neuroradiology ct protocols

143
1 Revised 7/22/09 (Gentry/Ranallo) ___________________ / ________________ _______________ / ______________ _____ Pediatric Brain _________________________ _____ Pediatric Trauma (< 6 y/o) _____ add 3D CT _________________________ _____ Adult Brain ________________ / ____________ _____ Pituitary & Cavernous Sinus ______________________________ _____ Stealth (Whole Brain Treatment Planning) _____ Without _____ Without and Check _____ Face and Mandible (No 3D) _____ With _____ With and Without _____ Face and Mandible (With 3D) _____ Orbit Only (use only for blowout Fxs) _____ Adult _____ (craniosynostosis, congenital facial anomaly) _____ Pediatric (< 6 Y/O) _____ Post-Myelogram _____ Haughton Rotational _____ Pediatric Diagnostic ( < 6 y/o) _____ Stealth: Stealth Levels ____________ _____ Adult Diagnostic _____ Follow-up Adult ENT Sinus ___ Cervical ___ Thoracic ___ Lumbar ___ Sacral Stealth (Landmarks) Only (No Longer Done per Dr Gentry) (non-traumatic) _____ (Acute Stroke Workup) _____ Routine Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Vascular Mass or CC-Fistula _____ (Stenosis, Trauma, Unknown Bleed) _____ With Valsalva Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Dynamic Multipositional _____ (Cerebrovascular Disease, Unknown Bleed) ___ With Perfusion ___ Without Perfusion (adult or peds) Includes: CTA head, CT head w/o & w/, +/ - perfusion ____ W/O ____ W/ ____ Both ____ Vascular Mass _____ (Cerebrovascular Disease) Includes: CTA neck and arch _____ _____ Head _____ Head & Neck _____ Routine Includes: CTV head +/- neck, CT head w/o & w/ _____ Salivary Gland Calculi (W/O & W/) _____ (Nontraumatic SAH, Known Aneurysm) _____ Vascular Mass Includes: CTA head, CT head w/o & w/, no perfusion _____ Parathyroid Adenoma _____ _____ Brachial Plexus CTA: _____ Head _____ Neck & Arch _____ Perfusion: _____ Yes _____ No _____ Puffed Cheek _____ Valsalva _____ Vocalization _____ Perfusion CT _____ Acute Stroke: _____ Carotid Stenosis: _____ Posterior Fossa: (Vertebrobasilar Insufficiency) CT Protocols: (Brain, ENT, Spine, Vascular) Name / MRN: Brain: DOB: Date of Scan: Protocoled By: Dr. Monitored By: Dr. CT Tech Name & #: CT Scanner: Contrast: Facial Trauma: Spine: 3D CT Sinuses: Spine Levels - Coverage Vascular Imaging: (CT/CTA/Perfusion) Orbit: Stroke Deluxe: Total Cerebrovascular: CTA Head Only: Temporal Bone: CTA Neck Only: Neck Nasopharynx Larynx: CT Venography: Aneurysm (Hi-Res COW): Ala Carte Studies: Add on Neck Options CT Perfusion (Levels Coverage) Other Protocol:

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Page 1: Neuroradiology CT Protocols

1 Revised 7/22/09 (Gentry/Ranallo)

___________________ / ________________

_______________ / ______________ _____ Pediatric Brain

_________________________ _____ Pediatric Trauma (< 6 y/o) _____ add 3D CT

_________________________ _____ Adult Brain

________________ / ____________ _____ Pituitary & Cavernous Sinus

______________________________ _____ Stealth (Whole Brain Treatment Planning)

_____ Without _____ Without and Check _____ Face and Mandible (No 3D)

_____ With _____ With and Without _____ Face and Mandible (With 3D)

_____ Orbit Only (use only for blowout Fxs)

_____ Adult _____ (craniosynostosis, congenital facial anomaly)

_____ Pediatric (< 6 Y/O)

_____ Post-Myelogram

_____ Haughton Rotational _____ Pediatric Diagnostic ( < 6 y/o)

_____ Stealth: Stealth Levels ____________ _____ Adult Diagnostic

_____ Follow-up Adult ENT Sinus

___ Cervical ___ Thoracic ___ Lumbar ___ Sacral Stealth (Landmarks) Only (No Longer Done per Dr Gentry)

(non-traumatic)

_____ (Acute Stroke Workup) _____ Routine

Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Vascular Mass or CC-Fistula

_____ (Stenosis, Trauma, Unknown Bleed) _____ With Valsalva

Includes: CTA head/neck/arch, CT perfusion, CT head w/o & w/ _____ Dynamic Multipositional

_____ (Cerebrovascular Disease, Unknown Bleed)

___ With Perfusion ___ Without Perfusion (adult or peds)Includes: CTA head, CT head w/o & w/, +/- perfusion ____ W/O ____ W/ ____ Both ____ Vascular Mass

_____ (Cerebrovascular Disease)

Includes: CTA neck and arch

_____ _____ Head _____ Head & Neck _____ Routine

Includes: CTV head +/- neck, CT head w/o & w/ _____ Salivary Gland Calculi (W/O & W/)

_____ (Nontraumatic SAH, Known Aneurysm) _____ Vascular Mass

Includes: CTA head, CT head w/o & w/, no perfusion _____ Parathyroid Adenoma

_____ _____ Brachial Plexus

CTA: _____ Head _____ Neck & Arch _____

Perfusion: _____ Yes _____ No _____ Puffed Cheek _____ Valsalva

_____ Vocalization _____ Perfusion CT

_____ Acute Stroke:

_____ Carotid Stenosis:

_____ Posterior Fossa: (Vertebrobasilar Insufficiency)

CT Protocols: (Brain, ENT, Spine, Vascular)

Name / MRN: Brain:DOB: Date of Scan:

Protocoled By: Dr.Monitored By: Dr.CT Tech Name & #:CT Scanner:

Contrast: Facial Trauma:

Spine: 3D CT

Sinuses:

Spine Levels - Coverage

Vascular Imaging: (CT/CTA/Perfusion) Orbit: Stroke Deluxe:

Total Cerebrovascular:

CTA Head Only:

Temporal Bone:

CTA Neck Only:

Neck – Nasopharynx – Larynx:CT Venography:

Aneurysm (Hi-Res COW):

Ala Carte Studies:

Add on Neck Options

CT Perfusion (Levels – Coverage)

Other Protocol:

Page 2: Neuroradiology CT Protocols

2 Revised 7/22/09 (Gentry/Ranallo)

Table of Contents:Page # Protocol Exam

5 1.1 Adult Head – Routine Helical

8 1.2 Adult Head – Helical Scan with Angled Axial Reformations

11 1.3 Adult Head – Axial

13 11.1 & 11.2 Pediatric Head – Routine Helical

17 11.3 & 11.4 Pediatric Head – Helical Scan with Angled Axial Reformations

21 11.5 & 11.6 Pediatric Head – Axial

24 11.7 & 11.8 Pediatric Head – Trauma

27 2.1 Orbit – Routine

33 2.2 Orbit – With and Without Valsalva

34 2.3 Orbit – Vascular Mass or Carotid-Cavernous Fistula

36 2.4 Orbit – Dynamic – EOM Movements

27 12.1 &12.2 Pediatric Orbit – Routine

33 12.3 & 12.4 Pediatric Orbit – With and Without Valsalva

34 12.5 & 12.6 Pediatric Orbit – Vascular Mass or Carotid-Cavernous Fistula

36 12.7 & 12.8 Pediatric Orbit – Dynamic – EOM Movements

37 2.5a Maxillofacial Trauma – Routine

43 2.5b Maxillofacial Trauma – Routine plus 3D

37 12.9 & 12.10 Pediatric Maxillofacial Trauma – Routine

43 12.9 & 12.10 Pediatric Maxillofacial Trauma – Routine plus 3D

44 1.5 3D CT – Craniosynostosis, Congenital Facial Anomaly

44 11.9 & 11.10 Pediatric 3D CT – Craniosynostosis, Congenital Facial Anomaly

48 2.6 Pituitary Gland and Cavernous Sinus

48 12.11 & 12.12 Pediatric Pituitary Gland and Cavernous Sinus

52 1.10 Stealth – Stereotactic Head (Whole Brain Treatment Planning)

52 11.11 & 11.12 Pediatric Stealth – Stereotactic Head (Whole Brain Treatment Planning)

53 2.7 Sinuses – Diagnostic

53 12.13 & 12.14 Pediatric Sinuses – Diagnostic

59 2.8 Sinuses – Follow-up Adult ENT Sinus

61 2.9 Sinuses – Conbined Diagnostic and Landmark

61 12.16 & 12.17 Pediatric Sinuses – Conbined Diagnostic and Landmark

62 2.10 Temporal Bone and Posterior Fossa (W/O Contrast)

62 12.18 & 12.19 Pediatric Temporal Bone and Posterior Fossa (W/O Contrast)

66 2.11 Temporal Bone and Posterior Fossa (W/O and W Contrast)

66 12.20 & 12.21 Pediatric Temporal Bone and Posterior Fossa (W/O and W Contrast)

70 2.12 Temporal Bone – Vascular Mass

70 12.22 & 12.23 Pediatric Temporal Bone – Vascular Mass

75 3.1 Neck – Routine

75 3.2 Neck – Feet First

81 3.1 Neck – Salivary Gland

82 3.3 Neck – Vascular Mass

Page 3: Neuroradiology CT Protocols

3 Revised 7/22/09 (Gentry/Ranallo)

Table of Contents (continued):Page # Protocol Exam

84 3.5 Neck – Add on Options

86 3.4 Neck – Parathyroid Adenoma

75 13.1 Pediatric Neck – Routine

75 13.2 Pediatric Neck – Feet First

81 13.1 Pediatric Neck – Salivary Gland

82 13.3 Pediatric Neck – Vascular Mass

86 3.4 Pediatric Neck – Parathyroid Adenoma

84 13.5 Pediatric Neck – Add on Options

90 3.1 Brachial Plexus – Adult

90 13.1 Brachial Plexus –Pediatric

91 3.5 Cervical Spine – Adult

93 7.5 Thoracic Spine – Feet First – Adult

94 7.6 Thoracic Spine – Head First – Adult

95 7.1 Lumbar Spine – Feet First – Adult

97 13.5 Cervical Spine – Pediatric

100 17.5 Thoracic Spine – Pediatric

103 17.1 Lumbar Spine – Pediatric

106 7.2 Stealth (Stereotactic) Spine

107 1.6 & 3.7 Vascular Imaging: Stroke Deluxe (Acute Stroke Workup)

111 1.6a Vascular Imaging: Total Cerebrovascular

112 1.7 Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed)

116 1.8 Vascular Imaging: Aneurysm (Hi-Res COW) (Non-traumatic SAH, Known Aneurysm)

120 3.8 Vascular Imaging: CTA Neck Only (Cerebrovascular Disease)

124 1.9 & 3.9 Vascular Imaging: CT Venography

107 11.16 & 11.17 Pediatric Vascular Imaging: Stroke Deluxe (Acute Stroke Workup)

111 11.16 & 11.17 Pediatric Vascular Imaging: Total Cerebrovascular

112 11.18 & 11.19 Pediatric Vascular Imaging: CTA Head Only (Stenosis, Unknown Bleed)

116 11.20 & 11.21 Pediatric Vascular Imaging: Aneurysm(Hi-Res COW)(Non-trauma SAH, Known Aneurysm)

120 11.22 & 11.23 Pediatric Vascular Imaging: CTA Neck Only (Cerebrovascular Disease)

124 11.24 & 11.25 Pediatric Vascular Imaging: CT Venography

128 Appendix #1 CTA Head: 2D Thin and Thick Slab Reformations

129 Appendix #2: CTA Neck: 2D-Reformations

130 Appendix #3: CT Perfusion Protocol

131 Appendix #4: CT Perfusion Coverage

132 Appendix #5: CT Perfusion Analysis Instructions

138 Appendix #6: Neck CT Contrast Timing for Routine Neck CT

139 Appendix #7: 64 Slice Scanner Prioity

140 Appendix #8: CT Scanner Type

141 Appendix #9: CT Scanner Limits

142 Appendix #10: Direction and Naming of 2D-Reformations

143 Appendix: #11 Combined Neuro and Body Contrast Studies

Page 4: Neuroradiology CT Protocols

4 Revised 7/22/09 (Gentry/Ranallo)

CTI – 1 16 800 Lightspeed Xtra

CTI – 2 4 440 LightSpeed 16

CTI – 3 16 800 LightSpeed 16 Pro

CTI - 4 64 800 LightSpeed VCT 64

ER 64 800 LightSpeed VCT 64

CT-RP 8 440 LightSpeed 8

East 8 440 LightSpeed 8

Scanner Nomenclature:

Scanner -Location

# of Slices

Maximum mA at 120 kV

Scanner Name Naming Convention in this Protocol Book

LS Xtra

LS 16

LS 16 Pro

LS VCT 64

LS VCT 64

LS 8

LS 8

Page 5: Neuroradiology CT Protocols

5 Revised 7/22/09 (Gentry/Ranallo)

Adult Head: Routine (Helical Mode) (Protocol # 1.1)

Billing: 1. CT Head without, or with, or without and with2. Contrast if used

Setup: 1. Supine, AP and lateral scouts, no gantry angle 2. Helical mode should be used routinely for adult head CT scans. Only use axial mode

when you cannot move the patient’s head into proper position (trauma, cervical collar, rigid neck).

3. Patient Positioning: Tilt the patients head so that a line connecting the lateral canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). Use axial mode and angle the gantry if you cannot place the patient’s head within 15 degrees of the proper setup angle.

4. Start scans at the bottom of C1 and scan through the top of the head

DFOV: Preferred 20 cm (Range 18-22)

Contrast: 1. 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes)2. Begin scanning as soon as contrast injection is finished

Other Info:

Page 6: Neuroradiology CT Protocols

6 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.6 0.4 0.4 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 200-660 130-440 200-660 190-620 130-440

Noise Index 2.8 2.8 2.8 2.8 2.8

(Manual mA) 530 350 530 500 340:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Full Full Full Full Full

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Head: HelicalAdult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 7: Neuroradiology CT Protocols

7 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 230-750 130-420 230-750 210-700 130-420

Noise Index 3.3 3.3 3.3 3.3 3.3

(Manual mA) 620 330 600 570 340:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 90/30 90/30 90/30 90/30 90/30

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Full Full Full Full Full

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Head: HelicalAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 8: Neuroradiology CT Protocols

8 Revised 7/22/09 (Gentry/Ranallo)

Adult Head: Helical Scan with Angled Axial Reformations (Protocol # 1.2)

Billing: 1. CT Head without, or with, or without and with2. Contrast if used

Setup: 1. Use this protocol when the head cannot be properly positioned for a routine helical head scan. Example: when you cannot move the patient’s head into proper position (trauma, cervical collar, rigid neck).

2. Supine, AP and lateral scouts, no gantry angle 3. Start the scans at C2 and scan through the top of the head4. Do not send the source images to PACS (Only send the 2D-reformations)5. Obtain 2D-reformations parallel to a line connecting the infraorbital rim with the

opisthion (see below). Use a sagittal view on Imageworks slightly off midline to choose proper angle of reconstruction. Start reformations at the bottom of C1 and go to the top of the head using a 20 cm DFOV.

6. Important: Be certain that dental filling artifact does not extend across the brain on the helical raw data. If it does, then use the axial mode head protocol instead.

