<br />The caudal-cranial directionis used because most emboli are located in the lower lobes and,if the patient breathes during image acquisition, there is more coverage of the lower lobes compared with the upper lobes.<br />
  32. 32. POST PROCESSING<br />Volume rendering technique (VR)<br />Maximum Intensity Projection (MIP)<br />
  33. 33. Multi planar reconstruction (MPR)<br />
  34. 34.
  35. 35.
  36. 36.
  37. 37.
  38. 38.
  39. 39.
  41. 41. ADVANTAGES AND DISADVANTAGES<br /><ul><li> Less time consuming
  42. 42. Non-invasive nature
  43. 43. Almost all radiology departments have CT scan
  44. 44. Less complication than conventional (elevated pulmonary arterypressures)
  45. 45. Lesser volume of contrast needed
  46. 46. Simple post procedure care
  47. 47. Can be done in out patient basis</li></li></ul><li>CONCLUSION<br />Conventional pulmonary angiography has long been consideredthe gold standard in the diagnosis of Pulmonary pathologies and historically itis the technique against which all other modalities have beenmeasured. <br />This position has now been seriously challenged byhelical CT Pulmonary Angiography and now it is set to replace it as the newgold standard.<br />
  48. 48. THANK YOU…<br />