TOPIC-5.

THORAX (ROUTINE
& HRCT); INDICATION,
CONTRAINDICATION,
PATIENT PREPARATION,
PROTOCOLS AND PATIENT
CARE.

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 TOPIC-5. THORAX

The thorax, commonly referred to as the chest, is the region of the

body between the neck and the abdomen. It houses vital organs,
including the heart, lungs, and major blood vessels.
ANATOMY OF THE THORAX:
Skeletal Structure:
1. Sternum (Breastbone):
1.The flat bone in the center of the chest.
2.Consists of the manubrium, body, and xiphoid process.
2. Ribs:
1.Twelve pairs of curved bones that form the ribcage.
2.Attached to the thoracic vertebrae in the spine.
3.True ribs (1-7) connect directly to the sternum.
4.False ribs (8-10) connect to the cartilage of the rib above.
5.Floating ribs (11-12) have no anterior attachment.
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3.Thoracic Vertebrae: The 12 vertebrae in the upper
and mid-back region.
Muscles:
4. Intercostal Muscles:
1.Found between the ribs.
2.External intercostals assist in inhalation.
3.Internal intercostals assist in exhalation.
5. Diaphragm:
1. A large, dome-shaped muscle separating the thoracic and
abdominal cavities.
2. Main muscle involved in breathing; contracts during
inhalation.
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Respiratory System:
6.Lungs:
1. Paired organs responsible for respiration.
2. Right lung has three lobes; left lung has two lobes.
7. Bronchi and Bronchioles:
1. Air passages that branch from the trachea into the lungs.
2. Bronchi further divide into smaller bronchioles.
8. Trachea (Windpipe):
1. Tube connecting the larynx to the bronchi.
2. Lined with ciliated epithelium to filter and moisten air.
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Cardiovascular System:
9. Heart:
1. Located in the mediastinum, between the lungs.
2. Composed of four chambers: left atrium, left ventricle, right atrium,
and right ventricle.
10. Major Blood Vessels:
1. Aorta: Artery carrying oxygenated blood from the heart to the body.
2. Superior and Inferior Vena Cava: Veins returning deoxygenated
blood to the heart.
3. Pulmonary Arteries: Carry deoxygenated blood from the heart to the
lungs.
4. Pulmonary Veins: Transport oxygenated blood from the lungs to the
heart.
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Other Structures:
11. Esophagus: A muscular tube that carries
food from the mouth to the stomach.
12. Thymus Gland: Part of the immune system;
more prominent in childhood.
13. Nerves and Vessels: Various nerves and
blood vessels supply the thoracic region.

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INDICATIONS FOR THORACIC CT SCAN

A CT (computed tomography) scan of the chest, also known as

a thoracic CT scan, may be performed for various reasons to
evaluate the structures within the chest.
INDICATIONS FOR A THORACIC CT SCAN:
1. Chest Pain or Discomfort:
1. To assess the cause of unexplained chest pain or discomfort.
2. Rule out or confirm conditions such as heart disease, angina, or
myocardial infarction.
2. Respiratory Symptoms:
1. Evaluate persistent cough, shortness of breath, or difficulty
breathing.
2. Assess lung diseases such as chronic obstructive pulmonary
disease (COPD), pneumonia, or interstitial lung disease.
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3. Trauma: To assess chest injuries resulting from accidents or

trauma, helping identify fractures, organ damage, or bleeding.
4. Tumors and Masses: Detect and evaluate tumors, nodules,
or masses in the chest, including lung cancer or metastases
from other organs.
5. Infections: Investigate suspected infections in the chest,
such as pneumonia or mediastinitis.
6. Vascular Issues:
1. Assess blood vessels in the chest, including the aorta, for
aneurysms or dissections.
2. Evaluate pulmonary blood vessels for pulmonary embolism.
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7. Cardiac Evaluation: Examine the heart and surrounding

structures for congenital anomalies, pericardial disease, or
other cardiac conditions.
8. Mediastinal Abnormalities: Evaluate the mediastinum for
abnormalities, such as lymph node enlargement or masses.
9. Screening for Lung Cancer: In some cases, thoracic CT
scans may be used for lung cancer screening in individuals
with a history of smoking.
10 Follow-up of Previous Findings: Follow-up on previously
identified abnormalities or lesions to monitor changes over
time.

