Computed tomography (CT) scan, also known as computerized axial

tomography (CAT), or CT scanning computerized tomography is a

painless, non-invasive diagnostic imaging procedure that produces cross-
sectional images of several types of tissue not clearly seen on a traditional X-
ray.

CT scans may be performed with or without contrast medium. A contrast may

either be an iodine-based or barium-sulfate compound that is taken orally,
rectally, or intravenously which can enhance the visibility of specific tissues,
organs, or blood vessels. The duration of the procedure will depend on the
area being scanned.

The roles and responsibilities of a medical assistant extend throughout the

whole duration of the CT scan procedure — from taking patient’s history,
obtaining informed consent, preparing the patient, and providing education.
To ensure the safety and accuracy of the procedure, learn about the nursing
interventions and concepts behind computed tomography (CT) scan.

Procedure

The protocol and procedures for computed tomography (CT) scan varies per
area but generally, the following steps are followed:

1. The patient is positioned on an adjustable table inside an

encircling body scanner (gantry); straps and pillows may be used
to help in maintaining the correct position.
2. The patient may be instructed to hold his breath during the
scanning.
3. A series of transverse radiographs are taken and recorded
4. The information is reconstructed by a computer and selected
images are photographed.
5. Once the images are reviewed, an I.V. contrast enhancement may
be ordered and additional images are obtained.
6. The patient is assessed carefully for adverse effects to the contrast
medium.
Types

The following are the different types of computed tomography (CT) scans:

Abdominal and pelvic

 CT scan of the abdomen and pelvis combines radiologic and computer
technology to determine the cause of unexplainable abdominal or
pelvic pain and diseases of the bladder, uterus, liver, colon, small bowel, and
other internal organs.

Indication Abnormal Results

 Detects inflammatory process

 Abscesses
 Inspect soft tissue and organs of the abdomen,
 Cysts
pelvis and retroperitoneal space
 Obstructive disease from
 Evaluates trauma
a tumor or calculi
 Helps in the staging of neoplasms
 Primary and metastatic
 Detects edema, hemorrhage, cysts, and tumors
neoplasms
 Measures effectiveness to chemotherapy
Bone and skeletal

Computed tomography (CT) scan of the bone is indicated to provide

information and assess the severity of different bone diseases and conditions
such as fractures, cancer, and infection.

Indication Abnormal Results

 Bone fractures
 Joint
 Identify any joint abnormalities
abnormalities
 Determine abnormalities in the upper and lower spine
 Primary bone
 Detect unsual active bone formation
tumors
 Establish the presence and extent of fractures, ligament, or
 Soft-tissue
tendon injuries, primary bone tumors, skeletal metastases,
tumors
and soft tissue tumors
 Skeletal
metastasis
Brain

Also known as “cranial CT scan” or “Head CT”. It is indicated to provide

detailed information on head injuries, stroke, brain tumors and other diseases
affecting the brain.

Indication Abnormal Results

 Identify intracranial abnormalities and lesions  Arteriovenous

 malformation
 Cerebral atrophy
 Determine focal neurological abnormalities  Cerebral edema
 Guides brain surgery or biopsy of brain tissue  Congenital
 Evaluate suspected head injury such as anomalies
subdural hematoma  Edema
 Monitor the effectiveness of chemotherapy,  Hydrocephalus
radiotherapy, or surgery, as part of the management of  Intracranial tumors
intracranial tumors  Intracranial
hematoma
 Infarction
Cardiac calcium scoring

The goal of a cardiac CT for calcium scoring is to detect coronary artery

disease (CAD) at an early stage in individuals who do not yet have any
symptoms but are at risk for the disease. Calcium Scoring is most often
suggested for males aged 45 years or older, and for females aged 55 and over.

Indication Abnormal Results

 Score of O: No plaque is present.

