Chest, Abdomen and Pelvis CT Protocols · Chest, Abdomen and Pelvis CT Protocols Chest Chest CT Low...
Transcript of Chest, Abdomen and Pelvis CT Protocols · Chest, Abdomen and Pelvis CT Protocols Chest Chest CT Low...
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Chest, Abdomen and Pelvis CT Protocols
Chest
Chest CT Low Dose Nodule Evaluation
Chest CT Lung Cancer Screening
Chest CT Routine With Contrast
Chest CT Without Routine
Chest CTA- Pulmonary Embolism
Chest CTA- Acute Aorta
Chest CTA- Aortic Aneurysm -Pre EVT
Chest CTA Aortic Aneurysm- Post EVT
Chest CTA- Acute Aorta- Trauma
Chest CT High Resolution
Coronary CTA Screening History
Chest, Abdomen and Pelvis
Chest Abdomen Pelvis: Acute Trauma
Abdomen and Pelvis
CT Cystogram
Oncology: Lymphoma
Oncology: Hypovascular Mets
Oncology: Hypervascular Mets
ADRENAL MASS Protocol
ABDOMEN PELVIS: ROUTINE
ABDOMEN PELVIS: TRAUMA
Abdomen Pelvis: FAST ER Protocol: R/O Acute
Appendicitis or Diverticulitis
Abdomen CTA- Aortic Aneurysm -Pre EVT
Abdomen CTA- Aortic Aneurysm –Post EVT
CT COLONOGRAPHY
CT Enterography
CT UROGRAM
CT UROGRAM LOW DOSE
Renal Mass
Renal CTA
Retroperitoneal Hemorrhage
Oncology: Hepatoma: (Triphasic Liver CT)
Oncology: Cholangiocarcinoma
Pancreatic Mass CT
CT VENOGRAM PELVIS: Pelvic Venous
Congestion
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LOWER EXTREMITIES
CT VENOGRAM LOWER EXTREMITY
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Chest
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Chest CT Low Dose Nodule Evaluation Typical Indications: Follow up pulmonary nodule(s). Normal or nearly normal radiograph
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration
Lower cervical spine through both
costophrenic angles
Arterial Phase
N N/A N/A
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Scan Comments: Low dose: reduce mAs appropriate to patients size: consider 100 kVP/mAS modulation per scanner software. Nodules are lesions <3cm. For pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast Routine protocol Scan Comments: Low dose: reduce kVP appropriate to patients size: consider 100 kVP for patients less than 200 lbs/90 kgs. If exam is requested because of an “abnormal CXR” please have outside CXR and report available for review. Note: “pulmonary nodules” are lesions <3cm ; pulmonary masses are >3cm. If scan is for pulmonary mass use Chest CT With Contrast Protocol.
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Contrast Parameters Parameters
Contrast Type None
Contrast Volume
N/A
Saline Flush
N/A
Injection Rate
N/A
Oral Contrast
N/A
Oral Contrast Volume N/A
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
Slice Thickness x Recon Spacing
Phase #1) Noncontrast
5mm x 5mm
#1
5mm x 5mm
#1
2mm x
1mm #1
3mm x
3mm #1
3mm x
3mm #1
Plane Axial Axial Axial Sag Cor
Reconstruction Algorithm
Soft Tissue
Lung
ST
ST
ST
Send to
PACS
PACS
Hold
PACS
PACs
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Chest CT Lung Cancer Screening (USPTF criteria) 1) Adults aged 55-80, with a >30 pack year history of smoking and who currently smoke or have stopped smoking in past 15 years 2) Screening should be discontinued once the individual has not smoked for 15 years or develops a health problem that significantly limits life expectancy or the ability or willingness to have curative lung surgery.
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration
Lower cervical spine thru both costophrenic
angles
Arterial Phase
N N/A N/A
Venous Phase
N N/A N/A
Delayed Phase
N N/A N/A
Scan Comments: Guidelines for techniques include: For BMI < 30 use kVP of 100; mAS < 40; mA 80; goal CTDIvol < 3 mGy For BMI > 30 use kVP of 120; mAS < 60; goal CTDIvol < 5 mGy mAS software modulation with ADIR (Toshiba) or CareDose(Siemens) may alter these parameters. Additional reported risk factors: documented high radon exposure, occupational exposures (silica,cadmium,asbestos,arsenic,beryllium,chromium,diesel fumes,niockel,coal smoke,soot), personal cancer history ( lung cancer, lymphoma, head and neck), COPD or pulmonary fibrosis, family history lung cancer.
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
Phase #1) Noncontrast
1 mm 1 mm 0.5 mm x 0.3 mm
2 mm x 2 mm
2 mm x 2 mm
NA
Plane Axial Axial Axial Sag Cor
Reconstruction Algorithm
Soft
Tissue
LUNG
LUNG
LUNG
LUNG
N/A
Send to
PACS
PACS
Hold
PACS
PACs
N/A
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Chest CT Routine With Contrast Typical Indications: Evaluate Infection, known or suspected lung cancer, empyema, evaluate pulmonary mass, hilar enlargement
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A
Arterial Phase
N Use Bolus Tracking
Inspiration Lower cervical spine through adrenal glands
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Scan Comments: Nodules are lesions <3cm. For incidental nodules may be able to use Noncontrast CT Nodule protocol. For pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast Routine protocol
Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 75-80cc Use 100 cc if combined with abdomen CT
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments:
Scan delay: usual 25 seconds; Use Bolus Tracking if available
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag Cor 3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane Axial Axial Axial Sag Cor NA
Reconstruction Algorithm Soft Tissue Lung ST ST ST NA
Send to
PACS
PACS
Hold
PACS
PACS
NA
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Chest CT Without Routine Typical Indications: Evaluate lung nodule(s)
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y
N/A
Inspiration
Lower cervical spine through both costophrenic angles
Arterial Phase
N
N/A
N/A
Venous Phase
N
N
N/A
Delayed Phase
N N/A N/A
Scan Comments: Nodules are lesions <3cm. For pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast Routine protocol
Reconstruction Parameters
Soft Tissue
Bone/
Lung Thin Data
Sag
Cor 3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane Axial Axial Axial Sag Cor NA
Reconstruction Algorithm
Soft Tissue
Lung ST ST ST NA
Send to PACS PACS Hold PACS PACS NA
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Chest CTA- Pulmonary Embolism Typical Indications: r/o PE; elevated D-Dimer
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A
Arterial Phase
Y Use Bolus Tracking
Inspiration Lung apex thru both costophrenic angles
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Scan Comments: In Pregnant patients confirm Duplex Venous Exam was NEGATIVE PRIOR to CTA; use low dose protocol; abdominal shielding; informed written consent for radiation during pregnancy; *oral thin barium for “internal shielding” if time permits. No need to breast pump/discard milk recommendations for 24 hours unless patient anxious regarding contrast* Pt info sheet regarding breast feeding available on mxcimaging.com.
