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Computed Tomography
Colin J. McCarthy, MB, BCh, BAO, MRCSI, FFR (RCSI); Lubdha M. Shah, MD
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KEY FACTS

  • Terminology

    • Imaging Anatomy

      • Anatomy Imaging Issues

        • Pathology Issues

          TERMINOLOGY

          • Abbreviations

            • Computed tomography (CT)
          • Definitions

            • CT plays complementary role to MR in preprocedural planning
              • Assessment of osseous etiologies of back/neck pain
              • Plan treatment approach
          • Best Practice Guidelines

            • CT scanners have wide detector arrays that enable increased coverage of patient anatomy in single rotation
            • When using CT guidance for pain management procedures, users should be cognizant of radiation dose
              • Image quality requirements for procedures are different from those for diagnostic CT procedures
              • Acquire images only of area necessary to perform the procedure
              • Reduce image quality (increase noise) wherever possible by acquiring images only of quality required to safely and accurately access target
              • Monitor radiation dose to both patient and operators
              • Be familiar with dose-reduction measures, such as tube current modulation and iterative image reconstruction
              • Number of different dose indices are used to quantify and describe radiation dose from CT examinations, including weighted CT dose index (CTDIw), dose-length product (DLP), volume CTDI (CTDIvol), size-specific dose estimate (SSDE), and effective dose (E)
              • Radiation dose associated with CT-guided pain management procedures is often at lower end of patient radiation doses that are normally encountered in diagnostic radiology

          IMAGING ANATOMY

          • General Anatomic Considerations

            • Critical Anatomic Structures

              • Anatomic Relationships

                ANATOMY IMAGING ISSUES

                • Key Concepts

                  • Imaging Approaches

                    • Imaging Protocols

                      • Imaging Pitfalls

                        • Normal Measurements

                          PATHOLOGIC ISSUES

                          • General Pathologic Considerations

                            Selected References

                            1. Jones AK et al: Best practice guidelines for ct-guided interventional procedures. J Vasc Interv Radiol. 29(4):518-9, 2018
                            2. Leng S: Radiation dose in CT-guided interventional procedures: establishing a benchmark. Radiology. 289(1):158-9, 2018
                            3. Pravatà E et al: Operator radiation doses during CT-guided spine procedures. Clin Neurol Neurosurg. 173:105-9, 2018
                            4. Wang D: Image guidance technologies for interventional pain procedures: ultrasound, fluoroscopy, and CT. Curr Pain Headache Rep. 22(1):6, 2018
                            5. Yang K et al: Procedure-specific CT dose and utilization factors for CT-guided interventional procedures. Radiology. 289(1):150-7, 2018
                            6. Weininger M et al: Accuracy of CT guidance of lumbar facet joint block. AJR Am J Roentgenol. 200(3):673-6, 2013
                            7. Sarti M et al: Low-dose techniques in CT-guided interventions. Radiographics. 32(4):1109-19; discussion 1119-20, 2012
                            8. Lyders EM et al: A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol. 30(9):1691-3, 2009
                            9. Hoeft MA et al: Cervical transforaminal injection and the radicular artery: variation in anatomical location within the cervical intervertebral foramina. Reg Anesth Pain Med. 31(3):270-4, 2006
                            10. Tierney RT et al: Cervical spine stenosis measures in normal subjects. J Athl Train. 37(2):190-193, 2002
                            11. Wilson DA et al: John Caffey award. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJR Am J Roentgenol. 152(5):1029-32, 1989
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging Anatomy

                                • Anatomy Imaging Issues

                                  • Pathology Issues

                                    TERMINOLOGY

                                    • Abbreviations

                                      • Computed tomography (CT)
                                    • Definitions

                                      • CT plays complementary role to MR in preprocedural planning
                                        • Assessment of osseous etiologies of back/neck pain
                                        • Plan treatment approach
                                    • Best Practice Guidelines

                                      • CT scanners have wide detector arrays that enable increased coverage of patient anatomy in single rotation
                                      • When using CT guidance for pain management procedures, users should be cognizant of radiation dose
                                        • Image quality requirements for procedures are different from those for diagnostic CT procedures
                                        • Acquire images only of area necessary to perform the procedure
                                        • Reduce image quality (increase noise) wherever possible by acquiring images only of quality required to safely and accurately access target
                                        • Monitor radiation dose to both patient and operators
                                        • Be familiar with dose-reduction measures, such as tube current modulation and iterative image reconstruction
                                        • Number of different dose indices are used to quantify and describe radiation dose from CT examinations, including weighted CT dose index (CTDIw), dose-length product (DLP), volume CTDI (CTDIvol), size-specific dose estimate (SSDE), and effective dose (E)
                                        • Radiation dose associated with CT-guided pain management procedures is often at lower end of patient radiation doses that are normally encountered in diagnostic radiology

                                    IMAGING ANATOMY

                                    • General Anatomic Considerations

                                      • Critical Anatomic Structures

                                        • Anatomic Relationships

                                          ANATOMY IMAGING ISSUES

                                          • Key Concepts

                                            • Imaging Approaches

                                              • Imaging Protocols

                                                • Imaging Pitfalls

                                                  • Normal Measurements

                                                    PATHOLOGIC ISSUES

                                                    • General Pathologic Considerations

                                                      Selected References

                                                      1. Jones AK et al: Best practice guidelines for ct-guided interventional procedures. J Vasc Interv Radiol. 29(4):518-9, 2018
                                                      2. Leng S: Radiation dose in CT-guided interventional procedures: establishing a benchmark. Radiology. 289(1):158-9, 2018
                                                      3. Pravatà E et al: Operator radiation doses during CT-guided spine procedures. Clin Neurol Neurosurg. 173:105-9, 2018
                                                      4. Wang D: Image guidance technologies for interventional pain procedures: ultrasound, fluoroscopy, and CT. Curr Pain Headache Rep. 22(1):6, 2018
                                                      5. Yang K et al: Procedure-specific CT dose and utilization factors for CT-guided interventional procedures. Radiology. 289(1):150-7, 2018
                                                      6. Weininger M et al: Accuracy of CT guidance of lumbar facet joint block. AJR Am J Roentgenol. 200(3):673-6, 2013
                                                      7. Sarti M et al: Low-dose techniques in CT-guided interventions. Radiographics. 32(4):1109-19; discussion 1119-20, 2012
                                                      8. Lyders EM et al: A case of spinal cord infarction following lumbar transforaminal epidural steroid injection: MR imaging and angiographic findings. AJNR Am J Neuroradiol. 30(9):1691-3, 2009
                                                      9. Hoeft MA et al: Cervical transforaminal injection and the radicular artery: variation in anatomical location within the cervical intervertebral foramina. Reg Anesth Pain Med. 31(3):270-4, 2006
                                                      10. Tierney RT et al: Cervical spine stenosis measures in normal subjects. J Athl Train. 37(2):190-193, 2002
                                                      11. Wilson DA et al: John Caffey award. MR imaging determination of the location of the normal conus medullaris throughout childhood. AJR Am J Roentgenol. 152(5):1029-32, 1989