 Score between 1-10: a minimal amount
of plaque is present.
 Identify presence, and extent of  Score between 11-100: evidence of
calcium buildup in the coronary plaque is present. (Mild or minimal
arteries coronary narrowings).
 Evaluates the risk  Score between 101 and 400: signifies
of atherosclerosis and coronary moderate amount of calcified plaque in
heart disease the arteries (an increased risk of MI)
 Score >400: reveals extensive
calcification and significant narrowing of
the arteries due to plaque
Ear

Indication Abnormal Results

 Diagnose cochlear abnormalities  Cochlear abnormalities

 Investigate ossification of the cochlea  Osseous changes of the external
coils prior to cochlear implantation auditory canal and middle and inner
 Depict osseous changes in the petrous ear structures
and temporal bone  Tympanosclerosis
 Determine the appropriate surgical and
therapeutic method for patients
 with inner and middle ear disorders
 Evaluate postsurgical therapy of
patients with middle and inner ear
disorders
 Differentiate cholesteatoma from
chronic inflammation
 Evaluate the cause of bilateral hearing
loss
In CT scan of the ear, the radiologist is able to diagnose conditions such as
chronic otitis media, ear infections, cholesteatoma, conductive hearing loss,
mastoiditis, and cochlear implants.

Liver and Biliary Tract

CT scan of the liver and biliary tract provides an in-depth information about
the liver, gallbladder, bile ducts, and other related structures.

Indication Abnormal Results

 Biliary duct
dilation
 Calculi
 Focal hepatic
defects
 Differentiate obstructive and nonobstructive jaundice
 Hepatic cysts
 Detect intrahepatic tumors and abscesses, subphrenic and
 Hepatic
subhepatic abscesses, cysts, and hematomas
abscesses
 Neoplasms
 Pancreatic
carcinoma
 Small lesions
Orbital

An orbital CT scan provides detailed information about the eye sockets, eyes,
and adjacent bone structures.

Indication Abnormal Results

 Identify the cause of unilateral  Encapsulated tumors (benign

exophthalmos hemangiomas and meningiomas)
 Assess pathologic conditions of  Early erosion or expansion of the medial
the eye and orbit orbital wall
  Intracranial tumors (gliomas,
meningiomas, and secondary tumors)
 Lymphomas and metastatic carcinomas
 Detect fractures of the orbit and  Space-occupying lesions in the orbit or
adjoining structures paranasal sinuses
 Space-occupying lesions
 Thickening of the medial and lateral rectu
muscles
Pancreas

Indication Abnormal Results

 Acute and chronic

pancreatitis
 Abscesses
 Adenocarcinoma
 Ascites
 Diagnose or evaluate pancreatitis
 Biliary obstructions
 Identify pancreatic carcinoma or pseudocyst
 Cystadenocarcinomas
 Differentiate pancreatic disorders and
 Cystadenomas
retroperitoneum disorders
 Islet cell tumors
 Metastases
 Pancreatic carcinoma
 Pseudocysts
 Pleural effusion
CT scan of the pancreas may be useful to diagnose cancer of the pancreas,
and pancreatitis, and to differentiate pancreatic problems and disorders of the
retroperitoneum.

Renal

A renal scan examines the structural and functional abnormalities of

the kidney. It is indicated to detect tumors, obstructions, and lesions.

Indication Abnormal Results

 Identify and diagnose renal abnormalities, such as calculi,  Abscesses

obstruction, tumor, polycystic disease, congenital  Calculi
anomalies, and abnormal fluid accumulation  Congenital
 Evaluate retroperitoneal pathologies anomalies
 Hematomas
 Kidney infection
 or damage
 Lymphoceles
 Obstructions
 Polycystic kidne
disease
 Renal cell
carcinoma
 Renal cysts or
masses
 Vascular or
adrenal tumors
Spinal

CT scan of the spine is performed to gain insight regarding the vertebrae and
other spinal structures and tissues. It is indicated to detect spinal related
injuries and diseases of the spine.

