Coronary Calcium Scoring

At my facility we do a large amount of Coronary Calcium Score Exams everyday. This exam is offered to the public as a promotional procedure that the patient self-orders. This exam is used to detect the presence of atherosclerosis. If any calcification is detected by the CT scanner it can indicate the presence of plaque in the vessel. The calcification that is detected by the CT scanner is Calcium Scored by the software to determine the regions that contain calcium. This report is intended to help your physician determine if further cardiac care is needed. A Calcium Score of zero shows no identifiable plaque, 1-10 minimal plaque burden, 11-100 mild plaque burden, 101-400 moderate plaque burden, and over 400 extensive plaque burden. These ranges indicate the likelihood of coronary artery disease. The results of this exam are to be used as a risk assessment test and not to be used as a substitute for examination by a physician.

CTA Chest

CTA Chest is becoming a very common exam. Almost everyone who presents with chest pain or sob gets a CTA Chest rather than a CT Chest w/contrast. CTA Chest exam is done to diagnose a Pulmonary Embolism (PE). A PE is a blood clot in the lung. This blood clot usually originates from somewhere else in the body and moves to the lung where it becomes lodged causing damage. A PE can be caused by immobilization such as stroke, travel (sitting), trauma, surgery, obesity, etc. Pregnancy can also be a leading cause of PE due to an increase in blood clots. The CTA Chest exam diagnoses a PE by injection of contrast at a high rate (4ml/sec.) This injection is then bolus tracked at the pulmonary artery to highlight a PE.

CT

I have been very busy in CT. I am learning so much and I am almost overwhelmed at times. One of my biggest challenges is learning the specific protocols for every doctor and every exam. It can be challenging at times but I am enjoying it very much. I am learning everything from head work, abd./pelvis, chest, extremities, etc. I do not see very much trauma at my facility, but I still see some very interesting cases daily.

Brain Scan

Recently, a women came into the ER with a severe headache. This was her only complaint and this headache was of sudden onset. The doctor ordered a CT head w/o contrast. When checking the images, the technologist who performed the exam noticed an area that looked abnormal in the lower right quadrant of the brain. It was not very noticeable to me, if noticeable at all. This technologist called the radiologist to mention the findings. After looking at the images, the radiologist ordered a CT head w/ contrast. The patient was given contrast and the abnormal area became very bright and noticeable. This patient was diagnosed with a brain tumor. This was a very good observation by the technologist. Because the technologist noticed this abnormality while the patient was still on the table, she did not have to be moved and her diagnoses was not delayed. It was very interesting what a huge difference the contrast made to the exam.

Clinicals

Clinicals have been very busy lately. I am getting lots of experience and learning many different exams. I am getting very used to running the scanner and working independently. I have been able to do exams from start to finish with minimal help. The different protocols in CT are still very hard to learn. Every doctor has a different protocol and every exam has a specific way that it has to be done. I have been seeing lots of extremity work and countless sinuses. I have been enjoying all of it. Recently, I saw an interesting abdomen/pelvis with contrast case. The patient was female in her 60's with several health problems. The patients kidneys did not pick up any contrast during the exam. It seemed strange that the kidneys would be completely void of contrast. I then noticed that the patient had an additional functioning kidney in her RLQ. This kidney was full of contrast and seemed to be the only functioning kidney the patient had. I was unable to find out the specifics of her case. I do not know if the patient just had an extra kidney from birth, or if she had a kidney transplant with her existing kidneys remaining. It was very interesting and I was surprised to see an extra kidney inside a patient.

Stellate Ganglion

I have been doing several pain injections during clinical. In addition to SI joint injections, I have been doing some Stellate Ganglion injections. A Stellate Ganglion Injection is an injection of local anesthetic in the "sympathetic nerve tissue." These nerves are located in the neck, bilaterally around C6-C7. The purpose of these injections are to reduce pain, swelling, and sweating changes in the upper extremity and to improve mobility. These injections are usually done as a series with up to 10 injections per patient. The patient that I have been working with is experiencing pain in her left arm/elbow after her arm was smashed in a car door. This procedure is set up like most pain injections and the local anesthetic is injected directly into the patient’s neck. The patient has to stay very still once we scan the first series of images so that the doctor will be in the correct area. Occasionally the doctor will inject contrast to track the path of the medicine. This procedure looks very uncomfortable and sometimes the patient has to be sedated.

"Whirl Sign"

A woman came in to clinical that presented with severe abdominal pain. She was 43 years old and was 5 years post gastric bypass. Her exam was an abdomen for stone protocol. Her exam was negative for stone but showed a mid-gut volvulus, inflamed bowl, and possible ischemia. The patient’s exam also showed a “whirl sign” that is a characteristic of a gastrointestinal volvulus. The “whirl sign” is a loop of bowl that presents in a whirl or swirl pattern on CT abdominal imaging. A “whirl sign” is usually associated with rotation of the superior mesenteric vein around the superior mesenteric artery or any mesenteric rotation or looping. The radiologist then ordered a dual phase contrast study of the abdomen and pelvis. The “whirl sign” with a gastrointestinal volvulus is a possible side effect of gastric bypass surgery. This problem can present itself 3-5 years post-surgery in some cases.