CT PNS MAAJID MOHI UD DIN MALIK LECTURER COPMS AU MM Ewa aR EasyCOMPUTED TOMOGRAPHY (CT) - SINUSES Computed tomography (CT) of the sinuses Tear er hMat imme ELC the paranasal sinus cavities — hollow, air- filled spaces within the bones of the face surrounding the nasal cavity. CT scanning is painless, noninvasive and accurate. It's also the most reliable imaging technique for determining if the sinuses are obstructed PRC nen aiiie li Ame Cm Rt OeWHAT IS CT (COMPUTED TOMOGRAPHY) OF THE SINUSES? » Computed tomography, more commonly known as PROM COMMU Rrra enced ined test. Like traditional x-rays, it produces multiple images or pictures of the inside of the body. » The cross-sectional images generated during a CT eee Mew Come eee MA can even generate three-dimensional images. These images can be viewed on a computer monitor, printed on film or by a 3D printer, or transferred toa CD or DVD.» CT images of internal organs, bones, soft tissue EUCM Ueto Oe eMC ca om Ce EL traditional x-rays, particularly of soft tissues and blood vessels. Pee Oem Cer ae eee tet mae el show a patient's paranasal sinus cavities. PPE U een LOPE es EL Cary tua EC RU Mme Coe TT surrounding the nasal cavity, a system of air PUN RRC Laem eC Ce et ms throat, There are four pairs of sinuses, each yee eee ee Ma Am Me) eeeWHAT ARE SOME COMMON USES OF THE PROCEDURE? COM RUOTOe eee hence cn » Help diagnose sinusitis. » Evaluate sinuses that are filled with fluid or thickened AUTOR Lo » Detect the presence of inflammatory diseases. Pe MO MCCUE MU CLO a) nasal cavity and sinuses. eMC UBM LeamaHOW SHOULD I PREPARE? » You should wear comfortable, loose-fitting clothing POC eR MRM Core ET Cease > Metal objects, including jewelry, eyeglasses, dentures and hairpins, may affect the CT images. RP CRORE COO AeL exam. You may also be asked to remove hearing aids and removable dental work. Women will be EO ROBO ERMC LU m Cmte ee od You may be asked to remove any piercings, if possible.> You will be asked not to eat or drink anything for a few EUS MRS lar AT ae ere eC OL OCT CCM LORI ELM mui icra ed NOE CR Ene COME Ae head Ce ENCE oy known allergy to contrast material, your doctor may prescribe medications (usually a steroid) to reduce the risk SO Ue Coes tC PMU Nm Moe eo PMO Cee eC CER Me EAE aCe Amtek a RUC problems. Any of these conditions may increase the'risk of PU Metre cued > Women should always inform their physician and the CT UI RC RMA ECAR mL PesanWHAT DOES THE EQUIPMENT LOOK LIKE? OU Oe TSC ay Ce AMe ELEC Deeb rae machine with a short tunnel in the center. You will lie CEC Boe nC me Ceram ie Tm ae this short tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each ene eae BRM cog BOSCO Me URE EL located in a separate control room. This is where the Pew e) orme CC ee exam in direct visual contact, The technologist will be able to hear and talk to you using a speaker and Pam tsHOW DOES THE PROCEDURE WORK? > In many ways, a CT sean works like other x-ray exams. ie eC eek MT mCliioes is PES Meer Cmte distinguish body parts from one another on an x-ray or 1O8 Metco » Ina conventional x-ray exam, a small amount of PETER ece CC ME nm MMOS examined. A special electronic image recording plate captures the image. Bones appear white on the x-ray. RUSE Om Me CORT SECM ee hee ae) eee Cale» With CT scanning, several x-ray beams and electronic x-ray detectors rotate around you. These measure the amount of radiation being absorbed throughout your body. Sometimes, the exam table will move during the scan, so Poe Ce RMS Tm ee my hectare computer program processes this large volume of data to create two-dimensional cross-sectional images of your body. These images are then displayed on:a monitor. CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the image slices are ere ct MMM eA ee ae ead detailed