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Introduction ⬇

Full-body CT, also known as total body CT, imaging provides detailed cross-sectional images of the chest, abdomen, pelvis, spine, and extremities. When used to evaluate patients with polytrauma or neoplastic and inflammatory disease, CT data acquisition can be rapidly sequenced to evaluate blood flow and to determine vascularity of an injury or mass. This technique, known as dynamic CT scanning, requires the administration of IV contrast. In addition, full-body CT can be used to detect intervertebral disk disease, herniation, and soft tissue damage to ligaments within joint spaces.

Conventional x-ray machines produce a flat picture, with organs in the front of the body appearing to be superimposed over organs toward the back of the body. The result is a two-dimensional image of the three-dimensional body part. CT imaging produces many cross-sectional anatomic views without superimposing structures. Spiral scanners allow CT angiography and three-dimensional reconstruction techniques.

Procedure ⬆ ⬇

  1. Have the patient drink a special contrast preparation several minutes before the CT abdominal examination. This contrast material outlines the bowel so that it can be more readily differentiated from other structures.

  2. Have the patient lie supine on a motorized couch that moves into a doughnut-shaped frame called a gantry. X-ray tubes within the gantry move around the patient as the pictures are taken. These images are concurrently projected onto a monitor screen.

  3. Have the patient lie motionless and give breathing instructions.

  4. Inject iodine contrast substance and take more pictures if a questionable area requires further clarification. Patients having pelvic CT scans are given a barium contrast enema. Furthermore, female patients undergoing pelvic CT scans may require insertion of a contrast-enhanced vaginal tampon to delineate the vaginal wall. Another indication for contrast is blood vessel delineation, the opacification of well-vascularized tissue, and evaluation of blood flow patterns (as for differential diagnosis of hemangioma).

  5. The patient may experience warmth, flushing of the face, salty taste, and nausea with IV injection of the contrast material. Slow, deep breaths may alleviate these symptoms. Have an emesis basin readily available. Watch for other untoward signs such as respiratory difficulty, heavy sweating, numbness, palpitations, or progression to an anaphylactic reaction. Resuscitation equipment and drugs should be readily available. Notify the healthcare provider immediately should any of these side effects occur.

  6. Follow guidelines in Chapter 1 for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

Abnormal full-body CT scan findings may reveal the following conditions:

  1. Tumors, nodules, and cysts

  2. Ascites

  3. Fatty liver

  4. Aneurysm of abdominal aorta

  5. Lymphoma

  6. Enlarged lymph nodes

  7. Pleural effusion

  8. Cancer of pancreas

  9. Retroperitoneal lymphadenopathy

  10. Abnormal collection of blood, fluid, or fat

  11. Skeletal bone metastasis

  12. Cirrhosis of liver

  13. Fractures

  14. Soft tissue or ligament damage

  15. Abscess

  16. Cardiovascular disease

  17. Traumatic internal injuries

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain test purpose and procedure. Written explanations may be helpful. Benefits and risks of the test should be explained to the patient before the procedure.

  2. Assess pregnancy status of female patients. If positive, advise the radiology department.

  3. Follow iodine and barium contrast test precautions.

  4. Allow the patient to take usual prescribed medications before CT studies, as ordered.

  5. Inform the patient that an iodine contrast substance may be administered before and during the examination. Determine whether the patient is allergic to iodine. Pelvic CT examinations usually require both IV and rectal administration of contrast material. A creatinine level may be required before the study.

  6. Warn the patient that abdominal cramping and diarrhea may occur; therefore, drugs such as glucagon may be ordered to decrease these side effects.

  7. Inform the patient that solid foods are usually withheld on the day of the examination until after test completion. Clear liquids may be taken up to 2 hours before examination. If in doubt, check with the diagnostic department for specific protocols. A patient with diabetes may need to adjust their insulin dose and diet before the test. For CT of the abdomen, the patient usually can take nothing by mouth.

  8. Instruct the patient that they may experience warmth, flushing of the face, a salty metallic taste, and nausea or vomiting if IV iodine is administered.

  9. Claustrophobic sensations while in the CT scanner are common. Show the patient a picture of the scanner before the procedure to alleviate anxiety.

  10. Remember that sedation and analgesic agents may help the patient lie quietly during the test to achieve optimal results.

  11. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Clinical Alert

  1. If the patient has diabetes and is taking metformin, special considerations may be necessary. Consult with the radiology department to determine whether this medication regimen must be discontinued the day of and several days after the study.

  2. Assess whether the patient is allergic to iodine. If iodine contrast allergies or sensitivities are known or suspected, inform the radiology department before study.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed.

  2. Observe and document reactions to iodine contrast material such as hives, skin rashes, nausea, swelling of parotid glands, iodine poisoning, or anaphylactic reaction.

  3. Notify the healthcare provider immediately if symptoms are serious.

  4. Administer antihistamines.

  5. Document preparation and instructions given to the patient or significant others, the time the procedure was completed, the patient’s response to the procedure, any allergic reactions, and subsequent treatment.

  6. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

  1. Retained barium can obscure organs in the upper and lower abdomen. Barium tests should be scheduled after CT scans when possible.

  2. Inability of the patient to lie quietly produces less-than-optimal pictures.

Reference Values ⬆

Normal

No apparent injury, tumor or pathology

On CT scans, air appears black, bone appears white, and soft tissue appears in various shades of gray. Shade patterns and their correlation to different tissue densities, together with the added dimensions of depth, allow identification of normal body structures and organs.