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Computed Tomography (CT)

What is CT Scanning?

Computed tomography (CT), sometimes called a CAT scan, uses special x-ray equipment to obtain many images from different angles and then join them together to show a cross-section of body tissues and organs called slices. CT can see inside the brain and other parts of the body, into areas that cannot be seen on regular x-rays. Just like a loaf of bread each slice would represent a picture inside the body.

What are the preps for CT Scanning

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible. Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, etc. Patients should bring a list of all medications.

We use two types of contrast for CT imaging: Oral and IV contrast.
For Abdominal and Pelvic scanning the patient must drink oral contrast (Readi-Cat) ½ bottle the night prior and the other ½ one hour prior to their scheduled appointment. Readi-Cat is available from NMMC outpatient Pharmacy at no charge to the patient or may be given to the patient by the physician (Readi-Cat can be obtained for your office by contacting the Radiology Customer Service Representative at 662-377-4771) If the patient can not obtain Readi-Cat, they must arrive 1 hour prior to their scheduled appointment to drink oral contrast. This contrast is used to enhance the visibility of the stomach and bowel. Patient should be on CLEAR LIQUIDS for 3 hours prior to exam. * If patient is scheduled for an Endoscopy exam on the same day, the patient must wait and drink oral contrast after the Endoscopy exam. If patient is scheduled for kidney stone protocol, CT Angio, or AAA stent follow-up they should not drink Readi-Cat.

The second type of contrast used for CT imaging is Intravenous Contrast (IV). The contrast in routinely injected via antecubital vein. Patient should be on CLEAR LIQUIDS for 3 hours prior to exam. The IV contrast is used to enhance the visibility of blood vessels and makes abnormalities easier to see. As with all medications, some patients are allergic to the IV contrast or dye. Newer forms of this contrast are safer and are used exclusively at NMMC, but on occasion, a patient will get a mild rash that may be treated with Benadryl. It is uncommon to have severe reaction, but life-threatening reactions do occur extremely rarely. For this reason we must know prior to IV contrast injection if the patient has a history of a know allergy to x-ray dye, iodine, or iodinated contrast. If the patient has a known allergy to IV contrast media (dye) they should be scheduled to arrive 1 hour early for pre-medication and must have someone to drive them home.
IV contrast can be harmful to kidneys that are not working normally from injury or other medical problems. If the patient is over the age of 50 and has renal disease, asthma, multiple myeloma, hypertension, or diabetes - particularly if he is taking Glucophage, Glucophage XR Metformin, Avandamet, Metaglip, Fortamet, Riomet, Actoplus Met, Glumetza, Janumet, Prandimet, Glucovance or Kombiglyze XR-he will need a recent Creatinine level prior to IV contrast injection (inpatients within 7 days and outpatients within 30 days) . We routinely require a Creatinine level on all patients over the age of 70 or anyone with renal disease. If lab work is not available from the office the patient should be scheduled to arrive 30 minutes prior to appointment. Stat Creatinine Please include I-Stat Creatinine on arrival on the referring physician orders. The referring Physician is responsible for your follow-up.
* Glucophage, Glucophage XR, Metformin, Avandamet, Actoplus Met, Metaglip, Fortamet, Riomet, Glumetza, Janumet, Prandimet, Glucovance or Kombiglyze XR.

Inpatient and ER patients:

Procedures can be performed by discontinuance of the following: Glucophage, Glucophage XR, Metformin, Avandamet, Actoplus Met, Metaglip, Fortamet, Riomet, Glumetza, Janumet, Prandimet, Glucovance and Kombiglyze XR at the time of the procedure but all patients must wait 48 hours and have a normal Creatinine prior to retaking the diabetic medications listed above. Note: Creatinine levels that have been performed within 7 days prior to test are adequate unless the patient’s medical condition is transitional and fragile which may result in changing values for this lab test.

