brain/head non-contrast - united radiology group, chartered

Brain/Head Non-contrast

Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical coverage Non-contrast Yes N/A N/A Base of skull through

apex Arterial Phase N/A N/A N/A N/A Venous Phase N/A N/A N/A N/A Delayed Phase N/A N/A N/A N/A Scan comments: Isocentering the patient within the gantry is key to image quality. All scans are performed using the ALARA principle. Technical Parameters Parameters

kVp 120

Effective mAs CareDose

Care Dose Reference mAs 260 (SAFIRE strength=1)

Time (Rotation) 1.0 sec

Average Acquisition Time 13 seconds

Collimation 64 x 0.6mm

Pitch Value 0.55

Scan Direction caudal-cranial

Comments: Decreasing the rotation time or increasing the pitch will allow for faster scan times when patient motion is a concern.

Reconstruction Parameters Soft Tissue Thin Data Bone

Slice Thickness 5mm 1.5mm

Reconstruction Spacing 5mm 1.5mm

Reconstruction Algorithm J30s J70

Window Width/Level 85/35 1600/400

Reconstruction Comments: Axial MPR’s should be performed to correct positioning to the canthomeatal plane. Bone windows for any type of trauma.

Contrast Parameters Parameters

Contrast Type Omnipaque 300 (if used)

Contrast Volume 50ml

Saline Flush No

Injection Rate Hand injection/wait 5 minutes before post contrast scan

Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is typically not necessary for this exam. Most radiologists when asked about IV contrast for a brain CT will suggest an MRI.

1. Remove hearing aids and any metal in the hair. Remove earrings if they remain in

the way. Try to position the patient with their chin tucked down to avoid scanning through fillings in the teeth and the lens of their eyes.

2. Dr. Whitlow or Boswell will sometimes want a pre-op scan and they will put some markers on the patient prior to scanning. There is a specific Brain Lab protocol for these scans.

Pediatric Head Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A Base of skull through apex

Arterial Phase N/A N/A N/A N/A

Venous Phase N/A N/A N/A N/A

Delayed Phase N/A N/A N/A N/A

Scan Comments: Isocentering the patient within the gantry is key to image quality. All scans are performed using the ALARA principle.

Technical Parameters Parameters

kVp 110




Average Acquisition Time 4 sec


Pitch Value 1.0 or greater


Comments: Decreasing the rotation time or increasing the pitch will allow for faster scan times when patient motion is a concern.

Reconstruction Parameters Soft Tissue Thin Data (if needed for 3D skull)

Bone

Slice Thickness 5mm 0.75mm 1.5mm

Reconstruction Spacing 5mm 0.4mm(overlap) 1.5mm

Reconstruction Algorithm J30f J30f J70

Window Width/Level 100/35 1600/400

Reconstruction Comments: Axial MPR’s should be performed to correct positioning to the canthomeatal plane. Bone windows and coronal MPR's for any type of trauma. 3D VR skull and coronal MPR's for craniosynostosis


Contrast Type Omnipaque 300 (if used)

Contrast Volume Weight based dosing

Saline Flush No

Injection Rate Hand injection/wait 5 minutes before post contrast CT scan

Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is typically not necessary for this exam. Most radiologists when asked about IV contrast for a brain CT will suggest an MRI.

1. Utilize sponges and blankets to minimize patient motion. 2. Remove any metal objects in the hair and earrings if they remain in the way. Try to

position the patient with their chin tucked down to avoid scanning through lens of eye.

Sinuses/Sinuses (landmark)(Brain Lab/OR) Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A maxillary through frontal sinus

Arterial Phase No N/A N/A N/A

Venous Phase No N/A N/A N/A

Delayed Phase No N/A N/A N/A



kVp 100






Pitch Value 0.8


Comments: Isocentering the patient within the gantry is key to image quality and dose modulation. 100 kVp with CareDose is used to limit patient dose.

Reconstruction Parameters Soft Tissue (routine) Landmark for Brain Lab (pre-op)

Slice Thickness 3mm 1mm

Reconstruction Spacing 3mm 1mm

Reconstruction Algorithm J45f J45f

Window Width /Level 1000/0 1000/0


Contrast Type N/A

Contrast Volume N/A

Saline Flush N/A

Injection Rate N/A

Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is not routinely necessary.

Sinuses-Landmark (Brain Lab/OR)

1. See attached Brain Lab protocol. This is usually a pre-op scan. Scan supine 1mm axial or helical slices through the sinuses. Be sure the FOV is large enough to include the facial region (nose, eyes, and forehead. Do not use any positioning devices that might bend the ears or shift any skin. Do not use any gantry angle.

2. Surgery can access the axial images from PACS to load into the Brain Lab guidance system.

Sinuses-limited screening Scan supine. This is actually an axial scan (step and shoot) rather than helical. Do just a few (4-6) scans through the sinuses. This works out to approximately one 3mm slice every 15-20mm. Be sure there is at least one image through each set of sinuses. This order is fairly specific to Dr. Bell (ENT) and Dr. Cossette (ENT) in Salina. Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A maxillary through frontal sinus






kVp 100



Time (Rotation) 1.0 sec Full


Collimation 1 x 5mm with 15mm feed

Pitch Value N/A


Comments: Isocentering the patient within the gantry is key to image quality and dose modulation. 100 kVp with CareDose is used to limit patient dose.

