Chest, Abdomen and Pelvis CT Protocols · 1 Chest, Abdomen and Pelvis CT Protocols Chest Chest CT Low Dose Nodule Evaluation Chest CT Lung Cancer Screening Chest CT Routine With Contrast

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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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4

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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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special



1 mm 1 mm 0.5 mm x 0.3 mm

2 mm x 2 mm

2 mm x 2 mm

NA



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 Type Per institution

Contrast Volume 75-80cc Use 100 cc if combined with abdomen CT

Injection Rate 4-5cc/sec

Oral Contrast N/A


Contrast Comments:

Scan delay: usual 25 seconds; Use Bolus Tracking if available


Soft Tissue

Bone/

Lung

Thin Data

Sag Cor 3D/Special


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


Soft Tissue

Bone/

Lung Thin Data

Sag

Cor 3D/Special


5mm x 5mm

5mm x 5mm

2mm x 1mm

3mm x 3mm

3mm x 3mm

NA



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 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.

http://www.mxcimaging.com/

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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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


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 Type

Per institution

Contrast Volume

100cc

Injection Rate

4-5cc/sec

Oral Contrast

N/A


N/A

Contrast Comments:

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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special



#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


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 Volume 75-80cc routine 100 cc if combining with abdomen


Oral Contrast N/A


Contrast Comments:

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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special



#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


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




Contrast Volume 80cc

Injection Rate 4cc/sec

Oral Contrast N/A


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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor



#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


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


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 Volume

80cc chest CTA only

100 cc if combined CAP


Oral Contrast 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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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special



#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


Reconstruction

Algorithm

Soft Tissue

Lung

ST

ST

ST

ST

Send to

PACS

PACS

1. To 3D

server 2. PACS

PACS

PACS

PACS : Reformat


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


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.


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


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 Type Isovue 370 if CTA Isovue 300 if non CTA

Contrast Volume 100 cc


Oral Contrast N/A


Contrast Comments:


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor


5mm x 5mm

5mm x 5mm

2mm x

1mm

3mm x

3mm

3mm x

3mm

Plane AX

AX AX SAG COR


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 Type Isovue 300



Oral Contrast

Per institution protocol

Oral Contrast Volume Per institution

Contrast Comments:

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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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


after 5 minutes for age >40, trauma,

or hematuria


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


Oral Contrast Per institution


Contrast Comments:

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Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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

32

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



Contrast Type Per insitution


Injection Rate

4-5cc/sec

Oral Contrast

Per Institution


Per Institution

Contrast Comments:

33


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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.


IV Contrast Per Institution

Contrast Volume 75-80 cc


Oral Contrast Use H20 Protocol

Oral Volume 400 cc H20 pre 400 cc H20 on table

Contrast Comments

35


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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

36

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


after 5-10minutes for age >40, trauma, or hematuria


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 Type

Per institution

Contrast Volume

100cc

Injection Rate

3-4cc/sec

Oral Contrast

Per insitution


Per institution

Contrast Comments:

37


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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


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 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


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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


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 Type Per Institution



Oral Contrast None


Contrast Comments:

41


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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


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 Volume 75-80cc routine 100 cc if combining with chest


Oral Contrast N/A

Oral Contrast Volume DO NOT GIVE ORAL CONTRAST; if scout shows barium consider delaying exam for elective cases

43


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


2mm x 2mm

5mm x 5mm

1mm x 0.5mm

3mm x

3mm

3mm x 3mm


MIPs in SAG and COR


Reconstruction

Algorithm

Soft Tissue

Lung

ST

ST

ST

ST

Send to

PACS

PACS

1. To 3D

server 2. PACS

PACS

PACs

PACs : Reformat


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


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



Contrast Type Per insitution

Contrast Volume 75-80cc routine 100 cc if combining with chest CTA


Oral Contrast N/A


Contrast Comments: DO NOT GIVE ORAL CONTRAST; if scout shows barium consider delaying exam for elective cases

45


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


2mm x 2mm

5mm x 5mm

1mm x 0.5mm

3mm x 3mm

3mm x 3mm


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


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 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


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 Type

Isovue 300

Contrast Volume

100cc

Injection Rate

4-5cc/sec

Oral Contrast

Volumen


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


Soft Tissue

Bone/ Lung Thin Data

Sag Cor


3mm x 3mm

5mm x 5mm

1mm x 0.5mm

3mm x

3mm

3mm x

3mm

Plane Axial

Axial

Axial

Sag

Cor


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


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


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


Soft Tissue

Lung

Thin Data

Slice Thickness

5mm 5mm 2mm

Reconstruction Spacing

5mm 5mm 2mm


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 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


Soft Tissue

Bone/ Lung

Thin Data

Sag

Cor


5mm x 5mm

5mm x 5mm

2mm x

1mm

3mm x

3mm

3mm x

3mm

Plane AX

AX AX NA COR


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


Inspiration Dome diaphragm thru iliac crests

Venous Phase

N N N/A

Delayed Phase

N N/A N/A





Oral Contrast

N/A


N/A

Contrast Comments:

58


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


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





Oral Contrast None


Contrast Comments

60


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


5mm x 5mm

5mm x 5mm

1mm x 0.5mm

3mm x 3mm

3mm x 3mm

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


Delayed Phase/Equilibrium

Phase

Y 3minutes Inspiration Liver

Scan Comments: This is the standard triphasic liver CT. Contrast Parameters Parameters




Oral Contrast H20 Protocol

Oral Contrast Volume 400 cc H20 PO 20 minutes prior to scan 400c H20 PO on table

Contrast Comments:

62


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


5mm x 5mm

5mm x 5mm

1mm x 0.5mm

3mm x 3mm

3mm x 3mm

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 Volume 75- 80 cc routine 100cc if combined with CAP

Injection Rate

4cc/sec

Oral Contrast

Per institution


Contrast Comments:

May use 800 cc H20 as alternative to positive oral contrast if

only scanning liver

64


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


5mm x 5mm

5mm x 5mm

1mm x 0.5mm

3mm x 3mm

3mm x 3mm

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


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 Volume 75-80cc routine 100 cc if combined with CAP


Oral Contrast

Per institution


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


Soft Tissue

Bone/

Lung

Thin Data

Sag

Cor

3D/Special


3mm x 3mm

3mm x 3mm

1mm x 0.5mm

3mm x 3mm

3mm x 3mm

NA



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


N/A

Contrast Comments:

SCAN DELAY 3 MINUTES

68


Soft

Tissue

Bone/ Lung

Thin Data

Sag

Cor

3D/Special


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


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


N/A

Contrast Comments:

SCAN DELAY 3 MINUTES

71


Soft

Tissue

Bone/ Lung

Thin Data

Sag

Cor

3D/Special


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


Soft Tissue

N/A

ST

ST

ST

ST

Send to

PACS

N/A

TO TERA

PACS

PACs

DONE BY MD

72

73

Chest, Abdomen and Pelvis CT Protocols · 1 Chest, Abdomen and Pelvis CT Protocols Chest Chest CT Low Dose Nodule Evaluation Chest CT Lung Cancer Screening Chest CT Routine With Contrast

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