DFOV: Preferred 20 cm (Range 18-22)

Contrast: 1. 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes)2. Begin scanning as soon as contrast injection is finished

Other Info: 1. 2D-Reformations

a. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mm

b. Axial Bone: 2.5 mm thick with an interval of 1.25 mm

Page 9: Neuroradiology CT Protocols

9 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.6 0.5 0.5 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.65 0.65 0.65 0.65 0.65

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 170-550 130-440 160-530 150-500 130-440

Noise Index 5.6 5.6 5.6 5.6 5.6

(Manual mA) 440 350 420 400 340:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Head: Helical Scan with Angled Axial Reformations - Adult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 10: Neuroradiology CT Protocols

10 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.65 0.65 0.65 0.65 0.65

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 240-750 130-420 230-750 210-700 130-420

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 630 330 600 570 340:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 90/30 90/30 90/30 90/30 90/30

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Head: Helical Scan with Angled Axial Reformations - Adult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 11: Neuroradiology CT Protocols

11 Revised 7/22/09 (Gentry/Ranallo)

Adult Head: (Axial Mode) (Protocol # 1.3)

Billing: 1. CT Head without, or with, or without and with2. Contrast if used

Setup: 1. Supine, AP and lateral scouts2. Helical mode should be used routinely `for adult head CT scans. Only use axial

mode when you cannot move the patient’s head into proper position (trauma, cervical collar, rigid neck). This mode can also be used in unstable patients in the emergency department when the CT scan time must be expedited.

3. Patient Positioning: Using the lateral scout image, angle the gantry so that it is parallel to a line connecting the infraorbital rim with the opisthion (see below).

4. Start scans at the bottom of C1 and scan through the top of the head

DFOV: Preferred 20 cm (Range 18-22)

Contrast: 1. 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes)2. Begin scanning as soon as contrast injection is finished

Other Info:

Page 12: Neuroradiology CT Protocols

12 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.7 0.9 0.6 0.6 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

2i 2i 2i 2i 2i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

mA 670 420 630 630 420:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 1.0 0.9 0.8 0.8 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

2i 2i 2i 2i 2i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Scan FOV Head Head Head Head Head

kV 100 120 100 100 120

mA 670 400 670 670 400:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 90/30 90/30 90/30 90/30 90/30:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Head: AxialAdult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Head: AxialAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 1

Recon 2

Page 13: Neuroradiology CT Protocols

13 Revised 7/22/09 (Gentry/Ranallo)

Pediatric Head: Routine (Helical Mode) (< 6 years of age)

(Protocol # 11.1 & 11.2)

Billing: 1. CT Head without, or with, or without and with2. Contrast if used

Setup: 1. Supine, AP and lateral scouts, no gantry angle 2. Helical mode should be used routinely for pediatric head CT scans. Only use axial

mode when you cannot move the patient’s head into proper position (trauma, cervical collar, rigid neck).

3. Patient Positioning: Tilt the patients head so that a line connecting the lateral canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). Use axial mode and angle the gantry if you cannot place the patient’s head within 15 degrees of the proper setup angle.

4. Start scans at the bottom of C1 and scan through the top of the head

Preferred: Preferred 16 cm (Range 14-18 cm)

Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec2. Begin scanning as soon as contrast injection is finished

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Other Info:

Page 14: Neuroradiology CT Protocols

14 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.6 0.4 0.4 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 170-680 110-400 170-680 160-640 110-420

Noise Index 2.6 2.6 2.6 2.6 2.6

(Manual mA) 510 340 510 480 330:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Full Full Full Full Full

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Head: Helical Pediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 15: Neuroradiology CT Protocols

15 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 190-675 110-400 180-675 170-675 100-400

Noise Index 3.0 3.0 3.0 3.0 3.0

(Manual mA) 560 340 540 510 310:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Full Full Full Full Full

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Head: Helical Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 16: Neuroradiology CT Protocols

16 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.7 0.4 0.4 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.5 1.5 1.5 1.5 1.5

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-675 80-390 140-675 130-640 80-390

Noise Index 3.3 3.3 3.3 3.3 3.3

(Manual mA) 460 260 460 430 260:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Plus Plus Plus Plus Plus:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Full Full Full Full Full

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Head: Helical Pediatric Infant (0– 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 17: Neuroradiology CT Protocols

17 Revised 7/22/09 (Gentry/Ranallo)

Pediatric Head: Helical Scan with Angled Axial Reformations (< 6 years of age)

(Protocol # 11.3 & 11.4)

Billing: 1. CT Head without, or with, or without and with2. Contrast if used

Setup: 1. Use this protocol when the head cannot be properly positioned for a routine helical head scan. Example: when you cannot move the patient’s head into proper position (trauma, cervical collar, rigid neck)

2. Supine, AP and lateral scouts, no gantry angle 3. Start the scans at C2 and scan through the top of the head4. Do not send the source data to PACS (Only send the 2D-reformations)5. Obtain 2D-reformations parallel to a line connecting the infraorbital rim with the

opisthion (see below). Start reformations at the bottom of C1 and go to the top of the head using a 20 cm DFOV.

6. Important: Be certain that dental filling artifact does not extend across the brain on the helical raw data. If it does, then use the axial mode head protocol instead.

DFOV: Preferred 16 cm (Range 14-18 cm)

Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec2. Begin scanning as soon as contrast injection is finished

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Other Info: 1. 2D-Reformationsa. Axial Soft Tissue: 5 mm thick with an interval of 2.5 mmb. Axial Bone: 2.5 mm with an interval of 1.25 mm

Page 18: Neuroradiology CT Protocols

18 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.6 0.5 0.5 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 130-560 110-420 130-540 120-510 110-420

Noise Index 5.2 5.2 5.2 5.2 5.2

(Manual mA) 420 340 400 380 330:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Head: Helical Scan with Angled Axial Reformations - Pediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 19: Neuroradiology CT Protocols

19 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 190-675 110-400 180-675 170-675 100-400

Noise Index 6.0 6.0 6.0 6.0 6.0

(Manual mA) 560 340 540 510 310:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Head: Helical Scan with Angled Axial Reformations - Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 20: Neuroradiology CT Protocols

20 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 110-570 80-390 110-550 100-520 80-390

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 370 260 360 340 260:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Head: Helical Scan with Angled Axial Reformations - Pediatric Infant (0– 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 21: Neuroradiology CT Protocols

21 Revised 7/22/09 (Gentry/Ranallo)

Pediatric Head: (Axial Mode) (Less than 6 years of age) (Protocol # 11.5 & 11.6)

Billing: 1. CT Head without, or with, or without and with2. Contrast if used

Setup: 1. Supine, AP and lateral scouts 2. Helical mode should be used routinely for pediatric head CT scans. Only use axial

mode when you cannot move the patient’s head into proper position (trauma, cervical collar, rigid neck). This mode can also be used in unstable patients in the emergency department when the CT scan time must be expedited.

3. Patient Positioning: Using the lateral scout image, angle the gantry so that it is parallel to a line connecting the infraorbital rim with the opisthion (see below).

4. Start scans at the bottom of C1 and scan through the top of the head

DFOV: Preferred 16 cm (Range 14-18 cm)

Contrast: 1. 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec2. Begin scanning as soon as contrast injection is finished

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Other Info:

Page 22: Neuroradiology CT Protocols

22 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.7 0.8 0.6 0.6 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

2i 2i 2i 2i 2i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

mA 640 420 600 600 420:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.9 0.8 0.8 0.8 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

2i 2i 2i 2i 2i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Scan FOV Head Head Head Small Head Head

kV 80 100 80 80 100

mA 670 420 600 600 420:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Head: Axial Pediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Head: Axial Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 1

Recon 2

Page 23: Neuroradiology CT Protocols

23 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

2i 2i 2i 2i 2i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

mA 660 400 640 640 400:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Head: Axial Pediatric Infant (0– 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 24: Neuroradiology CT Protocols

24 Revised 7/22/09 (Gentry/Ranallo)

Pediatric Head: (Trauma) (< 6 y/o) (with or without 3D CT) (Protocol # 11.7 & 11.8)

Billing: 1. CT Head without2. 3D CT Head if done

Setup: 1. Patient Supine, AP and lateral scouts, no gantry angle3. Remove all metallic and high-density objects from the scanning area3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). 4. Start scans at the bottom of C1 and scan completely through the top of the head5. Must be done with helical mode.

DFOV: Preferred 16 cm (Range 14-18 cm)

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Contrast: 1. None

Other Info: 1. See Maxillofacial Trauma Protocol for more information on 3D reconstructions.2. 3D Exam: Please perform three 3600 rotations at 100 intervals as follows

a. From a right lateral view = rotate the head horizontally for 3600

b. From an AP view = rotate vertically for 3600

c. From a Water’s type view = rotate horizontally for 3600 (note: to get a Water’s type projection rotate the patient’s nose upward about 200)

3. Networking 3D images to ALI Store 4. Place the 3D request in the 3D slot on the wall in the E3/3 control room!

Page 25: Neuroradiology CT Protocols

25 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.6 0.4 0.4 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 170-680 110-420 170-680 160-640 110-420

Noise Index 2.6 2.6 2.6 2.6 2.6

(Manual mA) 510 340 510 480 330:

DFOV 22 22 22 22 22

Recon Type Soft Soft Soft Soft Soft

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Head Trauma: Helical Pediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 26: Neuroradiology CT Protocols

26 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.7 0.4 0.4 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.5 1.5 1.5 1.5 1.5

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-680 80-390 140-680 130-640 80-390

Noise Index 3.3 3.3 3.3 3.3 3.3

(Manual mA) 460 260 460 430 260:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Plus Plus Plus Plus Plus:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Head Trauma: Helical Pediatric Infant (0 – 3 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 27: Neuroradiology CT Protocols

27 Revised 7/22/09 (Gentry/Ranallo)

1. CT Orbit without, or with, or with and without2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle.2. Extend the scouts to include aortic arch for smart prep.3. Patient Positioning: Tilt the patients head so that a line connecting the lateral canthus

of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). You may need to put a foam pad under the occiput to get the head in this position.

4. Ask the patient to look straight ahead and hold their eyes in a very still position.5. Start the scans at the infraorbital rim and scan through the top of the orbit

Preferred 14 cm (Range 14-16 cm)

1. Adults: 75 ml of 240 mg/ml nonionic contrast media (use 150ml of 240mg/ml if a CT of the head will also be obtained)

2. Pediatrics: 1 ml / pound (2 ml/kg) of 240 non-ionic contrast media3. Injection Rate: Adults: 3 ml/sec; Pediatric: 2 ml/sec4. Smart prep over the cavernous sinus (adults) or aortic arch (peds). Begin scanning

10 seconds (adults) or 6 seconds (pediatric) after arrival of contrast.

Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and bilateral oblique sagittal planes as shown in the image below.

2. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 3)

3. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the 1.25 mm standard algorithm images (Recon 1) only from the contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images from the non-contrast series (Recon 3).

4. Do not send the 0.625 mm (Recon 3) bone images to PACS.

Orbit: (Routine) (Protocol – Adult: # 2.1 – Pediatric: # 12.1 & 12.2)

Billing:

Setup:

DFOV:

Contrast:

Patient Age:

Recons & Reformats:

not

Page 28: Neuroradiology CT Protocols

28 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.6 0.5 0.5 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 160-550 130-440 160-530 150-500 130-440

Noise Index 5.6 5.6 5.6 5.6 5.6

(Manual mA) 440 350 420 400 340:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/0 300/0 300/0 300/0 300/0

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Orbit: RoutineAdult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 29: Neuroradiology CT Protocols

29 Revised 7/22/09 (Gentry/Ranallo)

Cavernous Sinus 80 10.0 2.0 50 12.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 240-750 120-420 230-750 210-700 130-420

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 620 330 600 570 340:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 350/20 350/20 350/20 350/20 350/20

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Orbit: Routine Adult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 30: Neuroradiology CT Protocols

30 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 140-560 100-390 130-540 120-510 100-380

Noise Index 5.2 5.2 5.2 5.2 5.2

(Manual mA) 420 290 400 380 290:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/0 300/0 300/0 300/0 300/0

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Orbit: RoutinePediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 31: Neuroradiology CT Protocols

31 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.0 50 6.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 0.8 0.6 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 160-650 110-400 150-610 170-675 110-400

Noise Index 6.0 6.0 6.0 6.0 6.0

(Manual mA) 510 340 460 510 340:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/0 300/0 300/0 300/0 300/0

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Orbit: RoutinePediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 32: Neuroradiology CT Protocols

32 Revised 7/22/09 (Gentry/Ranallo)

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Aortic Arch 40 10.0 2.0 50 6.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 110-570 80-390 110-550 100-520 80-390

Noise Index 5.1 5.1 5.1 5.1 5.1

(Manual mA) 370 260 360 340 260:

DFOV 15 15 15 15 15

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/0 300/0 300/0 300/0 300/0

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 15 15 15 15 15

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 15 15 15 15

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Smart Prep

Orbit: Routine Pediatric Infant (0 – 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 33: Neuroradiology CT Protocols

33 Revised 7/22/09 (Gentry/Ranallo)

1. CT Orbit with or with and without2. Contrast

1. Monitored Exam: ENT attending or fellow2. Patient Supine, AP and lateral scouts, no gantry angle3. Extend the scouts to include aortic arch for smart prep.4. Patient Positioning: Tilt the patients head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). You may need to put a foam pad under the occiput to get the head in this position.

5. Ask the patient to look straight ahead and hold their eyes in a very still position.6. Start the scans at the infraorbital rim and scan through the top of the orbit 7. Always done following either a routine orbit CT with contrast or a vascular mass

CT of the orbit with and without contrast

Part 1: Routine Orbit CT with contrast or Orbit Vascular Mass CT without and with contrast

Part 2: Valsalva Protocol (as below) - Use routine orbit scan factors- To be monitored by ENT attending or ENT fellow if possible- If there is any indication of increased intra-orbital or intra-ocular pressure, the

radiologist should 1st clear this procedure with the ordering ophthalmologist- First rehearse the maneuver with the patient- Ask the patient to take a deep breath and Valsalva for 15 seconds (do not do

CT scans at this point)- Have the patient take another deep breath, then - Do Valsalva maneuver again. - Begin 1.25 mm helical scans through entire orbit 5 seconds after the start of

the 2nd Valsalva maneuver- Acquire 1.25 mm helical images in axial plane using just the standard

algorithm (no bone algorithm)

Preferred 14 cm (Range 14-16 cm)

1. Do the routine 2D orbital reformations for Part 1.

2. Do additional 2 x 2 mm 2D-reformations (soft tissue only) from the post Valsalva images in Part 2 in the coronal and bilateral oblique sagittal planes as shown below.

Orbit: (With and Without Valsalva) (Protocol – Adult: # 2.2 – Pediatric: # 12.3 & 12.4)

Billing:

Setup Info:

Exam:

(but only Recon 1 – No bone images)

DFOV:

Reformats:

Page 34: Neuroradiology CT Protocols

34 Revised 7/22/09 (Gentry/Ranallo)

1. CT Orbit (with and without)2. Contrast

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include aortic arch and superior vena cava for smart prep.3. Always do exam with and without contrast4. Patient Positioning: Tilt the patients head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). You may need to put a foam pad under the occiput to get the head in this position.

5. Ask the patient to look straight ahead and hold their eyes in a very still position.6. Start the scans at the infraorbital rim and scan through the top of the orbit

14 cm (14-16 cm)

Part 1: Routine Orbit CT without contrast- Standard algorithm (Recon 1) only (no bone algorithm images & no reformats)

Part 2: Dynamic CT scans through lesion (as described below and on next page) - Choose eight 2.5 mm slices through the mass for dynamic scans- Smart prep over the superior vena cava- To be monitored by ENT attending or ENT fellow if possible- Adults: Inject 100 ml of 240mg/ml at 3.5 ml per sec (Injection time = 28.5 sec)

(note: use 150ml of 240mg/ml if a CT of the head will also be obtained)- Pediatrics: Inject 1 ml/lb (2 ml/kg) of 240 mg/ml contrast at 2 ml per sec - Begin scanning with the arrival of contrast in the superior vena cava- 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1

image every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec and 9 sec respectively) (scan time = 34 sec).

- Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o.- Allow all of the contrast to be injected then do Part 3- no reformats or bone algorithm with Part 2, only axial standard 2.5 mm images

Part 3: Post-contrast Orbit CT - Scan as in routine orbit “with contrast” protocol performing all 3 Recons:

standard, bone and, thin bone

1. Only do 2D-Reconstructions from the Part 3 contrast-enhanced images 2. Do 2 mm x 2 mm 2D-reformations using both the standard 1.25 mm images

(Recon 1) AND the bone 0.625 mm images (Recon 3) in the coronal and bilateral oblique sagittal planes as outlined below.