Reconstruction Parameters Soft Tissue

Slice Thickness 3mm

Reconstruction Spacing 15mm

Reconstruction Algorithm H50s

Window Width /Level 1000/0

Facial Bones Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A mandible through frontal sinus




Scan Comments: Isocentering the patient within the gantry is key to image quality. All scans are performed using the ALARA principle. IV contrast is not routinely necessary.


kVp 100


Care Dose Reference mAs 130




Pitch Value 0.8


Comments: 100 kVp with CareDose is used to limit patient dose.

Reconstruction Parameters Soft Tissue Bone



Reconstruction Algorithm H32s H60s

Window Width and Level 450/80 1600/400

Comments: Both soft tissue and bone windows are not necessary. Just use the one appropriate to diagnosis.


Contrast Type If needed, Omnipaque 300


Saline Flush No

Injection Rate Hand injection

Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is not typically necessary but sometimes will be utilized when looking for abscesses or cellulitis.

Orbits

Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A Through orbits






kVp 100






Pitch Value 0.8


Comments: 100 kVp with CareDose is used to limit patient dose.

Reconstruction Parameters Soft Tissue Bone



Reconstruction Algorithm H32s H60s


Comments: Both soft tissue and bone windows are not necessary. Just use the one appropriate to diagnosis.


Contrast Type If needed, Omnipaque 300


Saline Flush No


Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is not typically necessary. Will sometimes use contrast for abscesses or cellulitis.

Circle of Willis CTA

Acquisition Phase

Phase Included Scan Delay Respiration

Phase Anatomical Coverage

Non Contrast Yes N/A N/A Base of skull through apex

Arterial Phase Yes Bolus trigger None Base of skull through apex



Scan Comments: Isocentering the patient within the gantry is key to image quality and dose modulation. All scans are performed using the ALARA principle.


kVp 120

Effective mAs CareDose (quality reference mAs 180)


Average Acquisition Time 6-8 sec


Pitch Value 0.8


Comments:

Reconstruction parameters Soft tissue Thin axials for 3D Slice thickness 3mm 0.75mm Reconstruction spacing 3mm 0.4mm Reconstruction algorithm I26f (SAFIRE strength=2) I26f (SAFIRE strength=2) Window width/level 450/80 Comments: 2mm sagittal and coronal MPR's, curved MIP's, 3D VRT Contrast parameters Parameters Contrast type Omnipaque 350 Contrast volume 75ml

Saline flush yes Injection rate 4 ml/sec Oral contrast N/A Oral contrast volume N/A Comments: Make topogram length long enough to set bolus tracker in the aortic arch for triggering.

Temporal Bones/IAC’s/Mastoids Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A Through temporal bones. Include mastoids.






kVp 120






Pitch Value 0.8

Scan Direction caudocranial

Comments: Isocentering the patient within the gantry is key to image quality and dose modulation. CareDose is used to limit patient dose.

Reconstruction Parameters Bone Sagittal/Coronal Soft Tissue(if needed)

Slice Thickness 1mm 1mm thick/10cm DFOV each side 1mm

Reconstruction Spacing

1mm 1mm 1mm

Reconstruction Algorithm

H70h H70h H32s

Window Width and Level

4000/1100 4000/1100 450/80


Contrast Type Omnipaque 300


Saline Flush N/A


Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is not typically necessary, although it is utilized when 1) looking for an acoustic neuroma and 2) the patient is contraindicated to having an MRI. In this case you will need both pre and post contrast.

Cervical spine Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A N/A Base of skull through

T1-2 Arterial Phase No N/A N/A N/A Venous Phase No N/A N/A N/A Delayed Phase No N/A N/A N/A Scan Comments: All Scans are performed using the ALARA principle.

Technical parameters Parameters kVp 120 Effective mAs CareDose (Quality ref mAs 180) Time (rotation) 0.5 sec Average acquisition time 7 seconds Collimation 64 X 0.6mm Pitch value 0.8 Scan direction craniocaudal Comments: Isocentering the patient within the gantry is key to image quality and dose modulation. CareDose is used to limit patient dose.

Reconstruction parameters Bone Soft tissue (if needed) Slice thickness 3mm 3mm Reconstruction spacing 3mm 3mm Reconstruction algorithm B50f B40f Window width/level 1600/400 450/80 Comments: 2mm sagittal and coronal MPR's. Use 15cm DFOV for axial data sets Contrast parameters Parameters Contrast type Omnipaque 300 (if needed) Contrast volume 85ml Saline flush N/A Injection rate 2ml/sec Oral contrast N/A Oral contrast volume N/A Comments: IV contrast is not typically necessary, although it is utilized when looking for an epidural

hematoma or abscess.

Thoracic spine Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A N/A C-7 through L-1 Arterial Phase No N/A N/A N/A

Venous Phase No N/A N/A N/A Delayed Phase No N/A N/A N/A Scan Comments: All Scans are performed using the ALARA principle.