Contrast Parameters Parameters
Contrast Type
Per institution
Contrast Volume
80cc
Injection Rate
4-5cc/sec
Oral Contrast
450 cc thin standard barium PO ideally 20-30 minutes pre
for pregnant patients only if time allows
Oral Contrast Volume
450 cc
Contrast Comments:
Internal barium shielding provides some protection from scatter radiation to pelvis. Mid and lower abdomen pelvis external lead shielding will minimize direct beam radiation to pelvis. CTA has significantly less Fetal dose than standard VQ imaging but has
significantly higher Maternal breast dose.
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
2mm x 2mm
5mm x 5mm
1mm x 0.5mm
(or as thin as scanner
config allows)
3mm x 3mm
3mm x 3mm
10 mm thick Coronal MIPS
Plane Axial Axial Axial Sag Cor Cor
Reconstruction Algorithm
Soft Tissue
Lung
ST
ST
ST ST
Send to
PACS PACS Hold PACS PACS PACS
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Chest CTA- Acute Aorta Typical Indications: R/O Acute Aortic Dissection/ Aneurysm, follow up endovascular stent, aortic injury
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N**
N/A
N/A
Top of Aortic Arch to diaphragm
Arterial Phase
Y-GATED***
Bolus Tracking
Inspiration
Mid cervical spine thru iliac crests*
Venous Phase
N
N
N/A
* If AbdPel CT ordered for trauma; pause at
diaphragm and continue with 70 sec delay CT of
AbdPel
Delayed Phase
N N/A N/A
Scan Comments: ** For Acute Chest Pain with specific history of “r/o dissection” include NonContrast CT to evaluate for acute intramural hematoma. For routine f/u thoracic aneurysm Noncontrast not needed. Dissections often extend into abdomen or neck- coverage includes expanded FOV*. For acute symptoms add GATING*** to optimally see ascending aorta.
Contrast Parameters Parameters
Contrast Type
Per institution
Contrast Volume
100cc
Injection Rate
4-5cc/sec
Oral Contrast
N/A
Oral Contrast Volume
N/A
Contrast Comments:
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
Phase #1) Noncontrast
#2) Arterial Phase
2mm x 2mm
#1 #2
5mm x 5mm
#1
1mm x 0.5mm
#2
3mm x 3mm
#2
3mm x 3mm
#2
#3) 3D radial MPR #4) 5mm thick
MIPs in SAG and COR
Plane Axial Axial Axial Sag Cor 3) Radial Range 4) SAG/COR
Reconstruction
Algorithm
Soft
Tissue
Lung
ST
ST
ST
ST
Send to
PACS
PACS
1. To 3D
server 2. PACS
PACS
PACs
PACs : Reformat
3Ds AFTER transferring raw
data to PACS
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Chest CTA- Aortic Aneurysm -Pre EVT Typical Indications: f/u known or suspected thoracic aneurysm, preop evaluation stent graft
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N** N/A N/A
Arterial Phase
Y Use Bolus Tracking
Inspiration Mid cervical spine thru
costophrenic angles
Venous Phase N N N/A
Delayed Phase N N/A N/A
Scan Comments: For routine f/u thoracic aneurysm noncontrast not needed. ** For Acute Chest Pain with r/o dissection include NonContrast CT to evaluate for acute intramural hematoma and GATE the CTA exam. See CTA Acute Aorta
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd stent graft region
Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 75-80cc routine 100 cc if combining with abdomen
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments:
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
Phase #1) Noncontrast
#2) Arterial Phase
2mm x 2mm
#1 #2
5mm x 5mm
#1
1mm x 0.5mm
#2
3mm x 3mm
#2
3mm x 3mm
#2 #3) 3D radial MPR
#4) 5mm thick MIPs in SAG and COR
Plane Axial Axial Axial Sag Cor
3) Radial Range 4) SAG/COR
Reconstruction
Algorithm
Soft Tissue
Lung ST ST ST ST
Send to
PACS PACS
1. To 3D
server 2. PACS
PACS PACS
PACS : Reformat 3Ds
AFTER transferring raw data to PACS
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Chest CTA Aortic Aneurysm- Post EVT Typical Indications: f/u thoracic aneurysm stent graft
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A N/A Top of Aortic Arch thru
domes of diaphragm
Arterial Phase
Y
Use bolus tracking
Inspiration
Mid cervical spine thru costophrenic angles
(if aneurysm extends to abdomen include)
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Scan Comments: Include entirety of stented region on noncontrast phase. For routine f/u thoracic aneurysm only noncontrast phase not needed. ** For Acute Chest Pain with r/o dissection include NonContrast CT to evaluate for acute intramural hematoma and GATE CTA phase: See CTA Acute Aorta
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd stent graft region
Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 80cc
Injection Rate 4cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
Slice Thickness x Recon Spacing
Phase #1) Noncontrast
#2) Arterial Phase
2mm x 2mm
#1 #2
5mm x 5mm
#1
1mm x 0.5mm
#2
3mm x 3mm
#2
3mm x 3mm
#2
Plane Axial Axial Axial Sag Cor
Reconstruction
Algorithm
Soft Tissue
Lung ST ST ST
Send to
PACS PACS
1. To 3D server
2. PACS PACS PACs
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Chest CTA- Acute Aorta- Trauma Typical Indications: Severe trauma, Chest pain r/o Acute Aortic Dissection/tear, mediastinal widening
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A N/A
Arterial Phase
Y
*GATED Use Bolus Tracking
Inspiration Mid-cervical spine thru
Iliac Crests
Venous Phase
N N N/A
Delayed Phase N N/A N/A
Scan Comments: *For acute symptoms add GATING to optimally see ascending aorta; Gating improves motion artifact at aortic root and ascending aorta. If using Toshiba Acquillion One may omit gating and use Ultrafast Helical
Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume
80cc chest CTA only
100 cc if combined CAP
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments: pancreas/ duodenal/prox SB injury optimally assessed with oral in UGI tract but do not delay scan for oral contrast
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
Phase #1) Noncontrast
#2) Arterial Phase
2mm x 2mm
#1 #2
5mm x 5mm
#1
1mm x 0.5mm
#2
3mm x 3mm
#2
3mm x 3mm
#2
#3) 3D radial MPR
#4) 5mm thick MIPs in SAG and
COR
Plane Axial Axial Axial Sag Cor 3) Radial Range 4) SAG/COR
Reconstruction
Algorithm
Soft Tissue
Lung
ST
ST
ST
ST
Send to
PACS
PACS
1. To 3D
server 2. PACS
PACS
PACS
PACS : Reformat
3Ds AFTER transferring raw
data to PACS
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Chest CT High Resolution Typical Indications: Evaluate interstitial lung disease, emphysema, bronchiectasis, asbestosis
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y Supine Helical Supine Axial Prone Axials
N/A Inspiration Expiration Inspiration
Lung apices to domes diaphragms
Arterial Phase
N N/A N/A
Venous Phase
N N N/A
Delayed Phase N N/A N/A
Scan Comments: There are three scans in this protocol: supine inspiration helical, supine expiration axials, and prone inspiration axials. Every effort must be made to acquire prone images. Helical first run performed at 5mm x 5mm supine with inspiration. Second acquisiton is Supine Expiration 1.25mm x 10mm and third is Prone Inspiration Axials 1.25mm x 10mm.
Reconstruction Parameters
Soft Tissue Lung
Thin Data
Sag/Cor
Slice Thickness 1) Helical Run 2) Supine Hi
Res Axial 3) Prone Hi
Res Axial
1) 5mm
1) 5mm
2) 1.0mm
3) 1.0mm
1) 2mm
NA NA
1) 3mm
Reconstruction Spacing
1) Helical Run 2) Supine Hi
Res Axial 3) Prone Hi
Res Axial
1) 5mm
1) 5mm
2) 10mm
3) 10mm
1) 1.0mm
NA
NA
1) 3mm
Reconstruction Algorithm
Soft Tissue
Bone+ Algorithm
(Hi-Res Lung)
Soft Tissue
ST
SEND to #1,#2,#3
PACS PACS PACS PACS
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Coronary CTA Screening History
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Chest, Abdomen and Pelvis
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Chest Abdomen Pelvis: Acute Trauma Typical Indications: Severe trauma, Chest pain r/o Acute Aortic Dissection/tear, mediastinal widening; abdomen pelvis trauma
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A
ArterialPhase Y GATED Chest CTA Use Bolus Tracking
Inspiration Mid-cervical spine domes diaphragms
Venous Phase
Y Abdomen Pelvis
60-70 seconds
Inspiration Domes diaphragms to lesser trochanters
Delayed Phase
Y 5 -10 minutes Inspiration Kidneys 5 x 5mm Bladder 5 x 5mm
Scan Comments: Clamp foley catheter upon transfer to CT from ER. For acute severe chest trauma add GATING for Chest CTA to optimally see ascending aorta; Pause at diaphragm if needed to achieve portal venous phase 70 second delay thru abdomen/pelvis. If bladder injury is suspected because of multiple pelvic fractures, you should do CT cystogram following the routine abdominal CT. You need to actively distend the bladder in order to exclude bladder injury. Passive filling of the bladder via the I.V. injection is not sufficient to exclude rupture. • Inject 200-300 cc of dilute contrast in bladder via Foley catheter by gravity. Dilute contrast is a 2-3% solution of iodine. (100 cc of Isovue 300 contrast in a 1 liter saline bag.)
• The Foley catheter must be placed by the trauma or emergency service, who should have already cleared the patient from possible urethral injury. • Rescan lower abdomen and pelvis. Check for intraperitoneal extravasation along gutters and between bowel loops. Check for extraperitoneal extravasation anterior to the bladder and along the anterior abdominal wall and scrotum. Post-void images are not necessary.
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Contrast Parameters Parameters
Contrast Type Isovue 370 if CTA Isovue 300 if non CTA
Contrast Volume 100 cc
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments:
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x
1mm
3mm x
3mm
3mm x
3mm
Plane AX
AX AX SAG COR
Reconstruction Algorithm
ST Lung ST ST
ST
Send to PACS PACS To 3D Server then PACs
PACs PACs
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Abdomen and Pelvis
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CT Cystogram This exam is done specifically to rule out bladder rupture. If bladder injury is suspected because of multiple pelvic fractures or unexplained acites with history of trauma you should do CT cystogram following the routine abdominal CT. You need to actively distend the bladder in order to exclude bladder injury. Passive filling of the bladder via the I.V. injection is not sufficient to exclude rupture.
• Inject 200-300 cc of dilute contrast in bladder via Foley catheter by gravity drip 40 cm above table. Dilute contrast = 2-3% solution of iodine. (100 cc of Isovue 300 contrast in a 1 liter saline bag.)
• The Foley catheter must be placed by the trauma or emergency service, who should have already cleared the patient from possible urethral injury. • Rescan lower abdomen and pelvis at 5mm x 5mm making sure imaging goes through bottom of symphysis pubis joint. Recon these into ST windows and reformat images to 3mm x3mm SAG and COR planes.
Check for intraperitoneal extravasation along gutters and between bowel loops. Check for extraperitoneal extravasation anterior to the bladder and along the anterior abdominal wall and scrotum. Post-void images are usually not necessary.