3. Do not send the 0.625 mm (Recon 3) bone images to PACS

Orbit: (Vascular Mass or Carotid-Cavernous Fistula)

(Protocol – Adult: # 2.3 – Pediatric: # 12.5 & 12.6)

Billing:

Setup:

DFOV:

Exam:

Reformats:

Page 35: Neuroradiology CT Protocols

35 Revised 7/22/09 (Gentry/Ranallo)

Superior Vena Cava

40 (Adult)20 (Peds)

10.0 2.0 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial

Rotation Time (sec) 1.0 1.0 1.0 1.0 1.0

Detector Coverage (mm) 20 20 20 20 20

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

mA Adults 380 300 300 300 300

mA Peds < 6 y/o 190 150 150 150 150:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 350/20 350/20 350/20 350/20 350/20

Scan Factors for Part 2 only: (Adult and Pediatric)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Orbit: (Vascular Mass / Carotid-Cavernous Fistula)Adult and Pediatric

Contrast (Part 2 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 36: Neuroradiology CT Protocols

36 Revised 7/22/09 (Gentry/Ranallo)

1. CT Orbit without

1. Monitored Exam: (Only scheduled and done when an ENT attending is available)2. Always obtained following a Routine Orbit CT without contrast 3. Do only on 64 slice scanner 4. Patient Supine, AP and lateral scouts, no gantry angle5. Patient Positioning: Tilt the patients head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). You may need to put a foam pad under the occiput to get the head in this position.

6. Use a head restraint to help the patient hold their head still. 7. Ask the patient to look straight ahead and hold their eyes in a very still position.8. Start the scans at the infraorbital rim and scan through the top of the orbit

Part 1: Routine Orbit CT without contrast - The routine orbit protocol is performed as usual - The patient must be instructed to look straight ahead prior to the scan

Part 2: Dynamic Maneuver - Use the routine noncontrast orbit CT scan factors- Helical 1.25 mm scans will be obtained using standard algorithm only

(no bone algorithm) - Ask the patient to hold their head still and only move their eyes (practice this

with the patient ahead of time)- Do the following scans in these directions of gaze – IN THIS ORDER:

- Left gaze- Right gaze- Up gaze- Down gaze

Preferred 14 cm (Range 14-16 cm)

1. Do the standard 2 x 2 mm 2D-reformations for the routine orbit exam (Part 1)2. Do additional 2 x 2 mm 2D-reformations from Part 2 the as described below.

- Neutral gaze: coronal and bilateral oblique sagittal recons (Part 1)- Left gaze: No 2D recons- Right gaze: No 2D recons- Up gaze: coronal and bilateral oblique sagittal recons (Part 2)- Down gaze: coronal and bilateral oblique sagittal recons (Part 2)

Orbit: (Dynamic (EOM Movements) (Protocol – Adult: # 2.4 – Pediatric: # 12.7 & 12.8)

Billing:

Setup Info:

DFOV:

Reformats:

Page 37: Neuroradiology CT Protocols

37 Revised 7/22/09 (Gentry/Ranallo)

1. CT Maxi-face without, or with, or with and without2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include aortic arch for smart prep.3. Remove all metallic and high-density objects from the scanning area.4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus and the EAC is perpendicular to the CT tabletop (see head CT protocol). 5. Scanning begins just below the genu of the mandible to the top of the frontal sinuses

1. Routine: w/o contrast. Use the following injection parameters if done w/ contrast.2. Adults: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT head

will also be obtained); Pediatrics: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. 3. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 2 ml/sec 4. Smart prep over the aortic arch and begin scanning 15 seconds (adults) or 8

seconds (pediatrics) after arrival of contrast in the arch

: Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Preferred 17.2 cm (Range 15-18 cm)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats as shown in the image below

Oblique Sagittal: Through each orbit parallel to the optic nerves.Sagittal: Through both orbits. Be sure to include both TMJs.Coronal: From the anterior aspect of the superior orbital rim through the

sella. Be sure to include all of the TMJ.

2. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone images (Recon 2)

3. If this is a “with & without” contrast study: Do do Recon 2 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2mm x 2mm reformats using the bone images (Recon 2) from the non-contrast series.

Maxillofacial Trauma: (Routine)

(Protocol – Adult: # 2.5a – Pediatric: # 12.9 & 12.10)

Billing:

Setup:

Contrast:

Patient Age

DFOV:

Recons & Reformats:

not

Page 38: Neuroradiology CT Protocols

38 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.6 0.5 0.5 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 170-550 130-440 160-530 150-500 130-440

Noise Index 5.6 5.6 5.6 5.6 5.6

(Manual mA) 440 350 420 400 340:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/50 400/50 400/50 400/50 400/50

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Maxillofacial TraumaAdult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 39: Neuroradiology CT Protocols

39 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 2.5 50 15.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 240-750 130-420 230-750 210-700 130-420

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 620 330 600 570 340:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/70 450/70 450/70 450/70 450/70

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Maxillofacial TraumaAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 40: Neuroradiology CT Protocols

40 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 130-560 100-390 130-540 120-510 100-380

Noise Index 5.2 5.2 5.2 5.2 5.2

(Manual mA) 420 290 400 380 290:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/50 400/50 400/50 400/50 400/50

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Maxillofacial Trauma: Pediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 41: Neuroradiology CT Protocols

41 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 8.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 0.8 0.6 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 160-650 110-400 150-610 170-680 110-400

Noise Index 6.0 6.0 6.0 6.0 6.0

(Manual mA) 490 340 460 510 340:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/50 400/50 400/50 400/50 400/50

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Maxillofacial Trauma: Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 42: Neuroradiology CT Protocols

42 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 8.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 110-570 80-390 110-550 100-520 80-390

Noise Index 5.1 5.1 5.1 5.1 5.1

(Manual mA) 370 260 360 340 260:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/50 400/50 400/50 400/50 400/50

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 17.2 17.2 17.2 17.2 17.2

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Maxillofacial Trauma: Pediatric Infant (0 – 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 43: Neuroradiology CT Protocols

43 Revised 7/22/09 (Gentry/Ranallo)

1. CT Maxi-face without2. 3D CT charge

1. Patient Supine, AP and lateral scouts, no gantry angle2. Remove all metallic and high-density objects from the scanning area.3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus and the EAC is perpendicular to the CT tabletop (see head CT protocol). 4. Scanning begins just below the genu of the mandible to the top of the frontal sinuses

Part 1: Routine Maxiface Trauma Protocol

1. Do a routine maxillofacial trauma protocol 2. Scanning begins at the bottom of the mandible to the top of the frontal sinus (get

one air scan below chin to allow the 3D to show the entire mandible without artifacts)

Part 2: 3D Exam Post-Processing:

1. Cut away as much of the c-spine as possible2. Please perform three 360 degree rotations at 10 degree intervals as follows

a. From a right lateral view = rotate horizontally for 360 degreesb. From an AP view = rotate vertically for 360 degreesc. From a Water’s type view = rotate horizontally for 360 degrees (note: to get a

Water’s type projection rotate the patient’s nose upward about 20 degrees)

1. Do 2 mm x 2 mm 2D-Reformations as in the routine maxifacial protocol2. Network the 2D and 3D images to ALI Store 3. Place the 3D request in the 3D slot on the wall in the E3/3 control room!

Maxillofacial Trauma: (Routine plus 3D)

(Protocol – Adult: # 2.5b – Pediatric: # 12.9 & 12.10)

Billing:

Setup:

Exam:

Other Info:

Page 44: Neuroradiology CT Protocols

44 Revised 7/22/09 (Gentry/Ranallo)

1. CT Head without contrast2. 3D CT Charge

1. Patient Supine, AP and lateral scouts, no gantry angle2. Use 64 slice scanners if possible3. Remove all metallic and high-density objects from the scanning area.4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus and the EAC is perpendicular to the CT tabletop. (see head CT protocol)5. Scanning begins below the genu of the mandible all the way through the top of the

head (Get 1-2 air scans above the head and below the chin to allow the 3D program to show the entire head and mandible without artifacts)

Preferred 20 cm (Range 18-22 cm) Must include the entire head, face, and mandible

1. Only done without contrast.

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

1. Send the following source images to PACS: Recon 1: 5 mm slice thickness standard images (2.5 mm Plus recon for infants), and Recon 2: 1.25 mm slice thickness bone images.

2. Do not send the 0.625 mm (Recon 3) bone images to PACS.

1. Do 3D Reconstructions only from the Recon 3 thin bone images

2. Cut away as much of the c-spine as possible

3. Please perform three 360 degree rotations at 10 degree intervals as followsa. From a right lateral view = rotate horizontally for 360 degrees b. From an AP view = rotate vertically for 360 degrees c. From a Water’s type view = rotate horizontally for 360 degrees (note: to get a

Water’s type projection rotate the patient’s nose upward about 20 degrees)

4. Networking all 3D images to ALI Store

5. Make sure the 3D request is placed in the 3D slot on the wall in the E3/3 control room!

3D CT: (Craniosynostosis, Congenital Facial Anomaly)

(Protocol – Adult: # 1.5 – Pediatric: # 11.9 & 11.10)

Billing:

Setup:

DFOV:

Contrast:

Patient Age:

Other Info:

3D Reconstructions:

Page 45: Neuroradiology CT Protocols

45 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.6 0.5 0.5 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 170-550 130-440 160-530 150-500 130-440

Noise Index 2.8 2.8 2.8 2.8 2.8

(Manual mA) 440 350 420 400 340:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

3D CT: (Craniosynostosis, Congenital Facial Anomaly)

AdultNon-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 46: Neuroradiology CT Protocols

46 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 5 5 5 5 5

Interval (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 140-560 100-390 130-540 120-510 100-380

Noise Index 2.6 2.6 2.6 2.6 2.6

(Manual mA) 420 290 400 380 290:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

3D CT: (Craniosynostosis, Congenital Facial Anomaly)

Pediatric Child (3 – 6 yr)Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 47: Neuroradiology CT Protocols

47 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.5 1.5 1.5 1.5 1.5

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 110-570 80-390 110-550 100-520 80-390

Noise Index 3.3 3.3 3.3 3.3 3.3

(Manual mA) 370 260 360 340 260:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 80/25 80/25 80/25 80/25 80/25

Recon Option Full Full Full Full Full:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

3D CT: (Craniosynostosis, Congenital Facial Anomaly)

Pediatric Infant (0 – 3 yr)Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 48: Neuroradiology CT Protocols

48 Revised 7/22/09 (Gentry/Ranallo)

1. CT Head with and without contrast; CT Sella with contrast2. Contrast

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include aortic arch for smart prep.3. Use 64 slice scanners if possible4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see below).

Part 1: CT Head Without Contrast (do as in routine CT head)Part 2: Pituitary CT with Contrast (as outlined below)- Use a DFOV of approximately 14 cm (include the orbit and the sella- Perform helical axial scans between yellow lines as diagramed at bottom of page- Use a bolus contrast injection as listed below:

1. Adults: 150 ml of 240 mg/ml nonionic contrast at 3.5 ml/sec2. Pediatrics: 1 ml/lb (2 ml/kg) of 240 nonionic at 2.0 to 2.5 ml/sec

- Smart prep over the aortic arch and begin scanning 15 seconds (adults) or 8 seconds (pediatrics) after arrival of contrast in the arch

- Begin Part 3 when all of contrast is in.

Part 3: CT Head With Contrast (do as in routine CT head)

Head: Preferred 20 cm (Range 18-22 cm)Pituitary: 14 cm

For Part 2: 1. Only send the Standard 1.25 mm (Recon 1) images to PACS. Do not send the Recon 2 bone images to PACS.

2. Do 2 mm x 2 mm 2D-reformats using both the standard 1.25 mm (Recon 1) images AND the bone 0.625 mm (Recon 2) images as outlined below.

Pituitary Gland and Cavernous Sinus:(Protocol – Adult: # 2.6 – Pediatric: # 12.11 & 12.12)

Billing:

Setup:

Exam:

DFOV:

Page 49: Neuroradiology CT Protocols

49 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 2.5 50 15.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 240-750 140-420 230-750 210-700 140-420

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 620 370 600 570 370:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 350/20 350/20 350/20 350/20 350/20

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Scan Factors for Part 2 only:

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Pituitary Gland and Cavernous SinusAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 50: Neuroradiology CT Protocols

50 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 8.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 190-675 110-400 180-675 170-675 110-400

Noise Index 6.0 6.0 6.0 6.0 6.0

(Manual mA) 560 340 540 510 340:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/0 300/0 300/0 300/0 300/0

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Scan Factors for Part 2 only:

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Pituitary Gland and Cavernous SinusPediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 51: Neuroradiology CT Protocols

51 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 8.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.6 0.5 0.5 0.7Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 110-570 90-400 110-550 100-520 90-400

Noise Index 5.1 5.1 5.1 5.1 5.1

(Manual mA) 370 300 360 340 290:

DFOV 12 12 12 12 12

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/0 300/0 300/0 300/0 300/0

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 12 12 12 12 12

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Scan Factors for Part 2 only:

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Pituitary Gland and Cavernous SinusPediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 52: Neuroradiology CT Protocols

52 Revised 7/22/09 (Gentry/Ranallo)

1. CT Stereotactic2. Contrast if used

1. Patient Supine on table top2. AP and lateral scouts3. No gantry angle4. Using the lasers, line up patient so that the canthomeatal line is perpendicular to

the CT table. This may require you to tilt the patients head either up on down slightly.

5. Scan from the hard palate to the top of the head

1. Adult: 150 ml of 240 mg/dl non-ionic contrast @ 0.6 ml/sec (4.2 minutes)2. Peds: 1 ml / pound (2 ml/kg) of 240 non-ionic contrast @ 0.6 ml/sec 3. Begin scanning as soon as contrast injection is finished

Mode AxialTime 1 secMode 1.25 @ 8i - Interval 10.0KVP 120mA 250Algorithm StandardSFOV HeadDFOV 22 to 25

1. If there is ANY patient motion, start the scan over.2. All images should be networked to ALI Store.3. Archive only the axial images to the MOD that goes to the surgeon.4. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.

Stealth - Stereotactic Head: (Whole Brain Treatment Planning)

(Protocol – Adult: # 1.10 – Pediatric: # 11.11 & 11.12)

Billing:

Setup:

Contrast:

Scan Factors:

General Notes:

Page 53: Neuroradiology CT Protocols

53 Revised 7/22/09 (Gentry/Ranallo)

1. CT Sinus without, or with, or with and without2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include aortic arch for smart prep if the exam is to be done with

contrast.3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). The tip of the nose and the both zygomatic bones must be on the scan.

4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below)5. Note: If the scan is protocoled as a “with contrast” scan, start the scans at the genu

of mandible 6. Use axial CT scan factors if a coronal plane scan is ordered.

1. Adults: 100 ml of 240 mg/ml nonionic contrast media; Pediatrics: 1 ml/lb (2 ml/kg) of 240 nonionic contrast media.

2. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 0.6 to 2.5 ml/sec3. Smart prep over the aortic arch (use cavernous sinus if arch cannot be seen) and

begin scanning 15 seconds (adults) or 8 seconds (pediatrics) after arrival of contrast in the arch

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Preferred 14 cm (Range 14-16 cm)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats (see below)Sagittal: Through both orbits. Be sure to include both TMJs.Coronal: From the anterior aspect of the superior orbital rim through the sella. Be

sure to include all of the TMJ.

2. If this is an exam solely with contrast or solely without contrast: Do 2D reformats using both standard 1.25 mm images (Recon 1) and the bone images (Recon 2)

3. If this is a “with & without” contrast study: Do not do Recon 2 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series andalso do 2 mm x 2 mm reformats using bone images (Recon 2) from the non-contrast series.