multidimensional view of the body's interior, » Refinements in detector technology allow nearly all CT scanners to obtain multiple slices in a single rotation. These eRe CtM Ue on MU Caco ee Pee me RCM CMe ETL mE This results in more detail and additional view capabilities.» Modern CT seanners can sean through large CUM OMUM ReC mmo CCE Tima Co) faster in small children. Such speed is beneficial ee eee tee eel hme cee USP aC CUNO N ee TR eo CD Ce MME ACU CC eo metic necessary to obtain images. » For children, the CT scanner technique will be adjusted to their size and the area of interest to reduce the radiation dose. PCa Oe MOC eee him eer eC htm cl) enhance visibility in the area of the body being SauteHOW IS THE PROCEDURE PERFORMED? » The technologist begins by positioning patients on the CT examination table. >» Fora CT scan of the sinuses, the patient is most commonly positioned lying flat on the back. The patient may also be positioned face-down with the chin elevated. Pee eM OREM me re CO Re eee maintain the correct position and to hold still during fie Tie» Some patients require an injection of a contrast material to enhance the visibility of certain tissues CMU COC Ree meer acme leer) nurse or technologist will insert PU a ROMO UE Moe mes patient's hand or arm. The contrast material will PTC Cem ed eee co » Next, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed, Depending on the type of CT scan, the machine may make several passes.» You may be asked to hold your breath during the scanning. Any motion, including breathing and body movements, can lead to artifacts on the images. This loss of image quality can resemble the ee eet ye cme Ck object. >» When the exam is complete, you will be asked to wait until the technologist verifies that the images PIO Ce eee Ae era en interpretation. » The actual CT scan takes less than a minute and TAT ee RMS ER REMC Caco Pn ceWHAT WILL I EXPERIENCE DURING AND AFTER THE PROCEDURE? > CT exanis are generally painless, fast and easy. With multidetector CT, the amount of time that the patient oR Ce Met Cor » Though the scanning itself causes no pain, there may be some discomfort from having to remain still for several minutes. If you havea hard time staying still, PCE CR ERC ER LC a CT exam to be stressful. The technologist or nurse, under the direction of a physician, may offer you some PCCM A Coe Cte Om Mee TT rod procedure.PPV e er woo himnt oer ler coma cn my IT feel a pin prick when the needle is inserted into your ODE CO RUE MR Ee MU SUCRE Cena ELE is injected. You also may have a metallic taste in your Pe ee ee ewe co em ete coe Oe RO mC eee aha » When you enter the CT scanner, you may see special light lines projected onto your body. These lines are used to ensure that you are properly positioned. With modern CT scanners, you may hear slight buzzing, clicking and whirring sounds. These occur as the CT eMC CRC CAM UC COOL OV MCE UCU aT eM mee om Oe ot» You will be alone in the exam room during the CT scan, unless there are special circumstances. For example, sometimes a parent wearing a lead shield may stay in the room with their child. However, the technologist will always be able to see, hear and speak Ce MTU Lee Ca » With pediatric patients, a parent may be allowed in the room but will be required to wear a lead apron to PPA OPP LOCU che eCid o » After a CT exam, the technologist will remove the intravenous line used to inject the contrast material. The tiny hole made by the needle will be covered with a small dressing: You can return to your normal Brat ienWHAT ARE THE BENEFITS VS. RISKS? Tonto tiny Pee BCR meee eC R Mea tts STE » CT is the most reliable imaging technique for determining if the sinuses are obstructed. It is the best Pena EAU CMU POMOC ORC UM CUE Oe UBC Paice cone » CT of the sinuses is