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Oncology: Lymphoma Typical Indications: staging; r/o mets
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A
Arterial Phase
N N/A N/A
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser trochanters
Delayed Phase
N < 40 yo Y > 40 yo
Delayed kidneys/bladder
after 5minutes for age >40, trauma,
or hematuria
Inspiration Kidneys 5x5 Bladder 5x5
Scan Comments:
Contrast Parameters Parameters
Contrast Type Isovue 300
Contrast Volume 100cc
Injection Rate 3-4cc/sec
Oral Contrast
Per institution protocol
Oral Contrast Volume Per institution
Contrast Comments:
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm 5mm
5mm 5mm
2mm 1mm
3mm 3mm
3mm 3mm
NA
Plane AX
AX AX NA COR NA
Reconstruction
Algorithm
ST
LUNG
ST
NA
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
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Oncology: Hypovascular Mets Typical Indications: routine staging breast, ovarian, lung, colon
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A
Arterial Phase
N N/A N/A
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser
trochanters*
Delayed Phase
N < 40 yo Y > 40 yo
Delayed kidneys/bladder
after 5 minutes for age >40, trauma,
or hematuria
Inspiration Kidneys 5x5 Bladder 5x5
Scan Comments: *Include pelvis during PVP if pelvis CT ordered. Contrast Parameters Parameters
Contrast Type Isovue 300
Contrast Volume 75-80 cc routine use 100cc if scanning combined C-A-P
Injection Rate 3-4cc/sec
Oral Contrast Per institution
Oral Contrast Volume Per institution
Contrast Comments:
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane AX
AX AX NA COR NA
Reconstruction
Algorithm
ST
LUNG
ST
NA
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
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Oncology: Hypervascular Mets Typical Indications: Staging: neuroendocrine tumor: islet cell tumor/carcinoid, renal carcinoma, thyroid, choriocarcinoma, hepatoma, melanoma, sarcoma; leiomyosarcoma
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration Liver thru Pancreas
Arterial Phase Y
Use Bolus Tracking arterial phase (25-30 SECS)
Inspiration Liver
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru
lesser trochanters
Delayed Phase N < 40 yo
Y > 40 yo
Delayed kidneys/bladder after 5 minutes for age
>40, trauma, or hematuria
Inspiration Kidneys 5x5 Bladder 5x5
Contrast Parameters Parameters
Contrast Type Per insitution
Contrast Volume 100cc
Injection Rate
4-5cc/sec
Oral Contrast
Per Institution
Oral Contrast Volume
Per Institution
Contrast Comments:
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Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane AX
AX AX NA COR NA
Reconstruction
Algorithm
ST
LUNG
ST
NA
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
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ADRENAL MASS Protocol Typical Indications: adrenal mass, biochemical evidence adrenal lesion, elevated catecholamines/metanephrines; r/o pheochromocytoma
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y
N/A
Inspiration
Highest dome diaphragm thru kidneys
Arterial Phase
N
N/A N/A
Venous Phase
Y* 60 seconds** Inspiration Same as noncontrast; Scan thru pelvis if indication PHEO
Delayed Phase
Y* 15 minutes Inspiration Highest dome diaphragm thru kidneys
Scan Comments: *If noncontrast images demonstrate adrenal lesion <4cm and with HU < 10 contrast images may not be needed. If the noncontrast images demonstrate a homogeneous lesion that is less than 10 HU and less than 4cm the lesion is highly likely to be an adrenal adenoma and no further imaging is necessary. Therefore, the radiologist should check the noncontrast images prior to proceeding with the remainder of the study unless evaluation of the entire abdomen and pelvis was requested for other reasons. Relative Washout values >40% most c/w benign adenoma (RW= EAV-DAV/EAV). **Literature specifies 60 sec scan comparison to 15 minute scan: please do not fudge these scan times. If scanning for Pheochromocytoma: will need pelvis CT.
Contrast Parameters Parameters
IV Contrast Per Institution
Contrast Volume 75-80 cc
Injection Rate 3-4cc/sec
Oral Contrast Use H20 Protocol
Oral Volume 400 cc H20 pre 400 cc H20 on table
Contrast Comments
35
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
3mm 3mm
5mm 5mm
2mm 1mm
3mm 3mm
3mm 3mm
NA
Plane AX
AX AX NA COR NA
Reconstruction
Algorithm
ST
LUNG
ST
NA
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
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ABDOMEN PELVIS: ROUTINE Typical Indications: abdominal pain, mass, r/o abscess, appendicitis, diverticulitis, FUO, acute pancreatitis
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N
N/A
N/A
Arterial Phase
N
N/A N/A
Venous Phase
Y Bolus Tracking (60-70 SECS)
Inspiration Domes diaphragms thru lesser trochanters
Delayed Phase
No < 40 yo Yes > 40 yo
Delayed kidneys/bladder
after 5-10minutes for age >40, trauma, or hematuria
Inspiration Kidneys 5x5 Bladder 5x5
Scan Comments: Acute Pancreatitis: work-up should be done as routine abdomen. Noncontrast CT only need if concern for pancreatic hemorrhage. Contrast: For Pancreatitis cases OPACIFICATION AND DISTENTION OF DUODENUM IS VERY HELPFUL- drink additional oral contrast immediately before scan and consider placing patient right side down for 2-3minutes prior to scanning to mobilize contrast into duodenum.
Contrast Parameters Parameters
Contrast Type
Per institution
Contrast Volume
100cc
Injection Rate
3-4cc/sec
Oral Contrast
Per insitution
Oral Contrast Volume
Per institution
Contrast Comments:
37
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane AX
AX AX SAG COR NA
Reconstruction
Algorithm
ST
LUNG
ST
SAG
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
38
ABDOMEN PELVIS: TRAUMA Typical Indications: ACUTE TRAUMA
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N
N/A
N/A
Arterial Phase
N
N/A N/A
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser trochanters
Delayed Phase
Y 5-10 minutes Inspiration Kidneys 5x5 Bladder 5x5
Scan Comments: Clamp foley if present prior to scan. If multiple pelvic fractures and or bladder injury suspected will need to do a CT Cystogram (See Cystogram Protocol) to actively distend bladder (passive filling via IV is not sufficient). ALL SERIOUS TRAUMA PATIENTS INCLUDE PELVIS CT: Abdomen CT only is not option for serious trauma unless discussed and approved by radiologist.
