Pelvic CT scan

Done by:Alia BafqeehNora Alohaly

Pelvic CT. Indications. Contraindications. Pelvic CT protocols. - Truma protocol. - Pathology protocol. Patient after care .

Outlines :

It is an imaging method that uses x-rays to create cross-sectional pictures of the organs inside the pelvis (bladder, prostate, lymph nodes and pelvic bones).

CT scan of the pelvis:

Pelvic truma or fracture . Hematuria or suspected renal calculus.Hematoma. Suspected hemorrhage. Hip osteonecrosis.  Ischemic bowel.Pelvic inflammatory or infection disease(abscess/colitis).Pelvic vein thrombosis. Congenital abnormalities e.g. CHD. Tumors, suspected or known (Lymphadenopathy/Primary or

metastatic malignancies)

Indications of pelvic CT :

CHD Ewing sarcoma osteosarcoma of the ilium

There are no absolute contraindications to pelvic CT examinations, the relative benefits should be outweigh the exposure risk.

• Check the following conditions : – ALLERGIES, ASTHMA, DIABETIES, KIDNEY DISEASE

• Ask if a patient is PREGNANT. • Ask about prior reaction to contrast.

Contraindications of pelvic CT :

Pelvic CT scan : In KKUh there are 2 protocols

Truma . Pathology .

Truma protocol (C-) E.g. to rule out fractures or history of truma .

Patient preparation :No need for pt. preparation since he comes directly from the ER . - Pt. should be stable (vital sings).- On stretcher.- No need to be NPO except if a sedation is needed ( NPO for 3-4

hrs). Patient position : -Supine. -Feet first in gantry. -Hands above the head .

- The vertical center is in the middle of the pelvis .

- The axial center is in the iliac crest.

The scanning process :• Scout Images: PA : plane 180º Lat : plane 90º

Type of recons .

DFOV SFOV mA K.V End locat.

Start locat.

Space Thickness Type of scan

Standard 30 – 50 cm

The size of the Pt.

M ,LThe size of the

Pt.

Auto mA 200 - 400

120 Mid of thigh.

L4 2.5

5 Helical

Standard window Bone window

• The serial of procedure :

2nd reconstruction

Bone window fractures.

- When the scan is end we can have 2D reformats (coronal, sagittal ) and 3D pelvis .

pathology protocol (C+) E.g. Ca ovarian , mass or swelling

Patient preparation :

- 60 ml castor oil the night before the procedure. - NPO from mid night . - The patient should be in department 2hrs before start the procedure. - check that pt. not allergic or asthmatic . - Check pt. renal function test ; for inpatient 1 week outpatient (diabetic) 3 months outpatient (non-diabetic) 6 months

- Pt. is given the oral contrast gastrografin or telebrix 3% (30 ml in 1000 ml of water ), one cup every 10 min .

- After 1hr Pt. call and stay in beside room:

Pt. sign the consent formExplain to patients the risks of contrast and answer any questions they have. Check the blood pressure.start Pt. cannulated with IV cannula (18-20 Gag).

- The Pt. is then shift to the CT room .

Patient position : -Supine. -Feet first in gantry. -Hands above the head .- The vertical center is in the middle of the body .- The axial center is in the xiphoid process.

NOTE: we must include the abdomen to avoid repeation & injection of CM twice .

The scanning process :

• Scout Images: PA : plane 180º Lat : plane 90º

- Inject the Pt. with IV contrast omnipaque or xenetix 300 by injector machine.

Flow rate 3ml/sec. volume 120 ml.

By using the smart prep technique , after the CM is seen in the aorta in smart prep image the scan is delay for 65 sec ( portovenous phase ) .

• The serial of procedure :

Type of recons.

DFOV SFOV mA K.V End locat.

Start locat.

Space Thickness

Type of scan

Standard

30 – 50 cm The size of the Pt.

M ,LThe size of the

Pt.

Auto mA 200 - 400

120 Pubic bone

.

Mid of the

chest

5

5 Helical

2nd reconstruction

1.25 ×1.25For reformat only.

- When the scan is end we can have 2D reformats (coronal, sagittal ).

additional procedure :

- The doctor may need • Delayed image after 10 min ( full KUB) to localized the area &

size of the legion .• Rectal contrast 500 ml .

showing a large filling defect (mass) extending posteriorly (arrows).

(C) Coronal CT reformat shows fluid-filled diverticulum (arrow).

(D) Sagittal CT reformat shows a diverticulum descending from the inferior border of the small bowel (arrow).

CT axial images with oral and intravenous contrast. A fluid filled diverticulum .

Patient after care :- The site of contrast injection will be bandaged. - The technologist will continue to watch the patient for possible

adverse contrast reactions.

- Pt. can eat or drink as normal.

- If the Pt. inject with contrast, he/she should drink plenty of liquid to help flush it out from there system.