Computed tomography (CT) scan, also known as computerized axial
tomography (CAT), or CT scanning computerized tomography is a
painless, non-invasive diagnostic imaging procedure that produces cross-
sectional images of several types of tissue not clearly seen on a traditional X-
ray.
CT scans may be performed with or without contrast medium. A contrast may
either be an iodine-based or barium-sulfate compound that is taken orally,
rectally, or intravenously which can enhance the visibility of specific tissues,
organs, or blood vessels. The duration of the procedure will depend on the
area being scanned.
The roles and responsibilities of a medical assistant extend throughout the
whole duration of the CT scan procedure — from taking patient’s history,
obtaining informed consent, preparing the patient, and providing education.
To ensure the safety and accuracy of the procedure, learn about the nursing
interventions and concepts behind computed tomography (CT) scan.
Procedure
The protocol and procedures for computed tomography (CT) scan varies per
area but generally, the following steps are followed:
1. The patient is positioned on an adjustable table inside an
encircling body scanner (gantry); straps and pillows may be used
to help in maintaining the correct position.
2. The patient may be instructed to hold his breath during the
scanning.
3. A series of transverse radiographs are taken and recorded
4. The information is reconstructed by a computer and selected
images are photographed.
5. Once the images are reviewed, an I.V. contrast enhancement may
be ordered and additional images are obtained.
6. The patient is assessed carefully for adverse effects to the contrast
medium.
Types
The following are the different types of computed tomography (CT) scans:
Abdominal and pelvic
CT scan of the abdomen and pelvis combines radiologic and computer
technology to determine the cause of unexplainable abdominal or
pelvic pain and diseases of the bladder, uterus, liver, colon, small bowel, and
other internal organs.
Indication Abnormal Results
Detects inflammatory process
Abscesses
Inspect soft tissue and organs of the abdomen,
Cysts
pelvis and retroperitoneal space
Obstructive disease from
Evaluates trauma
a tumor or calculi
Helps in the staging of neoplasms
Primary and metastatic
Detects edema, hemorrhage, cysts, and tumors
neoplasms
Measures effectiveness to chemotherapy
Bone and skeletal
Computed tomography (CT) scan of the bone is indicated to provide
information and assess the severity of different bone diseases and conditions
such as fractures, cancer, and infection.
Indication Abnormal Results
Bone fractures
Joint
Identify any joint abnormalities
abnormalities
Determine abnormalities in the upper and lower spine
Primary bone
Detect unsual active bone formation
tumors
Establish the presence and extent of fractures, ligament, or
Soft-tissue
tendon injuries, primary bone tumors, skeletal metastases,
tumors
and soft tissue tumors
Skeletal
metastasis
Brain
Also known as “cranial CT scan” or “Head CT”. It is indicated to provide
detailed information on head injuries, stroke, brain tumors and other diseases
affecting the brain.
Indication Abnormal Results
Identify intracranial abnormalities and lesions Arteriovenous
malformation
Cerebral atrophy
Determine focal neurological abnormalities Cerebral edema
Guides brain surgery or biopsy of brain tissue Congenital
Evaluate suspected head injury such as anomalies
subdural hematoma Edema
Monitor the effectiveness of chemotherapy, Hydrocephalus
radiotherapy, or surgery, as part of the management of Intracranial tumors
intracranial tumors Intracranial
hematoma
Infarction
Cardiac calcium scoring
The goal of a cardiac CT for calcium scoring is to detect coronary artery
disease (CAD) at an early stage in individuals who do not yet have any
symptoms but are at risk for the disease. Calcium Scoring is most often
suggested for males aged 45 years or older, and for females aged 55 and over.
Indication Abnormal Results
Score of O: No plaque is present.
Score between 1-10: a minimal amount
of plaque is present.
Identify presence, and extent of Score between 11-100: evidence of
calcium buildup in the coronary plaque is present. (Mild or minimal
arteries coronary narrowings).
Evaluates the risk Score between 101 and 400: signifies
of atherosclerosis and coronary moderate amount of calcified plaque in
heart disease the arteries (an increased risk of MI)
Score >400: reveals extensive
calcification and significant narrowing of
the arteries due to plaque
Ear
Indication Abnormal Results
Diagnose cochlear abnormalities Cochlear abnormalities
Investigate ossification of the cochlea Osseous changes of the external
coils prior to cochlear implantation auditory canal and middle and inner
Depict osseous changes in the petrous ear structures
and temporal bone Tympanosclerosis
Determine the appropriate surgical and
therapeutic method for patients
with inner and middle ear disorders
Evaluate postsurgical therapy of
patients with middle and inner ear
disorders
Differentiate cholesteatoma from
chronic inflammation
Evaluate the cause of bilateral hearing
loss
In CT scan of the ear, the radiologist is able to diagnose conditions such as
chronic otitis media, ear infections, cholesteatoma, conductive hearing loss,
mastoiditis, and cochlear implants.
Liver and Biliary Tract
CT scan of the liver and biliary tract provides an in-depth information about
the liver, gallbladder, bile ducts, and other related structures.
Indication Abnormal Results
Biliary duct
dilation
Calculi
Focal hepatic
defects
Differentiate obstructive and nonobstructive jaundice
Hepatic cysts
Detect intrahepatic tumors and abscesses, subphrenic and
Hepatic
subhepatic abscesses, cysts, and hematomas
abscesses
Neoplasms
Pancreatic
carcinoma
Small lesions
Orbital
An orbital CT scan provides detailed information about the eye sockets, eyes,
and adjacent bone structures.
