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Utility of CT in Modern Medicine

Posted 01 February 2019

CT SCAN-Revolutionizing the Practice of Medicine

Both the spectrum of clinical application and the role that CT has played in enhancing the depth of our understanding of disease have been profound. We understand that radiation exposure associated with CT scan is a concern for many of our patients, which is why we dedicate ourselves to providing the best and safest care possible.

Western Radiology offers 128-slice and 160-slice CT Machines, powerful CT machines with the lowest radiation settings possible. Our machines allow for significant reduction in radiation as compared to many other scanners in local market.

Anatomy Revealed- Lung Imaging (The Secondary Pulmonary Lobule and Diffuse Lung Disease)

Fundamental to the effective characterisation of diffuse lung disease is the mapping of abnormalities to the apparatus of respiration. Thin section (or high-resolution) CT has the capability to the image secondary pulmonary lobule – the fundamental unit of lung structure. Careful correlation of thin-section CT findings with histological slices has resulted in the development of a system of interpretation centered on pulmonary lobular anatomy.

Current guidelines affirm the central role of HRCT (High Resolution CT Lungs) in making the diagnosis of usual interstitial pneumonia and other interstitial pneumonias. HRCT lungs has replaced surgical biopsy in the diagnosis of many cases of usual interstitial pneumonia.

In addition to the effective assessment of diffuse infiltrative lung disease, the ability of HRCT to assess airway disease has hastened the elimination of bronchography as a diagnostic tool. The appreciation of both anatomic (Bronchiectasis and bronchial wall thickening) and functional (air trapping) consequences of airway disease leads to important insights relating bronchiectasis with small airway disease and to the assessment of airway reactivity and asthma.

Among Symptomatic patients with normal radiographs and equivocal pulmonary function test results, HRCT can reveal emphysema and provide basis a for quantification.

The Lung Nodule Challenge: Isolating a great killer among many imitators

With an estimated prevalence of one in 500 on CXR, the incidental identification of solitary pulmonary nodules (SPN) can be a frequent occurrence at a busy radiology practice. Although benign abnormalities are the most likely cause of SPN, lung cancer manifests as a SPN.

With the advent of spiral CT scan combined with densitometry and volumetric assessment, it is possible to characterize these incidental SPN, with the goal being to diagnose and treat lung cancer at an early stage.

Lung Cancer and Low Dose CT

Lung cancer is one of the leading causes of death globally. In Australia, lung cancer is the most common form of cancer related to mortality. Low-Dose spiral CT scan has established the potential to detect lung cancer at an earlier and more curable stage than had been previously possible.

Low dose techniques can be used to detect early cancers particularly in asymptomatic high-risk adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

Pathophysiology redefined: Contrast-Enhancement Dynamics and Elusive Liver lesions

The liver is a common site for both primary cancer and metastatic cancer, making the accurate detection of liver lesions a critical element in the staging of many neoplasms. With a dual supply from the portal vein and hepatic artery, the source of blood supply to normal and diseased tissue is a complex issue that must be understood and accommodated when developing imaging protocols to accentuate tumors from background hepatic parenchyma.

It is known that the most hepatic neoplasms are derived the blood from the hepatic artery, while portal venous supply is the dominant source for normal hepatic parenchyma.

With improvement in acquisition techniques and CT scanner capabilities, dynamic multi-phasic CT is a valuable tool to assess focal liver lesions.

All-in-one Emergency Diagnosis and Triage for the Acute Abdomen

Acute abdominal pain is common and represents approximately 4-5% of all emergency department admissions. The cause of acute abdominal pain is highly diverse. An accurate diagnostic assessment is critical to identify patients in need of urgent surgical intervention.

There is an increasing reliance on helical CT for the primary diagnosis of virtually all causes of acute abdominal pain with the exception of acute cholecystitis. CT scan is particularly helpful in assessing diverticulitis, bowel obstruction, bowel ischemia, appendicitis, acute pancreatitis and renal colic.

For paediatric patients, the safe and cost-effective approach of performing ultrasound first and CT scan second – in patients with negative or equivocal ultrasound findings – is perhaps of great importance particularly when caring for patients suspected of having appendicitis. While the diagnostic superiority of CT scan over ultrasound in adults is compelling, its relative diagnostic advantage is lesser in children and safety dictates ultrasound be performed first.

Predicting Cancer outcome and Directing Cancer Therapy

Overt the last 40 years, CT scan has emerged as an important tool in effective staging of abdominopelvic neoplasia. Dynamic multiphase CT scan protocol helps in detection and delineation of pancreatic carcinoma. CT has also enabled detection of enlarged retropharyngeal, mediastinal and abdominal pelvic lymph nodes that cannot be palpated.

Over the last 10 years, FDG PET/CT has emerged as the primary tool in lymphoma assessment.

CT scan is an integral part of Radiation therapy planning for cancers.

All-in-One Emergency Diagnosis and Triage for the injured

Injury is the leading cause of death among persons younger than 45 years and accounts for the greatest numbers of years of potential lives lost before 65 years of age.

CT is recognised as a critical tool in trauma care. CT has profound effect on assessment of skeletal injuries, particularly pelvic and spinal injuries and has now replaced countless series of spinal and pelvic radiographs that resulted in failure to diagnose clinically important subtle fractures.

CT Angiogram plays an important role in quick and accurate assessment of not only aortic injuries but also head, neck and peripheral arterial injury.

The most commonly injured organ in blunt abdominal trauma is the spleen. The dynamic contrast enhanced CT, direct visualisation of active arterial extravasation is observed to be a key indicator of the need for surgical splenic repair. The delayed phase images facilitate discrimination of active haemorrhage from contained splenic vascular injury.

CT scan has established role in head trauma, where direct visualisation of intracranial haemorrhage and its localisation has a profound effect on the management of these injuries.

Stroke Visualized Directly

CT is frequently used in assessment of Transient Ischemic attack and intracranial hemorrhage. The helical CT scan has enabled highly accurate assessment of extra and intracranial arterial stenosis, occlusions, dissections, aneurysms, venous anomalies and other neurovascular lesions – largely replacing catheter angiography.