Sinuses (Diagnostic): (Adult and Pediatric)

(Protocol – Adult: # 2.7 – Pediatric: # 12.13 &12.14)

Billing:

Setup:

Contrast:

Patient Age:

DFOV:

Recons & Reformats:

Page 54: Neuroradiology CT Protocols

54 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.5 0.5 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 110-400 90-320 90-320 90-300 100-360

Noise Index 7.2 7.2 7.2 7.2 7.2

(Manual mA) 310 250 250 240 290:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/30 400/30 400/30 400/30 400/30

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Recon 2:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Sinuses (Diagnostic)Adult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 55: Neuroradiology CT Protocols

55 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 2.5 50 15.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.5 0.5 0.5 0.6Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 160-560 130-420 130-450 120-430 120-420

Noise Index 8.5 8.5 8.5 8.5 8.5

(Manual mA) 450 360 360 340 340:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/50 450/50 450/50 450/50 450/50

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Sinuses (Diagnostic)Adult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 56: Neuroradiology CT Protocols

56 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.5 0.5 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 100-410 80-330 80-330 80-310 90-370

Noise Index 6.8 6.8 6.8 6.8 6.8

(Manual mA) 300 240 240 230 280:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/30 400/30 400/30 400/30 400/30

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Sinuses (Diagnostic)Pediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 57: Neuroradiology CT Protocols

57 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 8.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.5 0.5 0.5 0.6Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-550 110-400 110-440 100-420 100-400

Noise Index 7.7 7.7 7.7 7.7 7.7

(Manual mA) 410 330 330 310 310:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/30 400/30 400/30 400/30 400/30

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Sinuses (Diagnostic)Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 58: Neuroradiology CT Protocols

58 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 8.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.5 0.5 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 90-410 70-330 70-330 60-310 70-370

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 280 220 220 210 250:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/30 400/30 400/30 400/30 400/30

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Sinuses (Diagnostic)Pediatric Infant (0 – 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 59: Neuroradiology CT Protocols

59 Revised 7/22/09 (Gentry/Ranallo)

1. CT Sinus without only (never use this protocol when giving contrast)

1. Patient Supine, AP and lateral scouts, no gantry angle2. Only use this protocol for ENT and allergy patients with multiple prior diagnostic

sinus CT scans3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see below). 4. Scan from the bottom of maxillary teeth to the top of the frontal sinuses (see below)

Preferred 14 cm (Range 14-16 cm)

1. Never give contrast with this protocol

1. Do 2 mm x 2 mm 2D-reformations using both the standard 1.25 mm images AND the bone 0.625 mm images as shown below.

Sinuses (Follow-up Adult ENT Sinus): (Protocol: # 2.7)

Billing:

Setup:

DFOV:

Contrast:

Reformats:

Page 60: Neuroradiology CT Protocols

60 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.5 0.5 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 80-260 60-210 60-210 60-200 70-240

Noise Index 8.8 8.8 8.8 8.8 8.8

(Manual mA) 210 170 170 160 190:

DFOV 14 14 14 14 14

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/30 400/30 400/30 400/30 400/30

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 14 14 14 14 14

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.625 0.625 0.625 0.625 0.75

Sinuses: (Follow-up ENT)Adult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 61: Neuroradiology CT Protocols

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Sinuses: (Combined Diagnostic and Landmarx): (Adult and Pediatric)

(Protocol – Adult: # 2.9 – Pediatric: # 12.16 & 12.17)

This exam is no longer done! Do a Diagnostic Sinus CT instead. If there is any questions by referring doctors ask them to contact either Dr. Gentry or Dr. Hartman.

Page 62: Neuroradiology CT Protocols

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1. Temporal Bone without

1. Patient Supine, AP and lateral scouts, no gantry angle2. Only use 16 and 64 slice scanners3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of the

eye and the EAC is perpendicular to the CT tabletop (see below). 4. Start scans at the mastoid tip and finish at the top of the petrous bone (see below)

1. Recon 1 and Retro Recons: Preferred 20 cm (Range 18-22 cm)2. Recon 2 and 3 of TB: 9.6 cm

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

1. Recon 1: 2.5 mm axial images using a bone algorithm. 2. Recon 2 & 3: Obtain left and right 0.625 mm temporal bone axial images with a DFOV of 9.6 cm.

3. Perform 1 additional Retro Recons to get the following axial images of the entire scan range:At 20 cm DFOV, standard algorithm, 2.5 mm slice thickness, 1.25 mm increment, (WW/WL: 400/30)

4. Do 1 mm by 1 mm 2D-reformats in the coronal, Stenver’s, and Pöschl planes of each temporal bone using Recon 2 & 3 as source images (below)

Temporal Bone: (W/O Contrast) (Protocol – Adult: # 2.10 – Pediatric: # 12.18 & 12.19)

Billing:

Setup:

DFOV:

Patient Age:

Recons & Reformats:

Page 63: Neuroradiology CT Protocols

63 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25

Scan FOV Head Head Head Head

kV 120 120 120 120

Smart mA/ Auto mA Range 190-610 130-420 180-590 170-560

Noise Index 3.7 3.7 3.7 3.7

(Manual mA) 490 340 470 450:

DFOV 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Full Full Full Full:

DFOV 9.6 9.6 9.6 9.6

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 9.6 9.6 9.6 9.6

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Temporal BoneAdult

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 3

Page 64: Neuroradiology CT Protocols

64 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25

Scan FOV Head Head Head Small Head

kV 100 100 100 100

Smart mA/ Auto mA Range 160-630 110-420 150-610 140-570

Noise Index 3.5 3.5 3.5 3.5

(Manual mA) 480 330 460 430:

DFOV 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Full Full Full Full

Recon Option: 9.6 9.6 9.6 9.6

DFOV Bone Plus Bone Plus Bone Plus Bone Plus

Recon Type 3000/300 3000/300 3000/300 3000/300

WW/ WL Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 9.6 9.6 9.6 9.6Recon Type Bone Plus Bone Plus Bone Plus Bone PlusWW/ WL 3000/300 3000/300 3000/300 3000/300Recon Option Plus Plus Plus FullRecon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Temporal BonePediatric Child (3 – 6 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 3

Page 65: Neuroradiology CT Protocols

65 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25

Scan FOV Head Head Head Small Head

kV 80 80 80 80

Smart mA/ Auto mA Range 120-630 90-400 120-610 120-580

Noise Index 3.4 3.4 3.4 3.4

(Manual mA) 430 290 410 380:

DFOV 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option

Recon 2: 9.6 9.6 9.6 9.6

DFOV Bone Plus Bone Plus Bone Plus Bone Plus

Recon Type 3000/300 3000/300 3000/300 3000/300

WW/ WL Full Full Full Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Recon 3:

DFOV 9.6 9.6 9.6 9.6

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Temporal BonePediatric Infant (0 – 3 yr)

Non-Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 66: Neuroradiology CT Protocols

66 Revised 7/22/09 (Gentry/Ranallo)

1. CT Temporal Bone (without and with) 2. Contrast

1. Patient Supine, AP and lateral scouts, no gantry angle:2. Extend the scouts to include aortic arch for smart prep.3. Only use 16 and 64 slice scanners4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).

1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm)2. TB: 9.6 cm

Part 1: Temporal Bone CT Without Contrast1. Use the same protocol as described in the Temporal Bone W/O Contrast protocol2. This includes axial Recon 1, 2 and 3; the additional Retro recons of soft tissue and of

bone; and all the reformatted 1 x 1 cm images of the temporal bones.

Part 2: Temporal Bone Examination With Contrast 1. Inject contrast and then obtain standard algorithm 1.25 mm scans with a 0.75 mm

interval from the bottom of C1 to 1 cm above the top of temporal bone. 2. Contrast Usage: Adults: 150 ml of 240 mg/ml nonionic contrast media; Pediatrics: 1 ml/lb

(2 ml/kg) of 240 nonionic contrast media.3. Injection Rate: Adults: 3.5 ml/sec; Pediatric: 2.0 to 2.5 ml/sec4. Smart prep over the aortic arch and begin scanning 30 seconds (adults) or 15 seconds

(pediatrics) after arrival of contrast in the arch. 5. Reconstruct the 1.25 mm axial slices into 2 mm x 2 mm images of the posterior fossa

(axial, coronal, and sagittal) using an 18-22 cm DFOV with standard algorithm only.

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

1. Part 1: Do 1 mm by 1 mm 2D-reformats in the coronal, Stenver’s, and Pöschl planes 2. Part 2: Do 2 mm by 2 mm 2D-reformats in the axial, coronal, and sagittal planes

Temporal Bone CT With Contrast Only1. Use the same technique as above except do Part 2 first then do Part 1 following the

contrast study.

Temporal Bone: (W/O & W/ Contrast) or (W/ Contrast Only):

(Protocol – Adult: # 2.11 – Pediatric: # 12.20 & 12.21)

Billing:

Setup:

DFOV:

Exam:

Patient Age:

Reformats:

Exam:

Page 67: Neuroradiology CT Protocols

67 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3 50 30.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 0.9 0.6 0.6Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625

Scan FOV Head Head Head Head

kV 100 100 100 100

Smart mA/ Auto mA Range 230-750 140-420 210-700 200-660

Noise Index 8.8 8.8 8.8 8.8

(Manual mA) 600 370 560 530:

DFOV 20 20 20 20

Recon Type Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Scan Factors: (For Part 2 Only - With Contrast)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Temporal Bone: (W/O & W/ Contrast)Adult

Contrast (Part 2 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 68: Neuroradiology CT Protocols

68 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.0 50 15.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 0.9 0.6 0.6Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625

Scan FOV Head Head Head Small Head

kV 80 80 80 80

Smart mA/ Auto mA Range 180-675 110-400 170-675 160-640

Noise Index 7.9 7.9 7.9 7.9

(Manual mA) 550 340 510 480:

DFOV 20 20 20 20Recon Type Standard Standard Standard StandardWW/ WL 400/40 400/40 400/40 400/40Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Scan Factors: (For Part 2 Only - With Contrast)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Temporal Bone: (W/O & W/ Contrast)Pediatric Child (3 – 6 yr)

Contrast (Part 2 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 69: Neuroradiology CT Protocols

69 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 2.5 50 15.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625

Scan FOV Head Head Head Small Head

kV 80 80 80 80

Smart mA/ Auto mA Range 130-630 90-400 120-610 120-580

Noise Index 6.8 6.8 6.8 6.8

(Manual mA) 430 290 410 380:

DFOV 20 20 20 20

Recon Type Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Scan Factors: (For Part 2 Only - With Contrast)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Temporal Bone: (W/O & W/ Contrast)Pediatric Infant (0 – 3 yr)

Contrast (Part 2 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 70: Neuroradiology CT Protocols

70 Revised 7/22/09 (Gentry/Ranallo)

1. CT Temporal Bone (without and with) 2. Contrast

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include aortic arch for smart prep.3. Only use 16 and 64 slice scanners4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). 5. The dynamic portion is a monitored exam by an ENT radiologist or ENT Fellow.

1. Posterior Fossa: Preferred 20 cm (Range 18-22 cm)2 TB: 9.6 cm

: Part 1: Temporal Bone CT Without Contrast1. Use the same protocol as described in the Temporal Bone W/O Contrast protocol2. This includes axial Recon 1, 2 and 3; the additional Retro recons of soft tissue and of

bone; and all the reformatted 1 x 1 cm images of the temporal bones.

Part 2: Dynamic Contrast Enhanced Exam Through the Vascular Mass (as described below)

1. Select eight 2.5 mm scans through the vascular mass of posterior fossa (per radiologist)2. 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 image

every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec and 9 sec respectively) (scan time = 34 sec).

3. Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o.4. Standard algorithm only5. Inject Contrast: Adults: Inject 150 ml of 240mg/ml at 4.0 ml per sec (Injection time = 37.5

sec). Pediatrics: Inject 1 ml/lb (2 ml/kg) of 240 mg/ml contrast at 2 ml per sec 6. Smart prep over superior vena cava; begin scanning with arrival of contrast in the

superior vena cava7. As soon as all contrast has been injected immediately start Part 3

Part 3: Temporal Bone Examination With Contrast 1. Inject contrast and then obtain standard algorithm 1.25 mm scans with a 0.75 mm

interval from the bottom of C1 to 1 cm above the top of temporal bone. 2. Reconstruct the 1.25 mm axial slices into 2 mm x 2 mm images of the posterior fossa

(axial, coronal, and sagittal) using an 18-22 cm DFOV with standard algorithm only.

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

1. Part 1: Do 1 mm by 1 mm 2D-reformations in the coronal, Stenver’s, and Pöschl planes

2. Part 3: Do 2 mm by 2 mm 2D-reformations in the axial, coronal, and sagittal planes

Temporal Bone: (Vascular Mass): (Protocol – Adult: # 2.11 – Pediatric: #12.20 & 12.21)

Billing:

Setup:

DFOV:

Exam

Patient Age:

2D Reformats:

Page 71: Neuroradiology CT Protocols

71 Revised 7/22/09 (Gentry/Ranallo)

Superior Vena Cava 40 10.0 2.0 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial

Rotation Time (sec) 1.0 1.0 1.0 1.0

Detector Coverage (mm) 20 20 20 20

Slice Thickness (mm) 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head

kV 100 100 100 100

mA Adults 380 300 300 300

mA Peds < 6 y/o 190 150 150 150:

DFOV 20 20 20 20

Recon Type Standard Standard Standard Standard

WW/ WL 350/20 350/20 350/20 350/20

Scan Factors for Part 2 only: (Dynamic Contrast Enhanced Exam)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Temporal Bone: (Vascular Mass)Adult & Pediatric

Contrast (Part 2 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 72: Neuroradiology CT Protocols

72 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 0.9 0.6 0.6Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625

Scan FOV Head Head Head Head

kV 100 100 100 100

Smart mA/ Auto mA Range 230-750 140-420 210-700 200-660

Noise Index 8.8 8.8 8.8 8.8

(Manual mA) 600 370 560 530:

DFOV 20 20 20 20

Recon Type Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Scan Factors for Part 3 only:

Temporal Bone: (Vascular Mass)Adult

Contrast (Part 3 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 73: Neuroradiology CT Protocols

73 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.6 0.6Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625

Scan FOV Head Head Head Small Head

kV 80 80 80 80

Smart mA/ Auto mA Range 180-675 110-400 170-675 160-640

Noise Index 7.9 7.9 7.9 7.9

(Manual mA) 550 340 510 480:

DFOV 20 20 20 20Recon Type Standard Standard Standard StandardWW/ WL 400/40 400/40 400/40 400/40Recon Option Plus Plus Plus FullRecon Option IQ Enhance

Scan Factors for Part 3 only:

Temporal Bone: (Vascular Mass) Pediatric Child (3 – 6 yr)

Contrast (Part 3 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 74: Neuroradiology CT Protocols

74 Revised 7/22/09 (Gentry/Ranallo)

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.7 0.5 0.5Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20

Detector Rows 16 16 16 16

Pitch 0.562 0.562 0.562 0.531

Speed (mm/rot) 5.625 5.625 5.625 10.62

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625

Slice Thickness (mm) 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625

Scan FOV Head Head Head Small Head

kV 80 80 80 80

Smart mA/ Auto mA Range 130-630 90-400 120-610 120-580

Noise Index 6.8 6.8 6.8 6.8

(Manual mA) 430 290 410 380:

DFOV 20 20 20 20

Recon Type Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Scan Factors for Part 3 only:

Temporal Bone: (Vascular Mass) Pediatric Child (0 – 3yr)

Contrast (Part 3 Only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 75: Neuroradiology CT Protocols

75 Revised 7/22/09 (Gentry/Ranallo)

1. CT Neck without, or with, or without and with2. Contrast if used

1. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle2. Extend the scouts to include aortic arch for smart prep.3. Have the patient remove any dentures or removable teeth, please place the

shoulders as low possible4. Start the scan at the carina and scan to the top of the orbit5. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).