Indication Abnormal Results
Identify the cause of unilateral Encapsulated tumors (benign
exophthalmos hemangiomas and meningiomas)
Assess pathologic conditions of Early erosion or expansion of the medial
the eye and orbit orbital wall
Intracranial tumors (gliomas,
meningiomas, and secondary tumors)
Lymphomas and metastatic carcinomas
Detect fractures of the orbit and Space-occupying lesions in the orbit or
adjoining structures paranasal sinuses
Space-occupying lesions
Thickening of the medial and lateral rectu
muscles
Pancreas
Indication Abnormal Results
Acute and chronic
pancreatitis
Abscesses
Adenocarcinoma
Ascites
Diagnose or evaluate pancreatitis
Biliary obstructions
Identify pancreatic carcinoma or pseudocyst
Cystadenocarcinomas
Differentiate pancreatic disorders and
Cystadenomas
retroperitoneum disorders
Islet cell tumors
Metastases
Pancreatic carcinoma
Pseudocysts
Pleural effusion
CT scan of the pancreas may be useful to diagnose cancer of the pancreas,
and pancreatitis, and to differentiate pancreatic problems and disorders of the
retroperitoneum.
Renal
A renal scan examines the structural and functional abnormalities of
the kidney. It is indicated to detect tumors, obstructions, and lesions.
Indication Abnormal Results
Identify and diagnose renal abnormalities, such as calculi, Abscesses
obstruction, tumor, polycystic disease, congenital Calculi
anomalies, and abnormal fluid accumulation Congenital
Evaluate retroperitoneal pathologies anomalies
Hematomas
Kidney infection
or damage
Lymphoceles
Obstructions
Polycystic kidne
disease
Renal cell
carcinoma
Renal cysts or
masses
Vascular or
adrenal tumors
Spinal
CT scan of the spine is performed to gain insight regarding the vertebrae and
other spinal structures and tissues. It is indicated to detect spinal related
injuries and diseases of the spine.
Indication Abnormal Results
Spinal lesions and abnormalities
Cervical spondylosis
Cervical cord compression
Congenital spinal malformations
(meningocele, myelocele, and spina bifida
Degenerative processes and structural
Diagnose lesions and
changes
abnormalities of the spine
Facet disorders
Detect or rule out spinal damage
Fluid-filled arachnoidal and other
in patients with injury
paraspinal cysts
Monitor the results of spinal
Herniated nucleus pulposus
surgery or therapy
Lumbar stenosis
Meningioma
Neurinoma (schwannoma)
Spinal cord compression
Spurring of the vertebrae
Vascular malformations
Thoracic
CT scan of the chest aids in determining the cause of an
unexplained cough, fever, difficulty of breath, chest pain, and other respiratory
symptoms. It is recommended for screening of possible lung cancer in its
early, curable stage.
Indication Abnormal Results
Diagnose a dissection or leak of an aortic
aneurysm or aortic arch aneurysm
Diagnose the invasion of a neck mass in the thorax
Differentiate emphysema or bronchopleural fistula from
a lung abscess
Distinguish tumors adjacent to the aorta from aortic Accumulation of
aneurysms fluid, blood, or fat
Differentiate tumors from calcified lesions Aortic aneurysms
(signifies tuberculosis) Cysts
Detect the mediastinal lymph nodes Enlarged lymph
Assess primary malignancy that may metastasize to the nodes
lungs, especially in the patient with a primary bone Nodules
tumor, soft-tissue sarcoma, or melanoma Pleural effusion
Identify the extent of lung diseases such as Tumors
bronchiectasis, emphysema, and diffuse interstitial lung
disease
Locate observed neoplasms (e.g., Hodgkin’s disease),
especially with the mediastinal involvement
Plan radiation therapy
Contraindication
Computed tomography (CT) is contraindicated in:
Pregnant patient (absolute contraindication)
Patients with a known allergy to iodine
Patients with claustrophobia
Patients with renal impairment unless the benefits outweigh the
risks
Patients with hyperthyroidism or toxic goiter (induce thyrotoxic
crisis)
Patients with complications after a previous administration of a
contrast
Patients with severe obesity (usually more than 300 pounds)
Interfering Factors
Retained oral or I.V. contrast material from previous diagnostic
studies may affect the visibility of the images.
Metal objects including eyeglasses, dentures, jewelry, and hairpins
Nursing Responsibilities for CT Scan
The following are the nursing interventions and nursing care considerations
for a patient undergoing computed tomography:
Before the procedure
The following are the nursing interventions before computed tomography:
Informed Consent. Obtain an informed consent properly signed.
Look for allergies. Assess for any history of allergies to iodinated
dye or shellfish if contrast media is to be used.
Get health history. Ask the patient about any recent illnesses or
other medical conditions and current medications being taken.
The specific type of CT scan determines the need for an oral or
I.V. contrast medium
Check for NPO status. Instruct the patient to not to eat or drink
for a period amount of time especially if a contrast material will
be used.
Get dressed up. Instruct the patient to wear comfortable, loose-
fitting clothing during the exam.
Provide information about the contrast medium. Tell the
patient that a mild transient pain from the needle puncture and a
flushed sensation from an I.V. contrast medium will be
experienced.
Instruct the patient to remain still. During the examination, tell
the patient to remain still and to immediately report symptoms of
itching, difficulty breathing or swallowing, nausea, vomiting,
dizziness, and headache.
Inform about the duration of the procedure. Inform the patient
that the procedure takes from five (5) minutes to one (1) hour
depending on the type of CT scan and his ability to relax and
remain still.
After the procedure
The medical assistant should be aware of these post-procedure nursing
interventions after computed tomography (CT) scan:
Diet as usual. Instruct the patient to resume the usual diet and
activities unless otherwise ordered.
Encourage the patient to increase fluid intake (if a contrast is
given). This is so to promote excretion of the dye.