Contrast Parameters Parameters
Contrast Type
Per insitution
Contrast Volume
100cc
Injection Rate
3cc-4cc/sec
Oral Contrast
No Oral Contrast Delay for Severe Trauma If NG Tube already present: Isovue 370/H20 (33cc/900cc)
on way to CT for indication upper abd trauma
Oral Contrast Volume ABD PEL CT: TRAUMA
If NG Tube already present: 400cc Isovue 370/H20
Contrast Comments:
(mix 33ccIsovue/900ccH20) on the way to CT for indication upper abd pancreas/ duodenal/prox SB injury optimally assessed with
oral in UGI tract but do not delay scan for oral contrast.
39
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane AX
AX AX SAG COR NA
Reconstruction
Algorithm
ST
LUNG
ST
ST
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
40
Abdomen Pelvis: FAST ER Protocol: R/O Acute Appendicitis or Diverticulitis ** For ER Patients with BMI >30 and Age >16 ** THIS IS NOT FOR ABSCESS:: INTR-ABDOMINAL ABSCESS EVALUATION NEEDS ORAL CONTRAST
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N
N/A
N/A
Arterial Phase
N N/A N/A
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser trochanters
Delayed Phase
N N/A N/A
Scan Comments: This is a limited scan focused to exclude acute cases of typical appendicitis in obese adults. If there is clinical suspicion for Abdominal Abscess then ORAL contrast is needed
Atypical presentations including prolonged symptoms or signs suggesting abscess are optimally imaged with oral contrast. Thin patients with BMI <30 and/or <16 years old use AbdPelvis CT: Routine. NOTE: Oral Contrast is critically important in thin patients and children to successfully exclude appendicitis.
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 100cc
Injection Rate 3-4cc/sec
Oral Contrast None
Oral Contrast Volume N/A
Contrast Comments:
41
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x 1mm
3mm x 3mm
3mm x 3mm
NA
Plane AX
AX AX NA COR NA
Reconstruction
Algorithm
ST
LUNG
ST
NA
ST
NA
Send to
PACS
PACS
HOLD
PACs
PACS
NA
42
Abdomen CTA- Aortic Aneurysm -Pre EVT Typical Indications: f/u known or suspected abdominal aneurysm, preop evaluation stent graft
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N** N/A N/A Dome Diaphragms to iliac crests
Arterial Phase
Y Use Bolus Tracking
Inspiration Domes Diaphragms thru lesser trochanters
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Scan Comments: For routine f/u abdominal aneurysm or initial preop evaluation Noncontrast phase not needed. ** For Acute Abdominal Pain with r/o dissection include NonContrast CT to evaluate for acute intramural hematoma: **For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd stent graft region: See Abdomen Aorta CTA Post EVT protocol Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 75-80cc routine 100 cc if combining with chest
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume DO NOT GIVE ORAL CONTRAST; if scout shows barium consider delaying exam for elective cases
43
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
2mm x 2mm
5mm x 5mm
1mm x 0.5mm
3mm x
3mm
3mm x 3mm
#3) 3D radial MPR #4) 5mm thick
MIPs in SAG and COR
Plane Axial Axial Axial Sag Cor 3) Radial Range 4) SAG/COR
Reconstruction
Algorithm
Soft Tissue
Lung
ST
ST
ST
ST
Send to
PACS
PACS
1. To 3D
server 2. PACS
PACS
PACs
PACs : Reformat
3Ds AFTER transferring raw
data to PACS
44
Abdomen CTA- Aortic Aneurysm –Post EVT Typical Indications: f/u known or suspected thoracic aneurysm, preop evaluation stent graft
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y** N/A N/A Domes diaphragms thru symphysis
Arterial Phase
Y Use Bolus Tracking
Inspiration Domes diaphragms thru lesser trochanters
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Scan Comments: For routine f/u thoracic aneurysm noncontrast not needed. ** For Acute Chest Pain with r/o dissection include NonContrast CT to evaluate for acute intramural hematoma: See CTA Acute Aorta
**For POST Endovacular Stent Graft patients add NonContrast phase thru chest/abd stent graft region
Contrast Parameters Parameters
Contrast Type Per insitution
Contrast Volume 75-80cc routine 100 cc if combining with chest CTA
Injection Rate 4-5cc/sec
Oral Contrast N/A
Oral Contrast Volume N/A
Contrast Comments: DO NOT GIVE ORAL CONTRAST; if scout shows barium consider delaying exam for elective cases
45
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
2mm x 2mm
5mm x 5mm
1mm x 0.5mm
3mm x 3mm
3mm x 3mm
#3) 3D radial MPR #4) 5mm thick
MIPs in SAG and COR
Plane
Axial
Axial
Axial
Sag
Cor
3) Radial Range 4) SAG/COR
Reconstruction
Algorithm
Soft
Tissue
Lung
ST
ST
ST
ST
Send to
PACS
PACS
1. To 3D
server 2. PACS
PACS
PACs
PACs : Reformat
3Ds AFTER transferring raw
data to PACS
46
CT COLONOGRAPHY Indications: Screening or Diagnostic
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y Sup + Prone
N/A
Inspiration
Domes diaphragms thru lesser trochanters
Arterial Phase
N/A N/A N/A
Venous Phase
N/A N/A N/A
Delayed Phase N/A N/A N/A
Scan Comments: Scan acquisitions in both Supine and Prone position
Contrast Parameters Parameters
Contrast Type Air per rectum