Outpatients:

Outpatients for IV contrast procedures that are Diabetic and taking the following diabetic medications: Avandamet, Actoplus Met, Glucophage, Glucophage XR Glucovance, Metaglip, Metformin, Fortamet, Glumetza, Janumet, Prandimet, Riomet and Kombiglyze XR will be identified at the time scheduling so that the referring physician can manage the discontinuance and the ordering of Creatinine lab test at 48 hours post IV contrast procedure. The patient must have a normal Creatinine level prior to continuance of the medications listed above. Note: Creatinine test results that have been performed within 30 days are adequate unless the patients’ medical condition is transitional and fragile which may result in changing values for this test.

Note: Referring Physicians are responsible for follow-up Creatinine and the continuance of Glucophage, Glucophage XR Glucovance, Metformin, Avandamet, Metaglip, Fortamet, Actoplus Met, Glumetza, Janumet, Prandimet, Riomet and Kombiglyze XR.

How does the CT scanner work and what does it look like?

Unlike conventional x-rays, which produce pictures or shadows cast by bones or other body structures from a single beam of x-ray, CT scanning uses small x-ray beams from many different angles that are sent to a computer to produce multiple images called slices or tomograms. CT scanning may be performed in the hospital or at an outpatient radiology center, but in either case the patient must have a referring physician order. The CT scanner is a large square machine with a hole in center, similar to a doughnut. The patient lies still on a table that slides into and out from the center of the hole. Inside the square machine an x-ray tube moves around the patient to produce the tomogram images.

How is the exam performed?

Technologists will completed a patient history form and answer any questions. The patient will be given oral contrast for abdominal/pelvic exams. Patient will lie on the scanner table. For CT exams that require IV contrast a needle will be placed in the arm. As the exam proceeds, the table will move slowly into or out of the CT scanner. A CT examination typically takes from 15 minutes to half and hour.

The most common uses of CT scanning:

CT can assist in

  • Locating Skull Fractures and brain damage in patients with head injuries.
  • Detecting blood clot or bleeding within the brain
  • Determining the extent of bone and soft tissue damage in patients with facial trauma
  • Detecting some brain tumors
  • Cause of hearing or vertigo problems
  • Guidance for needle biopsy
  • Diagnosing disease of the neck, chest and lungs
  • Diagnosing disease of the liver, spleen, pancreas, stomach and kidneys
  • Diagnosing disease of the heart and lungs
  • Diagnosing disease of the bowel, colon and bladder
  • Utilized for all types of trauma to head, neck, chest, abdomen and pelvis
  • Limited joint and extremity imaging

Radiology Report Turnaround Process:

We have a departmental goal of 6 hours for Radiology Report Turnaround time. We measure the time from radiology request entry to the time the transcriptionist types the final report. The radiology report is also available via our Digital Dictation System, immediately after Radiologist completes dictation. The DVI system phone number is 377-3745. You must first enter your six (6) digit PIN number, your department number, and the patient’s medical record number to access the report.

What are the benefits VS risks


Benefits

  • Unlike other imaging methods, CT scanning offers a detailed view of many types of tissue, including brain, lung, abdominal, bones, and blood vessels.
  • Accuracy and speed help diagnose many causes of pain and discomfort, enabling faster treatment and often eliminating the need for additional, more invasive diagnostic procedures.
  • CT shows changes in bone better than any other imaging method
  • CT scanning is painless and noninvasive
  • CT is the choice for screening trauma patients to detect internal bleeding or other life threatening conditions
  • CT is cost-effective imaging tool for a wide range of clinical problems

Risks


CT does involve exposure to radiation in the form of x-ray, but the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose from CT imaging is about 2-10 MSV which is about the same as the average person receives from background radiation in 3 years. Nursing mothers should wait for 24 hours after contrast material injection before resuming breast feeding.

The risk of serious allergic reaction to iodine-containing contrast material is rare and radiology departments are well-equipped to deal with them.

New Procedures:

We currently have a GE Multislice 64 Detector, 4 GE Multislice 16 Detector scanners and 1 GE Multislice 16 Detector Bariatric Scanner (weight limit 500 lbs) in the CT section of Radiology at the Main Unit and Longtown Imaging.

The CT technology we have to today enable a non-invasive evaluation of the circulatory system from the Diaphragm to the feet within 30 seconds.