Reconstruction parameters Bone Soft tissue (if needed) Slice thickness 3mm 3mm Reconstruction spacing 3mm 3mm Reconstruction algorithm B50f B30f Window width/level 1600/400 450/80 Comments: 2mm sagittal and coronal MPR's. Use 15cm DFOV for axial data sets Contrast parameters Parameters Contrast type Omnipaque 300 (if needed) Contrast volume 85ml Saline flush N/A Injection rate 2ml/sec Oral contrast N/A Oral contrast volume N/A Comments: IV contrast is not typically necessary, although it is utilized when looking for an epidural hematoma or abscess

Lumbar spine Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A N/A T-12 through mid-

sacrum

Arterial Phase No N/A N/A N/A Venous Phase No N/A N/A N/A Delayed Phase No N/A N/A N/A Scan Comments: IV contrast is not routinely necessary. All Scans are performed using the ALARA principle.


Reconstruction parameters Bone Soft tissue (if needed) Slice thickness 3mm 3mm Reconstruction spacing 3mm 3mm Reconstruction algorithm B50f B40f Window width/level 1600/400 450/80 Comments: 2mm sagittal and coronal MPR's. Use 15cm DFOV for axial data sets Contrast parameters Parameters Contrast type Omnipaque 300 (if needed) Contrast volume 85ml Saline flush N/A Injection rate 2ml/sec Oral contrast N/A Oral contrast volume N/A Comments: IV contrast is not typically necessary, although it is utilized when looking for an epidural hematoma or abscess

Neck Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast No N/A N/A

Arterial Phase No N/A N/A N/A Venous Phase Yes 45sec N/A Above frontal sinuses

through sternal notch Delayed Phase No N/A N/A N/A Scan Comments: All Scans are performed using the ALARA principle. Mark any palpable areas with a BB marker.


Reconstruction parameters Soft tissue Slice thickness 3mm

Reconstruction spacing 3mm

Reconstruction algorithm I31f (SAFIRE strength=2)

Window width/level 450/80 Comments: 2mm sagittal and coronal MPR's. Contrast parameters Parameters Contrast type Omnipaque 300 (if needed) Contrast volume 85ml Saline flush No Injection rate 2 ml/sec Oral contrast N/A Oral contrast volume N/A

Carotid CTA Acquisition Phase



Non Contrast No N/A N/A N/A

Arterial Phase Yes Bolus trigger N/A Tracheal bifurcation through orbits



Scan Comments: All scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments: Reconstruction parameters Soft tissue Thin axials for 3D Slice thickness 3mm 0.75mm Reconstruction spacing 3mm 0.4mm Reconstruction algorithm I26f (SAFIRE strength=2) I26f (SAFIRE strength=2) Window width/level 450/80 Comments: 2mm sagittal and coronal MPR's, curved MIP's, 3D VRT Contrast parameters Parameters Contrast type Omnipaque 350 Contrast volume 75ml Saline flush yes Injection rate 4 ml/sec Oral contrast N/A Oral contrast volume N/A Comments: Use bolus tracking. Set tracking ROI in ascending aorta.

Chest Routine Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast No N/A N/A N/A Arterial Phase No N/A N/A N/A

Venous Phase Yes 55 sec Inspiration Top of lungs through bottoms of lungs to include adrenal glands

Delayed Phase No N/A N/A N/A Scan Comments: All Scans are performed using the ALARA principle.





Window width/level 450/80 Comments: 2mm sagittal and coronal MPR's. If trauma, may need T-spine data sets reconstructed. If so, be sure to do axial, sagittal, and coronals coned down to the spine on a bone algorithm and bone window. Contrast parameters Parameters Contrast type Omnipaque 300 Contrast volume 75-100ml Saline flush No Injection rate 2 ml/sec Oral contrast N/A Oral contrast volume N/A

Chest AVM Acquisition Phase



Non Contrast N/A N/A N/A N/A

Arterial Phase Yes 25 sec Inspiration Through chest

Venous Phase Yes 55 sec Inspiration Through chest




kVp 120





Pitch Value 0.8

Scan Direction craniocaudal

Comments:




Window width/level 450/80 Comments: 2mm sagittal and coronal MPR's, and coronal MIP's. Contrast parameters Parameters Contrast type Omnipaque 350 Contrast volume 75ml Saline flush yes Injection rate 4 ml/sec Oral contrast N/A Oral contrast volume N/A Comments: AVMs can be recognized even on non-contrast CTs, but with contrast, the definition is

obviously better. VRT and MIP are critical to detect even the small AVMs.

SVC occlusion/subclavian steal Acquisition Phase





Venous Phase Yes 40 sec Inspiration Through chest




kVp 120





Pitch Value 0.8

Scan Direction Craniocaudal or caudocranial

Comments: The key is to avoid artifact off SVC as well as flow related changes which cause "pseudothrombosis". When in doubt, wait a bit longer. Scanning from base of heart through neck (caudal-cranial) may be helpful.




Window width/level 450/80 Comments: 2mm sagittal and coronal MPR's. Contrast parameters Parameters Contrast type Omnipaque 300 Contrast volume 75-100ml Saline flush N/A Injection rate 3 ml/sec Oral contrast N/A Oral contrast volume N/A Comments:

Pulmonary emboli

Acquisition Phase




Arterial Phase Yes Bolus triggered

Inspiration Top of the aortic arch through bottom of the heart



Comments: All scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments:

Reconstruction Parameters Soft Tissue Thin Data Lung

Slice Thickness 3mm


Reconstruction Algorithm B30f

Window Width and Level 550 / 50

Reconstruction Comments: 2mm coronal and sagittal MPR’s are performed as well as 10mm x 8mm coronal MIP’s.




