Computed Tomography

The first module of this twelve-module course will provide you with an excellent introduction to the world of computed tomography (CT) and whet your appetite for the rest of the course. Getting to grips with the underlying principles of CT, contrast media and thorough reporting of scan results will enable you to further your skills with this highly useful advanced imaging modality.

Learning objectives:

• Explain how CT images are obtained
• Discuss the types of CT scanner available for purchase
• Describe how to improve the quality of CT images
• List the steps required to perform a high-quality post-contrast study
• Recognise artefacts and understand how to avoid them
• Be familiar with the most commonly used software to read CT studies including how to create the most useful scan reconstructions
• Develop your ability to describe & report a CT study methodically    

The anatomy of the head and neck intrinsically makes radiographic interpretation challenging due to overlying structures even when orthogonal views are available. This module will show you how CT offers a more satisfactory alternative to investigate a large number of both every day and more unusual conditions.

Learning objectives:

• Discuss the CT protocols required for optimal imaging of the head, brain and neck
• Demonstrate familiarity with normal anatomy by being able to correctly identify bony and soft tissue structures of the head and neck including the nasal cavity, orbit, aural/oral structures, blood/lymphatic system, masticatory muscles, glandular tissue & pharynx/larynx
• Explain what characteristics of a CT scan allow you to differentiate between neoplasia, inflammation and infection to guide referring clinicians to diagnose neoplasia, fungal/chronic rhinitis, masticatory myositis, dental disease and retrobulbar abscesses
• Describe what methods can be employed to guide a surgeon when planning surgical margins for tumours of the head and neck in cases such as maxillary or thyroid neoplasia
• List the identifying features on a CT scan of a variety of tumours seen in the head and neck such as oral melanoma and squamous cell carcinoma
• Systematically review CT scans of trauma patients assessing for fractures of the skull/spine and soft tissue pathology
• Describe the CT approach to suspected penetrating stick injuries of the cervical region
• Differentiate between otitis externa, media/ interna and be able to identify more significant/unusual pathologies such as para-aural abscessation and cholesteatoma
• Review a CT scan of salivary mucocele identifying which salivary gland(s) are most likely to be the cause of the problem

Although MRI is often described as the best method for imaging the neural system there are times when CT can also be beneficial. This module will help you to understand the pros and cons of CT scanning such cases as well as showing you how to maximise the diagnostic utility of the resultant scan.

Learning objectives:

• Review the normal anatomy of the brain and spine and how changes on CT can aid differentiating pathologies such as congenital/acquired brain diseases
• Understand what clinical cases benefit more from CT versus MRI
• Discuss the limitations of using CT in imaging the nervous system
• Describe the typical changes seen in the brain and spinal column of trauma cases, understanding where imaging can be useful to guide a prognosis.
• List the features seen on CT with inflammatory/infectious/neoplastic diseases of the brain and spine such as hydrocephalus secondary to FIP, granulomatous meningoencephalitis and meningioma
• Explain how to differentiate between congenital and acquired spinal lesions including cranial thoracic stenotic myelopathy and vertebral neoplasia
• Summarise the technique and pitfalls of CT myelography and how it can be used to aid decision-making in cases of intervertebral disc disease

This module will give you the opportunity to start reading CT scans of the head, neck and neural system, putting into practice what you have learnt during the first three modules. A highly interactive module, you will be given a wide variety of CT scans to assess using DICOM viewers. Throughout the module you will be able to discuss the CT scans with the speaker and your fellow delegates in an online forum. During week 4 there will be further opportunity to discuss the cases during a live webinar moderated by the specialist tutor.

Learning Objectives

• Discuss a variety of CT scans with the speaker & other delegates to assess the quality of the scan & identify normal variations in anatomy 

• Describe the steps that should be taken to read a scan methodically & produce a clear & concise report describing your findings. 

