chest ct protocols - vcu radiology resident...

Chest CT Protocols Revisions Effective January 2012 Chest 1: Pulmonary Nodule Follow-up: Low-Dose Helical CT (Unenhanced) (Non-metastatic) Technologist Instructions

Technique Siemens Sensation 64 64 x 0.6

(beam collimation 32 x 0.6) Patient “must cough” several times prior to scan to clear secretions

kV 100 (≤180 LBS) 120 (180-250 LBS) 140 (>250 LBS)

Patient imaged supine with arms elevated over head to minimize beam-hardening artifact

Gantry Rotation Time 0.33 sec

Breathing: hyperventilate x3; Take a breathe in and stop breathing

mAs (Reg-Lg) 40-80

Scan extends from thoracic inlet through adrenal glands

Scanner effective mAs (Reg-Lg)

25-50

Primary Scout performed in PA projection (tube at gantry bottom, patient supine) to minimize breast dose

Detector Collimation (mm) (T)

0.6 mm

Repeat any scans with motion

Number of active channels (N)

32

Detector configuration (N x T)

32 x 0.6 mm

Collimation (on operator console)

64 x 0.6 mm

Image Sequence Cr-Ca Table incrementation

(mm/rotation) (I) 19.2 mm

Pitch ([mm/rotation]/beam collimation) (I/NT)

1.0 mm

Table Speed (mm/second) 38.4 mm/sec Scan Time (40 cm thorax) 11 sec Nominal Reconstructed Slice

Width 3 mm

Reconstruction Interval 3 mm Reconstruction Algorithm B40 CTDI vol (Dose in mGy) 1.9-3.8 mGy DFOV = smallest diameter of

the chest wall that will completely contain the lung parenchyma as measured from the widest point of outer rib to outer rib

Care Dose Breast Shield

Off” Will not be applied

PACS / TerraRecon/ Vitrea (for lung nodule volumetric analysis)

Yes

In addition to the axial soft tissue (B40f) and lung (B60f) window reconstructions, perform the following recons: Axial MIP: Lung Window (5 x 3) (B60f) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60f)

Chest CT Protocols Revisions Effective January 2012 Chest 2: Routine Chest CT (CECT) Chest CT alone or in combination with Abdomen/Pelvis CT Order Chest 2 Routine Chest Clinical Indications

Lung Cancer Staging Lymphoma Staging Solitary Lung Nodule

Evaluation (Baseline) Cancer Follow-up Baseline Baseline Metastatic Work-up Fever Unknown Origin (FUO)

Work-up Abscess Work-up

Non-Opportunistic Lung Infections

Air-space Disease (ASD) Non-resolving ASD

Pleural Effusion Empyema Malignant Pleural Disease Chest Wall Disease

Post-Thoracotomy (non-vascular)

Mediastinal Abnormalities (e.g., thymoma, vocal cord paralysis, etc)

Technologist Instructions

Technique 1st

(Soft-tissues) 2nd

(Lung) Available CXR within 1 month

kVp mAs Rotation time

100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

Patient “must cough” several times prior to scan to clear secretions

Collimation 24 x 1.2mm


Slice Width 3.0mm 3.0mm

Breathing: hyperventilate x3; Take a small breathe in and stop breathing

Pitch 0.75


Kernel B40f Medium

B60f Sharp

Increments 3.0mm 3.0mm Image Sequence Cr-Ca Cr-Ca FOV Tailored to

patient Same

Injection Rate 3.0ml/sec 80 ml Omni 350 30 ml saline flush

Prep Time (delay) 40 sec Care Dose

Breast Shield

“On” Appropriate patients after scout acquired

PACS Yes Yes Axial MIP: Lung

Window (5 x 3) (B60F) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)

Chest CT Protocols Revisions January 2012 Chest 3: Unenhanced Routine Chest CT Chest 3 Routine Chest Clinical Indications

Any routine CECT clinical indication but in the setting of abnormal laboratory parameters (e.g., eGFR; creatinine, etc)