Saline Flush Yes

Injection Rate 4-5ml / sec

Oral Contrast N/A

Contrast Volume N/A

Comments: Bolus Trigger off the pulmonary trunk using a 150 HU trigger.

CTA aorta

Acquisition Phase Phase Included Scan Delay Respiration


Non Contrast Only if pre-op aneurysm repair

N/A Inspiration Thoracic=top of lungs through renal arteries Abdominal=diaphragm through symphysis

Arterial Phase Yes Bolus triggered in aorta with

Inspiration Top of lungs through renal arteries

HU of 150

Venous Phase Only if post-op stent graft aneurysm repair

80 sec Inspiration Through stent graft

Delayed Phase No N/A N/A N/a

Scan Comments: For possible aortic dissection, scan arterial phase. For pre-op aortic aneurysm repair, a non contrast scan and arterial phase scan For post-op aortic stent graft repair (EVAR), arterial and venous scan. Dr. Toon wants pre, arterial, and venous on all of his EVAR surveillance scans. All scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments:

Reconstruction Parameters Soft Tissue Thin Data

Slice Thickness 3mm 0.75

Reconstruction Spacing 3mm 0.7

Reconstruction Algorithm I26f I26f

Window Width and Level 550 / 50 550/50

Reconstruction Comments: 2mm coronal and sagittal MPR data sets. Curved MPR's and 3D VRT




Saline Flush yes

Injection Rate 4 ml / sec

Oral Contrast N/A

Contrast Volume N/A

Comments: Bolus Trigger off the pulmonary trunk using a 150 HU trigger.

High Resolution Chest Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A Inspiration/Expiration Lung fields only Arterial Phase No N/A N/A N/A Venous Phase No N/A N/A N/A Delayed Phase No N/A N/A N/A Comments: Three non-contrast scans. The first is supine with inspiration breath hold. The second is supine with an expiration breath hold. The third is prone with an inspiration breath hold if the patient is physically able to do so. All Scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments:

Reconstruction Parameters Medistinum Lung

Slice Thickness 1mm/5mm 1mm

Reconstruction Spacing 1mm/5mm 10mm

Reconstruction Algorithm I31f (SAFIRE strength=2)

I70f

Window Width and Level 450/80 1500/-500

Comments: Supine inspiration. Helical acquisition with 6 reconstructions. a) 1mm x 1mm contiguous axial. Mediastinal algorithm & W/L b) Sagittal 2mm x 2mm. Mediastinal algorithm & W/L c) Coronal 2mm x 2mm. Mediastinal algorithm & W/L d) Coronal MIP 8mm x 5mm. Mediastinal algorithm & W/L e) 1mm x 10mm axial. Sharp algorithm & lung W/L

1. Supine expiration. Helical acquisition. Single reconstruction. a)1mm x 10mm. Sharp algorithm & lung W/L

2. Prone inspiration. (If patient physically capable) Helical acquisition. Single reconstruction. a) 1mm x 10mm. Sharp algorithm & lung W/L

CT Low-dose Lung Screening Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A Inspiration Lung fields only Arterial Phase No N/A N/A N/A Venous Phase No N/A N/A N/A Delayed Phase No N/A N/A N/A


kVp 120

Effective mAs 40mAs (no CareDose is utilized. This is a fixed technique and is in accordance with NCCN guidelines)




Pitch Value 0.8


Comments:

Reconstruction Parameters Lung Thins MPR's

Slice Thickness 3mm 1mm 2mm

Reconstruction Spacing 3mm 1mm 2mm

Reconstruction Algorithm B40f B40f B40f

Window Width and Level 1500/-500 1500/-500 1500/-500

Reconstruction Comments: This is a screening CT at a significantly reduced radiation dose, not a diagnostic CT scan. Our facility uses the NCCN, National Comprehensive Cancer Network, screening guidelines. The NCCN guidelines can be found online. The scan is performed with 3mm x 3mm axial and 1mm axial data sets. Send the 3mm to PACS. Send the thin set to TeraRecon for CAD utilization.

Renal calculus Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A Inspiration Diaphragm through

symphysis pubis. Arterial Phase N/A N/A N/A N/A Venous Phase N/A N/A N/A N/A Delayed Phase N/A N/A N/A N/A



kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm



Window Width and Level 450/80

Reconstruction Comments: 2mm coronal and sagittal MPR data sets.

Renal mass (initial work-up) Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes N/A Inspiration Through kidneys Arterial Phase Yes 25 sec Inspiration Through kidneys Venous Phase Yes 70 sec Inspiration Diaphragm through

pubis Delayed Phase Yes 5 min Inspiration Kidneys through

bladder

Comments: If both an abdomen and pelvis are ordered, the pelvis is imaged during the venous phase. All scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm







Contrast Volume 75-100ml

Saline Flush No

Injection Rate 3ml/sec

Oral Contrast H2O

Contrast Volume 1 liter/32oz

Comments:

Adrenal with washout


Non Contrast Yes None Inspiration Diaphragm to iliac crest


Venous Phase Yes 60sec Inspiration Diaphragm to iliac crest

Delayed Phase Yes 10min Inspiration Through adrenal glands

Scan Comments: 1. Do a non-contrast CT first and if attenuation is under 10HU and it measures 4 cm or less, it is an adenoma and you can stop. 2. If above 20Hu, you can inject 100cc of contrast and look at the washout value (check HU at 1 minute and then at 10 minutes to look for a 50% washout value). If both an abdomen and pelvis is ordered the pelvis is imaged during the venous phase. All scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm








Saline Flush No


Oral Contrast H2O


Comments:

Urogram/Hematuria

Acquisition Phase



Non Contrast Yes N/A inspiration Kidneys only

Arterial Phase Yes 25 sec inspiration Diaphragm through kidneys

Venous Phase Yes 70sec inspiration Diaphragm through symphysis

Delayed Phase No. By injecting 30ml and waiting 5 minutes prior to contrasted phases, contrast will be in the ureters and bladder.