6. Do angled views at 2.5 mm 4i for 8 slices at 2 different angles if there is lots of artifact from dental fillings or metal hardware (see below)

7. Note: see page 138 for protocol modifications if done as combined study with body/chest/abdomen/pelvis CT)

Preferred 30 cm (Range 26-30 cm)

1. Adults: 100 ml of 300 mg/ml nonionic contrast media, Pediatrics: 1 ml/lb (2 ml/kg) of 300 non-ionic contrast media.

2. Use a 50 ml saline chaser in adults and a 10-25 ml saline chaser in pediatrics.3. Injection Rate: Adults: 3.0 ml/sec; Pediatric: 2.0-2.5 ml/sec4. Smart prep over the aortic arch.5. CT scan delay after arrival of contrast in aortic arch:

Adult: 10 sec (4-8 slice scanner), 15 sec (16 slice scanner), 20 sec (64 slice scanner)Peds: 5 sec (4-8 slice scanner), 8 sec (16 slice scanner), and 10 sec (64 slice scanner)

1. For Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm slice thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3 for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats.

2. For Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone reformats.

3. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes

Neck: (Routine) (Protocol – Adult: # 3.1 – Pediatric: # 13.1)

(Feet First) (Protocol – Adult: # 3.2 – Pediatric: # 13.2)

Billing:

Setup:

DFOV:

Contrast:

Reformats and Recons:

Page 76: Neuroradiology CT Protocols

76 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3.0 50LS VCT64: 10.0

LS 16 & 16 Pro: 15.0LS 4 & LS 8: 20.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.8 1.0 0.6 0.6 1.0Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Scan FOV Large Large Large Large Body Large

kV 140 140 140 140 140

Smart mA/ Auto mA Range 280-715 180-380 300-715 280-715 200-380

Noise Index 11.4 11.4 11.4 11.4 11.4

(Manual mA) 450 290 480 450 330:

DFOV 30 30 30 30 30

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35

Recon Option Full Full Full Full Full

Recon Option IQ Enhance:

DFOV 30 30 30 30 30

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 30 30 30 30 30

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

Neck: RoutineAdult

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 77: Neuroradiology CT Protocols

77 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3.0 50LS VCT64: 5.0

LS 16 & 16 Pro: 8.0LS 4 & LS 8: 10.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 1.0 0.6 0.6 1.0Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Interval (mm) 1.25 1.25 1.25 1.25 1.25

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 240-720 130-400 220-670 210-630 150-440

Noise Index 14.9 14.9 14.9 14.9 14.9

(Manual mA) 430 240 400 380 270:

DFOV 26 26 26 26 26

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 26 26 26 26 26

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 26 26 26 26 26

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625 1.25

Interval (mm) 0.375 0.375 0.375 0.312 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

Neck: RoutinePediatric Child (3 – 6 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 78: Neuroradiology CT Protocols

78 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3.0 50LS VCT64: 5.0

LS 16 & 16 Pro: 8.0LS 4 & LS 8: 10.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 180-690 110-410 170-660 160-620 110-410

Noise Index 14.5 14.5 14.5 14.5 14.5

(Manual mA) 360 220 350 330 220:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Recon 3:

DFOV 22 22 22 22

Recon Type Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

Neck: Routine Pediatric Infant (0 – 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 79: Neuroradiology CT Protocols

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Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.7 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

4i 4i 4i 4i 4i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

mA 640 440 720 720 440:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.7 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

4i 4i 4i 4i 4i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

mA 630 420 700 700 420:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Neck: Routine Adult – Angled Axials

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Neck: Routine Pediatric Child (3 – 6 yr) – Angled Axials

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 1

Recon 2

Page 80: Neuroradiology CT Protocols

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Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Axial Axial Axial Axial Axial

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

10 10 10 10 10

Detector Rows 16 16 16 16 8Number of Images per Rotation

4i 4i 4i 4i 4i

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 16 x 0.625 8 x 1.25

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

mA 640 400 620 620 400:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 300/35 300/35 300/35 300/35 300/35:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 2500/250 2500/250 2500/250 2500/250 2500/250

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Neck: Routine Pediatric Infant (0 – 3 yr) – Angled Axials

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 81: Neuroradiology CT Protocols

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----

-

Neck: (Salivary Gland) (Protocol – Adult: # 3.3 – Pediatric: # 13.3)

Billing: 1. CT Neck (without and with)2. Contrast

Setup: 1. Patient Supine (AP and lateral scouts from sella to mid chest)2. Make sure the patient removes any dentures or removable teeth3. No gantry angle

Examination: Part 1: Limited Non-contrast CT of NeckScan from hyoid bone to EACAdd angled views if there are lots of dental fillingsNo 2D ReconstructionsUse same scan factors as in routine neck CT

Part 2: Do a routine Neck CT With Contrast Protocol Be sure to do angled views if there are lots of dental fillings

Page 82: Neuroradiology CT Protocols

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1. CT Neck with and without2. Contrast

1. Monitored exam (ENT Attending or ENT Fellow)2. Extend the scouts to include the superior vena cava for smart prep. 3. Patient supine, AP and lateral scouts from sella to mid chest, no gantry angle4. Have the patient remove any dentures or removable teeth, please place the shoulders

as low possible5. Start the scan at the carina and scan to the top of the orbit6. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol). 7. Do angled views if lots of artifact from dental fillings or metal hardware

Preferred 30 cm (Range 26-30 cm)

: Part 1: Limited Non-contrast CT of Neck (scan area per radiologist)1. Standard algorithm only

Part 2: Dynamic Contrast Enhanced Exam -Through the Vascular Mass (as described below)1. Select eight 2.5 mm scans through the vascular mass (ROI per radiologist)2. Use 100 kV; 300 mA for adults, 150 mA for peds less than 6 y/o.3. 1 image per sec X 5 (Using Cine Mode), then 1 image every 3 sec. X 3, then 1 image

every 10 seconds X 2 (5 groups using Axial Mode with a Prep Group Delay of 2 sec and 9 sec respectively) (scan time = 34 sec).

4. Standard algorithm only5. Smart prep over the superior vena cava. Start scanning with the arrival of contrast6. Adults: Inject 50 ml of 300 mg/ml at 4.0 ml per sec (Injection time = 18.7 sec) 7. Pediatrics: Inject 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast at 2 ml per sec 8. As soon as all contrast has been injected immediately start Part 3

Part 3: Routine Neck CT with Contrast (with the following modifications)1. Perform a Routine Neck CT Protocol (Use the same scan factors as in that protocol)2. Adults: Begin an additional injection of 50 ml of 300 mg/ml at 3.0 ml per sec and

immediately start scanning (no smart prep) from the carina to the top of the orbit.3. Pediatrics: Begin an additional injection of 0.5 ml/lb (1 ml/kg) of 300 mg/ml contrast

at 2 ml per sec and immediately start scanning (no smart prep) from the carina to the top of the orbit.

4. Use a 50 ml saline chaser in adults and a 10-25 ml saline chaser in pediatrics.5. Do angled views if necessary

Part 1: No 2D recons or bone algorithm, only axial standard algorithm imagesPart 2: No 2D recons or bone algorithm, only axial standard algorithm images

Part 3: A. Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm slice thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3 for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats.

B. Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone reformats.

C. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes

Neck: (Vascular Mass) (Protocol – Adult: # 3.3 – Pediatric: # 13.3)

Billing:

Setup:

DFOV:

Exam

Recons & Reformats:

Page 83: Neuroradiology CT Protocols

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40 (Adult)20 (Peds)

10.0 2.0 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial

Rotation Time (sec) 1.0 1.0 1.0 1.0 1.0

Detector Coverage (mm) 20 20 20 20 20

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

mA Adults 380 300 300 300 300

mA Peds < 6 y/o 190 150 150 150 150:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 350/20 350/20 350/20 350/20 350/20

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Superior Vena Cava

Scan Factors for Part 2 only:

Neck: Vascular Mass (Part 2 Dynamic Scan)Adult and Peds

Contrast (Part 2 only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 84: Neuroradiology CT Protocols

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1. Puffed Cheek: - Do after a complete routine neck CT - Ask the patient to purse their lips and gently distend the cheeks with air. Practice this

before the patient gets on the table.- Scan from the genu of the mandible to the EAC during this maneuver using the same

helical scan parameters as in the routine neck CT scan.- No 2D-recons but use standard and bone plus algorithms- If there are a lot of dental fillings, also do the scans with angled views- Check these scans with the radiologist before the patient leaves the CT scanner

2. Valsalva:- Do after a complete routine neck CT - Ask the patient to take a deep breath and bear down for about 10 seconds as if they

were having a bowel movement. Practice this before the patient gets on the table.- Scan from upper trachea to the angle of the mandible using the same helical scan

parameters as in the routine neck CT scan.- No 2D-recons but use standard and bone plus algorithms- Check these scans with the radiologist before the patient leaves the CT scanner

3. Vocalization:- Do after a complete routine neck CT - Ask the patient to take a deep breath and vocalize the vowel “EEEEEEEE” for 10

seconds during the scans. Practice this before the patient gets on the table.- Scan from upper trachea to the hyoid bone using the same scan parameters as in the

routine neck CT scan.- No 2D-recons but use standard and bone plus algorithms- Check these scans with the radiologist before the patient leaves the CT scanner

4. Perfusion CT: (To be monitored by Dr Gentry or Dr Hartman)

Part 1: CT Neck without contrast - Use PET CT scanner unless otherwise instructed- Do a limited noncontrast localizing scan (ROI per radiologist)- Use helical mode and no gantry angle

Part 2: CT Perfusion Study: - Perfusion ROI to be selected by Dr Gentry or Dr Hartman- 8 x 2.5 mm slices through lesion (prescribed from scout and Part 1)- No gantry angle- Cine mode with 80 KVP, 200 MA, DFOV = 18 cm, 1 rotation/sec- Inject 40 ml of 370 mg/ml contrast at 4 ml per sec with a 30 ml saline push - Begin scanning 5 seconds after the start of contrast injection- Scan Phases:

- Phase 1: 1 rotation/sec at 1 sec intervals for 45 seconds- Phase 2: 1 rotation/sec at 15 sec intervals 7 times for 105 seconds

- Image Processing:- 1 sec images reformatted to 0.5 sec images

- Perfusion Processing:- Kari Pulfer to process- Arterial and venous input functions: ROI on the ICA and EJV- Measure 25-30 mm3 freehand volumes in solid part of tumor for BV, BF,

MTT, and CP

Part 3: CT Neck with contrast: (optional)- Inject an additional 40 ml of 370 mg/ml contrast at 4 ml/sec- Immediately do our routine post contrast helical neck CT scan

Neck: (Add on Options) (Protocol – Adult: # 3.5 – Pediatric: # 13.5)

Option:

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Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Cine then Axial Cine then Axial Cine then Axial Cine then Axial Cine then Axial

Rotation Time (sec) 1.0 1.0 1.0 1.0 1.0

Detector Coverage (mm) 20 20 20 20 20

Slice Thickness (mm) 2.5 2.5 2.5 2.5 2.5

Scan FOV Head Head Head Head Head

kV 80 80 80 80 80

mA Adults 250 200 200 200 200

mA Peds < 6 y/o 130 100 100 100 100:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 350/20 350/20 350/20 350/20 350/20

Scan Factors for Part 2 only: CT Neck Perfusion Study

Neck: Perfusion CT (Part 2)Adult & Peds

Contrast (Part 2 only)

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Page 86: Neuroradiology CT Protocols

86 Revised 7/22/09 (Gentry/Ranallo)

1. CT Neck with 2. Contrast

1. Patient Supine, AP and lateral scouts from sella to mid chest, no gantry angle2. Only do on a 64 slice scanner3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).4. Remove any dentures or removable teeth; please place the shoulders as low possible

1. Part 1: 22 cm (adults), 20 cm (peds 3-6 y/o), 18 cm (peds 0-3 y/o)2. Part 2: (as in routine neck CT)

: Part 1: Arterial Phase of Lower Neck1. Standard only2. Start scans at the carina and scan to the bottom of the upper teeth3. Adult: 100 ml of Iohexol 300 with a 50 ml saline chase

Peds: 1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase4. Adult: 4 ml per sec

Peds: 2.0-2.5 ml/sec5. Over aortic arch (initiate scan at the entry of contrast in the aortic arch) 6. Do a routine Neck CT Protocol immediately following Part 1 with the

following modifications.

Part 2: Routine Neck CT with Contrast (with the following modifications)1. Perform a Routine Neck CT Protocol using the same scan factors as in that protocol2. Do not use any CT scan delay but start scanning the routine neck CT as soon as

Part 1 is finished.3. Do angled views if necessary

Part 1: A. Sagittal and coronal 2D reformations using standard algorithm images onlyPart 2: A. Adult scans: There is a soft tissue 2.5 mm slice thickness for Recon 1, a bone plus 1.25 mm slice

thickness for Recon 2, and a soft tissue 1.25 mm slice thickness for Recon 3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 3 for the soft tissue reformats. Use the 1.25 mm slices in Recon 2 for the bone reformats.

B. Pediatric scans: There is a soft tissue 1.25 mm slice thickness for Recon 1, a bone plus 1.25 mm slice thickness for Recon 2, and a bone plus 0.625 mm slice thickness for Recon 3. Only send Recon 1 and 2 to PACS. Do not send Recon 3 to PACS. Use the 1.25 mm slices in Recon 1 for the soft tissue reformats. Use the 0.625 mm slices in Recon 3 for the bone reformats.

C. Do 2 mm by 2 mm 2D-Reformations in the coronal and sagittal planes

Neck: (Parathyroid Adenoma) (Protocol – Adult: # 3.4 – Pediatric: # 13.4)

Billing:

Setup:

DFOV:

ExamAlgorithm:Scan Area:Contrast:

Injection Rate:

Smart Prep:Begin Part 2:

Recons & Reformats:

Page 87: Neuroradiology CT Protocols

87 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Head Large

kV 120 120 120 120 120

Smart mA/ Auto mA Range 200-800 120-440 190-800 180-800 130-440

Noise Index 11.1 11.1 11.1 11.1 11.1

(Manual mA) 530 320 510 480 360:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Neck: Parathyroid AdenomaAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 88: Neuroradiology CT Protocols

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Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 110

Smart mA/ Auto mA Range 170-800 100-420 160-770 150-740 100-420

Noise Index 10.6 10.6 10.6 10.6 10.6

(Manual mA) 490 290 470 440 330:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Neck: Parathyroid Adenoma Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 89: Neuroradiology CT Protocols

89 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-675 80-400 130-675 120-675 90-400

Noise Index 10.4 10.4 10.4 10.4 10.4

(Manual mA) 440 260 420 400 300:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

Neck: Parathyroid Adenoma Pediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 90: Neuroradiology CT Protocols

90 Revised 7/22/09 (Gentry/Ranallo)

1. CT Neck without, or with, or without and with2. Contrast if used

1. Inject the contralateral arm from the brachial plexus of interest.2. CT scan delay after arrival of contrast in aortic arch:

- Adult: 15 sec (all scanners), - Peds: 10 sec (all scanners),

3. DFOV: Range 26-32 cm.- Extend DFOV laterally to include bilateral humeral heads of the shoulders

4. 2D Reformations in addition to standard routine neck reformations (see below)

Brachial Plexus: (Routine) (Protocol – Adult: # 3.1 – Pediatric: # 13.1)

(Feet First) (Protocol – Adult: # 3.2 – Pediatric: # 13.2)

This protocol is the same as the routine neck CT with the following exceptions:

Billing:

Modifications:

Page 91: Neuroradiology CT Protocols

91 Revised 7/22/09 (Gentry/Ranallo)

1. CT cervical spine without, or with, or without and with2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used. 3. Patient Positioning:

- Warning: Do not flex or extend the neck if there has been recent spine trauma or if the patient is in a c-spine trauma collar.

- If no recent trauma, tilt the patient’s head so that a line connecting the lateral canthus of the eye and the EAC is perpendicular to the CT tabletop.

- The shoulders should be pulled down as much as possible4. Scan from the top of the sella to the bottom of T2

Preferred 17 cm (Range 16-18 cm)

1. Injection parameters:2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT of the

head will also be obtained). 3. Injection Rate: Adults: 3.5 ml/sec4. Smart prep over the aortic arch.5. CT scan delay after arrival of contrast in aortic arch: 10 sec (8 slice scanners),

15 sec (16 slice scanners), 20 sec (64 slice scanners)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and sagittal planes.

2. You must include the entire larynx and hyoid bone on the sagittal 2D reformats (see below)

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)

4. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series.

