CT Curriculum Guide

CT Task Force
Doreen Towsley-Cook, Chair
 

Course Description

This unit will provide the student with an overview of computed tomography. Program policies and student responsibilities will be outlined. It includes an introduction to the basics of computed tomography image formation, equipment and terminology. The role of the technologist in maintaining patient safety will be discussed as well as personal safety and safety of coworkers. A brief introduction about imaging parameters and the clinical application of computed tomography is included in this introduction to computed tomography.
 

Course Rationale

This introduction will provide basic knowledge of department policies, terminology, imaging parameters, and safety of the patient in the CT department. This information is useful to enable the student when they begin to observe in the clinical setting to better communicate with the CT imaging staff and to ensure the safety of the patient and co-workers.

Course Objectives

Upon completion of the course, the students will be able to:

1. Use computed tomography terminology correctly.
2. Demonstrate maintenance of a safe work environment.
3. Briefly explain how an image is produced.

I. Introduction - Orientation

A. Hospital tour

1. Radiology tour

2. Hospital orientation

B. Hospital physical examination

C. University registration

D. Policy/procedure manual

1. CPR certification

2. ARRT/Permit to Practice

E. Clinical and didactic manuals

F. Overview of CT department

A. Basic terminology

1. Meaning of computed tomography

2. Componets

a) imaging system

b) computer system

c) display system

B. Brief overview of image formation

C. Historical perspective

D. Digital image processing overview

E. Image manipulation

A. Radiation dose considerations

1. computed tomography dose index (CTDI)

2. multiple scan average dose (MSDA)

3. beam geometry

4. measuring dose

5. reduction of patient dose

6. technologist radiation dose considerations

B. Table weight limits

C. Pregnancy

D. Emergencies in the scanning area

1. code blue

2. fire emergency

3. materials safety data sheets

4. disaster plans

E. Contraindications to patient scanning

A. Protocol selection

1. options (ie: kvp, mAs, slice thickness, feed, matrix, algorithm)

2. raw data

3. indications for contrast media

B. Motion reduction

A. Information gained

B. Pathology demonstrated

C. Basic positioning guidelines

Course Description

This course is designed to provide knowledge about care giving skills specific to patients undergoing computed tomography examinations. The role of the technologist to effectively communicate and maintain patient safety and comfort will be discussed. Patient preparation and monitoring, contrast agents and venipuncture will be studied.

Course Rationale

This introduction will provide knowledge of patient preparation and monitoring. The examinations performed in CT have unique preparations to ensure that an optimal study is obtained. The technologist must be aware of these preparations and modifications to these preps to ensure an optimal study. The patients imaged in the CT department present with a wide variation in physical condition (i.e. trauma, acute care, ventilated) and the technologist must be equipped to perform the examination while monitoring the patients condition. This information is useful to enable the student when they work with patients in the clinical setting to ensure the patient's comfort and safety while providing for a quality examination.

Prerequisites

1. Medical Terminology - course in terminology used in the medical profession
2. Patient Care - basic elements of methods, equipment, psychology, communication and rationale of patient care techniques

1. Demonstrate proper patient assessment and communication.
2. Demonstrate proper screening and preparation of patients for computed tomography examinations including biopsy and interventional procedures.
3. Demonstrate proper venipuncture technique.
4. Demonstrate knowledge of contrast media use and contraindications to its use.
5. Demonstrate knowledge of care of the patient when an adverse reaction to contrast or medication occurs.
6. Monitor patients during procedures including trauma and patients from the intensive care areas.
7. Demonstrate proper post-procedural care of the patient undergoing CT examinations.

Content Outline

I. Patient Communication and Assessment

A. Gaining patient's confidence

B. Techniques to reduce anxiety

A. Information included in explanation

B. Patient history and assessment

1. proper preparation

2. indications for plain film radiography

3. Special considerations (ie:allergies-iodine, latex)

4. pregnancy

5. metallic objects, prosthesis, dentures

C. Patient preparation

1. prior preparation

2. alimentary and gastrointestinal opacifications

a) water soluable contrast

b) barium

3. interventional procedures

D. Venipuncture

1. Common veins for administration

2. Equipment and pharmaceuticals used in department

a) iodine based contrast

(1) ionic and non-ionic contrasts

(2) high osmolar and low osmolar contrast agents

(a) side effects and precautions

(b) dose

(c) effects

(d) anatomy most susceptible

(e) peak opacification time

b) sedations

(1) side effects and precautions

(2) dose

3. Selection and preparation of site

4. Insertion of needle / removal of needle

5. Injection

a) power injectors / other methods

b) extravasation

(1) treatment

c) use of IV pump in place

6. Adverse reactions and treatments

a) contrast media/latex

b) sedations

E. Interventional procedures (biopsy, drain placement)

1. equipment and setup

2. physical assessment

3. monitoring

4. post-care

A. equipment use and monitoring devices

1. pulse oximeter

2. suction

3. IV pumps

4. automated blood pressure device (dynamapp)

B. monitoring of the patient

1. routine

2. sedated or compromised patients

3. with injection of contrast media

4. head and spine injuries

5. pediatric

6. trauma

7. icu / ventilated

A. assessment

1. sedated persons

2. persons having interventional procedures

B. instructions

1. for sedated persons

2. persons having interventional procedures
 

Lippincott Manual of Nursing Practice, 4th Ed.;

Fundamentals of Special Radiographic Procedures, 3rd Ed.; Snopek; "Sedation of Children for CT and MRI Scanning"; Temme, Anderson, Matecko

