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CT Scan Introduction

History

CT was discovered independently by a British engineer named Sir Godfrey Hounsfield and Dr.
Alan Cormack. It has become a mainstay for diagnosing medical diseases. For their work,
Hounsfield and Cormack were jointly awarded the Nobel Prize in 1979.

CT scanners first began to be installed in 1974. Currently, 6,000 scanners are in use in the United
States. Because of advances in computer technology, CT scanners have vastly improved patient
comfort because they are now much faster. These improvements have also led to higher-
resolution images, which improve the diagnostic capabilities of the test. For example, the CT
scan can show doctors small nodules or tumors, which they cannot see on an x-ray.

Introduction

• CT or CAT scans are special x-ray tests that produce cross-sectional images of the body
using x-rays and a computer. These images allow the radiologist, a medical doctor who
specializes in images of the body, to look at the inside of the body just as you would look
at the inside of a loaf of bread by slicing it. This type of special x-ray, in a sense, takes
"pictures" of slices of the body so doctors can look right at the area of interest. CT scans
are frequently used to evaluate the brain, neck, spine, chest, abdomen, pelvis, and sinuses.

• CT has become a commonly performed procedure. Scanners are found not only in
hospital x-ray departments, but also in outpatient offices.

• CT has revolutionized medicine because it allows doctors to see diseases that, in the past,
could often only be found at surgery or at autopsy. CT is noninvasive, safe, and well-
tolerated. It provides a highly detailed look at many different parts of the body.

• If you are looking at a standard x-ray image or radiograph (such as a chest x-ray), it
appears as if you are looking through the body. CT and MRI are similar to each other, but
provide a different view of the body than an x-ray does. CT and MRI produce cross-
sectional images that appear to open the body up, allowing the doctor to look at it from
the inside. MRI uses a magnetic field and radio waves to produce images, while CT uses
x-rays to produce images. Plain x-rays are an inexpensive, quick exam and are accurate at
diagnosing things such as pneumonia, arthritis, and fractures. CT and MRI better evaluate
soft tissues such as the brain, liver, and abdominal organs, as well as look for subtle
abnormalities that may not be apparent on regular x-rays.

• People often have CT scans to further look at an abnormality seen on another test such as
an x-ray or an ultrasound. They may also have a CT to check for specific symptoms such
as pain or dizziness. People with cancer may have a CT to look for the spread of disease.
• A head or brain CT examines the various structures of the brain to look for a mass,
stroke, area of bleeding, or blood vessel abnormality. It is also sometimes used to look at
the skull.

• A neck CT checks the soft tissues of the neck and is frequently used to study a lump or
mass in the neck or to look for enlarged lymph nodes or glands.

• CT of the chest is frequently used to further study an abnormality on a plain chest x-ray.
It is also often used to look for enlarged lymph nodes.

• Abdominal and pelvic CT looks at the abdominal and pelvic organs (such as the liver,
spleen, kidneys, pancreas, and adrenal glands) and the gastrointestinal tract. These studies
are often ordered to check for a cause of pain and sometimes to follow up on an
abnormality seen on another test such as an ultrasound.

• A sinus CT exam is used to both diagnose sinus disease and to look for a narrowing or
obstruction in the sinus drainage pathway.

• A spine CT test is most commonly used to look for a herniated disc or narrowing of the
spinal canal (spinal stenosis) in people with neck, arm, back, and/or leg pain. It is also
used to look for a fracture or break in the spine.

Risks

CT is a very low-risk procedure.

• You will be exposed to radiation when undergoing a CT. However, it is a safe level.

• The biggest potential risk is if you need to get a contrast (also called dye) injection. This
can help distinguish normal tissues from abnormal tissues. It also helps to distinguish
blood vessels from other structures such as lymph nodes.

• Like any medication, some people can have a bad reaction to the contrast. The chance of
a fatal reaction to the contrast is about 1 in 100,000. Those at increased risk may require
special pretreatment and should have the test in a hospital setting. Anyone who has had a
prior contrast reaction or severe allergic reaction to other medications, has asthma or
emphysema, or has severe heart disease is at increased risk for a contrast reaction and is
referred to a hospital x-ray department for the exam.

