1、Anatomy and Terminology for the Interpretation and Reporting of Cardiac MDCT,广州军区总医院放射科欧陕兴,检查方法,设备：双源心脏CT（Somatom Definition 2008G） 序列：冠状动脉CTA 对比剂:碘必乐370mgI/ml CM:90ml FS:6ml/s 扫描心率：62 -66 /min 未服药物降心率：60/min 后处理：1、MIP；2、VRT；3、Circulation；4、AGascoring。,retrospective ECG gating techniques?,内容提要,技术细节
2、诊断规范 标准操作 严格执行,技术细节,总台（接待员） 护士 技师 医师,技术细节（总台）,总台（态度、业务、综合） 预约？ 准备？ 操作？,技术细节（总台）,总台 科室脸面 态度？微笑、真诚、和蔼 礼节？规范、得体、整洁 沟通？医师、技师、组长 语言？ 改进、跟进、形象,技术细节（总台）,业务？ 技术 细腻、精明、快捷 熟练、形象 热心、细心、用心！,技术细节（护士）,业务？ 技术 细腻、快捷 临床？急救、药物、操作 兼管技师,技术细节（护士）,沟通-技巧、尽量多嘴 态度：和蔼、亲切、主动 对待首长：稳重礼貌 不要多嘴.没有思考不能讲,技术细节（技师）,业务？ 技术 快捷、熟练、准确 临床？
3、学习.读片 经历？轮岗.学术活动,技术细节（技师）,沟通？ 医师-组长-主任 换位、同情、理解 责任心？积极.主动 新目标？短期.长期,技术细节（医师）,责任？ 最重要！ 领导者 值班.教育 指导者 技师与其他 执行者 规范.严谨,技术细节（医师）,思考能力？ 发展潜力 有序 良好习惯-记录 不乱 工作条理化 缜密 严谨-仔细-训练,技术细节（医师）,业务？ 报告、质量、信誉 学习 主动-基础-外语-社交 随访 病历-疑难-笔记 积累 抓住每次机会！,技术细节（组长）,领航员 排头兵 教练员 主动-基础-外语 社员 担当与业务 学员 指导员 宣传员 处理每次业务难题,诊断规范,操作 熟练.规范
4、.学习 数据 及时.准确.记录 思考 多听.多想.多比较 视野 多交流.多参加学术,Structured Cardiac CT Report Template,CT Coronary Calcium Scoring: LMA = ( ), LAD = ( ), LCX = ( ), RCA = ( ), PDA = ( )？ Total calcium score = ( ) using the AJ-130 method and ( ) volume score( ) ？ percentile rank for age and gender, meaning that ( )% of pat
5、ients of the same age and gender will have a higher score,Coronary CT Angiography:,Coronary arterial dominance (right, left, codominant)？ Left main, LAD and diagonals, LCX and obtuse marginal, RCA and posterior descending, ramus intermedius, and any anatomic Variants？ Quantification of stenoses (mil
6、d 70%),Cardiac Structure, Morphology, and Function:,Evaluation of short- and long-axis LV cines demonstrates (normal regional left ventricular wall motion) or (hypokinesis, akinesis, or dyskinesis; specify wall or if global)？ LV functional parameters: end-diastolic volume, end-systolic volume, strok
7、e volume, cardiac output, ejection fraction, LV mass？,Summary,1. Total coronary calcium score = ( ). 2. (Normal coronary arteries or specify abnormality). 3. (Normal or abnormal) left ventricular wall motion. LV ejection fraction = ( ). 4. (Normal or abnormal) cardiac chamber size.,Note：,LMA = left
8、main artery LAD = left anterior descending artery. LCX = left circumflex artery RCA = right coronary artery PDA =posterior descending artery AJ-130 method = Agatston-Janowitz score of 130 HU, mod = moderate LV = left ventricle.,Coronary CT Angiography, Technical Details,Pharmaceutical agents (quanti
9、ty, route, rate of administration)? Cardiac rate, rhythm, scan coverage zone Scan delay time method, biphasic/triphasic bolus technique?,Coronary CT Angiography, Technical Details,IV contrast: name, concentration, quantity, rate, and route? Prospective/retrospective ECG gating techniques? Radiation
10、dose-reduction measures? Computer workstation viewing software?,Reporting of Cardiac MDCT,Part 1.Structured Report. Coronary Calcium Screening. Coronary Artery Anatomy.,Reporting of Cardiac MDCT,Coronary CT Findings Coronary Arteries:Calcium score with age/sex percentile rank Coronary artery origin,
11、 course, and dominance Atherosclerosis (plaque composition, luminal narrowing),Noncoronary Cardiovascular Structures,Quantitative evaluation of left ventricle (LV) Stroke volume (SV), ejection fraction (EF), cardiac output (CO), end-diastolic and end-systolic volumes (EDV and ESV) Qualitative evalua
12、tion of LV wall motionCardiac chamber size and morphology (LV mass),Noncardiovascular Structures:,Lungs, pleura, airways Esophagus, mediastinal and hilar lymph nodes Diaphragm, body wall including osseous structures Upper abdominal contents (organs, bowel loops, mesentery),Noncoronary Cardiovascular
13、 Structures,Cardiac valve morphology Pericardium Other cardiovascular structures Aorta, pulmonary artery tree and pulmonary veins Superior and inferior venae cavae Coronary veins,Recommended Use for Calcium Scoring CT,Asymptomatic Patients: Intermediate risk for coronary artery disease; total calciu
14、m score 400 raises risk to high, justifying lifestyle modification and pharmacological therapy maximization Symptomatic Patients: A screeening tool before performing invasive procedures Functional testing (such as stress test) is not possible or is inconclusive,左侧听神经瘤 T1WI,左侧听神经瘤 T2WI,左侧听神经瘤T1WI-CE,左侧听神经瘤T1WI-CE,垂体微腺瘤T1WI,垂体微腺瘤T1WI,垂体微腺瘤T1WI,垂体微腺瘤T1WI,垂体微腺瘤T1WI-CE,垂体微腺瘤T1WI-CE,