"Basic Venipuncture Technique", Seven Hills Radiology Video Tape

Clinical Computed Tomography for the Technologist 2nd Edition Chui, Lipcamon, Yui-Chui

Radiographic Contrast Agents 2nd Ed.; Skucas

Phlebotomy Handbook 3rd Ed. Garza, Becan-McBride

Introduction to Computed Tomography Romans

Computed Tomography of the Whole Body Vol 2 Haaga and Alfidi

"Pulse Oximetry-an easy way to check oxygen saturation" Ehrhardt, Graham, Nursing 90 Mar (enclosed)

Seminars in Radiologic Technology "Pharmacology in the Radiologic Sciences" Editors Carlton and Adler

"Percutaneous biopsy of thoracic and vertebral lesions" Kennon Applied Radiology March 1996

"Pharmocology of Sedative Drugs in the Infant and Child"

P and T News "Management of Intravenous Extravasations" Dec 96
 
 

Course Description

This course presents information about data acquisition and processing. The components in the image acquisition system are outlined. The software and the technical parameters used in the acquisition of images is discussed.

Course Rationale

The information in this course is useful to enable the student to maximize image acquisition and image quality by understanding the fundamentals of CT imaging.

Course Objectives

By the end of this course the student will be able to:

1. Describe and discuss the principles of image acquisition.
2. Explain the components of the CT scanner and their operation.
3. Manipulate technical factors to achieve high quality images.
4. Discuss and utilize dose reduction to patients and personnel.
5. Discuss quality assurance measurements in CT imaging.

1. Radiation Physics - Fundamentals of x-ray production and interactions.

Content Outline

I. Computers Technology

A. Review of Computers

B. Digital Image Processing

A. Equipment

B. Software

A. Acquisition Methods

B. Spiral CT

C. Scanogram

D. Technical factors

E. Image Quality/Manipulation

F. Radiation Dose

G. Artifacts

H. Correcting Suboptimal Images

V. Quality Assurance and Equipment Purchase
 

Suggested References:

Computed Tomography: Physical Principles, Clinical Application & Quality Control Seeram, Euclid W.B Saunders 1994

Computed Tomography A Study Guide and Review Seeram, Euclid W.B Saunders 1997

Practical CT: Technology and Technique Berland Raven Press 1987

Principles of Radiographic Imaging Carlton and Adler Delmar 1992

Introduction to Computed Tomography Romans. Lois Williams and Wilkins 1995

Spiral CT Principles, Techniques and Clinical Applications Fishman, Jeffrey ,Jr.

"Physics of spiral CT" Gunderman Applied Radiology March 1996

"Helical CT: Advantages and artifacts" Klinke Applied Radiology March 1996

"Spiral (Helical) CT" Heiken, Brink, Vannier Radiology 1993; 189:647-656

Understanding Helical Scanning Blanck, Cheryl 1998
 
 

Course Description

This course presents information about scanning techniques related to the central nervous system. Anatomy, positioning criteria, specific choices and options in protocols and pathology will be discussed. Variations from routine examinations will be included in this section regarding scanning of the central nervous system.

Course Rationale

This course outlines the critical criteria relevant to the acquisition of high quality images of the central nervous system. Due to individual differences in patients, scanning protocols may vary. This course allows the student to study anatomy in planes, imaging options, pathology and the how these factors effect the image. Evaluation criteria for determining the quality of the images allows technologists a better understanding of what constitutes a high quality image.

Course Objectives

By the end of the course the student will be able to:

1. State the advantages and disadvantages of CT over traditional methods of diagnosing pathology.
2. Describe considerations in designing a scan protocol and state the application of protocols in specific situations.
3. Identify anatomical structures as seen in planes.
4. Describe gross anatomic relationships in the body.
5. Distinguish normal anatomy from abnormal anatomy on CT images.
6. State which structures are best seen in specific planes and discuss rationale for specific anatomy represented in axial, or coronal planes.
7. State tissue densities of anatomical structures with and without contrast.
8. Describe the use of contrast media in evaluation of pathology.
9. Describe common artifacts that occur during imaging.
10. Describe differences in scan protocols between adult and pediatric examinations.
11. Describe criteria for imaging windows for different parts of the body.

1. Introduction to CT - Overview of imaging parameters, terminology, safety issues.
2. Anatomy and Physiology - Anatomy of all body regions.
3. Physical Principles of Computed Tomography - The fundamentals of CT image acquisition and formation. (May be taking place simultaneously with Imaging Procedures)
4. Patient Care for Computed Tomography - Discussion of essential aspects related to patient preparation and monitoring during CT examinations.