Contrast Volume 50 puffs hand mechanical Scout after insufflation to assess air adequacy
Saline Flush N/A
Injection Rate
N/A
Oral Contrast
Tagitol Oral prep protocol
Oral Contrast Volume Tagitol V 3 bottles @ 20 ml each at 0800, 1200, 1700 day before
Contrast Comments:
See Virtual Colonography Prep Protocol: For Screening use Tagitol Oral Prep; For Diagnostic Cases coming from Incomplete
Endoscopy may scan immediately without Tagitol prep
Reconstruction Parameters
Soft Tissue
Lung
Thin Data
Slice Thickness 5mm 5mm 0.5mm
Reconstruction Spacing 5mm 5mm 0.5mm
Reconstruction Algorithm Soft Tissue B30f
Lung B80f
Soft Tissue B30f
Window and Level 400/40 1500/-500 400/40
Reconstruction Comments:
Supine and Prone Axial 5x5 mm in Soft Tissue to PACS Lung 5 x 5 mm Recons to PACS Sag/Cor recons 3 x 3 Soft Tissue to PACS Supine and Prone Thin Data Sets to 3D Server (Terarecon) Only
47
Insufflation Technique
1. Left down decubitus. Inflate balloon in rectum; pull back to create seal at anorectal junction; tape catheter to cheeks; Turn on CO2 with maximum pressure (the machine’s computer starts at a low pressure and gradually increases it, no need to do this manually). Inflate first 1000 mL in LLD position. Roll patient to supine for 2nd 1000 mL. When pressure equilibriates to 25 mm and/or 2000 mL is reached then do supine scout. Do not turn off the gas. Check the scout. If the patient is full of stool find out if they took the prep, and if not send them home to reprep. If there is a nondistended segment, try rolling the patient so that segment is UP (air rises). Make sure tip is still in the rectum. Re-scout. If still not well distended, try hand insufflation (locate plastic bag in the tubing between pump and patient; occlude tubing between bag and patient; bag fills with gas; occlude tubing between bag and pump; squeeze contents of bag into patient. Repeat sequence of maneuvers several times. Pump will shut off automatically at 4 liters. If this happens, turn it back on. Repeat scout. Scan. Check axial images for non-distended segments. Make a note of them. Turn patient prone. DO NOT TURN OFF THE GAS. Place boosters underneath thighs and chest. If pump turns off by itself put it back on. Wait a minute or two. Rescan. If there is a non-distended segment repeat procedure above. Scan. Check axial images for non-distended segments. If there is an area nondistended on both supine and prone do a third scan (after additional insufflation) in a decubitus or oblique with the collapsed segment up.
2. Alternate method of manual insufflation- cut tubing with scissors between bag and patient; attach blue puffer bulb and insufflate room air. About 10 puffs should do if there is CO2 in there already. This may overcome ileocecal reflux or slight rectal sphincter incompetence. A complete exam can be done if the pump breask or you run out of CO2 using 50 bulb squeezes supine, then additional 10 after position change.
3. If gas escapes: use large bore tip with a big balloon
48
CT Enterography Typical Indications: Suspected or known Crohn’s, small bowel tumor, GI bleeding, malabsorption.. THIS IS NOT FOR ISCHEMIA- see CTA
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast N N/A N/A
Arterial Phase
Y* for occult GI bleeding/tumor
Use Bolus Tracking
Inspritation Mid liver to bottom of ischial tuberosities
Enteric Phase (Crohn’s)
Y* 20 SECS after arterial phase
(50 seconds total)
Inspiration Mid liver to bottom of ischial tuberosities
Delayed Phase
No for Crohn’s Yes for Occult GI
Bleed/Tumor
90 SECS after arterial phase
Inspiration Mid liver to bottom of ischial tuberosities
Scan Comments: Biphasic and Triphasic scanning in young patients requires special consideration of lowering scan dose: 1) Scan range is directly related to the total radiation dose ; therefore, if the primary focus is imaging of the small bowel, coverage can be reduced to exclude the lung bases, breast tissue, and top of the liver. Imaging should be performed through the perineum, since perianal fistulas can be an essential diagnostic clue in Crohn colitis and may not be recognized clinically. 2) Dose reduction and improved lesion detection with lower kVP to 80-100 in normal to thin patients. Mucosal hyperenhancement and mural stratification of inflamed bowel are more pronounced at lower tube potentials, thus improving the conspicuity of abnormal segments. A potential radiation dose savings of 16%–30% can be achieved by reducing the kilovolt peak to 80 or 100 kVp.
From: July 2013 RadioGraphics, 33, 1109-1124.
Crohn disease or other diffuse bowel pathology: Enteric phase study only (approximately 50 seconds after start of injection) is sufficient. For occult GI bleeding and search for GI malignancy: arterial, enteric, and delayed scans are usually needed. Before giving IV contrast perform a low mA single slice through mid abdomen or topogram and check if there is adequate bowel distention. (Make sure most of Volumen is not in stomach) Pts need to be NPO 6hours except meds and oral contrast protocol. If patient cannot drink contrast NG tube required. Follow Volumen Protocol.