N/A N/A Kidneys through bladder

Scan Comments: After non contrast inject 30ml of contrast and wait 5 minutes. Then proceed with arterial and venous scans. Scan ranges are limited if possible to a specific area of interest to avoid unnecessary patient dose. All Scans are performed using the ALARA principle.


kVp 120




Collimation 0.6mm

Pitch Value 0.8


Comments:


Slice Thickness 3mm

Reconstruction Spacing 3mm 8mm x 5mm coronal MIP on venous phase

Reconstruction Algorithm B30F


Reconstruction Comments: Coronal and sagittal image reconstructions are also performed.




Saline Flush N/A


Oral Contrast H2O


Comments:

Routine abdominal pain Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage



Venous Phase Yes 70sec Inspiration Diaphragm to iliac crest if abdomen or through symphysis if Abdomen/Pelvis




kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm








Saline Flush No


Oral Contrast H2O


Comments: Have patient drink H2O approximately 1-1 1/2 hours prior to CT scan

Enterography Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage



Venous Phase Yes 60sec Inspiration Diaphragm through symphysis pubis




kVp 120





Pitch Value


Slice Thickness 2mm








Saline Flush No


Oral Contrast Breeza


Comments: Patient should drink 3/500ml bottles of Breeza Neutral 45 minutes prior to scan. H2O may be used only if Breeza is not available.

Pancreatic mass/Pancreatitis

Acquisition Phase

Phase Included

Scan Delay

Respiration Phase Anatomical Coverage

Non Contrast Yes N/A Inspiration Liver and pancreas

Arterial Phase Yes 25 sec inspiration Abdomen to include dome of liver through pancreas

Venous Phase Yes 70 sec inspiration Abdomen to include dome of liver through iliac artery bifurcation or symphysis pubis if Abdomen/Pelvis


Scan Comments: If both an abdomen and pelvis is ordered the pelvis is imaged during the venous phase. All scans are performed using the ALARA principle.


kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm 1mm axials through pancreas

Reconstruction Spacing 3mm 1mm axials through pancreas

Reconstruction Algorithm B30f






Saline Flush No


Oral Contrast H2O


Comments:

Hemangioma Acquisition Phase

Phase Included

Scan Delay



Arterial Phase Yes 25-30sec Inspiration Through liver only

Venous Phase Yes 70 sec Inspiration Abdomen to include dome of liver through iliac artery bifurcation.

Delayed Phase Yes 5 min Inspiration Through liver only

Scan Comments: If both an abdomen and pelvis is ordered the pelvis is imaged during the venous phase. If ordered as without and with, scan only the liver on the non contrast scan.


kVp 120




Collimation 0.6mm

Pitch Value 0.8


Comments:


Slice Thickness 3mm




Reconstruction Comments: Coronal and sagittal image reconstructions are also performed.


Contrast Type Non ionic


Saline Flush N/A


Oral Contrast H2O


Comments:

Trauma-Chest/Abdomen/Pelvis Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage



Venous Phase Yes 70sec Inspiration C7 through symphysis

Delayed Phase Yes 5min Inspiration Kidneys through bladder



kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm




Reconstruction Comments: 2mm coronal and sagittal MPR data sets. If the ED physician orders spine recons sets, be sure to divide out the T-spine from the L-spine and each set needs an axial, sagittal, and coronal.




Saline Flush No


Oral Contrast No

Contrast Volume

Comments:

Pelvis-routine Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage



Venous Phase Yes 70sec N/A C7 through symphysis




kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm








Saline Flush No


Oral Contrast No

Contrast Volume

Comments:

Pelvis/Hip-for fractures

Acquisition Phase

Phase Included

Scan Delay


Non Contrast Yes N/A N/A To include the iliac crest through the lesser trochanter of the femur






kVp 120






Pitch Value 0.8


Comments:

Reconstruction Parameters Soft Tissue Thin Data Bone

Slice Thickness 3mm




Reconstruction Comments: 2mm coronal and sagittal MPR data sets. Be sure to label your reconstructed data set with right or left.


Contrast Type N/A

Contrast Volume N/A

Saline Flush N/A

Injection Rate N/A

Oral Contrast N/A

Contrast Volume N/A

Comments: N/A

Extremities-wrist/hand/ankle/foot Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical Coverage

Non Contrast Yes N/A N/A Limited to area of interest




Scan Comments: All scans are performed using the ALARA principle. IV contrast may be useful if a soft tissue mass or abscess is being evaluated.


kVp 120

Effective mAs 150





Pitch Value 0.8

Scan Direction Craniocaudal

Comments: Caredose is used to limit patient exposure.