I. Anatomy of the CNS and Head

A. Bones of the skull and cranium

1. Skull and cranium

2. Cranial cavity

3. Facial skeleton

4. Paranasal sinuses

B. The Brain

1. Nervous tissue

a) White matter

b) Gray matter

2. Regions of the brain

a) Cerebrum

(1) Gray matter

(a) Cortex

(b) Basal ganglia

(c) Caudate nucleus

(d) Lentiform nucleus

(e) Claustrum

(2) White matter

(a) Internal capsule

(b) External capsule

(c) Corpus callosum

(d) Genu, body, spenium

b) Diencephalon

c) Brainstem

(1) Midbrain

(2) Pons

(3) Medulla oblongata

d) Cerebellum

C. The Ventricle System

D. Meninges

E. Arterial Blood Supply

F. Venous drainage

G. Cranial nerves

H. The Orbital Cavity

1. Orbital muscles

2. Vascular supply

3. Optic Nerve

I. Auditory Canal

J. Endocrine System - Pituitary Gland

A. Cervical vertebrae

B. Thoracic vertebrae

C. Lumbar vertebrae

D. Sacrum

E. Coccyx

F. Intervertebral discs

1. Nucleus pulposus

2. Annulus fibrosus

a) Herniated disc

G. Vertebral column

1. Curvatures

a) Secondary

b) Types

H. Spinal cord

1. Composition

a) White matter

b) Gray matter

2. Conus medullaris

3. Cauda equina

4. Filum terminale

I. Spinal plexus

1. Preparation criteria

2. Positioning criteria

3. Planes / anatomy best demonstrated

4. Technical parameters

a) Computed Tomography Angiography

5. Artifact and motion reduction

6. Windowing

1. Clinical Indications

a) vascular

b) trauma

c) neoplasia / metastasis

d) inflammation

e) anomolies

2. Anatomic Locations

a) head

b) c-spine

c) t-spine

d) l/s spine

e) spinal cord

Course Description

This course presents information about scanning techniques related to the musculoskeletal regions. Anatomy, positioning criteria, specific choices and options in protocols and pathology will be discussed. Variations from routine examinations will be included in this section.

Course Rationale

This course outlines the critical criteria relevant to the acquisition of high quality images of the musculoskeletal regions. Due to individual differences inpatients, scanning protocols may vary. This course allows the student to study anatomy in planes, imaging options, pathology and the how these factors effect the image. Evaluation criteria for determining the quality of the images allows technologists a better understanding of what constitutes a high quality image.

Course Objectives

By the end of the course the student will be able to:

1. State the advantages and disadvantages of CT over traditional methods of diagnosing pathology.
2. Describe considerations in designing a scan protocol and state the application of protocols in specific situations.
3. Identify anatomical structures as seen in planes.
4. Describe gross anatomic relationships in the body.
5. Distinguish normal anatomy from abnormal anatomy on CT images.
6. State which structures are best seen in specific planes and discuss rationale for specific anatomy represented in axial, coronal or sagittal planes.
7. State tissue densities of anatomical structures with and without contrast.
8. Describe the use of contrast media in evaluation of pathology.
9. Describe common artifacts that occur during imaging.
10. Describe differences in scan protocols between adult and pediatric examinations.
11. Describe criteria for imaging windows for different parts of the body.

1. Introduction to CT - Overview of imaging parameters, terminology, safety issues.
2. Anatomy and Physiology - Anatomy of all body regions.
3. Physical Principles of Computed Tomography - The fundamentals of CT image acquisition and formation. (May be taking place simultaneously with Imaging Procedures)
4. Patient Care for Computed Tomography - Discussion of essential aspects related to patient preparation and monitoring during CT examinations.

I. The Upper Extremity

A. Shoulder joint

1. Bony components

2. Ligaments

3. Musculature

B. Upper arm (brachium)

1. Bony components

2. Muscular components

3. Vasculature

4. Innervation

C. Elbow joint

1. Bony components

2. Articulations

3. Ligaments

4. Musculature

5. Vasculature

6. Innervation

D. Cubital Fossa

1. Musculature

2. Fascia

3. Contents

E. Forearm

1. Bony components

2. Muscular components

a) Anterior compartment

b) Posterior compartment

3. Vasculature

4. Innervation

F. Wrist

1. Bony compartments

2. Ligamentous components

3. Tendenous components

4. Vasculature

5. Innervation

G. Hand

1. Bony components

2. Muscular components

3. Vasculature

4. Innervation

A. Hip joint

1. Bony components

2. Ligamentous components

3. Muscular components

4. Vascular components

5. Innervation

B. The Thigh

1. Bony components

2. Muscular components

3. Vasculature

4. Innervation

C. The Knee

1. Bony components

2. Ligamentous components

3. Muscular components

4. Neurovascular components

D. The Leg

1. Bony components

2. Muscular components

3. Vasculature

4. Innervation

E. The Ankle

1. Bony components

2. Ligamentous components

3. Musculotendonous components

4. Neurovascular components

F. The Foot

1. Bony components

2. Muscular components

3. Innervation

4. Vasculature

A. Preparation criteria

B. Positioning criteria

C. Planes / anatomy best demonstrated

D. Technical parameters

E. Artifact and motion reduction

F. Windowing

A. Clinical Indications

1. cortical bone and periosteal reaction

2. trauma

a. shoulder

b. knee

c. pelvis

3. neoplasia / metastasis

4. inflammation / infectious

5. pediatric hip

B. Anatomic Locations
 

1. TMJ

2. shoulder

3. knee

4. wrist

5. hip and pelvis

6. foot and ankle

Course Description

This course presents information about scanning techniques related to the neck, thorax and mediastinum. Anatomy, positioning criteria, specific choices and options in protocols and pathology will be discussed. Variations from routine examinations will be included in this section.

Course Rationale

This course outlines the critical criteria relevant to the acquisition of high quality images of the neck, thorax and mediastinum. Due to individual differences in patients, scanning protocols may vary. This course allows the student to study anatomy in planes, imaging options, pathology and the how these factors affect the image. Evaluation criteria for determining the quality of the images allows technologists a better understanding of what constitutes a high quality image.

Course Objectives

By the end of the course the student will be able to:

1. State the advantages and disadvantages of CT over traditional methods of diagnosing pathology.
2. Describe considerations in designing a scan protocol and state the application of protocols in specific situations.
3. Identify anatomical structures as seen in planes.
4. Describe gross anatomic relationships in the body.
5. Distinquish normal anatomy from abnormal anatomy on CT images.
6. State which structures are best seen in specific planes and discuss rationale for specific anatomy represented in axial, coronal or sagittal planes.
7. State tissue densities of anatomical structures with and without contrast.
8. Describe the use of contrast media in evaluation of pathology.
9. Describe common artifacts that occur during imaging.
10. Describe differences in scan protocols between adult and pediatric examinations.
11. Describe criteria for imaging windows for different parts of the body.