49
Contrast Parameters Parameters
Contrast Type
Isovue 300
Contrast Volume
100cc
Injection Rate
4-5cc/sec
Oral Contrast
Volumen
Oral Contrast Volume
See Volumen protocol
Contrast Comments:
For Gastric Mass/Ulcer evaluation use H2O
water protocol
Scan Supine and have rad review need on while
patient table to assess need for Prone images
Reconstruction Parameters
Soft Tissue
Bone/ Lung Thin Data
Sag Cor
Slice Thickness x Recon Spacing
3mm x 3mm
5mm x 5mm
1mm x 0.5mm
3mm x
3mm
3mm x
3mm
Plane Axial
Axial
Axial
Sag
Cor
Reconstruction Algorithm
Soft Tissue
Lung
ST
ST
ST
Send to PACS PACS 1. To 3D server
2. PACS
PACS PACs
50
51
CT UROGRAM Typical Indications: hematuria; bladder mass; see Renal Mass Protocol for known renal mass
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y
N/A
Inspiration
Kidneys thru lesser
trochanters
Arterial Phase/Early
Corticomedullary Phase
Y
Approx 30 secs
Inspiration
Kidneys
Venous Phase/ Nephrographic
Phase
Y
80-90 seconds
Inspiration
Domes diaphragms thru lesser trochanters
Delayed Phase/ Urographic Phase
Y* 8-10 minutes Inspiration Kidneys thru lesser trochanters
Scan Comments: Patients should be well hydrated for exam. *For Renal Mass protocol only do NonContrast, Arterial, and Nephrographic Phases ( no urographic phase). If obstructing renal stone identified on noncontrast contact Radiologist- may be able to omit other phases
Contrast Parameters
Parameters
Contrast Type
Per Institution
Contrast Volume
100cc
Injection Rate
4-5 cc/sec
Oral Contrast
H20
Oral Contrast Volume
800cc
Contrast Comments:
400 cc H20 20 minutes prior to scan
400 cc H20 on table
52
Reconstruction
Parameters
Soft Tissue
Bone/ Lung
Thin Data
Sag
Cor
Slice Thickness x Recon Spacing
5mm 5mm
5mm 5mm
2mm 1mm
3mm 3mm
3mm 3mm
Plane AX
AX
AX NA COR
Reconstruction
Algorithm
ST
LUNG
ST
NA
ST
Send to
PACS
PACS
HOL
D
PACs
PACS
53
CT UROGRAM LOW DOSE
Acquisition Phase
Phase Included
Scan Delay
Respiration Phase
Anatomical Coverage
Non Contrast
Y
N/A
Inspiration
Kidneys
thru lesser trochanters
Combined Nephrographic/ Urographic Phase
Y
1)30cc @ 2cc/sec Then NS flush 200cc @1.5cc/sec
Pause 10 mins 2) 55cc @ 1.5cc/sec Pause 20 secs 3)65cc @ 3 cc/sec
Inspiration
Domes thru
bottom of symphysis pubis joint
CT LOW DOSE UROGRAM- TRIPHASIC INJECTION Typical Indications: “hematuria; bladder mass”
54
Reconstruction Parameters
Soft Tissue
Lung
Thin Data
Slice Thickness
5mm 5mm 2mm
Reconstruction Spacing
5mm 5mm 2mm
Reconstruction Algorithm
Soft Tissue B30f
Lung B80f
ST
Window and Level
400/40 1500/-500 400/40
55
Renal Mass Typical Indications: abnormal renal ultrasound/suspected renal mass
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration Kidneys 5 x 5mm
Corticomedullary Phase
Y
30-40 secs
Inspiration
Top of Liver to bottom of Kidneys 5 x 5mm
Nephrographic Phase
Y 90 secs Inspiration Top of Liver to Lesser Trochanters
DelayedPhase N N/A N/A N/A
Scan Comments:
Contrast Parameters
Parameters
Contrast Type Per institution
Contrast Volume
100cc
Injection Rate 3cc-4cc/sec
Oral Contrast
H20 Oral Contrast protocol
Contrast Comment
400 ml H20 20 minutes prior to scan 400 ml H20 on table
56
Reconstruction Parameters
Soft Tissue
Bone/ Lung
Thin Data
Sag
Cor
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
2mm x
1mm
3mm x
3mm
3mm x
3mm
Plane AX
AX AX NA COR
Reconstruction Algorithm
ST
LUNG
ST
NA
ST
Send to
PACS
PACS
HOLD
PACs
PACS
57
Renal CTA Typical Indications: r/o renal artery stenosis
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A N/A
Arterial Phase
Y Use Bolus Tracking
Inspiration Dome diaphragm thru iliac crests
Venous Phase
N N N/A
Delayed Phase
N N/A N/A
Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 80cc
Injection Rate 4-5cc/sec
Oral Contrast
N/A
Oral Contrast Volume
N/A
Contrast Comments:
58
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
3mm x 3mm
5mm x 5mm
1mm x 0.5mm
3mm x 3mm
3mm x 3mm
1) 3D radial MPR 2) 5mm thick MIPs
in SAG and COR
Plane
Axial
Axial
Axial
Sag
Cor
1) Radial Range
2) SAG/COR
Reconstruction
Algorithm
Soft Tissue
Lung
ST
ST
ST
ST
Send to PACS PACS
To 3D server then to PACS
PACS PACs
PACs : Reformat 3Ds AFTER
transferring raw data to PACS
59
Retroperitoneal Hemorrhage Typical Indications: post heart cath r/o bleeding, unexplained drop in Hg/Hct, r/o acute bleeding
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration Domes diaphragms thru lesser trochanters 5 x
5mm
Arterial Phase
N* Bolus Tracking Inspiration
Venous Phase
N N N/A
Delayed Phase
N* N/A N/A
Scan Comments: Consider IV contrast if Noncontrast Positive and/or if needed to detect acute vascular extravasation (especially immediately post heart cath, recent biopsy, or trauma)
If extravasation seen on initial scan call radiologist and consider delayed scans thru area of extravasation depending on patient condition
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 100cc
Injection Rate 4-5cc/sec
Oral Contrast None
Oral Contrast Volume N/A
Contrast Comments
60
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
1mm x 0.5mm
3mm x 3mm
3mm x 3mm
NA
Plane Axial Axial Axial Sag Cor NA
Reconstruction
Algorithm
Soft Tissue
Lung
ST
ST
ST
NA
Send to
PACS
PACS
Hold
PACS
PACs
NA
61
Oncology: Hepatoma: (Triphasic Liver CT) Typical Indications: Staging: Hepatoma; Hepatocellular CA; h/o liver cirrhoiss r/o HCC screening for hepatoma
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration Liver
