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The mm sections reconstructed from the current multi-detector CT scanners allow both high-resolution and thin-section images of the entire chest, with coronal and sagittal reconstructions that are of equal resolution to the standard axial images. Such imaging allows for better assessment of the relationship of lesions to pertinent anatomy and provides an assessment of the distribution of lung or pleural disease in the cranio-caudal, medio-lateral, and antero-posterior planes. High-resolution chest CT describes a sampling technique in which axial scans obtained throughout the chest at discrete, noncontiguous intervals are generated to assess for diffuse airway and pulmonary parenchymal abnormalities.

The technique is particularly helpful in the assessment of bronchiectasis, cystic fibrosis, emphysema, and diffuse interstitial lung diseases. Serial studies can be used to assess the course of a disease and its response to treatment. Adult patients being assessed for diffuse disease in whom radiation exposure is not associated with long-term sequelae are most often evaluated using multi-detector CT of the entire lungs during a breath hold i.

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Frontal chest radiograph in a patient with bilateral breast prostheses shows a focal right upper lobe density arrow. CT scan at lung windows through the upper lobes shows an irregular lesion with internal lucencies indicative of an lung adenocarcinoma, proven at biopsy and subsequent resection. Axial CT image through the heart shows right ventricular dilatation arrow indicative of strain resulting from the embolism. Axial CT at lung windows through the upper lobes confirms a spiculated left apical mass arrow and a small contralateral nodule arrowhead.

Scan through the lung bases shows fissural and costal pleural nodules on the left arrows. CT-PET showed hypermetabolic activity in the aortopulmonary nodes, left pleural nodules, and right apical nodule indicative of metastatic lung cancer. Frontal chest radiograph in a patient with scleroderma shows decreased lung volumes with lower zone predominant peripheral reticulation.

Axial CT through the lung bases shows reticular interstitial disease with traction bronchiectasis. Findings reflect UIP associated with scleroderma. Note the dilated esophagus. Coronal CT image through the posterior lungs shows the basilar distribution of reticulation characteristic of UIP. Evaluation of the trauma patient with suspected injury to the aorta or great vessel, central airway, parenchymal, chest wall, or diaphragm. Characterization and assessment of the extent of pleural fluid accumulation or pleural thickening. Detection and follow-up of thoracic aortic diseases, including aortic aneurysm and dissection Figure 6A, Figure 6B.

High-resolution chest CT, which samples only about percent of the chest, is associated with significantly lower effective radiation doses than standard, volumetric multi-detector CT does. The radiation dose is of particular concern for younger patients, especially young females, as exposure of the breasts to ionizing radiation is associated with a small but definable increased risk of breast cancer. Nephrotoxicity secondary to administration of iodinated contrast agents is a significant concern in patients with pre-existing renal dysfunction, particularly those with diabetes-associated chronic kidney disease.

Pre-study estimation of the glomerular filtration rate GFR to assess for risk of contrast administration is routine in most radiology departments. When such risk is noted, preventative measures to reduce the likelihood of contrast-induced nephrotoxicity may be implemented, or consideration may be given to an alternative imaging procedure, such as sonography or MRI.

A history of contrast allergy, significant atopic history, or prior anaphylactic reaction to intravenous contrast warrant prophylactic administration of corticosteroids and anti-histamines at least six hours prior to contrast administration. Alternatively, another form of imaging should be considered.

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Multidetector computed tomography - Pulmonology Advisor

Multi-detector chest CT scans are usually performed with the patient supine and arms raised above the shoulders. For scans performed with intravenous contrast, placement of an gauge intravenous catheter in the antecubital fossa is preferred. When intravenous contrast is used, the scans are timed to begin when a threshold value of attenuation is detected via monitoring, low-dose scans done through the pulmonary artery for CT pulmonary angiography or aorta for evaluation of the aorta and great vessels. Using the latest detector arrays of or detector rows, the entire chest can be scanned in two or three seconds.