1. Introduction to CT - Overview of imaging parameters, terminology, safety issues.
2. Anatomy and Physiology - Anatomy of all body regions.
3. Physical Principles of Computed Tomography - The fundamentals of CT image acquisition and formation. (May be taking place simultaneously with Imaging Procedures)
4. Patient Care for Computed Tomography - Discussion of essential aspects related to patient preparation and monitoring during CT examinations.

I. The Soft Tissue Neck

A. (Skeletal Components -- see Spine)

B. Tissue organization

1. Suprahyoid

2. Infrahyoid

C. Viscera of the neck

1. Pharynx

2. Rectopharyngeal space

3. Larynx

4. Esophagus

5. Trachea

6. Thyroid gland

7. Salivary glands

a) Parotid

b) Sublingual

c) Submandibular

D. Vascular supply

E. Musculature of the neck

A. Skeletal anatomy of the thorax

1. Sternum

2. Thoracic vertebrae

3. Ribs

B. Thoracic cavity

1. Mediastinum

C. Superficial features of the heart

D. Chambers

E. Vascular supply and drainage

F. The great vessels of the heart

G. Associated thoracic structures

1. Thymus

2. Trachea

3. Azygos veins

H. Lymphatic system

1. Preparation criteria

2. Positioning criteria

3. Planes / anatomy best demonstrated

4. Technical parameters

5. Artifact and motion reduction

6. Windowing

1. Clinical Indications

a) vascular

b) trauma

c) neoplasia / metastasis

d) inflammation / infectious

e) anomolies

f) lymph node enlargement

2. Anatomic Locations

a) soft tissue neck

b) mediastinum

c) heart

d) pericardium

e) lungs

f) pleura
 

Whole Body Computed Tomography 2nd Edition Wegener

Computed Body Tomography Basic Techniques and Principles Fishman and Siegelman

Imaging of Diseases of the Chest 2nd Edition Armstrong, Wilson et al

Clinical Computed Technology for the Technologist 2nd Ed.; Chui, Lipcamon, Yui-Chui

Introduction to Computed Tomography Romans

The Sectional Anatomy Learning System; and Applications Workbook.

"Sectional Anatomy for Radiology Sciences" Digital Tutors Software Program Radke/Falconer)

Spiral CT Principles, Techniques, and Clinical Applications Fishman and Jeffrey, Jr.

Fundamental of Body CT 2^nd Edition Webb, Brant, and Helms

The Neuroradiology Companion Castillo
 
 

Course Description

This course presents information about scanning techniques related to the abdomen and pelvis. Anatomy, positioning criteria, specific choices and options in protocols and pathology will be discussed. Variations from routine examinations is included in this section.

Course Rationale

This course outlines the critical criteria relevant to the acquisition of high quality images of the abdomen and pelvis. Due to individual differences inpatients, scanning protocols may vary. This course allows the student to study anatomy in planes, imaging options, pathology and the how these factors affect the image. Evaluation criteria for determining the quality of the images allows technologists a better understanding of what constitutes a high quality image.

Course Objectives

By the end of the course the student will be able to:

1. State the advantages and disadvantages of CT over traditional methods of diagnosing pathology.
2. Describe considerations in designing a scan protocol and state the application of protocols in specific situations.
3. Identify anatomical structures as seen in planes.
4. Describe gross anatomic relationships in the body.
5. Distinquish normal anatomy from abnormal anatomy on CT images.
6. State structures best seen in specific planes and discuss rationale for specific anatomy represented in axial, coronal or sagittal planes.
7. State tissue densities of anatomical structures with and without contrast.
8. Describe the use of contrast media in evaluation of pathology.
9. Describe common artifacts that occur during imaging.
10. Describe differences in scan protocols between adult and pediatric examinations.
11. Describe criteria for imaging windows for different parts of the body.

1. Introduction to CT - Overview of imaging parameters, terminology, safety issues.
2. Anatomy and Physiology - Anatomy of all body regions.
3. Physical Principles of Computed Tomography - The fundamentals of CT image acquisition and formation. (May be taking place simultaneously with Imaging Procedures)
4. Patient Care for Computed Tomography - Discussion of essential aspects related to patient preparation and monitoring during CT examinations.