• Assess CT scans of the head, neck & neural systems and prepare a thorough & systematic report for each describing the abnormalities identifiable & providing a comprehensive differential diagnosis list. 

One of the most useful things about CT is the speed with which you can acquire diagnostic images of the thorax showing early pathologies that would not be visible on a radiograph. In this module you will become adept at reviewing thoracic CTs and identifying normal and abnormal anatomical structures.

 Learning objectives:

• Identify the best CT protocols for the thorax
• Recognise the advantages and disadvantages of conscious protocols using radiolucent restraint contraptions
• List appropriate contrast protocols to differentiate between pathologies on a CT scan of the thorax
• Learn how to interpret various lung pathologies on CT, including lungworm, lung lobe torsion, pulmonary fibrosis, bronchopneumonia, pulmonary thrombolism
• Describe the characteristics of pleural effusion on a CT scan and how to interpret a CT scan with pleural effusion
• Summarise what abnormalities associated with the heart can be seen on a CT scan including patent ductus arteriosus, aberrant coronary arteries, pericardial effusions and peritoneo-pericardial diaphragmatic hernias
• Recognise how neoplastic conditions can be diagnosed including vertebral, chest wall, mediastinal and primary & secondary pulmonary tumours
• Discuss how thoracic trauma cases can benefit from thoracic CT
• Identify diseases of the pleura, mediastinum and lymph nodes associated with the thorax

The sixth module in this course will give you the chance to interpret CT scans of the thorax with a variety of abnormalities. Another highly interactive module you will be given many CT scans to assess and discuss in an online forum.

 Learning Objectives:

• Demonstrate good knowledge of the normal anatomy of the thorax
• Discuss a variety of thoracic CT scans with the speaker and other delegates to assess the quality of the scan and identify normal variations in anatomy
• Describe the steps that should be taken to read a thoracic CT scan methodically and produce a clear and concise report describing your findings
• Explain how to differentiate pulmonary metastatic neoplasia from non-neoplastic pulmonary nodules
• Be able to reach a precise list of differential diagnoses from a thoracic CT scan
• Identify the most appropriate next-steps options to guide the primary case clinician towards a diagnosis

Previously ultrasound was considered the gold standard for assessing intra-abdominal disease. In this module you will discover how CT scanning benefits the clinician during the diagnosis, treatment and monitoring of these cases.

Learning objectives:

• Learn the best CT protocols for the abdomen with an emphasis on dual and triple phase angiography
• Be able to recognise and describe portosystemic shunts and other vascular anomalies such as arteriovenous fistulas and thrombosis
• Understand when CT is more appropriate than ultrasound for liver and peritoneal diseases
• Explain the typical appearance on a CT scan of hepatic tumours and characteristics that allow you to help differentiate benign and malignant neoplasia
• Describe the appearance of a normal gallbladder and biliary tract and how CT can help diagnose conditions such as extrahepatic biliary obstruction and gallbladder mucocele
• Describe the typical features of splenic neoplasia and how to differentiate from other splenic pathologies such as torsion and thrombosis
• Formulate a prioritised differential list for a CT scan showing ascites and justify your opinion
• Identify normal and abnormal lymph nodes within the abdomen and be aware of what pathologies can cause lymphadenopathy
• Be familiar with abnormalities of the peritoneum/retroperitoneum such as peritonitis, migrating foreign bodies and carcinomatosis

Consolidating your new knowledge of the theoretical content from modules 5, 6 & 7, this module will be a highly interactive case-based module where you will start to formulate your own CT reports, differential diagnosis lists and access model answers. You will be able to discuss CT cases given to you in the online forum. A journal club delivered by the specialist tutor in week 4 will help you to answer an EBVMQ using the relevant literature.

Learning Objectives

• Be familiar and confident with the normal anatomy of the abdominal vasculature, liver & lymphatic abdominal system  

• Discuss a variety of CT scans with the speaker & other delegates to assess the quality of the scan & identify normal variations in anatomy 

• Describe the steps that should be taken to read a scan methodically & produce a clear & concise report describing your findings. 