  • CT of coronary arteries (cardiac)
  • Cardiac Scoring which is a screening for hard plaque in the coronary arteries
  • CT Angiography of the Brain, Renal, Carotid arteries and Abd/Pelvis
  • Perfusion scans which help identify strokes so patients can receive Tissue Plasminogen Activator (TPA) a new drug treatment for strokes). TPA must be given within the first 3 hours of onset of symptoms
  • Colon Cancer Screening called CT Virtual Colonoscopy

Cardiac CT Protocol/Prep
Beta Blocker – (metoprolol)
Write script for four (4) 50 mg tablets
50 mg tablet twelve (12) hours before the exam
50 mg tablet on (1) hour prior to exam
Bring remaining doses when coming to exam as other doses may be required at this time

Patient Prep
NPO four (4) hours prior to exam-except for medications
No caffeine twelve (12) hours prior to exam
Drink sixteen (16) ounces of water one (1) hour prior to exam
Beta blockers (as listed above)
Discontinue any Metformin-containing medications (Glucophage, Glucophage XR, Glucovance, Metaglip, Avandamet, Fortamet, Riomet, Metformin, Actoplus Met, Janumet, Prandimet, Glumetza and Kombiglyze XR) for at least forty-eight (48) hours after exam
Creatinine clearance for all patients seventy (70) and older as well as patients who are fifty (50) and older with diabetes, hypertension and insufficient renal function
Patients must have someone to drive them after the exam

Contraindications
Reactive airway disease
Contrast allergy with failed premeds
Patients that is unable to take beta blockers due to heart blockage and breathing problems such as emphysema.
Patients must be off ED meds 72 hours prior to exam (CT Heart)
ED meds and Nitro for CT Heart cannot be given together
Patients must bring a list of all medication.

 

Radiology Procedure Guide CT:

Procedure Prep Estimated Time of Study

CT Head without and with IV contrast

CT Head with IV contrast

CT Facial bones without and with IV contrast

CT Facial bones with IV contrast

CT Guidance/stereotactic loc

CT IAC-inner ear

CT Orbits non trauma

CT Cervical spine with IV contrast

CT Cervical spine without and with IV contrast

CT Thoracic spine with IV contrast

CT Thoracic spine without and with IV contrast

CT Lumbar spine with IV contrast

CT Lumbar spine without and with IV contrast

CT Lower extremity with IV contrast-left

CT Lower extremity with IV contrast-right

CT Lower extremity with and without IV contrast-lt

CT Lower extremity with and without IV contrast-rt

CT Upper extremity with IV contrast-rt

CT Upper extremity with IV contrast-lt

CT Chest with IV contrast

CT Chest without and with IV contrast

CT Chest-PE

CT Neck soft tissue with IV contrast

CT Neck soft tissue without and with IV contrast

 

Diet: Clear liquids three (3) hours prior to exam.

Patient will have to sign a consent for IV contrast in the CT Department.

All patients 70 or older must have creatinine results less than 30 days old.

All patients 50 or older with a clinical history of renal disease, hypertension or diabetes must have creatinine results less than 30 days old.

Any patient with renal disease must have creatinine results less than 30 days old.

Patients with insulin pump must have pump removed before going to CT.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

Patients MUST bring a list of all medications.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

We must know prior to IV contrast injection if the
patient has a history of a
known allergy to x-ray
dye, iodine or iodinated
contrast. If the patient has
a known allergy to dye they should be scheduled
to arrive 1 hour early for
pre-medication and MUST
have someone to drive
them home.

Patients that are DIABETIC and TAKING the following diabetic medications:Avandamet, Actoplus Met, Glucophage, Glucophage XR, Glucovance, Metaglip, Metformin, Fortamet, Glumetza, Janumet, Prandimet, Riomet and Kombiglyze XR will be identified at the time scheduled so that the referring physician can manage the discontinuance and the ordering of Creatinine lab test 48 hours post IV contrast. The patient must have a normal creatinine level prior to continuance of the medications listed above.