I. The Abdomen

A. Abdominal regions

B. Diaphragm

1. Structure

2. Openings

C. Abdominal musculature

D. Abdominal peritoneum

1. Mesentery

2. Peritoneal elements

E. Peritoneal Cul-De-Sacs

F. Abdominal vasculature

G. Venous draingage of the abdomen

H. Hepatic portal system

I. Abdominal viscera

1. Liver

a) Lobes

b) Vasculature

2. Gallbladder

3. Esophagus

4. Stomach

a) Vasculature

b) Divisions

5. Small intestine

6. Large intestine

7. Spleen

8. Pancreas

a) Vascular landmarks

b) Divisions

c) Blood Supply

9. Kidneys

10. Suprarenal gland

A. Pelvic cavity

B. Bony pelvis

C. Pelvic musculature

D. Innervation

E. Pelvic viscera

1. Gastrointestinal organs

2. Urinary organs

F. Viscera of female pelvis

1. Peritoneal folds

2. Ligaments

3. Ovaries

4. Uterus

5. Uterine tubes

6. Cervix

7. Vagina

G. External genitalia and related perineum

1. Regions

a) Anal

b) Genital

2. Female external genitalia

3. Male external genitalia

H. Musculature

I. Reproductive organs of the male pelvis

1. Preparation criteria

2. Positioning criteria

3. Planes / anatomy best demonstrated

4. Technical parameters

5. Artifact and motion reduction

6. Windowing

1. Clinical Indications

a) vascular

b) trauma

c) neoplasia / metastasis

d) inflammation

e) anomolies

2. Anatomic Locations

a) abdomen

(1) liver

(2) pancreas

(3) vessels

(4) spleen

(5) kidneys

b) pelvis

(1) reproductive organs

(2) urinary organs

Course Description

This course presents information about techniques using electron beam CT technology, 3D and physiological imaging reconstruction strategies, radiation therapy and radiosurgical planning strategies. Included are the rationale, theory, specific choices and options in protocols as these relate to pathology and imaging.

Course Rationale

This course outlines the critical criteria relevant to the acquisition and production of high quality image production using electron beam technology, physiologic imaging strategies, radiation therapy and radiosurgical planning strategies. Evaluation criteria for determining the quality of the images allows technologists a better understanding of what constitutes a high quality image.

Course Objectives

By the end of the course the student will be able to:

1. State the advantages and disadvantages of electron beam CT technology over traditional methods of CT scanning.
2. Describe considerations in designing a scan protocol and state the application of protocols in specific situations.
3. Discuss pathology especially well diagnosed using electron beam CT technology.
4. Participate in scanning using the electron beam CT scanner.
5. Describe physiologic imaging and strategies in 3D image generation.
6. Participate in 3D image generation.
7. Discuss radiosurgical planning and CT protocols in radiosurgical planning.
8. Participate in radiation therapy planning.

1. Physical Principles of Computed Tomography - The fundamentals of CT image acquisition and formation.

Content Outline

I. Electron Beam CT Technology

A. Basic Principles

1. historical perspective

2. electron beam technology

3. mechanical motion

4. acquisition geometry

a) tube

b) target rings

c) collimation

d) detectors

e) DAS

f) reconstruction

g) storage

B. Technical Considerations

1. dose

2. positioning and couch movements

3. scanner modes

a) volume, movie, flow

4. ECG trigger

5. contrast administration

6. scanning planes

C. Applications

1. conventional scanning

2. cardiac edge detection and border definition

3. cardiac structure and function

4. coronary calcification

5. bypass graft patency

6. LV function

7. other

A. Clinical Applications

1. neuroimaging and neurosurgery planning

2. maxillofacial imaging

3. tumor response to treatment

4. radiation treatment planning

5. orthopedic surgery

6. cardiac imaging

7. lung volume studies

8. airway

B. Volume data acquisitions

1. Terminology

2. Technical parameters

a) Scan parameters

b) Circulation times

c) Design of IV bolus of contrast for CTA.

(1) injection rate, injection duration, delay between injection start and start of data acquisition

(2) parameters for spiral CT acquisition timed to occur while the target vasculature is maximally opacified

(a) scan duration, collimation, table speed

3. Artifacts on CT images.

4. Reduce or eliminate motion.

C. Computer requirements for 3D image reconstruction.

1. workstation

a) instrumentation and operation

b) software

2. image storage

3. memory

D. Data transfer requirements

1. networking

E. Image processing

1. algebraic

2. histogram

3. filter

F. Display

1. requirements

2. options

3. windowing

4. optimizing

G. Image generation and display

1. multiplanar reformatting

2. oblique sectioning

3. curved sectioning

H. 3D Image generation and display

1. surface rendering

2. volume rendering

a) MIP

b) voxel summation

c) surface projection

d) shading computations

I. Image measurement/quantitization

1. ROI

J. Applications

1. Software

2. Clinical applications

A. Stereotactic surgery and CT guidance systems

1. Stereotactic surgery

2. Hardware

3. Procedure

4. Advantages and disadvantages

B. CT Simulation

1. Components

2. Uses

3. Positioning and data acquisition

4. Treatment planning

5. Terminology

3D Imaging in Medicine Udupa and Herman

Three-Dimensional Biomedical Imaging Robb

Ultrafast Computed Tomography in Cardiac Imaging: Principles and Practice Stanford and Rumberger

Computed Tomography Physical Principles, Clinical Applications and Quality Control Seerum

Ultrafast CT--Users Guide

"Volumetric 3-D Imaging of Computerized Tomography Scans" Offutt, Vannier, Gilila et al Radiologic Technology Vol. 61/3 1990

"Current applications and techniques for computed tomographic angiography" Wallace Applied Radiology March 1996

CT Simulation for Radiotherapy Jani Medical Physics Publishing Co. 1993

Computed Tomography of the Whole Body Haaga and Alfidi Vol. 2

"Virtual reality imaging: New techniques in diagnostic imaging" Dunco Applied Radiology March 1996

CT Simulation for Radiotherapy Jani Medical Physics Publisher 1993

Progress in Clinical Radiology Part 1, 2,3 Katzberg-editor Investigative Radiology Vol 29, No. 4, 5,7

"Tool Box Cardiac Volumes: Visualization and Quantitization by Computed Tomography" Hoffman, Hoford American Journal of Cardiac Imaging Vol 7, No3 1993
 
 

Fellowship in Computed is based on a "competency" approach. The skills and abilities of the students must meet predetermined expectancies stated in the form of objectives before they will be allowed to receive a certificate of completion. Objectives are stated in both the clinical and didactic portions of the program, which ensures that students are able to perform in all facets of CT at competent levels before entering into their careers in the allied health profession.