• Any time an injection is done into a vein, there is a risk of the contrast leaking outside of
the vein under the skin. If a large amount of contrast leaks under the skin, in rare cases,
this can cause the skin to break down

CT Scan Preparation
If you are to have a contrast injection, you should not have anything to eat or drink for a few
hours before your CT scan because the injection may cause stomach upset. To receive the
contrast injection, an IV is inserted into your arm just prior to the scan. The contrast then enters
your body through the IV.

Prior to most CT scans of the abdomen and pelvis, it is important to drink an oral contrast agent
that contains dilute barium. This contrast agent helps the radiologist identify the gastrointestinal
tract (stomach, small and large bowel), detect abnormalities of these organs, and to separate
these structures from other structures within the abdomen. You will be asked to drink slightly
less than a quart spread out over 1.5-2 hours.

During the Procedure

Most CT scans are conducted as an outpatient procedure. You have the test and then go home.

• The CT scanner looks like a large donut with a narrow table in the middle. Unlike MRI,
in which you would be placed inside the tunnel of the scanner, when undergoing a CT,
you rarely experience claustrophobia because of the openness of the doughnut shape of
the scanner. Typically you lie on your back on the table, which moves through the center
of the machine. You move through the scanner either head first or feet first, depending on
the part of the body being scanned. For certain scans such as sinuses and middle ear, you
would lie on your stomach and go through head first.

• You must remain motionless for the length of the study, which is typically just a few
minutes. The entire procedure, which includes set-up, the scan itself, checking the
pictures, and removing the IV if needed, takes 15-45 minutes depending on what part of
the body is being scanned.

o For some studies, you will be asked to hold your breath for up to 20 seconds.

o No metal may be worn.

o What clothing you wear depends on the nature of the study. For a CT of the chest,
abdomen, or pelvis, for example, usually you will change into a hospital gown.
For a head CT, you can wear normal street clothes.

o Sedation is rarely necessary. The machine is quiet, so all you hear during the test
is a quiet whirr.

o The technologist is in the next room and can observe you through a large window.

After the Procedure

If you received a contrast injection, the IV is removed from your arm before you go home. There
should be no effects from the scan or the contrast injection. In the rare circumstance that you
received sedation, you will be sent home once you are awake and alert. Someone will have to
drive you home.
Next Steps

Your CT scan is interpreted by a radiologist, a medical doctor trained to interpret various x-ray
studies. The results are sent to your doctor. How soon your doctor receives the report depends on
the imaging center where the study is performed.

When to Seek Medical Care

The reaction to the contrast is almost always immediate, so it is very rare to have a reaction after
you leave the facility. However, if you think you are having a delayed reaction to the contrast,
call the facility where you had the exam.

Symptoms include itching and difficulty breathing or swallowing. If contrast leaked under the
skin, you should look for increased redness, swelling, or pain. You will often be asked to come
back the next day so your skin can be checked. There are no side effects to the exam itself.

Multimedia

Media file 1:A CT scan of the neck.

Media type: CT

Media file 3:CT scan machine.

Media type: Photo


Synonyms and Keywords

CAT scan, computed tomography, computerized tomography, CT scanner, CT scan

References

1. Dach J.CAT SCAN: Computerized axial tomography.Medexpert.net.Available at


http://www.karlloren.com/ultrasound/p44.htm.Accessed February 1, 1998.

2. Imaginis.Computed tomography imaging (CT scan, CAT scan).Imaginis.com.Available at


http://www.imaginis.com/ct-scan/.Accessed January 27, 2000.

3. Patient Education Institute. X-Plain online.Medlineplus.

Authors and Editors

Author:Lawrence M Davis, MD, Assistant Professor of Diagnostic Imaging (Clinical),


Department of Diagnostic Imaging, Brown Medical School.

Coauthor(s): Lisa Davis, MA, Medical Writer, eMedicine.com, Inc.

Editors:Steven C Gabaeff, MD, FAAEM, Attending Physician, Emergency Medicine, Sutter


Amador Hospital, Jackson, CA; Expert Consultant, Medical Board of California, Sacramento,
CA; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; James S Cohen,
MD, Consulting Staff, James Cohen, PC.