5. Do not send the 0.625 mm (Recon 2) bone images to PACS.

Cervical Spine: (Adult Routine) (Protocol: # 3.5)

Billing:

Setup:

DFOV:

Contrast:

Recons & Reformats:

not

Page 92: Neuroradiology CT Protocols

92 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3.0 50LS VCT64: 20

LS Xtra, LS 16 & 16 Pro: LS 8: 10

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.8 1.0 0.6 0.6 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Large Body Large

kV 140 140 140 140 140

Smart mA/ Auto mA Range 280-715 180-380 300-715 280-715 200-380

Noise Index 16.2 16.2 16.2 16.2 16.2

(Manual mA) 450 290 480 450 330:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

.015.0

.0

Cervical Spine: RoutineAdult

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 3

Page 93: Neuroradiology CT Protocols

93 Revised 7/22/09 (Gentry/Ranallo)

1. CT thoracic spine without, or with, or without and with2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used.3. Non-contrast unless otherwise protocoled4. Scan from the top of C7 to the bottom of L1 5. Post myelography patients: Please remember to roll the patient 360 degrees before

scanning to distribute the contrast evenly in the spinal canal.

Preferred 17 cm (Range 16-18 cm)

1. Injection parameters:2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150ml of 240mg/ml if a CT of the

head will also be obtained). 3. Injection Rate: Adults: 3.5 ml/sec4. Smart prep over the aortic arch.5. CT scan delay after arrival of contrast in aortic arch: 10 sec (8 slice scanners),

15 sec (16 slice scanners), 20 sec (64 slice scanners)

Increase scan time to on CT1, CT3, CT4, and ER CT.Raise kV to on CT2, East & RP CT.For VERY large patients, increase scan time to increase kV to on CT1, CT3, CT4, and ER CT.

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and sagittal planes.

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)

3. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series.

4. Do not send the 0.625 mm (Recon 2) bone images to PACS.

Thoracic Spine: (Feet First) (Adult Routine) (Protocol: # 7.5)

Thoracic Spine: (Head First) (Adult Routine) (Protocol: # 7.6)

Billing:

Setup:

DFOV:

Contrast:

For Large Patients: 1.0 sec140 kV

1.0 sec 140 kV

Recons & Reformats:

not

and

Page 94: Neuroradiology CT Protocols

94 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3.0 50LS VCT64: 2

LS Xtra, LS 16 & 16 Pro: LS 8: 1

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Large Body Large

kV 120 120 120 120 120

Smart mA/ Auto mA Range 170-760 90-440 160-760 150-750 90-440

Noise Index 14.4 14.4 14.4 14.4 14.4

(Manual mA) 330 180 320 300 180:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

0.015.0

0.0

Thoracic Spine: RoutineAdult

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 95: Neuroradiology CT Protocols

95 Revised 7/22/09 (Gentry/Ranallo)

1. CT lumbar spine without, or with, or without and with2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used.3. Non-contrast unless otherwise protocoled4. Scan from the top of T12 to the top of S25. Post myelography patients: Please remember to roll the patient 360 degrees before

scanning to distribute the contrast evenly in the spinal canal.

Preferred 17 cm (Range 16-18 cm)

1. Injection parameters:2. Volume: 100 ml of 240 mg/ml nonionic contrast (use 150 ml of 240 mg/ml if a CT of the

head will also be obtained). 3. Injection Rate: Adults: 3.5 ml/sec4. Smart prep over the aortic arch. 5. CT scan delay after arrival of contrast in aortic arch: 10 sec (8 slice scanners),

15 sec (16 slice scanners), 20 sec (64 slice scanners)

Increase scan time to on CT1, CT3, CT4, and ER CT.Raise kV to on CT2, East & RP CT.For VERY large patients, increase scan time to increase kV to on CT1, CT3, CT4, and ER CT.

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and sagittal planes.

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)

3. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2mm x 2mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series.

4. Do not send the 0.625 mm (Recon 2) bone images to PACS.

Lumbar Spine: (Adult Routine) (Protocol: # 7.1)

Billing:

Setup:

DFOV:

Contrast:

For Large Patients: 1.0 sec140 kV

1.0 sec 140 kV

Recons & Reformats:

not

and

Page 96: Neuroradiology CT Protocols

96 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3.0 50LS VCT64: 2

LS Xtra, LS 16 & 16 Pro: LS 8: 1

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Large Body Large

kV 120 120 120 120 120

Smart mA/ Auto mA Range 170-760 90-440 160-760 150-750 90-440

Noise Index 14.4 14.4 14.4 14.4 14.4

(Manual mA) 330 180 320 300 180:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

0.015.0

0.0

Lumbar Spine: RoutineAdult

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Recon 3

Page 97: Neuroradiology CT Protocols

97 Revised 7/22/09 (Gentry/Ranallo)

1. CT cervical spine without, or with, or without and with2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used.3. Patient Positioning:

- Warning: Do not flex or extend the neck if there has been recent spine trauma or if the patient is in a c-spine trauma collar.

- If no recent trauma, tilt the patient’s head so that a line connecting the lateral canthus of the eye and the EAC is perpendicular to the CT tabletop.

- The shoulders should be pulled down as much as possible4. Scan from the top of the sella to the bottom of T2 5. Post myelography patients: Please remember to roll the patient 360 degrees before

scanning in order to distribute the contrast evenly in the spinal canal.

Preferred 15 cm (Range 14-18 cm)

1. Injection parameters:2. Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. 3. Injection Rate: 2 ml/sec4. Smart prep over the aortic arch.5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners),

8 sec (16 slice scanners), 10 sec (64 slice scanners)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and sagittal planes.

2. You must include the entire larynx and hyoid bone on the sagittal 2D reformats (see below)

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)

4. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series.

5. Do not send the 0.625 mm (Recon 2) bone images to PACS.

Cervical Spine: (Pediatric Routine) (Protocol: # 13.5)

Billing:

Setup:

DFOV:

Contrast:

Recons & Reformats:

not

Page 98: Neuroradiology CT Protocols

98 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3.0 50LS VCT64:

LS Xtra, LS 16 & 16 Pro: LS 8: 5

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.7 1.0 0.6 0.6 1.0Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 120 120 120 120 120

Smart mA/ Auto mA Range 230-700 130-400 220-670 210-630 150-440

Noise Index 14.9 14.9 14.9 14.9 14.9

(Manual mA) 420 240 400 380 270:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

10.08.0

.0

Cervical Spine: RoutinePediatric Child (3 – 6 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 99: Neuroradiology CT Protocols

99 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3.0 50LS VCT64:

LS Xtra, LS 16 & 16 Pro: LS 8: 5

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 180-690 110-410 170-660 160-620 110-410

Noise Index 14.5 14.5 14.5 14.5 14.5

(Manual mA) 360 220 350 330 220:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

10.08.0

.0

Cervical Spine: RoutinePediatric Infant (0 – 3yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 100: Neuroradiology CT Protocols

100 Revised 7/22/09 (Gentry/Ranallo)

1. CT thoracic spine without, or with, or without and with2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used.3. Non-contrast unless otherwise protocoled4. Scan from the top of C7 to the bottom of L1 5. Post myelography patients: Please remember to roll the patient 360 degrees before

scanning to distribute the contrast evenly in the spinal canal.

Preferred 15 cm (Range 14-18 cm)

1. Injection parameters:2. Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. 3. Injection Rate: 2 ml/sec4. Smart prep over the aortic arch.5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanners),

8 sec (16 slice scanners), 10 sec (64 slice scanners)

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and sagittal planes.

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)

3. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series.

4. Do not send the 0.625 mm (Recon 2) bone images to PACS.

Thoracic Spine: (Pediatric Routine) (Protocol: # 17.5)

Billing:

Setup:

DFOV:

Contrast:

Patient Age:

Recons & Reformats:

not

Page 101: Neuroradiology CT Protocols

101 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3.0 50LS VCT64: 10

LS Xtra, LS 16 & 16 Pro: LS 8:

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Medium Body Large

kV 100 100 100 100 100

Smart mA/ Auto mA Range 170-750 100-420 160-750 150-700 100-420

Noise Index 12.8 12.8 12.8 12.8 12.8

(Manual mA) 310 190 300 280 190:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

.08.0

5.0

Thoracic Spine: RoutinePediatric Child (3 – 6 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 102: Neuroradiology CT Protocols

102 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3.0 50LS VCT64:

LS Xtra, LS 16 & 16 Pro: LS 8:

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Small Small Small Small Body Small

kV 80 80 80 80 80

Smart mA/ Auto mA Range 160-675 90-400 150-675 140-650 90-400

Noise Index 11.3 11.3 11.3 11.3 11.3

(Manual mA) 280 170 270 260 170:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years) 2. Infant: (0 – 3 years)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

10.08.0

5.0

Thoracic Spine: RoutinePediatric Infant (0 – 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 103: Neuroradiology CT Protocols

103 Revised 7/22/09 (Gentry/Ranallo)

1. CT lumbar spine without, or with, or without and with2. Contrast if used

1. Patient Supine, AP and lateral scouts, no gantry angle2. Extend the scouts to include the aortic arch for smart prep if IV contrast is to be used.3. Non-contrast unless otherwise protocoled4. Scan from the top of T12 to the top of S25. Post myelography patients: Please remember to roll the patient 360 degrees before

scanning to distribute the contrast evenly in the spinal canal.

Preferred 15 cm (Range 14-18 cm)

1. Injection parameters:2. Volume: 1 ml/lb (2 ml/kg) of 240 non-ionic contrast. 3. Injection Rate: 2 ml/sec4. Smart prep over the aortic arch.5. CT scan delay after arrival of contrast in the aortic arch: 5 sec (8 slice scanner),

8 sec (16 slice scanners), 10 sec (64 slice scanners)

Choose the CT scan factors on the scanner for the proper age range of the patient

1. Child: (3 – 6 years)2. Infant: (0 – 3 years)

1. All 2-D reformats described below are to be done as 2 mm x 2 mm reformats. Do them in the coronal and sagittal planes.

3. If this is an exam solely with contrast or solely without contrast: Do 2D-reformats using both the standard 1.25 mm images (Recon 1) AND the bone 0.625 mm images (Recon 2)

3. If this is a “with & without” contrast study: Do do Recons 2 and 3 on the contrast scan. Do 2D-reformats using the standard 1.25 mm images (Recon 1) only from the contrast series AND also do 2 mm x 2 mm reformats using the bone 0.625 mm images (Recon 2) from the non-contrast series.

4. Do not send the 0.625 mm (Recon 2) bone images to PACS.

Lumbar Spine: (Pediatric Routine) (Protocol: # 17.1)

Billing:

Setup:

DFOV:

Contrast:

Patient Age:

Recons & Reformats:

not

Page 104: Neuroradiology CT Protocols

104 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3.0 50LS VCT64: 10

LS Xtra, LS 16 & 16 Pro: LS 8: 5

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Medium Body Large

kV 100 100 100 100 100

Smart mA/ Auto mA Range 170-750 100-420 160-750 150-700 100-420

Noise Index 12.8 12.8 12.8 12.8 12.8

(Manual mA) 310 190 300 280 190:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years)2. Infant: (0 – 3 years)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

.08.0

.0

Lumbar Spine: RoutinePediatric Child (3 – 6 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 105: Neuroradiology CT Protocols

105 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3.0 50LS VCT64: 10

LS Xtra, LS 16 & 16 Pro: LS 8: 5

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

10 10 10 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 5.625 5.625 5.625 10.62 6.25

Detector Configuration 16 x 0.625 16 x 0.625 16 x 0.625 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Small Small Small Small Body Small

kV 80 80 80 80 80

Smart mA/ Auto mA Range 160-675 90-400 150-675 140-650 90-400

Noise Index 11.3 11.3 11.3 11.3 11.3

(Manual mA) 280 170 270 260 170:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

DFOV 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full

Recon Option IQ Enhance

Slice Thickness (mm) 0.625 0.625 0.625 0.625

Interval (mm) 0.375 0.375 0.375 0.312:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.625 0.75

Patient Age: Choose the CT scan factors on the scanner for the proper age range of the patient 1. Child: (3 – 6 years)2. Infant: (0 – 3 years)

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold Diagnostic Delay (sec)

.08.0

.0

Lumbar Spine: RoutinePediatric Infant (0 – 3 yr)

Non-Contrast or Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2:

Recon 3

Page 106: Neuroradiology CT Protocols

106 Revised 7/22/09 (Gentry/Ranallo)

1. CT Stereotactic2. Contrast if used

1. Patient Supine, AP and lateral scouts2. No gantry angle3. Non-contrast unless otherwise protocoled4. Scan one vertebrae above and below the vertebrae of interest. The region of interest

should be noted on the CT request or CT protocol.5. Call ordering M.D. to verify levels if necessary.

14 cm (for average patient)

1. Mode = Axial2. Rotation = 1 sec3. Detector Config = 1.25 @ 8i 4. Interval = 10.05. KVP = 1206. MA = 2507. Algorithm = Standard8 Scan FOV = Large9. DFOV = 14 (for average patient)

1. If there is ANY patient motion, start the scan over.2. Do not change the DFOV, centering, or move the patient during the CT exam.3 Only the axial images are to be archived on the MOD that goes to the surgeon.4. When IV contrast is needed, wait until it is all injected before starting the scan.5. No bone windows are needed.6. No overlapping slices.7. Technical support is available 24 hours and day, 7 days a week at 800-595-9709.

Stealth (Stereotactic) Spine: (Protocol: # 7.2)

Billing:

Setup:

DFOV:

Scan Factors:

Notes:

Page 107: Neuroradiology CT Protocols

107 Revised 7/22/09 (Gentry/Ranallo)

1. CT Head with and without2. CTA Head and Neck with contrast3. CT Brain Perfusion4. Contrast

1. Patient Supine, AP and lateral scouts, No Gantry Tilt2. Extend the scouts to include the aortic arch for smart prep.3. 16 or 64 slice scanners only4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).

Preferred 20 cm (Range 18-22 cm)

1. from the top of the head to the bottom of the carina (see below)

2. scan from top to bottom

3.100 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

150 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase

4. 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time)

2.0-2.5 ml/sec

5. over aortic arch (initiate the scan at the entry of contrast in the aortic arch)

1. Wait at least 5 min from start of CTA contrast injection before beginning Perfusion Injection.2. Contrast 40 ml of 370 nonionic contrast (14.8 g Iodine) with 30 ml saline chase 3. Injection Rate Adults: 5 ml per sec with a 5 sec prep delay

Pediatric: 3-5 ml per sec (Depends on size of needle and age of patient)4. Prep Delay 5 seconds

1. Perform immediately after Perfusion Imaging (Part 3). No need to wait 5 min.

(Appendices 1 and 2)

(Appendices 3 and 4)

(Do on Stent Cases)

Vascular Imaging: Stroke Deluxe: (Acute Stroke Workup)

(Protocol – Adult: # 1.6 & 3.7 – Pediatric: # 11.16 & 11.17)

Billing:

Setup:

DFOV:

Exam: Part 1: Routine Head CT without contrast (helical)

Part 2: CTA Head and Neck

Scan Area

Scan direction

Contrast Adult: On LS VCT 64 and LS 16 Pro:

Adult: On LS 16, LS 8 and LS 4:

Peds:

Injection Rate Adult:

Peds:

Smart Prep

Part 3: CT Perfusion (see perfusion page for details)

Part 4: Routine Head CT with contrast (helical)

Networking:

1. ALI store, CTAW2 and CTAW3

Post Processing:

1. 2-D Reformation Instructions

2. Perfusion Analysis (3D Lab)

3. 3D Intravascular Image Analysis on ADW workstation

Page 108: Neuroradiology CT Protocols

108 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Head Large

kV 120 120 120 120 120

Smart mA/ Auto mA Range 200-800 120-440 190-800 180-800 130-440

Noise Index 11.1 11.1 11.1 11.1 11.1

(Manual mA) 530 320 510 480 360:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Stroke DeluxeAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 109: Neuroradiology CT Protocols

109 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 110

Smart mA/ Auto mA Range 170-800 100-420 160-770 150-740 100-420

Noise Index 10.6 10.6 10.6 10.6 10.6

(Manual mA) 490 290 470 440 330:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Stroke Deluxe: Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 110: Neuroradiology CT Protocols

110 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-675 80-400 130-675 120-675 90-400

Noise Index 10.4 10.4 10.4 10.4 10.4

(Manual mA) 440 260 420 400 300:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Stroke Deluxe: Pediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 111: Neuroradiology CT Protocols

111 Revised 7/22/09 (Gentry/Ranallo)

Vascular Imaging: Total Cerebrovascular: (Stenosis, Trauma, Unknown Bleed)

(Protocol – Adult: # 1.6a or 13.7a – Pediatric: # 11.16 or 11.17)

Note: This protocol is identical to the stroke deluxe protocol.