If lab work is not available from the office the patient should be scheduled to arrive 30 minutes prior to appointment. I-STAT CREATININE on arrival should be on the physician’s order.

 

30 minutes
PROCEDURE (OP)

CT Head without IV contrast

CT Paranasal sinuses

CT Sinus (coronal view)

CT Temporal bone

CT Orbit-trauma

CT Facial bones without IV contrast

CT Sinus Survey

CT 3D reconstruction

CT Lower extremity without IV contrast

CT Upper extremity without IV contrast

CT Abdomen-stone protocol-(no oral-no IV contrast)

CT Chest without IV contrast

CT Neck without IV contrast

CT Cervical spine without IV contrast

CT Thoracic spine without IV contrast

CT Lumbar spine without IV contrast

PREP

Patients with insulin pump must have pump removed before going to CT.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

EST TIME OF EXAM

30 minutes

PROCEDURE (OP)

CT Abdomen with IV and oral contrast

CT Abdomen without and with IV and oral contrast

CT Pelvis with IV and oral contrast

CT Pelvis without and with IV and oral contrast

PREP

Pt must drink oral contrast (Redi-Cat) ½ bottle the night prior and the other ½ one hour prior to their scheduled appointment.

If the patient cannot obtain Redi-Cat, they must arrive 1 hour prior to their scheduled appointment to drink oral contrast.

The patient should be on clear liquids 3 hours prior to the exam.

We must know prior to IV contrast injection if the
patient has a history of a
known allergy to x-ray
dye, iodine or iodinated
contrast. If the patient has
a known allergy to dye they should be scheduled
to arrive 1 hour early for
pre-medication and MUST
have someone to drive
them home.

Patient will have to sign a consent for IV contrast in the CT Department.

All patients 70 or older must have creatinine results less than 30 days old.

All patients 50 or older with a clinical history of renal disease, hypertension or diabetes must have creatinine results less than 30 days old.

Any patient with renal disease must have creatinine results less than 30 days old.

Patients that are DIABETIC and TAKING the following diabetic medications:Avandamet, Actoplus Met, Glucophage, Glucophage XR, Glucovance, Metaglip, Metformin, Fortamet, Glumetza, Janumet, Prandimet, Riomet and Kombiglyze XR will be identified at the time scheduled so that the referring physician can manage the discontinuance and the ordering of Creatinine lab test 48 hours post IV contrast. The patient must have a normal creatinine level prior to continuance of the medications listed above.

Patients with insulin pump must have pump removed before going to CT.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

Patients MUST bring a list of all medications.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

If lab work is not available from the office the patient should be scheduled to arrive 30 minutes prior to appointment. I-STAT CREATININE on arrival should be on the physician’s order.

EST TIME OF EXAM

30 minutes

PROCEDURE (OP)

CT Abdomen without IV contrast–Oral contrast only

CT Pelvis without IV contrast-Oral contrast only

PREP

Pt must drink oral contrast (Redi-Cat) ½ bottle the night prior and the other ½ one hour prior to their scheduled appointment.

If the patient cannot obtain Redi-Cat, they must arrive 1 hour prior to their scheduled appointment to drink oral contrast.

Patients with insulin pump must have pump removed before going to CT.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

EST TIME OF EXAM

30 min

PROCEDURE (OP)

CT Pelvis-ortho-no IV contrast, no oral contrast

PREP

Patients with insulin pump must have pump removed before going to CT.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

 

 

 

EST TIME OF EXAM

30 min

PROCEDURE (OP)

CT Colonography DX–Virtual Colonography

PREP

Call radiology CT at 4073 for prep information

EST TIME OF EXAM

1 hour

PROCEDURE (OP)

CT Ang-Abdomen without and with IV contrast

CT Ang-Aorto/Ilio/Fem Runoff

CT Ang-Chest without and with IV contrast (THIS IS NOT THE CT CORONARY/HEART PROTOCOL/ORDER)

CT Ang-Head without and with IV contrast

CT Ang-Neck without and with IV contrast

CT Ang-Pelvis without and with IV contrast

CT Angio Upper Extremity without and with IV contrast

PREP

DO NOT GIVE ORAL CONTRAST

Diet: Clear liquids three (3) hours prior to exam.

