CT Clinicals Update

I had no idea I would have something for everyone so soon! We had an interesting case that I got to follow through on beginning with the planning of the patient with the Radiologist's portion of the exam to the CT exam at the end. This patient was in the ICU and intubated and a request came down for a cervical myelogram. Most Radiologists perform their lumbar punctures with the patient prone so he wanted to have some senior tech involvement and the Team Leader for the area was off. So, I assisted. Below is a brief case study of the patient:


We received a 61 y/o male through the emergency room for a CT cervical spine among everything else ordered. He was alert and orientated and was responding to questions. However, he had tingling sensation to the nipple line, but was unable to feel anything from that point down. He suffered a 4 foot fall from a truck bed.

The exam was performed and it was noted that he had a significant C-3 fracture with significant offset. All other imaging studies were negative. After a short time in the emergency room, the patient's respiratory effort declined significantly and had to be intubated.

The following day a CT cervical myelogram was ordered. An attempt by the Radiologist was made, but due to equipment and patient condition a blind stick by the Neurosurgeon in the ICU was performed. The patient then returned to the CT suite to have post images performed.

I've attached the reformats performed and it shows a moderate to severe disc bulge. This certainly can be causing his paralysis.

Neurosurgeon re-evaluated patient and states he is ineligible for MRI due to pain stimulator implant. He will give the patient another day to recover and see him again to evaluate stability with flexion and extension movements. He also states that he has cord contusion that can resolve with some time.

Due to the numbness/tingling and inability to feel past that point the ED physician felt certain that there was a spine injury. These injuries can resolve on their own, with medications, or often require surgery to assist healing.

Update from Deaconess!

Well, things are very busy for me lately. Our new EMR has been implemented and like all new systems...there have been a few bumps in the road. I've had to spear-head collection of issues and assist in getting information out to staff. Lots of issues surrounding availability of reports in a timely manner.

Things are very busy in our CT and MRI departments after a brief lull. We are seeing flu symptoms of course, but have had a influx of trauma and broken bones as well. We have a new traumatologist at Deaconess and he is having us do lots of 3d images via our Tera Recon workstation now. So, we've been training everyone on those. Here is an example...

This was scanned at 2mm increments on our VCT 64 slice scanner. We then reformat an AP pelvis, and inlet and outlet views on every trauma for sure, but he'd like them for all ER pelvis exams. They are just a little time consuming so we haven't gotten that far yet. This particular patient had IV contrast for an abdomen as well and had a catheter in. It showed that really well! It's unbelievable the detail we get from our workstation.

I hope everyone has a great Thanksgiving!