CT CHEST LOW DOSE – LUNG CANCER SCREENING - CANYON PARK CRITERIA: 1. Age 55-79 2. >29 pack-years of smoking 3. Currently smoking or quit within 15 years 4. Stop screening when quit 15 years 5. No co-morbidities that would significantly limit life expectancy 6. Willing and able to have curative surgery PATIENT PREP: No Prep IV CONTRAST: None ORAL CONTRAST: None POSITIONING: Feet First Supine, Arms above head. TOPOGRAMS: AP. Range: Above lung apices through lung bases/costophrenic angles. 25 mA, 110 kV Lateral: Range: Above lung apices through lung bases/costophrenic angles. 25 mA, 110 kV SCAN TYPE: Spiral/Helical SCAN RANGE: Above Lung Apices through Lung Bases/Costophrenic Angles (CPA) DISPLAY FIELD OF VIEW: DFOV: 1cm beyond the rib cage. Does not need to include entire chest wall thickness. NOTES: ALARA – Keep radiation dose As Low As Reasonably Achievable. Packs Per Day X Number of Years Smoking = Pack-Years

CARE DOSE OFF kV: 110 Adjust mAs According to BMI BMI <30: 25 mAs BMI 30-34.9: 30 mAs BMI >35: 40 mAs

BMI Calculator Website: www.nhlbisupport.com/bmi/

CHEST LOW DOSE – LUNG CANCER SCREENING Scan Scan Direction Respiration Scan CARE mAs kV Detector Configuration Pitch Rotation SFOV Range Delay DOSE Time (cm) Scan Type (Seconds) 4D Slices Per Tube Rotation Table Increment/Speed: (mm/rotation) (Seconds) -Above Lung Craniocaudal Suspended 6 OFF BMI <30: 25 mAs 110 Detectors: 16 x 1.2 mm Pitch: 0.8 0.6 50 Apices Thru Inspiration Seconds BMI 30-34.9: 30 mAs Seconds cm Bases/CPA Spiral/Helical BMI >35: 40 mAs Slices Per Tube Rotation: 16 Table Increment/Speed: 15.36mm/rotation Plane Slice Interval Kernal Window DFOV Thickness Width/Level (cm) RECON – AXIAL SOFT TISSUE Axial 2.0 mm 2.0 mm B35s Mediastinum 1cm beyond HeartView Medium 400/40 rib cage RECON – AXIAL LUNG Axial 2.0 mm 2.0 mm B70s Lung 1cm beyond Sharp 1200/-600 rib cage RECON – AXIAL MIPS Axial MIPS 10.0 mm 2.0 mm B70s Lung 1cm beyond Axial MIPS Recon Card 3D Axial MIP Thin Sharp 1200/-600 rib cage RECON – CORONAL SOFT TISSUE MPR Coronals Angled in Plane to Body Part 2.0 mm 2.0 mm B35s Mediastinum 1cm beyond Coronals Angled in Plane to Body Part Recon Card 3D Coronal MPR HeartView Medium 400/40 rib cage RECON – SAGITTAL SOFT TISSUE MPR Sagittals Angled in Plane to Body Part 2.0 mm 2.0 mm B35s Mediastinum 1cm beyond Sagittals Angled in Plane to Body Part Recon Card 3D Sagittal MPR HeartView Medium 400/40 rib cage Page 1 of 2 *The operator must check the CTDIvol before and after the scan to ensure it is within the allowed dose range. Scans performed outside of the allowed range must be documented and reviewed by the designated radiologist and/or physicist. Allowed CTDIvol Dose Ranges: 0.25 mGy – 8 mGy XR29 Dose Notification Value (CTDIvol): 8 mGy

Approximate Values for CTDIvol

Patient Size Weight (kg) Weight CTDIvol (lbs) (mGy) Small 50-70 110-155 0.25-2.8 Average 70-90 155-200 0.5-4.3 Large 90-120 200-265 1.0-5.6 Reference: AAPM Allowed CTDIvol Dose Ranges: 0.25 mGy – 8 mGy XR29 Dose Notification Value (CTDIvol): 8 mGy

The allowed CTDIvol is for a *standard size patient. Individual patients may have higher or lower values to reflect adjustment for patient size.

*The ACR Reference Dose for a "standard size patient" (by definition, is approximately 5' 7" and 155 lbs or 170 cm and

70kg, with a BMI of about 24) is a CTDIvol of less than 3 mGy. **There is no AAPM recommended NEMA XR29 Dose Notification Value for lung screening scans. In general, lung screening exams should not have a CTDIvol greater than 7 mGy. Exams with CTDIvol values less than the minimum allowed range should not be performed unless approved by a radiologist.

NETWORK: Exam to PACS

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