Patient will have to sign a consent for IV contrast in the CT Department.

All patients 70 or older must have creatinine results less than 30 days old.

All patients 50 or older with a clinical history of renal disease, hypertension or diabetes must have creatinine results less than 30 days old.

Any patient with renal disease must have creatinine results less than 30 days old.

Patients with insulin pump must have pump removed before going to CT.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

Patients MUST bring a list of all medications.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

We must know prior to IV contrast injection if the
patient has a history of a
known allergy to x-ray
dye, iodine or iodinated
contrast. If the patient has
a known allergy to dye they should be scheduled
to arrive 1 hour early for
pre-medication and MUST
have someone to drive
them home.

Patients that are DIABETIC and TAKING the following diabetic medications:Avandamet, Actoplus Met, Glucophage, Glucophage XR, Glucovance, Metaglip, Metformin, Fortamet, Glumetza, Janumet,
Prandimet, Riomet and Kombiglyze XR will be identified at the time
scheduled so that the referring physician can
manage the discontinuance and the ordering of Creatinine lab test 48 hours post IV contrast. The patient must have a normal creatinine level prior to continuance of the medications listed above.


EST TIME OF EXAM

30 min

PROCEDURE (OP)

CT Cardiac/Heart

PREP

Beta Blocker-Metoprolol

Write script for four (4) 50 mg tablets.

50 mg tablet twelve (12) hours before the exam.

50mg tablet one (1) hour before the exam.

Bring the remaining doses when coming to exam as other doses may be required at this time.

NPO four (4) hours prior to exam-except for medications.

No caffeine twelve (12) hours prior to exam.

Drink sixteen (16) ounces of water one (1) hour before the exam.

Beta blockers (as listed above).

Patients that are DIABETIC and TAKING the following diabetic medications:Avandamet, Actoplus Met, Glucophage, Glucophage XR, Glucovance, Metaglip, Metformin, Fortamet, Glumetza, Janumet,
Prandimet, Riomet and Kombiglyze XR will be identified at the time
scheduled so that the referring physician can manage the discontinuance and the ordering of Creatinine lab test 48 hours post IV contrast. The patient must have a normal creatinine level prior to continuance of the medications listed above.

Patient will have to sign a consent for IV contrast in the CT Department.

All patients 70 or older must have creatinine results less than 30 days old.

All patients 50 or older with a clinical history of renal disease, hypertension or diabetes must have creatinine results less than 30 days old.

Any patient with renal disease must have creatinine results less than 30 days old.

Patients with insulin pump must have pump removed before going to CT.

Anything that might interfere with imaging will have to be removed such as jewelry, hairpins, eyeglasses, dental work, etc.

Patients should wear comfortable, loose-fitting clothing without metal snaps or zippers when possible.

We must know prior to IV contrast injection if the
patient has a history of a
known allergy to x-ray
dye, iodine or iodinated
contrast. If the patient has
a known allergy to dye they should be scheduled
to arrive 1 hour early for
pre-medication and MUST
have someone to drive
them home.

Patients must have someone to drive them home after the exam.

If lab work is not available from the office the patient should be scheduled to arrive 30 minutes prior to appointment. I-STAT CREATININE on arrival should be on the physician’s order.



EST TIME OF EXAM

1 hour

PROCEDURE (OP)

CT ABDOMEN/PELVIS TO CHECK FOR LEAK AROUND PERITONEAL CATHETER

PREP

DO NOT GIVE ORAL OR IV CONTRAST

Pt MUST bring their own dialysis supplies.

Schedule the patient in two different time slots. The first time should be 1 hour and the second time should be 30 minutes with 30 minutes in between the two scans.

EST TIME OF EXAM

2 hours

Pt will have a non contrast scan of their abdomen and pelvis.

Then the patient will connect and fill the dialysis fluid.

Then the patient must wait 30 minutes before rescanning.

The patient will normally drain the fluid once the scan is done.