Arterial Phase
Y Use arterial bolus tracking
software
Inspiration Liver
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser trochanters
Delayed Phase/Equilibrium
Phase
Y 3minutes Inspiration Liver
Scan Comments: This is the standard triphasic liver CT. Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 100cc
Injection Rate 4cc/sec
Oral Contrast H20 Protocol
Oral Contrast Volume 400 cc H20 PO 20 minutes prior to scan 400c H20 PO on table
Contrast Comments:
62
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
1mm x 0.5mm
3mm x 3mm
3mm x 3mm
NA
Plane Axial Axial Axial Sag Cor NA
Reconstruction
Algorithm
Soft Tissue
Lung
ST
ST
ST
NA
Send to
PACS
PACS
Hold
PACS
PACs
NA
63
Oncology: Cholangiocarcinoma Typical Indications: Staging: cholangiocarinoma, bile duct tumor
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
N N/A N/A
Arterial Phase
Y 25-30 SECS Inspiration Liver
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser
trochanters*
Delayed Phase
Y 8 minutes Inspiration Liver
Scan Comments: * Include pelvis during PVP if ordered
Contrast Parameters Parameters
Contrast Type Per institution
Contrast Volume 75- 80 cc routine 100cc if combined with CAP
Injection Rate
4cc/sec
Oral Contrast
Per institution
Oral Contrast Volume Per institution
Contrast Comments:
May use 800 cc H20 as alternative to positive oral contrast if
only scanning liver
64
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
5mm x 5mm
5mm x 5mm
1mm x 0.5mm
3mm x 3mm
3mm x 3mm
NA
Plane Axial Axial Axial Sag Cor NA
Reconstruction
Algorithm
Soft Tissue
Lung
ST
ST
ST
NA
Send to
PACS
PACS
Hold
PACS
PACs
NA
65
Pancreatic Mass CT Typical Indications: Evaluate Pancreatic Mass (For evaluation standard pancreatitis use Routine Abdomen Pelvis CT)
Acquisition
Phase
Phase
Included
Scan
Delay
Respiration
Phase
Anatomical Coverage
Non Contrast
Y N/A Inspiration Liver through pancreas
Arterial Phase
Y Use bolus tracking software
Inspiration Liver through pancreas
Venous Phase
Y 60-70 SECS Inspiration Domes diaphragms thru lesser trochanters
Scan Comments: Acute Pancreatitis: work-up should be done as Routine Abdomen-pelvis. For Pancreas cases OPACIFICATION AND DISTENTION OF DUODENUM IS VERY IMPORTANT- drink additional oral contrast immediately before scan and consider placing patient right side down for 2-3minutes prior to scanning to mobilize contrast into duodenum. Venous phase through pelvis if pelvis CT ordered.
Contrast Parameters Parameters
Contrast Type Per Institution
Contrast Volume 75-80cc routine 100 cc if combined with CAP
Injection Rate 4cc/sec
Oral Contrast
Per institution
Oral Contrast Volume
Contrast Comments: Be sure to give extra oral contrast immediately prior to scanning to distend stomach/ duodenum. Check for adequacy of duodenal
contrast on un-enhanced series
66
Reconstruction Parameters
Soft Tissue
Bone/
Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
3mm x 3mm
3mm x 3mm
1mm x 0.5mm
3mm x 3mm
3mm x 3mm
NA
Plane Axial Axial Axial Sag Cor NA
Reconstruction Algorithm
Soft Tissue
Lung
ST
ST
ST NA
Send to
PACS
PACS
Hold
PACS
PACs
NA
67
CT VENOGRAM PELVIS: Pelvic Venous Congestion Typical Indications: Evaluate Ovarian Vein Reflux/ Pelvic Venous Congestion ; pelvic varicosities, exclude pelvic vein or lower extremity deep venous thrombosis
:
Acquisition Phase
Phase Included
Scan Delay
Respiration Phase
Anatomical Coverage
Non Contrast
N
N/A
N/A
N/A
Arterial Phase
N
N/A
N/A
N/A
Venous Phase
Y
3MINS
QUIET
Top of Kidneys to below Lesser Trochanters
Delayed Phase
N
N/A
N/A
N/A
Scan Comments: MAY BE ABLE TO DECREASE KVP TO 100 OR 80 IN SMALL PTS
Contrast Parameters Parameters Contrast Type
Isovue 370
Contrast Volume
100CC
Injection Rate
2CC/sec CONTRAST
2CC/SEC SALINE FLUSH X 30 CC Oral Contrast
N/A
Oral Contrast Volume
N/A
Contrast Comments:
SCAN DELAY 3 MINUTES
68
Reconstruction Parameters
Soft
Tissue
Bone/ Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
1MM X 1MM
N/A
0.75MM X 1MM
3mm x 3mm
3mm x 3mm
SEND THINSTO PACS FOR MD RECONS
Plane Axial
N/A
Axial
Sag
Cor
AX
Reconstruction Algorithm
Soft Tissue
N/A
ST
ST
ST
ST
Send to
PACS
N/A
TO TERA
PACS
PACs
DONE BY MD
69
LOWER EXTREMITIES
70
CT VENOGRAM LOWER EXTREMITY Typical Indications: Evaluate Venous varicosities, exclude pelvic vein or lower extremity deep venous thrombosis
:
Acquisition Phase
Phase Included
Scan Delay
Respiration Phase
Anatomical Coverage
Non Contrast
N
N/A
N/A
N/A
Arterial Phase
N
N/A
N/A
N/A
Venous Phase
Y
3MINS
QUIET
TOP OF L4 TO FEET
Delayed Phase
N
N/A
N/A
N/A
Scan Comments: IF PATIENT IS BEING SCANNED TO RULE OUT OVARIAN VEIN REFLUX, PELVIC VENOUS CONGESTION PLEASE SEE OVARIAN VEIN REFLUX/ PLEVIC VENOUS CONGESTION PROTOCOL. MAY BE ABLE TO DECREASE KVP TO 100 OR 80 IN SMALL PTS
Contrast Parameters Parameters Contrast Type
Isovue 370
Contrast Volume
100CC
Injection Rate
2CC/sec CONTRAST
2CC/SEC SALINE FLUSH X 30 CC Oral Contrast
N/A
Oral Contrast Volume
N/A
Contrast Comments:
SCAN DELAY 3 MINUTES
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Reconstruction Parameters
Soft
Tissue
Bone/ Lung
Thin Data
Sag
Cor
3D/Special
Slice Thickness x Recon Spacing
1MM X 1MM
N/A
0.75MM X 1MM
3mm x 3mm
3mm x 3mm
SEND THINSTO PACS FOR MD RECONS
Plane Axial
N/A
Axial
Sag
Cor
AX
Reconstruction Algorithm
Soft Tissue
N/A
ST
ST
ST
ST
Send to
PACS
N/A
TO TERA
PACS
PACs
DONE BY MD
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