• Assess CT scans of the thorax / abdomen & prepare a thorough & systematic report for each describing the abnormalities identifiable & providing a comprehensive differential diagnosis list. 

In this module you will consolidate your knowledge and understanding of the gastrointestinal and genito-urinary systems and the benefits of CT scanning for such cases.

Learning Objectives

• Identify the best CT protocols for scanning the abdomen. 

• Describe how the difference between normal & abnormal gastrointestinal tracts can be determined from a CT scan. 

• Be confident in identifying mechanical obstructions of the intestinal tract. 

• Summarise the typical appearance on a CT scan of a variety of both congenital & acquired hernias including umbilical, inguinal, scrotal, femoral & perineal 

• Explain how you would determine the significance to the patient of an ‘incidentaloma’ of the adrenal gland & what further testing and/or treatment options might be recommended. 

• List the characteristics seen on CT that can help to differentiate between pancreatic inflammation / infection / neoplasia  

• Be able to review a CT scan of the urinary tract in a case of neoplasia or obstruction & give appropriate advice on the best course of action for the patient 

• Assess prostatic size and morphology from a CT scan and advise of most likely causes of any prostatomegaly present. 

CT scanning is a particularly useful imaging modality for complex musculoskeletal cases where radiography and ultrasound combined can’t compete due to the 3D nature of the resulting images. In this module you will learn how to select those cases and how to acquire the most diagnostically useful CT scans.

 Learning objectives:

• Know the appropriate scan techniques and protocols for imaging the appendicular skeleton
• List the steps necessary to perform a CT-arthrogram
• Review the typical CT changes seen with a variety of elbow conditions including dysplasia & incomplete ossification of the humeral condyle
• Describe how to diagnose osteochondritis dissecans of various joints from a CT scan
• Explain the CT scan characteristics of inflammatory, erosive, neoplastic & infectious arthropathies
• Formulate a methodical way to assess complex fractures such as intra-articular carpal / tarsal fractures from a CT scan
• Be familiar with the normal anatomy of tendons and how they appear on a CT scan when they become inflamed e.g. bicipital tenosynovitis
• Discuss how a variety of tumours of the musculoskeletal system can appear on a CT scan and features that help guide you to whether they are benign or malignant neoplasias
• Identify key characteristics that might make you diagnose an inflammatory condition of the musculoskeletal system such as panosteitis or myositis from a CT scan
• Understand the use of CT in assessing antebrachial and femoral deformities

Consolidating your new knowledge of the content from modules 9 &10 this module will be the penultimate interactive session where you will have the opportunity to practice your CT reading, report writing and discuss a variety of appropriate cases in an online webinar.

Learnign Objectives:

• Be familiar and confident with the normal anatomy of the abdominal organs. 

• Learn how to methodically assess the gastrointestinal tract.  

• Learn how to identify pancreatic pathology and to try and differentiate pancreatic inflammation from masses. 

• Know how to perform and interpret a CT-IVU study. 

• Be confident in recognising or excluding ectopic ureters. 

• Identify prostatic and uterine pathology and draw up a list of appropriate differential diagnoses.  

• Be familiar and confident with the normal anatomy of the appendicular system.  

• Learn the best CT protocols, including arthrography.  

• Be able to read methodically studies of the appendicular system.  

• Have a good knowledge of the most common pathologies of the limbs and joints. 

The final module of the course is when you will have the opportunity to present your case & your CT report for that case to the speakers and other delegates.

Learning Objectives

• Be able to review a CT scan and prepare a thorough report 

• Present a case to an audience 

• Discuss your differential diagnosis list and explain why you have reached your conclusions 

• Describe what steps would be necessary in your case to reach a final diagnosis. 

• Critique your fellow delegates’ reports & justify your opinions on it