Before receiving a periodic grade based on the semester, the student must meet the levels of competency specific to that exam, as stated in the objectives listed.

To evaluate the clinical performance of the student to determine their level of competency necessitates the use of multiple methods of evaluation. The following list of methods and their definitions will be used in accordance with the Clinical Competency Evaluation Form as a standard with which to determine the competency level of the student in the clinic.

A. Laboratory - The student will witness examinations conducted by the staff technologists.

B. Observation - The student will be observed by a staff technologist and/or the clinical instructor during each CT examination prior to competency completion.

C. Image Analysis - The staff CT technologist will evaluate the performance of a student by reviewing a finished exam performed by that student.

D. Competency - When the student has successfully completed the didactic portions of an exam and believes they can competently perform the exam, they will ask a staff technologist to observe that exam for competency. If the student has to repeat the competency, it must be repeated on a different day. After demonstrating competency, the student may perform exams under indirect supervision.
 
 

EXPLANATION

Clinical competency tests are a method of verification of accuracy in scanning skillsroutinely performed during CT exams for all parts of the human anatomy. These tests are performed on patients in the radiology department. This method of verification is in the form of a checklist. Other competency examinations involve the use of equipment.
 

INSTRUCTIONS

Each student will be given one form for each examination at the beginning of the

program. After formal instruction and adequate practice, including two signatures

by staff technologist indicating that the student has been observed correctly doing the exam, when the student feels able to pass the clinical competency examination he/she will notify the staff technologist. The exam is then performed under direct supervision of the staff technologist who grades the student's performance at that time on the competency checklist. The student must be able to provide a form at the time of the clinical competency test.
 
 

Poor = 1

Average = 2

Great = 3
 

Preliminary Preparation:

1 2 3 ____ Properly evaluate the requisition

1 2 3 ____ Demonstrate room readiness

1 2 3 ____ Properly enter the patients name, hospital number, gender, age into the machine

1 2 3 ____ Utilize knowledge of proper patient preparation

Patient Care and Handling:

1 2 3 ____ Demonstrate professionalism

1 2 3 ____ Identify the correct patient and check the name band (if applicable)

1 2 3 ____ Introduce yourself to the patient

1 2 3 ____ Obtain history and provide explanation

1 2 3 ____ Prepare and inject contrast (as required)

Scanning Techniques:

1 2 3 ____ Utilizes knowledge of proper patient positioning

1 2 3 ____ Demonstrates proper centering of patient

1 2 3 ____ Demonstrate scanning of the entire anatomy in required sections

1 2 3 ____ Utilizes equipment controls to obtain the best possible image

1 2 3 ____ Utilizes protocols and adjustments to protocols to obtain the scan

1 2 3 ____ Demonstrate pathology and its relationship to normal structures

1 2 3 ____ Demonstrate knowledge of steps required if pathology is present.

1 2 3 ____ Demonstrate speed and accuracy in scanning technique

Post-Imaging and Filming

1 2 3 ____ Demonstrates proper image labeling

1 2 3 ____ Produce images of optimum technical quality

1 2 3 ____ Choose window that best demonstrates anatomy and pathology

1 2 3____ Archives images. Records data in logbook as required

1 2 3 ____ Properly dismisses patient and gives post exam instructions

___Pass

___Repeat

_________________________     ___________________

Signature of Staff Technologist         Date
 
 

I. Clinical Evaluation

A. Clinical History

Student must be able to:

1. Correlate clinical history to the requested exam.

2. Correlate reported physical exam findings to the requested exam.

3. Correlate history to ensure proper safety precautions.

4. Monitor the patient to ensure no unnecessary metals enter the scan room.

A. Requisition evaluation

Student must be able to:

1. Identify procedure to be followed for requested exam.

2. Identify the reason for the requested exam.

B. Patient Identification

Student must be able to:

1. Enter patient name and hospital number into equipment

2. Enter patient gender, age and weight into equipment

C. Room Readiness

Student must be able to:

1. Prepare clean, comfortable environment

2. Demonstrate proper precautions in the prevention of disease transmission.

3. Have the necessary accessory equipment available.

4. Monitor the linen and supplies, and restock when necessary.

5. Have the machine ready for the patient, to include:

a. Machine is turned on.

b. Correct protocol for the required scan.

c. Selection of appropriate accessory devices

D. Patient Preparation

Student must be able to:

1. Demonstrate knowledge of proper patient preparation required for requested exam.

2. Demonstrate knowledge of action required if the patient requires contrast media.

3. Demonstrate knowledge of action required if the patient requires sedation.

Student must be able to:

1. Select the correct patient and check the nameband if inpatient. Have patient

repeat their name if outpatient.

2. Introduce yourself to the patient using Mr. or Ms. and patient's last name.

3. Question and record any relevant patient history for the exam.

4. Explain in layman's terms to the patient a brief summary of the nature of the exam.

5. Speak with the patient in a professional manner to alleviate any fears expressed by the patient.

6. Demonstrate empathy when confronting the concerns of the patient.

7. Demonstrate professional ethics by preserving the patient's modesty.

8. Assist the patient into the examining room.

9. Demonstrate the ability to gain as much patient cooperation as possible when giving proper instructions to the patient during the examination.

10. Demonstrate a responsibility for the safety and welfare of the patient.

A. Patient Positioning

Student must be able to:

1. Position the patient correctly on the table.

2. Demonstrate the proper patient positions required for the requested exam.

3. Demonstrate proper position variations and technical adjustments necessary for an optimum image due to variations in body habutis.