Reconstruction Parameters Bone Thin Data Soft Tissue

Slice Thickness 1mm 0.6mm 2mm

Reconstruction Spacing 1mm 0.6mm 2mm

Reconstruction Algorithm B70s B30s B30s

Window Width and Level 1600/500 1600/500 450/80

Reconstruction Comments: No need to reconstruct both bone and soft tissue. Diagnosis will dictate which is necessary. Additionally a soft tissue thin axial set is also performed using a 0.6mm x 0.6mm slices with a B20f algorithm incase 3D VRT are needed. Do not send this thin set to PACS.




Saline Flush No


Oral Contrast N/A

Contrast Volume N/A

Comments: IV contrast is not routinely necessary however if warranted we use the above protocol.

Hip


Non Contrast Yes N/A N/A Limited to area of interest






kVp 120

Effective mAs Care Dose





Pitch Value 0.8


Comments:


Slice Thickness 3mm 0.6mm 5mm (if needed)

Reconstruction Spacing 3mm 0.6mm 5mm (if needed)

Reconstruction Algorithm B70s B30f B30f (if needed)






Saline Flush N/A


Oral Contrast N/A

Contrast Volume N/A


Shoulder

Acquisition Phase

Phase Included

Scan Delay


Non Contrast Yes N/A inspiration To include the clavicle through entire scapula






kVp 120






Pitch Value 0.8


Comments:


Slice Thickness 2mm 0.75mm 2mm

Reconstruction Spacing 2mm 0.5mm 2mm

Reconstruction Algorithm B30s B30s B30s






Saline Flush N/A


Oral Contrast N/A

Contrast Volume N/A


IVC thrombosis

Acquisition Phase

Phase Included

Scan Delay




Venous Phase Yes 90 sec inspiration Abdomen to include the liver through the pubic symphysis




kVp 120

Effective mAs 150




Pitch Value 0.8


Comments: Effective mAs is adjusted based on a patient’s body habitus. In addition, CareDose can be used to maintain image quality while lowering patient dose.


Slice Thickness 3mm


Reconstruction Algorithm B30s


Reconstruction Comments: 2mm coronal and sagittal MPR'S and coronal MIP's



Contrast Volume 125cc

Saline Flush No


Oral Contrast No

Contrast Volume

Comments: The injection is performed using a fixed delay of 90 seconds to fully opacify the Inferior Vena Cava.

Lower Extremity Run-off

Acquisition Phase

Phase Included

Scan Delay



Arterial Phase Yes Bolus trigger

None Diaphragm through toes



Scan Comments: All scans are performed using the ALARA principle. Place a rolled towel between the patient's ankles and tape their toes together to aid in reducing patient motion. A small pillow may be used under the patient's knees for comfort if needed.


kVp 120

Effective mAs 150 (Care Dose)




Pitch Value 0.8


Comments: CareDose can be used to maintain image quality while lowering patient dose.


Slice Thickness 3mm 0.75mm

Reconstruction Spacing 3mm 0.75mm

Reconstruction Algorithm B30s B30s


Reconstruction Comments: Coronal and sagittal MPR'S are performed through abdomen/pelvis, thighs, and lower legs.(three sets) Additionally curved MIP's, and 3D VRT



Contrast Volume 125cc

Saline Flush Yes


Oral Contrast No

Contrast Volume

Comments: Bolus trigger in aorta at level of diaphragm at 150HU. Then, there is an additional 15 second delay after the bolus trigger before scanning. We have a second axial scan through the distal femur through the toes just in case the initial scan is faster than the patient’s blood flow. It’s rarely necessary.

General information

1. If there are any questions, refer to the protocol book or ask the radiologist if they are available.

2. Always check the creatinine level if over 60 years of age, if the patient is diabetic, has hypertension, or has only one kidney regardless of age. See P&P Contrast Media (7040-30).

3. Always document the patient’s creatinine for each exam. If you are injecting a patient with an elevated creatinine, document which radiologist or physician gave approval to inject that patient.

4. Routine exams use Omnipaque 300. Standard injection rate is 2cc/second. CT angiography routinely uses Omnipaque 350 at a rate of 4cc/second with saline flush.

5. Most routine diagnostic exams can be done with 85ml of contrast depending on the speed of the CT scanner being used. Heavier patients or long multiple scans such as neck, chest, abdomen, and pelvis may need 100ml. Use your discretion.

6. Can only use PICC lines, mid lines, or most central lines that are proven to be compatible with pressure injectors. These are usually clearly marked with allowable flow rate on the hub or side clamp of the line. Follow manufacturer’s guidelines.

7. Never use any central line that is specific for dialysis. Ever.

8. For optimal CTA exams, use a 20 gauge IV or larger at a rate of no less than 4cc/second for CT angiograms. May have to adjust according to patient.

http://insight2.srhc.net:8080/insight/policies/policies/department-specific/diagnostics_imaging/7040-30.pdf

http://insight2.srhc.net:8080/insight/policies/policies/department-specific/diagnostics_imaging/7040-30.pdf

9. Check PT, PTT, INR before interventional procedures and patients should be off any anticoagulants. See SRHC P&P Radiology Anticoagulation Guidelines (7045-06)

CT Cardiac: The orders in Meditech are as follows and mostly self-explanatory: CT Heart Cardiac Function CT Heart Congenital Disease CT Heart Coronary Arteries/CT Angio Heart These exams will all be performed on the scanner at the main hospital. Please plan to schedule for a one hour time block. It is not necessary to block time for a radiologist. These are all performed with IV contrast so please screen according to department policy as with any other IV contrasted exam. These will all follow the same patient prep. Patient prep:

1) Patient may have nothing to eat for 4 hours but may drink any amount of clear liquids. The patient may take any necessary medications except Metformin.