Multiple myeloma Acute Sickle Cell Crisis Solitary Lung Nodule

Follow-up Chest Wall Disease Technologist Instructions

Technique 1st

(Soft-tissues) 2nd

(Lung) Scan extends from thoracic inlet through adrenal glands


100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s






Pitch 0.75

Available CXR within 1 month

Kernel B40f Medium

B60f Sharp

Increments 3.0mm 3.0mm Image Sequence Cr-Ca Cr-Ca FOV Tailored to Same

patient Injection Rate - Prep Time (delay) - Care Dose

Breast Shield



Window (5 x 3) (B60F) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)

Chest CT Protocols Revisions January 2012 Chest 4: CTA Pulmonary Angiography (CTA) (Preference: Flash Scanner) Chest 4 CTA Pulmonary

Angiography (CTA)

Clinical Indications

Primary diagnosis of Acute Pulmonary Embolism (PE)

Follow-up evaluation of previously diagnosed Pulmonary Embolism (PE)

Evaluation of candidates for possible Pulmonary Thromboendartectomy

Evaluation of Chronic Pulmonary Thromboembolic disease (Chronic PE)

Pulmonary Arterial Hypertension (PAH)

Pulmonary Arteriovenous Malformation (AVM)


Technique 1st

(Soft-tissues) 2nd

(Lung) Available CXR same day if acute PE work-up; otherwise within 1 month


100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

Patient “must cough” several times if capable prior to scan to clear secretions


Breathing: hyperventilate x3; Take a


breathe in and stop breathing Pitch 0.9 Kernel B31f

medium-smooth ++ B70f

very sharp Increments 1.0mm 1.0mm Image Sequence Cr-Ca FOV Tailored to

patient

Injection Rate 4.0ml/sec 80-100 ml Isovue 370 + 30 ml saline chaser

Prep Time (delay) Bolus Tracking Trigger @ Main Pulmonary Artery @ 200HU




Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window

Chest CT Protocols Revisions January 2012 Chest 5: CTA Thoracic Aortography (CTA): Acute Dissection (Preference: Flash Scanner) Chest 5 CTA Thoracic

Angiography (CTA)


Thoracic Aorta Dissection (baseline and follow-up without stent graft)

Thoracic Aorta Aneurysms (baseline and follow-up without stent graft)

Atheromatous disease and Penetrating Ulcers

Intramural Hematoma (baseline and follow-up without stent graft)

Aortitis Technologist Instructions

Technique 1st

Unenhanced 2nd

Enhanced Available CXR same day if acute work-up; otherwise within 1 month


100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s


Collimation 24 x 1.2mm 64 x 0.6mm



Pitch 0.9 0.9 Kernel B40f

Medium B25f

Smooth Increments 5.0mm 1.0mm Image Sequence Cr-Ca FOV Tailored to patient Injection Rate N/A 4.0ml/sec

150 ml Isovue 370 + 30 ml saline chaser

Prep Time (delay)

N/A Bolus Tracking Trigger @ Arch at 150HU



“On” Yes


Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal / Sagittal Oblique: Soft-tissue Window

Chest CT Protocols Revisions January 2012 Chest 6: Thoracic Aortography (CTA): Follow-up Aorta Dissection / Repair (Preference: Flash Scanner) Chest 6 CTA Thoracic

Angiography (CTA)


Thoracic Aorta Dissection (follow-up with stent graft / hardware)

Thoracic Aorta Aneurysms (follow-up with stent graft / hardware)

Atheromatous disease and Penetrating Ulcers (follow-up with stent graft / hardware)

Intramural Hematoma (follow-up with stent graft / hardware)


Technique 1st

Unenhanced 2nd

Enhanced 3rd

60 sec Delay

Available CXR same day if acute work-up; otherwise within 1 month


100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

Same Same


Collimation 24 x 1.2mm 64 x 0.6mm 64 x 0.6mm

Breathing: hyperventilate x3; Take a small breathe

Slice Width 5.0mm 2.0mm 2.0mm

in and stop breathing Pitch 0.9 0.9 0.9 Kernel B40f

Medium B25f

Smooth B25f

Smooth Increments 5.0mm 1.0mm 0.7mm Image

Sequence Cr-Ca

FOV Tailored to patient

Injection Rate N/A 4.0ml/sec 150 ml Isovue 370 + 30 ml saline chaser

N/A

Prep Time (delay)

N/A Bolus Tracking Trigger @ Arch at 150HU



“On” Yes

“On” Yes

PACS Yes Yes Yes Axial MIP:

Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal / Sagittal Oblique: Soft-tissue Window

Chest CT Protocols Revisions January 2012 Chest 7: CTA Thoracic Aortography (CTA): Trauma Chest (Preference: Flash Scanner or Cardiac Gated if Non-Flash) Technologist Note: Only send 2 x 2’s to PACS (not 3 x 3’s) Chest 7 CTA Thoracic

Aortography (CTA) Clinical Indications

Suspected Acute Traumatic Aorta or Branch Vessel Injury

Trauma-related Hemomediastinum


Technique 1st

(Soft-tissues) 2nd

(Lung) kVp

mAs Rotation time

100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

Collimation 64 x 0.6mm Slice Width 2.0mm 2.0mm Pitch 0.75 Kernel B40f

Medium B20f

Smooth Increments 1.0mm 1.0mm Image Sequence Cr-Ca FOV 300 300 Injection Rate 4.0ml/sec

80-100 ml Omni-300 + 30 ml saline chaser

Prep Time (delay) Bolus Tracking Trigger @ aortic arch @ 150HU


“On” “Off” Baseline exams

Breast Shield

“On” Follow-up studies on appropriate patients after scout acquired


Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal / Sagittal Oblique: Soft-tissue Window

Chest CT Protocols Revisions January 2012 Chest 8: High-Resolution (HRCT) Chest CT-Interstitial Lung Disease Chest 8 HRCT Clinical Indications

Unexplained Dyspnea on Exertion Suspected or Known

Chronic Interstitial Lung Disease Follow-up CILD on Therapy Technologist Instructions

Technique 1st

(Soft-Tissues and Lungs)

2nd HRCT

Sequence Supine

(Inspiration)

3rd HRCT

Sequence Prone

(Inspiration) Patient “must cough” several times prior to scan to clear secretions


100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

Same Same (Carina through Diaphragm)


Collimation 64 x 0.6mm 1mm x 2.0mm 1 x 2.0 mm

If patient unable to lie prone; must acquire HRCT supine with B70 kernel

Slice Width 3.0mm 1.0mm 1.0mm


Pitch 0.75 Feed 10mm Feed 10mm


Kernel B40f Medium

(soft-tissues)

B60f Sharp (lungs)

B70s Very Sharp

B70s Very Sharp

Increments 3.0mm 10mm 10mm Image Cr-Ca Cr-Ca Cr-Ca

Sequence FOV Tailored to

patient Same Same

Oral Contrast - - - Injection Rate N/A Prep Time

(delay) N/A - -



“Off” “Off”

PACS Yes Yes Yes Axial MIP:

Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)

Chest CT Protocols January 2012 Chest 9: Chest CT-Small Airways Disease Chest 9 HRCT Clinical Indications

Suspected or Known Small Airways Disease

Suspected or Known Bronchiectasis Known or Suspected GVHD Bone Marrow Transplants

(pre- and post-procedure) Technologist Instructions

Technique 1st

Soft-Tissues and Lungs)

2nd Supine

Expiration Patient “must cough” several times prior to scan to clear secretions


100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s


Collimation 64 x 0.6mm 64 x 0.6mm




Pitch 0.75 0.75

Kernel B40F Medium

(soft-tissues)

B70s Very Sharp

B70s Very Sharp

Increments 1.0 mm 1.0 mm

Image Sequence

Cr-Ca Cr-Ca

FOV Tailored to patient

Same

Oral Contrast - - Injection

Rate N/A

Prep Time (delay)

N/A -



“Off”


Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Lung Window (B60F)

Chest CT Protocols Revisions January 2012 Chest 10: Large Airways Disease-Stenosis Chest 10 Large Airways

Disease Clinical Indications

Tracheal Stenosis Bronchial Stenosis Tracheal-Esophageal Fistula Suspected Tracheal or Bronchial Injury or

Fracture Technologist Instructions

Technique 1st

Angle of Mandible to

3rd Order Bronchi

1st

(Soft-tissues)

2nd (Lung)

3rd (Expiratory

Lung)



