Neuro CT Protocols

Introduction
• Neuro CT refers to CT examination of the Central Nervous System CNS
• This consists of the brain and the spinal cord
• The CNS is the body's processing center, receiving, processing, and
responding to sensory information
• The Brain Controls most of the body's functions, including
movement, thinking, speech, and the five senses
• Responsible for responses, sensation, movement, emotions,
communication, thought processing, and memory
• Protected by the skull, meninges, and cerebrospinal fluids
Introduction cont….
• The Spinal cord is an extension of the brain that carries messages to and
from the brain to the rest of the body
• Sends motor commands from the brain to the peripheral body
• Relays sensory information from the sensory organs to the brain
• Protected by the vertebrae, meninges, and cerebrospinal fluids.
• Disruption of the CNS by diseases, Trauma, malformations, or vascular
supply will disrupt the system’s activities.
• CT brain refers to the examination of the brain and surrounding cranial
structures. It is most commonly performed as a non-contrast study, but
a contrast-enhanced phase is added for some indications.
Anatomy
Anatomy Cont….
Spinal Cord
Indications for CT Brain
• Head injury: A CT scan can detect brain injuries, bleeding, and skull fractures. It
can also help determine if a patient has a concussion or other type of brain injury.
• Stroke: A CT scan can help identify a blood clot or bleeding in the brain that may
be causing a stroke.
• Brain tumor: A CT scan can help detect brain tumors or other lesions.
• Hydrocephalus: A CT scan can help identify enlarged brain cavities, also known as
ventricles.
• Infection: A CT scan can help detect brain infections or abscesses.
• Aneurysm: A CT scan can help detect a ruptured or leaking aneurysm that may be
causing bleeding in the brain.
• Brain surgery: A CT scan can help guide brain surgery or biopsies.
Indications cont…
• Suspected skull fracture in trauma
• Post-traumatic seizure
• Focal neurological deficit
• Vomiting
• Altered mental status
• Suspected central nervous system infection
• Hypertensive emergency
• Acute delirium
• Dementia
• Epilepsy
Patient Preparation
• A simple generalized instruction leaflet to include:
• Appointment
• Explanation of Procedure
• Waiting Time
• Description of the CT Scanner and procedure
• Contrast Agent Injection
• And what to Expect
• Pregnancy status should be established for women of childbearing age
• Patients should be asked if they suffer from certain illnesses such as diabetes,
Asthma, Kidney disease, heart problems, multiple myeloma. This may
increase the risk of reactions if CA is involved
• Patients may be asked to continue to take their medications as required
• Ask the patient about known allergies such as reactions to iodine compounds
• Dressing: The patient may be instructed to remove clothing and change into
an appropriate examination gown
• Necklaces, Earrings, hair pins, heavily braided hair, headgear, caps, and any
object that may introduce artifacts in the images should be removed
Routine Brain
Diagnostic Task
• Detect collections of blood;
• Identify brain masses;
• Detect brain edema or ischemia;
• Identify shift in the normal locations of the brain structures including in the cephalad
or caudal directions;
• Evaluate the location of shunt hardware and the size of the ventricles;
• Evaluate the size of the sulci and relative changes in symmetry;
• Detect abnormal collections;
• Detect calcifications in the brain and related structures;
• Evaluate for fractures in the calvarium (skull);
• Detect any intracranial air.
Axial Vs Helical Scan
• A choice can be made between using axial scan and using helical scan
• The method for conventional C. T is axial scanning.
• - X-ray tube rotates round the patient for a specific couch location.
• A single image is then produced from the data set.
• This is followed by another couch movement for another data
acquisition.
• During each axial data acquisition the couch speed is zero.
• In helical scanning the data necessary for reconstruction are acquired as
the x-ray tube rotates in an equidistant circular path around the patient
while the couch moves at a constant speed
Helical
• In helical scan the couch moves continuously at a steady speed
• The tube makes a number of revolutions around the patient
Patient Positioning
• Scan may be performed axial/sequentially, but may be performed helically
in higher-end scanners
• Contrast enhancement (if indicated by radiologist).
• Radiation Dose Management
• Tube Current Modulation (or Automatic Exposure Control) may be used,
but is often turned off;
• The diagnostic reference level (in terms of volume CTDI) is 75 mGy. - The
pass/fail limit (in terms of volume CTDI) is 80 mGy. - These values are for a
routine adult head exam and may be significantly different (higher or lower)
for a given patient with unique indications. NOTE: All volume CTDI values are
for the 16-cm diameter CTDI phantom
Positioning
• Patient should be supine, head first into the gantry, with the head in the head-holder
whenever possible.
• Center the table height such that the external auditory meatus (EAM) is at the center of
the gantry.
• To reduce or avoid ocular lens exposure, the scan angle should be parallel to a line
created by the supraorbital ridge and the inner table of the posterior margin of the
foramen magnum.
• This may be accomplished by either tilting the patient’s chin toward the chest (“tucked”
position) or tilting the gantry.
• While there may be some situations where this is not possible due to scanner or patient
positioning limitations, it is considered good practice to perform one or both of these
maneuvers whenever possible.
• SCAN RANGE: Top of C1 lamina through top of calvarium.
 Table 1
PROTOCOL FOR ROUTINE BRAIN SCAN (AXIAL)

Patient Position: Supine, Head in Head Rest Scanner gantry

(Lateral scan projection radiograph may be used if

Start Position: RBL

PROTOCOL
Slice Thickness - 5mm
Table Increment - 5mm
KVP - 120KV
mAs/Slice - 300mAs
Algorithm -Standard
Scan FOV - 25cm
Window Width - 150/100/80
Window Level - 40
Scout or Scanogram
Images
Contrast
• Oral: None.
• Injected: Some indications require injection of intravenous or intrathecal contrast
media during imaging of the brain.
• Intravenous contrast administration should be performed as directed by the
supervising radiologist using appropriate injection protocols and in accordance
with Practice Guideline for the Use of Intravascular Contrast Media.
A typical amount would be 100 cc at 300 mg/cc strength, injected at 1 cc/sec. A
delay of 4 minutes between contrast injection and the start of scanning is typical.
AXIAL VERSUS HELICAL SCAN MODE: There are advantages and disadvantages to
using either axial or helical scans for routine head CT exams. The decision as to
whether to use axial or helical should be influenced by the specific patient
indication, scanner capabilities, and image quality requirements.
Neonates