Indication Abnormal Results

 Spinal lesions and abnormalities

 Cervical spondylosis
 Cervical cord compression
 Congenital spinal malformations
(meningocele, myelocele, and spina bifida
 Degenerative processes and structural
 Diagnose lesions and
changes
abnormalities of the spine
 Facet disorders
 Detect or rule out spinal damage
 Fluid-filled arachnoidal and other
in patients with injury
paraspinal cysts
 Monitor the results of spinal
 Herniated nucleus pulposus
surgery or therapy
 Lumbar stenosis
 Meningioma
 Neurinoma (schwannoma)
 Spinal cord compression
 Spurring of the vertebrae
 Vascular malformations
Thoracic

CT scan of the chest aids in determining the cause of an

unexplained cough, fever, difficulty of breath, chest pain, and other respiratory
symptoms. It is recommended for screening of possible lung cancer in its
early, curable stage.
Indication Abnormal Results

 Diagnose a dissection or leak of an aortic

aneurysm or aortic arch aneurysm
 Diagnose the invasion of a neck mass in the thorax
 Differentiate emphysema or bronchopleural fistula from
a lung abscess
 Distinguish tumors adjacent to the aorta from aortic  Accumulation of
aneurysms fluid, blood, or fat
 Differentiate tumors from calcified lesions  Aortic aneurysms
(signifies tuberculosis)  Cysts
 Detect the mediastinal lymph nodes  Enlarged lymph
 Assess primary malignancy that may metastasize to the nodes
lungs, especially in the patient with a primary bone  Nodules
tumor, soft-tissue sarcoma, or melanoma  Pleural effusion
 Identify the extent of lung diseases such as  Tumors
bronchiectasis, emphysema, and diffuse interstitial lung
disease
 Locate observed neoplasms (e.g., Hodgkin’s disease),
especially with the mediastinal involvement
 Plan radiation therapy
Contraindication

Computed tomography (CT) is contraindicated in:

Pregnant patient (absolute contraindication)


 Patients with a known allergy to iodine
 Patients with claustrophobia
 Patients with renal impairment unless the benefits outweigh the
risks
 Patients with hyperthyroidism or toxic goiter (induce thyrotoxic
crisis)
 Patients with complications after a previous administration of a
contrast
 Patients with severe obesity (usually more than 300 pounds)
Interfering Factors

Retained oral or I.V. contrast material from previous diagnostic


studies may affect the visibility of the images.
 Metal objects including eyeglasses, dentures, jewelry, and hairpins
Nursing Responsibilities for CT Scan
The following are the nursing interventions and nursing care considerations
for a patient undergoing computed tomography:

Before the procedure

The following are the nursing interventions before computed tomography:

 Informed Consent. Obtain an informed consent properly signed.

 Look for allergies. Assess for any history of allergies to iodinated
dye or shellfish if contrast media is to be used.
 Get health history. Ask the patient about any recent illnesses or
other medical conditions and current medications being taken.
The specific type of CT scan determines the need for an oral or
I.V. contrast medium
 Check for NPO status. Instruct the patient to not to eat or drink
for a period amount of time especially if a contrast material will
be used.
 Get dressed up. Instruct the patient to wear comfortable, loose-
fitting clothing during the exam.
 Provide information about the contrast medium. Tell the
patient that a mild transient pain from the needle puncture and a
flushed sensation from an I.V. contrast medium will be
experienced.
 Instruct the patient to remain still. During the examination, tell
the patient to remain still and to immediately report symptoms of
itching, difficulty breathing or swallowing, nausea, vomiting,
dizziness, and headache.
 Inform about the duration of the procedure. Inform the patient
that the procedure takes from five (5) minutes to one (1) hour
depending on the type of CT scan and his ability to relax and
remain still.
After the procedure

The medical assistant should be aware of these post-procedure nursing

interventions after computed tomography (CT) scan:

 Diet as usual. Instruct the patient to resume the usual diet and
activities unless otherwise ordered.
 Encourage the patient to increase fluid intake (if a contrast is
given). This is so to promote excretion of the dye.