2) No nicotine or caffeine for 12 hours prior to exam. 3) No stimulants (i.e. Viagra or Cialis) 24 hours prior to exam. 4) Obtain resting heart rate. Please understand that this scan is

affected by heart rate, both rate and rhythm. If the patient’s resting heart rate is irregular or greater than 70bpm, the ordering physician may want to medicate with beta blockers prior to exam? An irregular rhythm may render the scan non-diagnostic or unattainable.

Please understand that larger body habitus’ will have an effect on image quality.

http://insight2.srhc.net:8080/insight/policies/policies/department-specific/diagnostics_imaging/radiology-anticoagulation-guidelines

CT Cystogram

This is most often ordered when looking for a leak in the bladder wall and is usually ordered by a urologist. It is charged as a CT Abdomen/Pelvis w/o IV contrast or a CT Pelvis w/o IV contrast (whichever the physician orders). Often, it is ordered because the patient’s creatinine is too elevated to inject them intravenously. They will still need to be screened for contrast allergy and pre-medicated if necessary. IV contrast needs to be really dilute when putting it retrograde into the bladder. Do not use Cystografin. Even though the CT scan is an Abdomen/Pelvis without contrast, you will still need to charge for the amount of contrast that you use. The dilution is 25ml of Omnipaque 240 to 475ml saline. Withdraw 25ml of saline out of a 500ml bag of saline (can be found in an upper cupboard in angio) and dispose. Draw up 25ml of Omnipaque 240 in a syringe and inject it into a 500ml bag of saline. Spike the bag with the tubing used for VCUG’s. There are a couple of ways to introduce this mixture retrograde into the bladder. The patient will need a Foley catheter. Some catheters have a little luer lock connection near to where the end of the Foley catheter and the tubing to the bag connect. 1) You can use this luer lock to hand inject one syringe (full) at a time. This is best method if the urologist doesn't want very much fluid in the patient's bladder. They will be specific about this if this is the case. 2) You can connect IV tubing (like the kind used for VCUG's) to the saline bag and connect that to the patient side and then fill the bladder as full as the patient can tolerate. 3) If the catheter doesn’t have a luer lock connection, you’ll have to get creative with straight needles or Christmas trees adapters and tape and the like.

4) Be sure to clamp the catheter to the bag so whatever you inject doesn’t just run back into the catheter bag. 5) Document on requisition dilution and amount of contrast/saline injected in a retrograde fashion.

Acquisition Phase Phase Included Scan Delay Respiration Phase Anatomical

coverage Non-contrast Yes. 2 scans. One

prior to inserting contrast through bladder catheter and one after.

N/A Inspiration 1st scan is through the bladder. 2nd is diaphragm through symphysis.

Arterial Phase N/A N/A N/A N/A Venous Phase N/A N/A N/A N/A Delayed Phase N/A N/A N/A N/A



kVp 120





Pitch Value 0.8


Comments:


Slice Thickness 3mm







Contrast Volume 25ml diluted into 475ml saline

Saline Flush No

Injection Rate N/A-IV drip in a retrograde fashion into bladder

Oral Contrast No

Contrast Volume

Comments:

Different oral contrast agents Water: Used for most CT scans. Barium: We use Readi-Cat. Drink one bottle 1-2 hours prior to CT Abdomen/Pelvis. If you use Readi-Cat for rectal contrast, dilute it a little bit with warm water. Gastrografin (water-soluble): This needs to be mixed with some kind of clear liquid before use. Any kind of clear liquid can be used, i.e. water, Breeza, Gatorade, Kool-Aid, lemonade, juices, 7-up. Use 15-30ml of Gastrografin to 450-550ml (16-20oz) of liquid. If the patient is actually drinking this, please use something other that water as it doesn’t taste that great. If it is being put down an NG tube or Dobhoff, then just use water to dilute. Omnipaque: Mix with clear liquid like Gastrografin. Use 20ml of Omnipaque to 500ml (16oz) of water. This is actually mostly tasteless.

Water-soluble contrast options Breeza does not have contrast in it. It is like flavored water that is designed to mask the taste of Gastrografin. Please only use it if the patient is going to actually drink the contrast. If it is going to be put down an NG tube or Dobhoff, then just mix the Gastrografin with water. Option #1: One bottle of Breeza to 15-20ml of Gastrografin. The bottles are under filled for this purpose so just add it in and shake it up. It tastes fruity. Option #2: Mix 20ml of Omnipaque 240 to 16-20oz of water. This is basically tasteless. OR Mix: One bottle (30ml) of Gastrografin to 32oz of water. This will taste like Gastrografin which is somewhat bitter.

Remember-a 30ml bottle of Gastrografin is single use only. That means we cannot use on more than one patient so toss what you don’t use.

