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2.0 Clinical Applications of CT

2.1 Trauma

Trauma CT has changed over recent years in response to National Institute for Health and Care Excellence (NICE) and RCR guidelines and with the incorporation of the military protocol for whole body CT. 2  Trauma scanning has improved both in terms of the volume and the value of data produced. Patients benefit from reduced risk due to less time spent in the scan room and faster diagnoses owing to better image quality.

2.2 Diagnosis of diseases and staging of cancer

CT aids the diagnosis and surveillance of many diseases throughout the body including cancer.

2.3  CT use in Nuclear Medicine / PET

CT is currently used in Nuclear Medicine for: 1) supplementing gamma camera images with anatomical information to help confirm aetiology (non-fused); 2) co-registration (fusion) of high quality anatomical information with physiological information produced from SPECT or PET imaging; 3) attenuation correction of SPECT and PET images.

CT image co-registration for SPECT and PET has become standard practice for many examinations, enabling a more accurate diagnosis and more accurate planning of treatment in oncology.  There are also non-oncological uses for gamma camera SPECT/CT e.g. in cardiac and MSK imaging. Fused data attenuation correction, improves image positional and functional data accuracy.

CT in nuclear medicine is further discussed in the professional document entitled Computerised Tomography (CT) scanners in Nuclear Medicine facilities; use by nuclear medicine practitioners from both radiographic and technologist backgrounds.3

2.4 Vascular studies

The use of CT with rapid injection of intravenous contrast agents allows arguably “non-invasive” visualisation of blood vessels. CT is readily available and quick to perform.  Faster tube rotation times in cardiac CT have enabled greater visualisation of the coronary arteries in a beating heart. Coronary computed tomography angiography (CCTA) is now more widely available as a non-invasive tool for the diagnosis of coronary artery disease (CAD).4

Patients may also undergo investigation of the arteries supplying the lungs with CT pulmonary angiography, which helps to identify blood clots known as PEs (pulmonary emboli).

 CT can assist in the diagnosis of acute stroke by excluding haemorrhage as a cause. CT intracranial angiography highlights the blood supply to the brain. It can detect ischaemic stroke and determine the potential benefit of recanalization treatments such as intravenous thrombolysis or intra-arterial clot extraction. Rapid diagnosis and early treatment can have a profound impact on the quality of life a patient experiences following a stroke.

2.5 Intervention

CT guided intervention provides an opportunity for sampling or biopsy of abnormal tissue. It provides guidance in the placement of drains used in the therapeutic treatment of conditions such as infective collections. This enables patients, who may not be fit for conventional surgery, to have access to potentially life- saving treatment.

CT guided fluoroscopy can be used in interventional procedures such as injections, biopsies, drainages and radiofrequency ablations (a treatment using high-frequency electrical currents that create heat to destroy cancer cells).

2.6 Paediatrics

CT is one of several imaging pathways used in the investigation of diseases such as cancer in children.

2.7 CT planning in therapeutic radiography

Therapeutic radiographers use CT simulators to plan radiotherapy treatment.

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