Page 112: Neuroradiology CT Protocols

112 Revised 7/22/09 (Gentry/Ranallo)

Billing: 1. CT Head with and without2. CTA Head with contrast3. CT Brain Perfusion if done4. Contrast used if done

Setup: 1. Patient Supine, AP and lateral scouts, No Gantry Tilt2. Extend the scouts to include the aortic arch for smart prep.3. 16 or 64 slice scanners 4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see below).

DFOV: Preferred 20 cm (Range 18-22 cm)

1. from the top of the head to the bottom of C2 (see below)2. scan from top to bottom3. 80 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase4. 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time)

2.0-2.5 ml/sec5. over aortic arch (initiate the scan at the entry of contrast in the aortic arch)

1. Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection.2. Contrast 40 ml of 370 nonionic contrast (14.8 g Iodine) with 30 ml saline chase 3. Injection Rate Adults: 5 ml per sec with a 5 sec prep delay

Pediatric: 3-5 ml per sec (Depends on size of needle and age of patient)4. Prep Delay 5 seconds

1. If Perfusion is done, perform immediately after the Perfusion Imaging - No need to wait 5 min.2. If Perfusion is not done, perform scan at least 5 min after start of CTA contrast injection

1. ALI store, CTAW2 and CTAW3

1. Thick Slab Reformat Instructions (See Appendix 1) 2. Perfusion Analysis (3D Lab) (See Appendices 3 and 4)3. 3D Intravascular Image Analysis on ADW workstation (Do on Stent Cases)

Vascular Imaging: CTA Head Only: (Stenosis, Unknown Bleed):

(Protocol – Adult: # 1.7 – Pediatric: # 11.18 & 11.19)

Exam: Part 1: Routine Head CT without contrast (helical)

Part 2: CTA Head OnlyScan AreaScan directionContrast Adult:

Peds:Injection Rate Adult:

Peds:Smart Prep

Part 3: CT Perfusion (see perfusion page for details)

Part 4: Routine Head CT with contrast (helical)

Networking:

Processing:

Page 113: Neuroradiology CT Protocols

113 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 280-780 170-420 270-750 260-710 190-420

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 620 380 600 570 420:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Head OnlyAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 114: Neuroradiology CT Protocols

114 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 220-675 130-400 210-675 200-660 150-400

Noise Index 6.0 6.0 6.0 6.0 6.0

(Manual mA) 540 330 520 490 370:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Head Only: Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 115: Neuroradiology CT Protocols

115 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.6 0.4 0.4 0.6Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 160-660 110-400 160-660 150-620 120-400

Noise Index 5.2 5.2 5.2 5.2 5.2

(Manual mA) 440 290 440 410 330:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Head Only: Pediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 116: Neuroradiology CT Protocols

116 Revised 7/22/09 (Gentry/Ranallo)

1. CT Head with and without2. CTA Head with contrast3. Contrast

1. Patient Supine, AP and lateral scouts, No Gantry Tilt2. Extend the scouts to include the aortic arch for smart prep.3. 16 or 64 slice scanners 4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see below).

: 18 cm

1. From the top of the lateral ventricles to the bottom of the C2 vertebrae (use Part 1 to select the top slice, see below)

2. scan from top to bottom3. 150 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase4. 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast transit time)

2.0-2.5 ml/sec5. Over aortic arch (initiate the scan at the entry of contrast in the aortic arch)

1. Wait at least 5 min from start of CTA contrast inject before beginning Perfusion Injection.2. Contrast 40 ml of 370 nonionic contrast (14.8 g Iodine) with 30 ml saline chase 3. Injection Rate Adults: 5 ml per sec with a 5 sec prep delay

Pediatric: 3-5 ml per sec (Depends on size of needle and age of patient)4. Prep Delay 5 seconds

1. If Perfusion is done, perform immediately after the Perfusion Imaging - No need to wait 5 min.2. If Perfusion is not done, perform scan at least 5 min after start of CTA contrast injection

1. ALI store, CTAW2 and CTAW3

1. Thick Slab Reformat Instructions (See Appendix 1) 2. Perfusion Analysis (3D Lab) (See Appendices 3 and 4)3. 3D Intravascular Image Analysis on ADW workstation (Do on Stent Cases)

Vascular Imaging: Aneurysm (Hi-Res COW): (Nontraumatic SAH, Known Aneurysm)

(Protocol – Adult: # 1.8 – Pediatric: # 11.20 & 11.21)

Billing:

Setup:

DFOV

Exam: Part 1: Routine Head CT without contrast (helical)

Part 2: CTA Head OnlyScan Area

Scan directionContrast Adult:

Peds:Injection Rate Adult:

Peds:Smart Prep

Option: CT Perfusion (see perfusion page for details)

Part 3: Routine Head CT with contrast (helical)

Networking:

Processing:

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Aortic Arch 80 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 280-780 170-420 270-750 260-710 190-420

Noise Index 6.6 6.6 6.6 6.6 6.6

(Manual mA) 620 380 600 570 420:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 450/60 450/60 450/60 450/60 450/60

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Aneurysm (Hi-Res COW)Adult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 118: Neuroradiology CT Protocols

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Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 220-675 130-400 210-675 200-660 150-400

Noise Index 6.0 6.0 6.0 6.0 6.0

(Manual mA) 540 330 520 490 370:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Aneurysm (Hi-Res COW): Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 119: Neuroradiology CT Protocols

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Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.5 0.6 0.4 0.4 0.6Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Small Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 160-660 110-400 160-660 150-620 120-400

Noise Index 5.2 5.2 5.2 5.2 5.2

(Manual mA) 440 290 440 410 330:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Aneurysm (Hi-Res COW): Pediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

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120 Revised 7/22/09 (Gentry/Ranallo)

1. CTA Neck/Arch (with contrast)2. Contrast

1. Patient Supine, AP and lateral scouts, no gantry tilt2. Extend the scouts to include the aortic arch for smart prep.3. 16 or 64 slice scanners 4. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral

canthus of the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).

1. Start scans at the carina and scan to the EAC (see below)2. Scan from bottom to top

3.80 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

120 ml of Iohexol 300 (24 g Iodine) with a 50 ml saline chase

1 ml/lb (2 ml/kg) of Iohexol 300 with a 10-25 ml saline chase4. 4 ml per sec

2.0-2.5 ml/sec5. Over aortic arch (initiate the scan at the entry of contrast in the aortic arch)

1. ALI store, CTAW2 and CTAW3

1. Thick Slab Reformat Instructions (See Appendix 1) 2. Perfusion Analysis (3D Lab) (See Appendices 3 and 4)3. 3D Intravascular Image Analysis on ADW workstation (Do on Stent Cases)

Vascular Imaging: CTA Neck Only: (Cerebrovascular Disease)

(Protocol – Adult: # 3.8 – Pediatric: # 11.22 & 11.23)

Billing:

Setup:

Examination: CTA Neck and Arch Scan AreaScan direction

Contrast Adult: On LS VCT 64 and LS 16 Pro:

Adult: On LS 16, LS 8 and LS 4:

Peds:Injection Rate Adult:

Peds:Smart Prep

Networking:

Processing:

Page 121: Neuroradiology CT Protocols

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Aortic Arch 80 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Large Large Large Head Large

kV 120 120 120 120 120

Smart mA/ Auto mA Range 200-800 120-440 190-800 180-800 130-440

Noise Index 11.1 11.1 11.1 11.1 11.1

(Manual mA) 530 320 510 480 360:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Neck OnlyAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 122: Neuroradiology CT Protocols

122 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 110

Smart mA/ Auto mA Range 170-800 100-420 160-770 150-740 100-420

Noise Index 10.6 10.6 10.6 10.6 10.6

(Manual mA) 490 290 470 440 330:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Neck OnlyPediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

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Aortic Arch 40 10.0 3 50 3.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.8 0.5 0.5 0.8Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-675 80-400 130-675 120-675 90-400

Noise Index 10.4 10.4 10.4 10.4 10.4

(Manual mA) 440 260 420 400 300:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CTA: Neck OnlyPediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

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124 Revised 7/22/09 (Gentry/Ranallo)

1. CT Head with and without2. CTA of Head +/- CTA of Neck with contrast3. Contrast

1. Patient Supine, AP and lateral scouts, no gantry tilt2. Extend the scouts to include the aortic arch for smart prep.3. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see below).

1. From the top of the head to the bottom of C2 (see below)2. Scan from top to bottom3. 150 ml of Iohexol 240 (36 g Iodine) with a 50 ml saline chase

1 ml/lb (2 ml/kg) of Iohexol 240 with a 10-25 ml saline chase4. 4 ml per sec (26.6 sec contrast injection time) (43.3 sec contrast

transit time) 2.0-2.5 ml/sec

5. Over aortic arch (initiate the scan 5 seconds after entry of contrast in the aortic arch)

1. Do as in Part 2 except:2. From the top of the head to the carina

1. Wait at least 5 min from start of CTV contrast injection before beginning scan.

Vascular Imaging: CT Venography:(Protocol – Adult: #1.9 & 3.9 – Pediatric: # 11.24 & 11.25)

Billing:

Setup:

Exam: Part 1: Routine Head CT without contrast (helical)

Part 2: CTV Head Scan AreaScan directionContrast Adult:

Peds:Injection Rate Adult:

Peds:Smart Prep

Part 2b: Option: CTV Head and Neck

Scan Area:

Part 3: Routine Head CT with contrast (helical)

Page 125: Neuroradiology CT Protocols

125 Revised 7/22/09 (Gentry/Ranallo)

Aortic Arch 80 10.0 3 50 5.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Medium Medium Medium Head Medium

kV 120 120 120 120 120

Smart mA/ Auto mA Range 200-800 110-440 190-800 180-800 120-440

Noise Index 11.1 11.1 11.1 11.1 11.1

(Manual mA) 530 280 510 480 320:

DFOV 22 22 22 22 22

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 22 22 22 22 22

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3500/350 3500/350 3500/350 3500/350 3500/350

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CT VenographyAdult

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

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Aortic Arch 40 10.0 3 50 5.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 100 100 100 100 100

Smart mA/ Auto mA Range 170-800 90-420 160-770 150-740 100-420

Noise Index 10.6 10.6 10.6 10.6 10.6

(Manual mA) 490 260 470 440 290:

DFOV 20 20 20 20 20

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 20 20 20 20 20

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CT Venography: Pediatric Child (3 – 6 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

Page 127: Neuroradiology CT Protocols

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Aortic Arch 40 10.0 3 50 5.0

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8

Scan Type Helical Helical Helical Helical Helical

Rotation Time (sec) 0.6 0.9 0.5 0.5 0.9Detector Coverage (mm)Beam Collimation (mm)

20 20 20 20 10

Detector Rows 16 16 16 16 8

Pitch 0.562 0.562 0.562 0.531 0.625

Speed (mm/rot) 11.25 11.25 11.25 10.62 6.25

Detector Configuration 16 x 1.25 16 x 1.25 16 x 1.25 64 x 0.625 8 x 1.25

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Scan FOV Head Head Head Head Head

kV 80 80 80 80 80

Smart mA/ Auto mA Range 140-675 70-400 130-675 120-675 80-400

Noise Index 10.4 10.4 10.4 10.4 10.4

(Manual mA) 440 230 420 400 260:

DFOV 18 18 18 18 18

Recon Type Standard Standard Standard Standard Standard

WW/ WL 400/40 400/40 400/40 400/40 400/40

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance:

DFOV 18 18 18 18 18

Recon Type Bone Plus Bone Plus Bone Plus Bone Plus Bone Plus

WW/ WL 3000/300 3000/300 3000/300 3000/300 3000/300

Recon Option Plus Plus Plus Full Plus

Recon Option IQ Enhance

Slice Thickness (mm) 1.25 1.25 1.25 1.25 1.25

Interval (mm) 0.75 0.75 0.75 0.625 0.75

Smart Prep

Prep Over mAMonitoring Delay

(sec)Monitoring ISD (sec)

Enhancement Threshold

Diagnostic Delay (sec)

CT Venography: Pediatric Infant (0 – 3 yr)

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

Recon 2

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128 Revised 7/22/09 (Gentry/Ranallo)

1. 1 mm X 1 mm right oblique sagittal (see example below) (FOV = 12)2. 1 mm X 1 mm left oblique sagittal (mirror image of example below) (FOV = 12)

a. Make sure the reference line is parallel to the carotid canal (see image below)b. Use a window with and level of 800/200c. Axial images to use for obtaining the oblique sagittal 2-D Reformations

- CTA Head Protocol: Images from C2 to the top of the lateral ventricles- CTA Head and Neck: Images from C2 to the top of the lateral ventricles

d. Send to ALI Store

1. Choose the 1.25 mm slices2. Select Ref. Detail.3. Use a window width 600 and window level 2004. Choose batch. (You don’t need to change slice thickness & rendering mode on image 1st)5. Do axial, sagittal, and coronal thick-slab MIPs through the entire head. (See examples below)6. Change the slice thickness to 10 mm with an interval of 2.5 mm and change the rendering mode from

Average to MIP.7. Send to ALI Store. 8. Put the CT Angio request in the box on the wall in the E3/3 control room for the 3D to be done.9. All patients should have a duplicate request made, write duplicate on it, put the duplicate request in the 3D

box, all remaining requests go to the neuro reading room.

Appendix # 1

CTA Head: 2D Thin and Thick Slab ReformationsA. Do Thin 2D-Reformations through the vertebral and carotid arteries

B. 2D Thick-Slab MIP Reformats of Head:

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1. For each carotid bifurcation, calculate the percent stenosis (NACET) using Vitrea2. Do 1 mm by 1 mm curved reformations through any vessel that has been previously stented3. Send all images to ALI Store.

1. Use an axial image near the level of the hyoid bone at the carotid bifurcation to prescribe the correct oblique angles. Use an image that shows the external and internal carotid arteries.

2.3. Use a window width 800 and window level 2004. Bilateral oblique sagittal 2D reformations: Do 2 mm X 2 mm reformations thru each carotid bifurcation.

Angle so that the reformations go through both the external and internal carotid arteries. (See below)5. Coronal 2D reformations: Do 2 mm X 2 mm reformations thru both sides at the same time. Include both

the carotid and vertebral arteries (See example below)6. Send to 3D Lab for Intravascular Analysis of the carotid bifurcations (i.e. severity of carotid stenosis).7. Send all images to ALI Store. 8. All patients should have a duplicate request made, write duplicate on it, put the duplicate request in the 3D

box, all remaining requests go to the neuro reading room.

Appendix # 2

CTA Neck: 3D Vascular Analysis and 2D-ReformationsA. 3D Analysis through the vertebral and carotid arteries

B. Do 2D-Reformations through the vertebral and carotid arteries

Choose only the axial images from the aortic arch to the EAC.