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 CONTRAINDICATION THORAX
While CT scans of the thorax (chest) are generally safe and
widely used for diagnostic purposes, there are some
contraindications to consider. Contraindications are factors or
conditions that may make the procedure inadvisable or riskier.
Contraindications for routine and HRCT thorax:
1. Pregnancy: CT scans use ionizing radiation, which can
potentially harm the developing fetus. If a woman is pregnant or
there is a possibility of pregnancy, alternative imaging methods or
a different time for the scan may be considered.
2. Allergies: Some people may have allergies to contrast agents
used in CT scans. If you have a known allergy to iodine-based
contrast agents, it's essential to inform your healthcare provider.
They may use an alternative method or take precautions to
minimize the risk of an allergic reaction.
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PATIENT PREPARATION FOR NCCT
& CECT THORAX CT SCAN
FOR NON-CONTRAST CT (NCCT) THORAX CT SCAN:
1. Fasting: In most cases, fasting is not required for non-contrast brain
CT scans. You can typically eat and drink normally before the scan.
2. Medications: Continue taking any necessary medications unless
otherwise instructed by your healthcare provider. Inform the radiology
team of any medications you are taking.
3. Clothing: Wear comfortable, loose-fitting clothing without any
metal objects (zippers, buttons, jewelry) that could interfere with the
imaging process. You may be asked to change into a hospital gown,
depending on the facility's policy.
4. Contrast Allergies: If you have a known allergy to iodine or
contrast agents, inform your healthcare provider and the radiology
team before the scan.

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FOR CONTRAST-ENHANCED CT (CECT) THORAX CT SCAN:
1. Fasting: For CECT Thorax scans, The fasting duration may vary, but it's
common to fast for at least 4-6 hours before the CECT scan. Be sure to follow
the specific fasting instructions provided to you.
2. Allergies: If you have a known allergy to iodine, contrast agents, or any
previous adverse reactions to contrast media, inform your healthcare provider
and the radiology team. They may take specific precautions or use alternative
contrast agents.
3. Renal Function: If you have known kidney problems or renal impairment,
your healthcare provider may assess your kidney function before the scan.
Contrast agents can affect the kidneys, and special precautions may be
necessary.
4. Medications: If you are taking metformin (a medication for diabetes), your
healthcare provider may recommend temporarily discontinuing it before and
after the CECT scan, as it can interact with contrast media. However, do not
stop taking any medication without your doctor's guidance.
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 PROTOCOL FOR NCCT AND
CECT THORAX:
NCCT THORAX:
1. Patient Positioning:
1. Supine position with arms raised above the head.
2. Breath-hold instructions to minimize motion artifacts.
 Imaging Parameters:
2. Scan Range:
1. From the lung apices to the diaphragm.
2. Adjust as needed based on the clinical indication.
3. Slice Thickness: 5mm for NCCT and CECT
Scan.
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4. kVp and mA: KVp commonly around 120

kVp. And 300-400 mA based on patient size.
Pitch 1:1.5
5. Breath-Hold Instructions: Instruct the
patient to hold their breath during image
acquisition.
6. Scan without Contrast: Acquire images
without the use of contrast media.

