RADIOGRAPHIC PROCEDURES

BACKGROUND OF THE PROCEDURE

General radiography is a useful initial imaging tool for evaluating thoracic
abnormalities, often serving as a screening method for conditions such as pulmonary
infections, including tuberculosis. However, when findings on chest X-rays are
inconclusive or further anatomical detail is required, computed tomography (CT)
becomes the preferred modality due to its superior spatial resolution and ability to
produce cross-sectional images.
In cases of suspected pulmonary tuberculosis, CT imaging—particularly high-resolution
computed tomography (HRCT)—provides greater sensitivity in detecting early
parenchymal changes. It can identify subtle lesions not clearly visible on plain
radiographs, such as centrilobular nodules, tree-in-bud patterns, and small cavitations.
CT is also valuable in evaluating disease extent, lymph node involvement, and
complications such as bronchiectasis or pleural effusion.
In this case, the CT scan of the chest was performed to further evaluate symptoms
suggestive of pulmonary tuberculosis. The scan revealed multiple centrilobular nodules
with a tree-in-bud appearance, areas of patchy consolidation, and cavitary lesions
predominantly in the upper lobes—findings characteristic of active pulmonary TB.
The imaging modality used in this patient is computed tomography (CT) of the chest,
which plays a crucial role in the diagnosis, assessment of disease severity, and
guidance for treatment planning in pulmonary tuberculosis.

Indication and Contraindication

Indication
- Neurological Indications
- Thoracic Indications
- Abdominal/Pelvic Indications
- Musculoskeletal Indications
- Cardiovascular Indications
- Oncological Indications
- Interventional/Preoperative Planning
Contraindication
- Pregnancy
- Allergy to Contrast Material
- Renal Impairment
 - Hyperthyroidism
- Myasthenia Gravis
- Metformin Use
MATERIALS NEEDED
- CT Scanner Unit
- Hospital gown
- IV Cannula
- Contrast Media
- Saline Flush and Syringes
- Oral contrast
- Head/arm rests and cushions

PATIENT PREPARATION
Verification. The radiographer should ask the patient for details and personal

information for identity verification.

 Name

 Age

 Address

INSTRUCTION

 The radiographer explained the CT procedure to the patient and obtained verbal
confirmation of understanding and consent.
 The patient was asked to remove any metal objects, such as jewelry,
eyeglasses, dentures, or hearing aids, as these can interfere with image quality.
 The patient was then instructed to lie on the CT table in a supine position and
remain still throughout the scan to ensure clear and accurate imaging.
 If contrast material was required, the patient was informed about the injection
process and potential sensations (e.g., warm feeling or metallic taste). Allergy
history was reviewed beforehand.
 Breathing instructions were given, if applicable, such as holding breath for a few
seconds during the scan to reduce motion artifacts, especially for chest or
abdominal scans.
 The radiographer remained in contact with the patient via intercom, providing
reassurance and real-time instructions during the procedure.
  After the scan, the patient was advised to wait briefly in case additional images
were needed. If contrast was used, the patient was instructed to drink plenty of
fluids to help flush it from the body.

DIAGNOSTIC PROCEDURE

 The radiographer instructed the patient to lie down on the CT scanner table in a
supine position, ensuring proper alignment and comfort. An immobilizing device,
such as a velcro strap, may be used to reduce movement during scanning. A
blanket was provided if needed for patient comfort.
 To minimize radiation exposure and ensure optimal image quality, the targeted
area (e.g., the knee) is positioned at the center of the CT gantry. Positioning aids
such as sponges or cushions may be used to maintain the correct angle and
avoid motion.
 The CT table moves slowly into the gantry, aligning the area of interest with the
scanner's isocenter.
 During the scan, the CT X-ray tube rotates around the patient, capturing multiple
images from different angles. Detectors measure the X-ray beams that pass
through the body.
 A computer processes the data into cross-sectional images (slices) of the
examined area, which can be reconstructed into 3D views if needed.
 The patient is monitored continuously throughout the scan to ensure their comfort
and to respond promptly to any issues. The procedure typically takes only a few
minutes unless contrast is administered.

POST-PATIENT CARE

 The radiographer encourages the patient to increase fluid intake following a CT

scan with contrast media. Adequate hydration supports the efficient elimination of
the contrast agent from the body, helps reduce the risk of nephrotoxicity, and
promotes overall kidney function.
 The patient is advised to monitor for any delayed allergic reactions, such as rash,
itching, or difficulty breathing, and to report any concerning symptoms to a
healthcare provider immediately.
 If no contrast was used, the patient can usually resume normal activities and diet
immediately after the scan.
 The radiographer provides reassurance and ensures the patient is feeling well
before discharge. Post-scan instructions are reviewed and explained to support
the patient's safety and well-being.

IMPRESSION:

- Mediastinal nodules and mases, as described. Consider mediastinal lymphoma

VS. metastasis.

Results:
- The trachea and left bronchial tree are patent, with no intraluminal lesions
evident.
- There is significant diminution of the right-sided pleural effusion and pericardial
effusion. Note of right-sided draining catheter.
- The oblique fissure is slightly thickened, may relate to residual fissural fluid
collection.
- There is interval increase in size of the previously noted several enlarged
enhancing ovoid nodules and masses in the mediastinum, two dominant masses
are still seen in the right superior mediastinal region now measures 8.8 x 6.8 cm,
previously 6.8 x 5.3 cm which is intimately adjacent and causes mass effect to
the superior vena cava and displacement of the trachea to the left side. There is
note of luminal narrowing of the superior vena cava. The one in the subcarinal
region now measures 8.0 x 5.9 cm, previously 7.5 x 4.5 cm which is intimately
adjacent to the right pulmonary artery and vein.
- The abovementioned masses encase the right pulmonary artery and vein and
right bronchus with suspicious transbronchial infiltration. There is interval clearing
of the ground glass opacities in the right lung with residual centrilobular nodule,
exhibiting tree in bud sign. There are still few nodular densities observed in both
lungs, largest are in the right posterior basal segment measuring 1.6 x 1.3 cm
while in the left is at superior segment of the lower lobe measuring 1.8 x 1.2 cm.
- Heart is not enlarged. Calcification are seen along the aorta. Degenerative
changes are seen in the spine. No osteolytic or blastic changes seen. The
anterior chest wall, thyroid gland and breasts are unremarkable. Visualized upper
abdomen grossly shows few dense structures within the gallbladder measuring
0.8 cm in its aggregate size.
MATERIALS NEEDED

CT Scanner Unit

Patient Gown
IV Cannula

Contrast Media

Saline Flush and Syringes

Oral contrast
Head/arm rests and cushions