4. Demonstate proper centering of patient to gantry and x-ray tube..

B. Equipment Utilization

Student must be able to:

1. Select the appropriate accessories for the exam.

2. Select monitoring devices as required by patient condition.

C. Scanning Skills

Student must be able to:

1. Select proper protocols for producing optimal images.

2. Select proper region to scan.

3. Select proper views for a particular exam.

4. Modify protocols as required to produce optimal images.

5. Produce optimal images through entire region of interest in proper planes.

D. Pathology

Student must be able to:

1. Identify pathology.

2. Utilize additional steps required if pathology is identified.

A. Correct Windows

Student must be able to:

1. Demonstrate the ability to recognize and record the proper windows for a particular exam.

B. Labeling

Student must be able to:

1. Demonstrate the ability to correctly label images as required.

C. Technical Quality

Student must be able to:

1. Demonstrate the correct use of the imaging windows in the display of the finished image.

2. Demonstrate proper image recording and processing procedures.

3. Identify images of acceptable and unacceptable technical quality.

1. Demonstrate the ability to obtain all measurements required for the requested exam.

2. Demonstrate knowledge of abnormal size of structures.

1. Demonstrate ability to work with and without supervision.

2. Demonstrate ability to work and maintain schedule flow.

3. Demonstrate an awareness of the cost of the exam by keeping department costs and patient charges at a feasible minimum without sacrificing the quality of the exam.

4. Perform the exam in a competent fashion within the specified amount of time.

5. Demonstrate flexibility when adjusting technical factors to obtain optimal images.

6. Demonstrate the ability to discriminate between satisfactory CT scans and unsatisfactory scans for image recording.

7. Complete all paper work required for an exam in order to maintain correct hospital records.

8. Archive images as required.

1. Recognize and display all pertinent anatomy relating to the prescribed examination.

2. Recognize and demonstrate abnormal anatomical conditions.

A. Oral
Student must be able to:

1. Display the CT images in an organized manner for the radiologist to view.

2. Using CT terminology, describe the exam identifying all structures pertinent to the exam as demonstrated on the images.

3. Emphasize any pathology which was identified.

4. Note any areas which could not be evaluated well.

Explanation

Clinical objectives are a way of evaluating the students progress through the educational program. They are designed to evaluate the student's technical knowledge of the equipment, clinical knowledge and skills, and broaden their understanding of extra departmental areas. The clinical objectives give deadlines for clinical competency assignments, both signatures and completion of competencies. These deadlines assure that the student progresses at an acceptable rate.
 

Instructions

Each student will be given one form for each clinical objective at the beginning of the program. At the end of the specified objective period (noted at the top of each objective form), the student is required to turn in an objective progress check. For each objective the student has not completed satisfactory points will be deducted. See Clinical Evaluation section of this notebook for grading scale and procedures for missed objectives. The student must turn in progress check at the end of the clinical objective time period.
 
 

A. First Semester

B. Second Semester

Name___________________________ Date ___________Evaluator______________

The patient care rotation for computed tomography students will be one week in length. The rotation will consist of supervised observation and demonstration of patient care routines within the radiology department. At the end of the rotation the student will be required to demonstrate knowledge gained through the week by taking a short quiz.

Goal:

The patient care rotation is designed to build on the skills the radiographer has acquired during their radiography program. It is designed to enhance the team approach to patient care and to build an understanding of goals of the nursing service in regard to facilitating and maintaining appropriate patient care. The rotation is designed to allow a hands-on approach and an opportunity to increase patient care skills and practice rapport building. The students should feel free to ask questions, observe until comfortable to offer assistance, and take initiative to perform skills under observation of the nurse.

Patient Care Rotation Objectives

Following the completion of this rotation, the student radiographer should:

1. Appreciate and identify specialized standards of care for procedures in the radiology department.

2. Demonstrate appropriate procedures for charting patient information.

3. Assess patients before, during, and after patient procedures.

4. Prepare patients for exams (CT, epidural, angiography).

5. Assist in the event of a contrast reaction.

6. Assist in care of patients utilizing pumps, Hickman lines, O2, etc.

7. Demonstrate increasing awareness of patients' needs in the radiology department.

8. Demonstrate proper venipuncture technique. (must complete course work first)

9. Discuss drainage systems (foley catheter system, chest tubes, colostomy, nephrostomy tubes, etc).

10. Demonstrate EKG setup and monitoring.

11. Discuss appropriate use of emergency medications and medication for contrast reactions and sedative purposes.

12. Demonstrate use of pulse oximeter and dynamapp blood pressure device.

13. Recognize terminology associated with the care of patients in the radiology department.

14. Locate crash cart, defribrillator and emergency medications. Discuss how to call a code blue.

15. Demonstrate therapeutic communication techniques with patients in the clinical setting.

LOC

SaO2

P, R, BP

Standard of Care

PO

anaphylaxis

diaphoresis

hypotension

lethargy

ad lib

TID

D.C.

I & O

IM

p.c.

p.r.n.

q.h.

SQ

TPR

q. 15 minutes

ABG

AMA

BID

BR

BRP

PTT

N/V

PT

NKA

DX

CVN

CIRC

CR

BUN

BX

C&S
 

 
 
 
 

SAMPLE CLINICAL OBJECTIVES FOR FIRST SEMESTER

WEEK 2

Name___________________________ Date ___________Evaluator______________

Complete the following objectives at the end of the rotation.