Oblique Sagittal 2D-ReformatsThrough Carotid Bifurcations

Coronal 2D-Reformats

Through Carotid Bifurcations

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1. Perfusion and contrast used

1. Patient Supine, AP and lateral scouts, no gantry tilt2. Patient Positioning: Tilt the patient’s head so that a line connecting the lateral canthus of

the eye and the EAC is perpendicular to the CT tabletop (see head CT protocol).3. Usually done in conjunction with a CT/CTA of the Head or CT/CTA of Head/Neck

Cine45 seconds(next page)40 ml of 370 nonionic contrast with 30 ml saline chase Adult: 5 ml per sec Pediatric: 3-5 ml per sec (Depends on size of needle and age of

patient)5 secondsUse maximum number (4-8-16) of contiguous 5 mm slabs allowed by each specific CT scanner (use toggle/shuttle mode if possible)

Preferred 20 cm (Range 18-22 cm)

(See next Page)

(see Appendix 5 for further details):

1. Prospectively reconstruct the images to .5 seconds. This is found under thick/speed - (Go under show recon 2).

2. When you are in recon 2, enter the RAS coordinates manually. 3. Network raw perfusion images to CTAW3 & ALI Source – DO Not send the perfusion part to

ALI store

Scanner GE LS Xtra GE LS 16 GE LS 16 Pro GE LS VCT 64 GE LS 8Scan Type Cine Cine Cine Cine Cine Rotation Time (sec) 1.0 1.0 1.0 1.0 1.0Detector Coverage (mm) 20 20 20 40 20Slice Thickness (mm) 5 5 5 5 5Cine Time Between Images 0.5 sec 0.5 sec 0.5 sec 0.5 sec 0.5 secScan FOV Head Head Head Head HeadkV 80 80 80 80 80mA Adults 250 200 200 200 200mA Peds < 6 y/o 190 150 150 150 150Cine Duration (sec) 45 45 45 45 45

:DFOV 22 22 22 22 22Recon Type Standard Standard Standard Standard StandardWW/ WL 350/20 350/20 350/20 350/20 350/20

Appendix # 3CT Perfusion Protocol: (Specific Instructions):

Billing:

Setup:

Exam: CT Perfusion1. Scan Type2. Cine Duration3. Perfusion Area4. Contrast5. Injection Rate

6. Prep Delay7. Perfusion Slabs

DFOV:

Perfusion Locations:

Perfusion Post Processing:

CT Perfusion: Adult and Pediatric

Contrast

CT 1 CT 2 CT 3 CT 4 & ER CT East & RP CT

Recon 1

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Appendix # 4: CT Perfusion Coverage

A. 8-16 Channel CT Perfusion: (4 slice coverage)

B. 64 Channel CT Perfusion: Non-shuttle Mode(8 slice coverage)

C. 64 Channel CT Perfusion: Obtain 16 contiguous 5 mm slices from EAC UpwardShuttle/Toggle Mode: (16 slice coverage)

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Appendix # 5: CT Perfusion Analysis Instructions

Suggestions for ROI Placement

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Suggestions for ROI Placement

Continued on next page

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135 Revised 7/22/09 (Gentry/Ranallo)

a. Select Perfusion series from patient list

b. From Applications menu at right of screen choose CT PerfusionN (exam will load)

c. From list of protocols choose Brain Tumor

d. Using slide bar at bottom of upper left port, slide back and forth to look for motion. If there is motion click apply registration, then . If not, .

e. Now you will see a box called Processing Thresholds. Your object here is to get all little boxes/pixels out of the brain tissue and include as much brain parenchyma as you can. Your slide bar that you used to check for motion must be all the way to the left and rank should be 1/89. Slide air bar to left to remove boxes/pixels from ventricles and there are any diagonal lines with pieces missing, this air bar may fill them in. This is a very slight movement. Your average range should be (-27 to around -63). It can go higher and that is ok but usually doesn’t

f. Slide bone bar to right to bring circle out to edge of bone only. This is easiest when using a bone window. Middle mouse will change window/level. .

g. Using slide bar in upper left port again, move it left to right to find a slice where contrast is fairly bright.

. Click on ROI to the left of your screen

and place over an artery. . This should result in a small purple circle being placed in an artery with a label and arrow.

h. Now do the same for a vein. A good place to look is down in the sinus. . If you have gone up several levels to find your vein/artery, make sure you go back to the beginning to place your ROIs! The vein and artery do not have to be on the same slice!

i. Roam your image over to the right. Do this by grabbing the “ on the bottom of your upper left port (you will see a hand) and moving your head.

j. Now place your cursor in the upper right port and hit the space bar. This will bring up a graph with 2 lines (1) and (2). 1 is the artery you marked and 2 is the vein. On the line that says “Last pre-enhancement image” grab the number and a white line will appear in your graph. You want to move the line to the last spot before the contrast spikes. You do this on line 1 only. (If you are having trouble seeing the 2 lines separately, click on the word arteryin your upper left port. This will activate it and turn it green and you will be able to distinguish the two lines. When you are done click in the upper left port to de-activate the artery so it returns to purple.) .

k. Click compute. This will take a minute. .

l. In the lower left port there will be a drop down menu under DFOV called Blood Flow. to Mean Transit Time.

m. Click on Film/Save box and choose ROIs/Templates. Click on Neuro template for upper levels and Neuro-lower for lower levels (the only difference between these two is that Neuro-lower only has 2 ROIs to place instead of four. . This will bring up your ROIs and Axis line. You may need to adjust their placement depending on your centering.

.

n. Look for any obvious perfusion abnormality. This is where you will place your ROI. If there isn’t any obvious abnormality then you will place your ROIs in the standard places.

GE Advantage: CT Perfusion Post Processing Protocol

click next click next

Click next

Look on upper slices for anterior cerebrals, just above frontal horns. This is the best place to look for an artery You can move up levels by right-clicking on your image location in your upper left port.

Click next

Click next

P”

Click next

Close Final Settings box

Change this view

Hit Load

You can now close this box

Page 136: Neuroradiology CT Protocols

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o. to split the brain into two equal hemispheres.

p. After you have done this, hold the control key down and click on all ROI’s and the axis line. This will turn them all green. Go back to the symmetry button and there is a little black tab, open that and click on that button. This will place the ROI’s on the left side. Now you are ready to film.

q. In the upper left port, .

r. In the upper right port go outside yellow box and . After doing that there are some numbers in red at the top and bottom left of the grid.

. This should move your 1 and 2 graph up and out of the yellow box and bring the ROI’s you just created up in view. If it doesn’t, you can also grab the numbers at the bottom and bring them up. Once they are in view right mouse click and click on multiple graphs. This will show them in a nice graph.

s. Go out of the yellow box again and .

t. Place your cursor in the lower right port and on your keyboard hit the key with the ( ). This will bring up all 4 views at once. Now you can film them in order without having to change each one. Mean Transit Time first, then Blood Flow, Blood Volume, andPermeability Surface.

u. Go Back up to your upper left port and hold down the control key and click on your ROI’s to turn them green. Hit CTRL-C to copy. Go to the image location and right mouse click to go to the next level. This will take a minute to process. Once it is done, Hit CTRL-V to paste or you can also use the right click menu.

v. Now all ROI’s will be in the same spot as before. You may need to move them just a hair if they get too close to bone or a big blood vessel but otherwise try to leave them in the same spot.

w. Now repeat all filming. Upper left port first, upper right port next, Mean Transit Time, Blood Flow, Blood Volume, Permeability Surface. This time when you finish you just click on the next level. You don’t need to copy again because you have already done it once. If you move them a lot you will need to make them green again and recopy. When you get to the third level, CTRL-V or right click to paste your ROI’s, adjust them if necessary, then film.

x. After you have done all four/eight levels, . Choose Functional Data and hit save. This will bring up a graph to the right called functional data. Click next until the button goes gray, and go back to the film/save box and click save again.

y. Now you can exit and go back to the patient list. Send to ALI-STORE.

1. CTRL-C copy

2. CTRL-V or right click menu to paste

3. CTRL-X cut

4. CTRL and click to make ROI’s green

You must straighten the Axis line by grabbing the boxes at either end

right mouse click and save view

right mouse click and save viewGrab the

numbers at the top and middle mouse scroll to the left

save view

?/

Film

click on film/save

Page 137: Neuroradiology CT Protocols

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a. Go to PACS and choose perfusion series.

b. Right click 3D and choose “View selected series in Vitrea 3D”. This will launch Vitrea and may take a few minutes.

c. When perfusion comes up, it will be auto-selecting your artery and vein. The amount of time it takes will show on the task bar at the bottom of the screen. You need to check the placement of both vessels. Before you do this check for rotational motion. If there is motion click on motion correction. This should help unless the patient picked up their head completely. If no motion proceed with checking artery and vein placement. If you are happy with the vessels selected, click compute. If not scroll to your alternate location and left click to draw oval over the new artery. Click artery button. Do the same for the vein. These do not have to be on the same slice. After you have manually selected vessels click compute.

d. You will now have your 4 main images – grey scale, blood volume, blood flow and mean transit time. Scroll to first image and check axis line for centering. If it needs adjusting, do so.

e. Click on ROI Templates, choose the one that has square ROI’s all around periphery and 2 oval ROI’s in the center. Tight fit which is the box directly below this, should be checked. There is no need to adjust ROI’s. If you want to make them bigger, you can change the thickness. Default thickness is 15 mm and default count of ROI’s is 12.

f. You are done except for screen saving images.

g. Click on the camera (snap) or hit S on the keyboard. This activates the camera. Hold down the control key and left click in the grey-scale port (upper left hand box). Do this for all levels. On the bottom left task bar click back to HRS. Export all.

a. Wheel-roll the wheel in the middle of the mouse to go up and down levels.

b. Window/Level-Click on the window/level button in the upper left hand side of the machine and left click with your mouse to change w/l. you MUST change back to ellipse when done.

c. To delete something click on it to make it purple and hit delete on the keyboard.

d. To screen save images-click on camera (snap) or hit S on the keyboard, hold down ctrl and left-click. This will save all four images as long as you are in upper left hand port.

Vitrea: CT Perfusion Post Processing Protocol

Helpful hints:

Page 138: Neuroradiology CT Protocols

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Scanner (Age)

InjectionRate

InjectionVolume

(300 mg/dl)

Volume

Saline

Chaser

TotalInjectionVolume

CT Scan Delay after

contrast arrival in arch on

Smart Prep

Contrast volume injected from detection by Smart Prep to Start of CT

Scan

Time available to

scan from the initiation of

the CT scans

64 Slice (Adult) 3.0 100 50 150 20 33.3 - 20 >13.3 sec

16 Slice (Adult) 3.0 100 50 150 15 33.3 - 15 >18.3 sec

8 Slice (Adult) 3.0 100 50 150 10 33.3 - 10 >23.3 sec

64 Slice (Peds) 2.0 1 ml/lb 10-25 ? 5 Volume

Dependant ?

16 Slice (Peds) 2.0 1 ml/lb 10-25 ? 7 Volume

Dependant ?

8 Slice (Peds) 2.0 1 ml/lb 10-25 ? 10 Volume

Dependant ?

Appendix: 6

Neck CT Contrast Timing Table For Routine Neck CT

Page 139: Neuroradiology CT Protocols

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Appendix: 7

64 Slice Scanner Priorities

1. CTA (High-res COW)

2. CTA (Stroke Deluxe)

3. Temporal Bone CT

4. Any Pediatric CT

5. C-Spine CT

6. T-Spine CT

7. Orbit, Maxiface, Sinus CT

8. Neck-Nasopharynx CT

9. L-Spine CT

10. Brain CT

Page 140: Neuroradiology CT Protocols

140 Revised 7/22/09 (Gentry/Ranallo)

CTI – 1 16 0.625 0.4 sec LightSpeed Xtra(LS Xtra)

500

CTI – 2 16 0.625 0.4 sec LightSpeed 16(LS 16)

400 - 450

CTI – 3 16 0.625 0.4 sec LightSpeed 16 Pro(LS 16 Pro)

400 - 450

CTI - 4 64 0.625 0.4 sec LightSpeed VCT 64(LS VCT 64)

500

ER 64 0.625 0.4 sec LightSpeed VCT 64(LS VCT 64)

500

CT-RP 8 1.25 0.5 sec LightSpeed 8(LS 8)

400 - 450

East 8 1.25 0.5 sec LightSpeed 8(LS 8)

400 - 450

Appendix: 8

CT Scanner Type

* When one number is given, that is the maximum allowed weight limit AND the table positioning accuracy at that weight limit is 0.25 mm. When two numbers are given the first indicates the weight limit that will provide 0.25 mm positional accuracy; the second number is the absolute maximum allowed weight limit and will provide a positional accuracy of 1.0 mm.

Scanner -Location

# of Slices

Thinnest Slice

Minimum Scan Time

Scanner Name Weight* Limits

Page 141: Neuroradiology CT Protocols

141 Revised 7/22/09 (Gentry/Ranallo)

Scanner Name Scan FOV 140 kV 120 kV 100 kV 80 kV

All except Ped HeadLS VCT 64 & LS 16 Pro

Ped Head

All except Ped HeadLS 16, & LS 8,

Ped Head

Scanner Name Scan FOV Maximum Display FOV (cm)

Default Display FOV (cm)

Large Body

Medium Body

Small Body

Head

Small Head

Ped Body

LS VCT

Ped Head

Large

Small

Head

LS 16 Pro, LS 16, & LS 8,

Ped Head

Appendix: 9

CT Scanner Limits

mA Limits

Scan FOV

715 800 770 675

170 200 240 300

380 440 420 400

170 200 240 300

50 50

50 36

32 25

32 25

32 25

32 20

32 20

50 50

25 25

25 25

25 25

Page 142: Neuroradiology CT Protocols

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Appendix: 10

Direction and Naming of 2D-Reformations

1. Always do Bone 2D-Reformations before Soft Tissue 2D Reformations

2. Always do 2D-Reformations in this order: a. Axialb. Coronalc. Sagittald. Oblique Sagittal

3. Always do 2D-Reformations in these directionsa. Axial = Bottom to Topb. Coronal = Front to Backc. Sagittal = Right to Leftd. Oblique Sagittal = Right to Left

4. Naming of 2D-Reconstructionsa. Axial Bone = AX BONEb. Coronal Bone = CO BONEc. Sagittal Bone = SA BONEd. Right Oblique Bone = RT BONEe. Left Oblique Bone = LT BONEf. Axial Soft Tissue = AX STg. Coronal Soft Tissue = CO STh. Sagittal Soft Tissue = SA STi. Right Oblique Soft Tissue = RT STj. Left Oblique Soft Tissue = LT STk. TB - Right Stenver’s = RT STENVl. TB - Right Pöschel = RT POSCHm. TB - Left Stenver’s = LT STENVn. TB - Left Pöschel = LT POSCHo. CTA - Right Carotid Bifurcation = RT Carp. CTA - Left Carotid Bifurcation = LT Carq. CTA - Right ICA Oblique = RT ICA

r. CTA - Left ICA Oblique = LT ICA

Page 143: Neuroradiology CT Protocols

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Appendix: 11

Combined Neuro and Body Contrast Studies

1. Split the total contrast dose equally with Body/Chest/Abdomen so that neuro has a total of about 50 cc of 300 mg / ml of nonionic contrast unless otherwise indicated.

2. When the neuro CT study follows a body/chest/abdomen study, initiate the neuro CT scans immediately after detection of contrast on smart prep. Do not use a CT delay in these cases.

3. Modify the injection parameters of the following studies for the combined studies as follows: (Omnipaque 300 unless otherwise specified) (Note: CTA studies will require a total dose of contrast that exceeds 150 ml)

Volume (cc) Rate (cc/sec)

A. CTA Head Only: 50 4

B. CTA Head with Perfusion: (only 64 slice scanner)- CTA (Omnipaque 300) 40 3.3- Perfusion (Omnipaque 370) 40 5

C. CTA Head & Neck: (only 64 slice scanner) 80 2.8

D. CTA Neck Only: 50 4

E. CT Neck: 50 3

F. CT Orbit/Maxiface/Sinus/TB: 50 3

G. CT Spine (C-T-L): 50 3

H. CT Sella: 50 4

4. Do not do the following studies as combined studies with Body/Chest/Abdomenunless the studies are urgent and a total of 150 cc of 300 mg/dl nonionic contrast can be exceeded. Ideally, the most urgent study should be performed on one day and the other study done on a separate day. A MRI/MRA study is an alternative when the 150 ml total dose of contrast cannot be exceeded in a particular patient.

A. CTA Head & Neck with Perfusion:- CTA (Omnipaque 300) 80 2.8- Perfusion (Omnipaque 370) 40 5