Images obtained during intravenous contrast injection are optimized to assess the pulmonary arteries for pulmonary embolism, the aorta, and its branches for congenital or acquired disease, and the coronary arteries for atherosclerrotic disease. The mm sections reconstructed from the current multi-detector CT scanners allow both high-resolution and thin-section images of the entire chest, with coronal and sagittal reconstructions that are of equal resolution to the standard axial images. Such imaging allows for better assessment of the relationship of lesions to pertinent anatomy and provides an assessment of the distribution of lung or pleural disease in the cranio-caudal, medio-lateral, and antero-posterior planes.

High-resolution chest CT describes a sampling technique in which axial scans obtained throughout the chest at discrete, noncontiguous intervals are generated to assess for diffuse airway and pulmonary parenchymal abnormalities. The technique is particularly helpful in the assessment of bronchiectasis, cystic fibrosis, emphysema, and diffuse interstitial lung diseases. Serial studies can be used to assess the course of a disease and its response to treatment.

Adult patients being assessed for diffuse disease in whom radiation exposure is not associated with long-term sequelae are most often evaluated using multi-detector CT of the entire lungs during a breath hold i. Frontal chest radiograph in a patient with bilateral breast prostheses shows a focal right upper lobe density arrow.

CT scan at lung windows through the upper lobes shows an irregular lesion with internal lucencies indicative of an lung adenocarcinoma, proven at biopsy and subsequent resection. Axial CT image through the heart shows right ventricular dilatation arrow indicative of strain resulting from the embolism. Axial CT at lung windows through the upper lobes confirms a spiculated left apical mass arrow and a small contralateral nodule arrowhead. Scan through the lung bases shows fissural and costal pleural nodules on the left arrows. CT-PET showed hypermetabolic activity in the aortopulmonary nodes, left pleural nodules, and right apical nodule indicative of metastatic lung cancer.

Frontal chest radiograph in a patient with scleroderma shows decreased lung volumes with lower zone predominant peripheral reticulation. Axial CT through the lung bases shows reticular interstitial disease with traction bronchiectasis. Findings reflect UIP associated with scleroderma. Note the dilated esophagus.


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Coronal CT image through the posterior lungs shows the basilar distribution of reticulation characteristic of UIP. Evaluation of the trauma patient with suspected injury to the aorta or great vessel, central airway, parenchymal, chest wall, or diaphragm. Characterization and assessment of the extent of pleural fluid accumulation or pleural thickening.

Detection and follow-up of thoracic aortic diseases, including aortic aneurysm and dissection Figure 6A, Figure 6B. High-resolution chest CT, which samples only about percent of the chest, is associated with significantly lower effective radiation doses than standard, volumetric multi-detector CT does. The radiation dose is of particular concern for younger patients, especially young females, as exposure of the breasts to ionizing radiation is associated with a small but definable increased risk of breast cancer.

Nephrotoxicity secondary to administration of iodinated contrast agents is a significant concern in patients with pre-existing renal dysfunction, particularly those with diabetes-associated chronic kidney disease. Pre-study estimation of the glomerular filtration rate GFR to assess for risk of contrast administration is routine in most radiology departments.

When such risk is noted, preventative measures to reduce the likelihood of contrast-induced nephrotoxicity may be implemented, or consideration may be given to an alternative imaging procedure, such as sonography or MRI. A history of contrast allergy, significant atopic history, or prior anaphylactic reaction to intravenous contrast warrant prophylactic administration of corticosteroids and anti-histamines at least six hours prior to contrast administration. Alternatively, another form of imaging should be considered.

Multi-detector chest CT scans are usually performed with the patient supine and arms raised above the shoulders. Frush has published very widely and has served as a guest editor and invited reviewer for numerous medical journals. He is currently the associate editor North American of the journal Pediatric Radiology. How does this compare to chest X-rays and to normal daily-life annual background radiation?

Radiation dose from CT scans of the chest, abdomen, or pelvis varies depending on the individual patient, and the technique used. In general, in adults, most abdomen CTs are performed at approximately 10 mSv. The dose is less for a chest CT. The doses should be the same-to-less, if size adjusted, for children.

Radiation Dose from Adult and Pediatric Multidetector Computed Tomography

Head CT doses are generally less than about mSv. As a rough approximation, one abdomen pelvis CT in an adult is equal to chest x-rays. The risk of low-level radiation, such as that used in CT, is unknown.


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