___ 1. Demonstrate (simulate) how to call for a fire/ code.

___ 2. Identify location of disaster manuals and MSDS.

___ a.

___ b.

___ c.

___ d.

___ 4. Demonstrate knowledge of the location and proper use of the patient pull-cord.

___ 5. Prepare the oxygen tubing system and suction system for use.

___ 6. Prepare and use patient monitoring equipment correctly.

___ 7. Explain the paging system and physician notification for on-line reading.

___ a.

___ b.

___ c.

___ 10. Demonstrate how to send "in" and "out" patients away.

___ 11. Demonstrate proper body mechanics when assisting with patients.

12. Demonstrate how to operate the laser imager.

___ a. loading film

___ b. format changes

14. Demonstrate how to type in patient data.

15. Demonstrate how to record images for specific exams.

16. Demonstrate how to view images and type labeling.

17. Demonstrate and discuss patient preparation.

___ a. Prep instructions

___ b. Contrast information

___ c. Contrast administration (IV and GI)

___ d. Complications and contraindications to oral and intravenous contrast

___ e. Mixing of oral and rectal contrast agents

___ f. Use of ionic and non-ionic IV agents

___ g. Treatment of any adverse situation

___ a. Prepare room and equipment for the examination.

___ 1. Demonstrate use of control buttons on gantry.

___ 2. Select appropriate holder for exam.

___ 3. Demonstrate how to change holder on the machine.

___ 4. Demonstrate how to select the appropriate protocol.

___ b. Explain to the patient the nature of the examination and obtain a history

___ c. Record any pertinent data from the patient relative to the requested examination

___ d. Remove artifacts from areas of interest.

___ e. Bring patient into the scan room and ensure patient comfort

___ f. Complete paperwork and deliver patient and film to appropriate areas.

___ a. patient identification

___ b. scan numbering

___ c. pertinent technical information

___ a. schedules

___ b. requisition and fog cards completed

___ c. films/film check-out

____ 22. Discuss keyboard functions from orientation checklist and explain their use.
 
 

Name___________________________ Date ___________Evaluator______________

Complete the following objectives by the end of the rotation.

1. Be responsible for all previous objectives.

___ a.

___ b.

___ c.

___ a. Prepare room and equipment for the examination.

___ 1. Demonstrate use of control buttons on gantry.

___ 2. Select appropriate holder for exam.

___ 3. Demonstrate how to change holder on the machine.

___ 4. Demonstrate how to select the appropriate protocol.

___ 5. Calibrate scanner as required prior to scanning.

___ b. Explain to the patient the nature of the examination and obtain a history

___ c. Record any pertinent data from the patient relative to the requested examination

___ d. Remove artifacts from areas of interest.

___ e. Bring patient into the scan room and ensure patient comfort.

___ f. Inject contrast media and monitor patient for signs of adverse situation.

___ g. Complete paperwork and deliver patient and film to appropriate areas.

___ a. patient identification

___ b. scan numbering

___ c. pertinent technical information

___ d. anatomy and pathology

___ a. field of view

___ b. feed/feed direction

___ c. slice thickness

___ d. number of projections

___ e. kVp/mA/seconds

___ f. center

___ g. resolution

___ h. algorithm/kernel

___ i. matrix

___ j. zoom

___ a. brain

___ b. spine

___ c. coronal sinus/sella/maxillofacial

___ d. temporal bones/IAC

___ e. abdomen/pelvis

___ a. brain

___ b. spine

___ c. coronal sinus/sella/maxillofacial

___ d. temporal bones/IAC

___ e. abdomen/pelvis

___ 8. Describe the following equipment and supplies.

___ a. Franseen

___ b. Westcott

___ c. Chiba

___ d. Turner

___ e. Spinal

___ f. Ring-McLean sump drainage kit

___ g. Van Sonenberg sump kit

___ h. Sack one step fluid drain kit

___ i. aerobic and anaerobic culture tubes

Perform and observe as many examinations as possible!
 
 

Name____________________________Date_____________Evaluator_______

Complete the following objectives at the end of the rotation.

1. Explain the following clinical applications of 3-D images.

a) neuroimaging and neurosurgery planning

b) tumor response to treatment

c) radiation treatment planning

d) orthopedic surgery

e) cardiac imaging

f) lung volume

a) thorax

b) abdomen

c) kidney

d) carotid birfurcation

e) circle of Willis

f) portography

4. Given requisitions, determine specific area of interest and changes in protocols to achieve best demonstration of anatomy in 2D acquisition.

5. Describe the design of IV bolus of contrast.

a) (injection rate, injection duration, delay between injection and start of data acquisition)

a) scan duration, table speed, collimation

8. Describe source and action required to eliminate or reduce artifact.

9. Describe methods to reduce or eliminate motion.

a) further instructions to patient

b) immobilization

c) reduce scan time

11. Explain how to retrieve and load data into the workstation.

12. Explain searching, deleting, viewing, filming and archiving on the specific workstation to which you are assigned.

13. Discuss the role of image processing programs.

14. Explain the requirements for displaying images to be used by the physiologic imaging group.

a) bit requirements

b) windowing

c) pixel requirements

16. Explain how a clear, unrestricted view of important features in the 2-D image allow better 3-D images.

17. Explain the techniques for visualization of 3-D images.

a) surface rendering

b) volume rendering

a) MIP

b) voxel summation

c) surface projection

a) depth shading

b) depth gradient shading

c) voxel gradient shading

21. Describe types of measurements and their applications.

22. Explain region of interest measurements and their applications.

23. Explain stereological measurement techniques

24. Explain measurements in the frequency domain.

25. Demonstrate knowledge of these functions using available software.

a) visualizing image data

b) analyzing images

c) file manipulation

d) loading data

e) display

f) managing shared memory