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CECT THORAX PROTOCOL:
Patient Preparation additional to NCCT Protocol :
1.Informed Consent:
1. Explain the use of contrast and any potential risks to the patient.
2. Obtain informed consent.
Imaging Parameters:
2. Contrast Injection:
1.Administer iodinated contrast through a peripheral IV line.
2.Timing is crucial; acquire images during the peak contrast
enhancement phase.
3. Assess renal function test (RFT) in patients who will receive
contrast, especially for those at risk of contrast-induced
nephropathy.
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3.Contrast Medium: Use a non-ionic contrast agent.
4. Injection Rate: Adjust injection rate 2.5 ml/sec based on
the type of scanner and patient characteristics.
5. Delay Scanning:
1.Obtain pre-contrast images followed by post-contrast images.
2. Consider acquiring delayed images for specific indications.
6. Slice Thickness and Reconstruction: Similar to NCCT
protocol, with adjustments for optimal contrast-enhanced
imaging.
Post-Processing:
7. Multiplanar Reconstruction (MPR) and 3D
Reconstruction: Utilize MPR and 3D reconstructions for
better visualization of structures.
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Protocol of HRCT thorax:

1. Patient Preparation: Similar to routine CT
scans, patients should wear comfortable clothing
and remove metallic objects or jewelry.
2. Positioning: The patient is usually positioned
supine on the CT scanner table.
3. Breathing Instructions: The patient may be
asked to hold their breath for shorter periods and
breathe normally to capture images at different
lung inflation levels.
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4. Scanning Parameters: Slice Thickness: Typically very thin slices,
often less than 1 mm.
 Tube Voltage (kV): Usually around 120 kV.
 Tube Current 300-400mA
 Gantry Rotation Time: Quick to reduce motion artifacts.
5. Contrast Material (if used): HRCT of the thorax is often performed
without contrast, but in some cases, contrast may be administered as
needed.
6. Scan Range: The scan usually covers the entire lung area with a focus
on lung parenchyma.
7. Image Reconstruction: High-resolution images are reconstructed, and
multiplanar reconstructions are common.
8. Radiation Dose Reduction: Efforts to reduce radiation exposure
should be employed, including low-dose protocols and dose modulation.

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 PATIENT CARE
Patient care for non-contrast CT (NCCT) and contrast-enhanced CT
(CECT) brain:
PRE-PROCEDURE PATIENT CARE:
 Explain the purpose of the CT scan and provide clear instructions to the
patient.
 Discuss any preparation requirements, such as fasting for CECT scans or
removing metal objects from clothing.
 Inform the patient about the use of contrast media in CECT scans, potential
side effects, and any allergies or previous reactions they should report.
2. Screening and Assessment:
 Confirm the patient's medical history, including allergies and any pre-
existing conditions that might affect the scan.
 Verify pregnancy status, as radiation exposure and contrast agents may be
contraindicated during pregnancy.
 Assess renal function test (RFT) in patients who will receive contrast,
especially for those at risk of contrast-induced nephropathy.
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3. Comfort and Reassurance:
Ask the patient about any anxiety before the procedure.
4. Safety Precautions:
 Screen the patient and remove any metal objects or jewelry that could
interfere with imaging and pose a safety risk.
 Establish that the patient is not wearing any clothing with metal
components, like zippers or buttons.
5. Intravenous (IV) Line Insertion (for CECT scans):
 Place an IV line for the administration of contrast media. Ensure that
the IV site is appropriate and secure.
 Explain the IV procedure to the patient and reassure them about
potential discomfort.
6. Contrast Media Administration (for CECT scans):
 Administer contrast media according to the prescribed dose, rate, and
timing.
 Monitor the patient for any immediate adverse reactions to the contrast,
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7. Radiation Safety:
 Minimize radiation exposure should be given to the patient.
 If applicable, provide lead shielding to protect sensitive areas of the
body from radiation.
8. Monitoring and Communication:
 Observe the patient during the scan, maintaining visual and auditory
contact.
 Communicate with the patient throughout the procedure, assuring them
of their progress and the estimated remaining scan time.
9. POST-PROCEDURE CARE:
 After the scan, help the patient off the CT table and ensure their comfort.
 Observe the patient for half an hour for any type of contrast reaction and
then remove the IV line which was inserted for a CECT scan.
 Monitor the patient for any delayed reactions to contrast media, and
provide instructions on post-scan care, such as increased fluid intake
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Topic-6. ABDOMEN AND PELVIS;
INDICATION,
CONTRAINDICATION,
PATIENT PREPARATION,
PROTOCOLS AND PATIENT
CARE.

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