now widely available and is performed in a relatively short time, especially when compared to magnetic resonance imaging (MRI),» CT scanning is painless, noninvasive and accurate. » A major advantage of CT is its ability to image bone, soft tissue and blood vessels all at the same time. » Unlike conventional x-rays, CT scanning provides very detailed images of many types of tissue as well as the lungs, bones, and blood vessels, POMOC NEU eee Miami mi Ue ame Ame ema ato and bleeding quickly enough to help save lives. » CT has been shown to be a cost-effective imaging UR ee CCR hee ee ee Ce PaO Seem mC ee» CT can be performed if you have an implanted medical device of any kind, unlike MRI. > CT imaging provides real-time imaging, making it a good tool for guiding minimally invasive procedures Se cue cue Gr RETA areas of the body, particularly the lungs, abdomen, pelvis and bones. >» A diagnosis determined by CT scanning may eliminate the need for exploratory surgery and surgical biopsy. » No radiation remains in-a patient's body after a CT Ce ELEC » X-rays used in CT scans should have no immediate side effects.KS Puce IMME meee me Ome eH excessive exposure to radiation, However, the benefit of an accurate diagnosis far outweighs the risk, » The effective radiation dose for this procedure SEMA h eo DUC eae Tee ray or CT technologist if there is any chance they are esis Oe ea Ue mC oe Ce RSET mC hme aoe ee CeCe OLPee MAMET ete Came eC MUO eee Pee Cae eae Eee PEACE Odea mA aaa) College of Radiology (ACR) Manual on Contrast Media UOMO ee Relea by the infant during breastfeeding is extremely low PUSS ee ae ee Oem eco elLy that contain iodine is extremely rare, and radiology Cro eee olor em ORCC TUR » Because children are more sensitive to radiation, they SC ee eC ACR ONr Cee reay diagnosis and should not have repeated CT exams unless absolutely necessary. CT scans in children should always be CUED Ure CoM nC coWHAT ARE THE LIMITATIONS OF CT OF THE SINUSES? » CT is usually the first test ordered when a sinus tumor is suspected. If additional information is needed to determine the extent of soft tissue of the tumor, magnetic resonance imaging (MRI) Te MMe aye » A person who is very large may not fit into the opening of a conventional CT scanner or may RI ROR Me ET AMOUR COT for the moving table.PROTOCOL FOR THE NASAL AND PARANASAL SINUS REGION PEt te >» Trauma to the face. Pap UC tice uie Pere ETS » Infiltrative diseases and their complications. » Preoperative staging of tumors. » Postoperative follow up.Patient positioning- » For direct Coronal scanning- Prone with head first, RC emcee ee Ng oe eco c mY UU RU Teco Re Conn ae od Puce rear Ueki msec) Me Tome Co >» For axial scanning- Supine with head first, with arms beside the trunk.Topogram position/ Landmark- Lateral » For Coronal scanning = 2-3 cm anterior to the tip of eitoe con » For Axial scanning- Level of the vertex. >» Mode of seanning- Helical. » Scan orientation- Posterior to anterior in Coronal ee Or Cee eet RL oa Rema rem Cre Leto » For Coronal scanning- Level of the clivex. Pao CCU UT oe Oe R mc LcoeEnd location- » For Coronal scanning- Anterior part of the nasal cavity anterior to the frontal sinuses. Pee UMAR ECC emer nt m ema Come e Oe: sinuses. Gantry tilt- » As many degrees as required making the scanning Pecos >» For Coronal scanning- Parallel to the face or perpendicular to the hard plate. » For Axial scanning- Parallel to the hard plate,» Field of view- including the cavernous sinuses as Moe » Contrast Administration- Intravenous. >» Volume of Contrast- 10-20mL. Pee CLR Moat eee tr Pam oe heared ee co » Slice thickness in Reconstruction- 1.0-1.5 mm. ae ee eae ee >» 3D reconstruction- MRP,MIP, virtual endoscopy.Ethmoid sinus Maxillary sinusACUTE SINUSITISNORMAL ANATOMY OF THE PARANASAL SINUSES