Overview

CT guided intervention is an intervention procedure that performed by the radiologist, with the help of CT machine. The intervention procedure that usually being done is guided biopsy, especially at the thorax and mediastinal region.

Protocol Structure

00_Biopsy_Intervention (Adult)

  • Topogram
  • Biopsy Planning
  • i-Sequence

Topogram

  • Position the patient according to the request by the radiologist (usually related to the location of the pathology.
  • Place the patient’s arms in proper position (avoid obscure the progress of procedure).
  • Align the patient in Mid-Sagittal plane of the table.
  • Position the transverse laser light beam accordingly.
    • Thorax: 1 cm above shoulder
    • Abdomen: level of nipple line / armpit

Scanning Parameters

  • kVp: 80
  • mAs: Effective mAs
  • Scanning Direction: Caudocranial
  • Scan Delay: 2 s
  • Slice: 4.0 mm
  • Image Comment: –
  • Pitch: –
  • Gantry Angulation: ZERO (No Angulation)

 

Biopsy Planning

  • Plan the Scan FOV (SFOV) box at topogram image
  • Set the top line above the pathology*
  • Set the bottom line below the pathology*
  • Ensure the lateral line to cover patient’s body outline.

Note:

*The scanning area can be vary depending on the radiologist preference.

Scanning Parameters

  • kVp: 100
  • mAs:Tube Current Modulation (TCM)
  • Scanning Direction: Caudocranial
  • Scan Delay: 4 s
  • Slice: 5.0 mm
  • Image Comment: Pre-contrast
  • Pitch: 0.6
  • Gantry Angulation: ZERO (No Angulation)

 

Recon 1Recon 2
NameBiopsy Planning 5.0 B31fBiopsy Planning 1.0 B31f
Slice Thickness5.0 mm1.5 mm
Increment3.5 mm1.0 mm
KernelB31f medium smoothB31f medium smooth
WindowingMediastinumMediastinum

Reminder

  • After finish scanning the biopsy planning, system will not automatically recon the image.
  • To recon the image, click CANCEL button.
  • Click again CANCEL MOVE button.
  • The first recon job will be completed.
  • To add another recon image, click RECON tab.
  • Select the available number of recon job & set the Kernel and Windowing accordingly.
  • Click RECON button.
  • The radiologist will review the image and identify the image that is most preferable.
  • Copy the image position (SP value).
  • Open the i-Sequence window
  • Paste the SP value into the Table → Position.
  • Press ENTER on the keyboard.
  • Press MOVE button 
  • Click LOAD button
  • Click CANCEL MOVE button
  • The PRESS FOOT SWITCH command will be displayed.

i-Sequence

  • IR will save the specific position using their control panel.
  • Select ‘HandCare’ based on puncture site and needle position.
  • Change ‘Start button’  to Foot Switch to enable IR control the scanning by themselves.
  • Make sure correct monitor position is selected.

Scanning Parameters

  • kVp: 80
  • mAs: Effective mAs
  • Scanning Direction: Caudocranial
  • Scan Delay: 2 s
  • Slice: 4.0 mm
  • Image Comment: –
  • Pitch: –
  • Gantry Angulation: ZERO (No Angulation)

 

Recon 1
Namei-Sequence 4.8 B31s
Slice Thickness4.8 mm
IncrementN/A
KernelB31s medium smooth
WindowingMediastinum

Selection of Detector Size

Shortcut Button to Change Windowing

Post Biopsy (Optional)

  • Post biopsy scanning is depend on the IR’s request.
  • It can be with or without contrast.

Multiplanar Reconstruction (MPR)

N/A

Siemens SyngoVia 3D Rendering

N/A

Series of Images Send to PACS

  1. Topogram 0.6 T20f
  2. Biopsy Planning 5.0 B31f
  3. Biopsy Planning 1.5 B31f
  4. i-Sequence 4.8 B31s
  5. Post Biopsy (if any)
  6. Patient Protocol