100 (≤180lbs) 120 (180-250lbs) 140 (>250lbs) 130 0.33s

Same Same Send to TerraRecon as 3x2 for Radiologist to reconstruct


Collimation 2 x 1.0 mm 24 x 1.2mm


Slice Width 3.0mm 3.0mm 3.0mm 5.0 mm


Pitch 3-5mm/sec or Pitch 1-1.6

0.75

Kernel B70s Very Sharp

B40F Medium

B60F Sharp

Increments 1-2mm 3.0mm 3.0mm 5.0 mm

Image Sequence

Cr-Ca Cr-Ca Cr-Ca

FOV Tailored to Airway

Tailored to patient

Same

Oral Contrast - 3.0ml/sec 80 ml Omni 350 30 ml saline flush

Injection Rate N/A 40 sec Prep Time

(delay) N/A “On”

Appropriate patients after scout acquired



Yes After scout acquired

Yes

PACS Yes Yes Yes Volume

Rendering with Lung Isolation Algorithm

Yes

Axial MIP: Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window VRT: Tracheal-bronchial Tree

Chest CT Protocols Revisions January 2012 Chest 11: Large Airways Disease-Malacia Chest 11 Tracheomalacia Clinical Indications

Tracheomalacia Tracheobronchomalacia Mounier-Kuhn Syndrome SERIES 1: SCOUT AP and LATERAL Send all Data to PACS SERIES 2: TRACHEA END INSPIRATION MID C4 THRU ADRENAL GLAND HELICAL 3mm 3mm Interval DELAY 39.37 100kVp 0.5SEC .984 :1 320 mA Standard

RECON 1 3mm X 3mm Interval Standard RECON 2 2.5mm X 2.5mm Interval Lung RECON 3 1.25mm X 1.25mm Interval Standard SERIES 3 DYNAMIC BREATHING MID C4 TO DIAPHRAGM

Patient should inhale to full lung capacity and begin to forcefully exhale like “blowing out a candle” during scan. Use designated “mouthpiece” COORDINATE ONSET OF SCAN ACQUISITION WITH BEGINNING OF FORCEFUL EXHALATION

HELICAL 3mm 3 5mm Interval 39.37 120kVp 0.5SEC .984 :1 80 mA Standard

NOTE: TRACHEA SHOULD CHANGE IN SHAPE (ANT BOWING POST WALL OR COLLAPSE)

RECON 1 2.5mm X 2.5mm Interval Standard RECON 2 2.5mm X 1.25mm Interval Standard

Chest CT Protocols Revisions Effective January 2012 Designated Lung Cancer Screening Program (LCSP) Patients Only!: Chest 12: LCSP: Chest Low-Dose Helical CT (Unenhanced) Technologist Instructions

Technique Siemens Sensation 64 64 x 0.6

(beam collimation 32 x 0.6) Patient “must cough” several times prior to scan to clear secretions

kV 120

Patient imaged supine with arms elevated over head to minimize beam-hardening artifact

Gantry Rotation Time 0.5 sec


mAs (Reg-Lg) 40-80


Scanner effective mAs (Reg-Lg)

25-50

Primary Scout performed in PA projection (tube at gantry bottom, patient supine) to minimize breast dose

Detector Collimation (mm) (T)

0.6 mm


Number of active channels (N)

32

Detector configuration (N x T)

32 x 0.6 mm

Collimation 64 x 0.6 mm

(on operator console) Image Sequence Cr-Ca Table incrementation

(mm/rotation) (I) 19.2 mm

Pitch ([mm/rotation]/beam collimation) (I/NT)

1.0 mm

Table Speed (mm/second) 38.4 mm/sec Scan Time (40 cm thorax) 11 sec Nominal Reconstructed Slice

Width 2 mm

Reconstruction Interval 1.8 mm Reconstruction Algorithm B30 CTDI vol (Dose in mGy) 1.9-3.8 mGy DFOV = smallest diameter of

the chest wall that will completely contain the lung parenchyma as measured from the widest point of outer rib to outer rib


Off” Will not be applied

PACS / TerraRecon/ Vitrea (for lung nodule volumetric analysis)

Yes

In addition to the axial soft tissue (B40f) and lung (B60f) window reconstructions, perform the following recons: Axial MIP: Lung Window (5 x 3) True Coronal: Soft-Tissue & Lung Window True Sagittal: Soft-tissue Window

chest ct protocols - vcu radiology resident...

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