Rectal contrast in CT

Use an empty BE bag from the diagnostic department and fill with one of the following. Try to use warm (not hot) water to help alleviate cramping. Water soluble- Gastrografin (Gastroview) dilution for CT scans: 30ml Gastrografin (Gastroview) to 32oz clear liquid (water). Double if need be for volume. Barium- Readi-Cat: may dilute with warm water to be not more dilute than a 3(barium) to 1(water) ratio. Double if need be for volume. Place the patient on the CT table on their left side, tip them and inflate the balloon on the tip just like for a BE. Tie a knot in the blue tube that we would normally use for puffing in air. Leave the patient on their left side and begin slowly filling their colon. When they feel full, clamp the bag, roll them onto their back and then up

onto their right side to let the contrast backfill. Slowly try to add more contrast and when the patient feels really full, clamp the back, roll the patient onto their back and place the bag and tubing on the patient’s legs so that it cannot get caught up in table motion. Proceed to scan a routine CT Abdomen/Pelvis. When finished, place the bag on the floor and open the clamp and let the patient expel as much contrast as possible back into the bag, just like a BE. Do not throw away the balloon tip insufflator!! CT Colonography 1. Patient must be bowel prepped. Often we get these patients

after a failed colonoscopy so they are already prepped. Otherwise, they will need to follow the recommended prep.

2. IV contrast is utilized, so patient screening is needed. 3. Place a Foley catheter connected to a blue insufflation bulb into

the patient’s rectum and have patient lay supine. Insufflate the colon with puffs of air until colon is well distended. Patient can tell you when they cannot tolerate any more. Perform a scout. If the colon does not appear well distended, add more air.

4. Do supine scan with a 2cc/second injection of Omni 300 85ml. 60 second delay. Have patient turn over onto stomach. You may have to help them hold the small tip in. Add more air. Repeat process and do prone scan.

5. Scan 2mm x 2mm axially supine and prone. 6. Reconstruct 2mm x 2mm coronal images and a thin set of axial

images. Sagittal images are not necessary. 7. Send axials and coronal to PACS. 8. Send thin axials to TeraRecon for fly through. 9. There is no such thing as an unprepped colonography. CT Colonography prep

Colongraphy continued... IV contrast is used so the patient needs risk factors screened according to our policy. 30 min time slot needed. Patient sedation is not utilized so there is no recovery time or alternate driver needed. Arrive 15 min early for registration. Those patients who are paying for their own exams because their insurance doesn’t cover will have to sign an ABN at the time of registration. The patient will need to pick up one bottle of Readi-Cat CT barium from the radiology department and one 10oz. bottle of Magnesium Citrate solution along with four (4) Biscacodyl (or Dulcolax) tablets from their pharmacy. No physician prescription is necessary for any of the above items. *Two days prior to exam eat a low-residue diet for all meals that day. Guidelines are on the next page. *One day prior to exam only clear liquids are allowed including broth. Clear Liquids include: Fruit juices without pulp, Water, Clear broth or bouillon, Coffee or tea (without milk or creamer), Gatorade, carbonated or non-carbonated drinks, Kool-Aid or other fruit flavored drinks, Plain Jell-O (without toppings) *At noon drink 225ml (half-bottle) of Readi-Cat (CT barium) along with the clear liquid lunch. (barium may be chilled)

*8oz glass of water at 1pm and then one 8oz glass of water hourly until 9pm. *At 5:00pm drink 225ml (half-bottle) of Readi-Cat (CT barium) along with the clear liquid dinner. *At 5:30pm drink 10oz. bottle of Magnesium Citrate solution (may be chilled) *At 7:30pm take four (4) Bisacodyl (or Dulcolax) tablets

Low Residue Diet

Grain Products:

• enriched refined white bread, buns, bagels, english muffins

• plain cereals e.g. Cheerios, Cornflakes, Cream of Wheat, Rice Krispies, Special K

• arrowroot cookies, tea biscuits, soda crackers, plain melba toast

• white rice, refined pasta and noodles

• avoid whole grains

Fruits:

• fruit juices except prune juice

• applesauce, apricots, banana (1/2), cantaloupe, canned fruit cocktail, grapes, honeydew melon, peaches, watermelon

• avoid raw and dried fruits, raisins and berries. Vegetables:

• vegetable juices

• potatoes (no skin)

• well-cooked and tender vegetables including alfalfa sprouts, beets, green/yellow beans, carrots, celery, cucumber, eggplant, lettuce, mushrooms, green/red peppers, squash, zucchini

• avoid vegetables from the cruciferous family such as broccoli, cauliflower, brussels sprouts, cabbage, kale, Swiss chard etc

Meat and Protein Choice:

• well-cooked, tender meat, fish and eggs

• avoid beans and lentils

Nuts and Seeds:

http://www.healthcastle.com/berries_benefits.shtml

• Avoid all nuts and seeds, as well as foods that may contain seeds (such as yogurt)

Dairy:

• as directed by your healthcare providers

CT table weight limit: This needs to be accurate as putting a patient on the table that exceeds the weight limit for the equipment renders the service contract with the equipment vender useless. This is totally a patient safety issue. Be advised that even if the patient weighs less than the table limit, the table still might not work properly or they might just not fit in the gantry. Hospital=both department and ED scanners=484lbs or 220 kg IC=PET/CT scanner=500lbs or 227kg

brain/head non-contrast - united radiology group, chartered

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