INDICATIONS: Cancer Restaging

CT NECK/CHEST INDICATIONS: Cancer restaging PATIENT PREP: NPO for solid foods, water only, for 4 hours prior to scan IV CONTRAST: Perform as directed by the supervising radiologist. With: 100mL Isovue 370 @ 2.0 mL/second WithOut: None ORAL CONTRAST: None POSITIONING: Head First Supine. Arms above head for the Chest scan, then arms by sides for the Neck scan. TOPOGRAMS: AP. Range: Above superior orbits through lung bases/costophrenic angles or adrenals if history of lung cancer. 25 mA, 110 kV. Lateral. Range: Above superior orbits through lung bases/costophrenic angles or adrenals if history of lung cancer. 25 mA, 110 kV. SCAN TYPE: Spiral/Helical. If necessary: Sequential Axials angled behind dental work. NOTES: *If History of Lung Cancer scan through Adrenals* Mark with MRI Marker/Vitamin E Capsule at any site of mass/lump. Adjust scan delay on Neck scan according to Chest scan time in order to scan Neck at 90 seconds ALARA – Keep radiation dose As Low As Reasonably Achievable. CHEST- ARMS OVERHEAD Scan Scan Direction Respiration Scan CARE Quality kV Detector Configuration Pitch Rotation SFOV Range Delay DOSE Reference Time (cm) Scan Type (Seconds) 4D mAs Slices Per Tube Rotation Table Increment/Speed: (mm/rotation) (Seconds) -Above Lung Apices Craniocaudal Suspended 40 ON 70 110 Detectors: 16 x 1.2 mm Pitch: 0.8 0.6 50 Thru Bases/CPA Inspiration Seconds Seconds cm -If H/O Lung CA Spiral/Helical Slices Per Tube Rotation: 16 Table Increment/Speed: 15.36 mm/rotation Scan thru Adrenals Plane Slice Interval Kernal Window DFOV Thickness Width/Level (cm) RECON – AXIAL SOFT TISSUE Axial 3.0 mm 3.0 mm B35s Mediastinum FOV just beyond HeartView Medium 400/40 patient’s body RECON – AXIAL LUNG Axial 3.0 mm 3.0 mm B70s Lung FOV just beyond Sharp 1200/-600 patient’s body RECON – AXIAL MIPS Axial MIPS 10.0 mm 2.0 mm B70s Lung FOV just beyond Axial MIPS Through Chest Recon Card 3D Axial MPI Thin Sharp 1200/-600 patient’s body RECON – CORONAL SOFT TISSUE MPR Coronals Angled in Plane to Body Part 3.0 mm 3.0 mm B35s Mediastinum FOV just beyond Coronals Angled in Plane to Body Part Recon Card 3D Coronal Coronal MPR HeartView Medium 400/40 patient’s body RECON – SAGITTAL SOFT TISSUE MPR Sagittals Angled in Plane to Body Part 3.0 mm 3.0 mm B35s Mediastinum FOV just beyond Sagittals Angled in Plane to Body Part Recon Card 3D Sagittal MPR HeartView Medium 400/40 patient’s body

HAVE PATIENT LOWER ARMS BY SIDES

SOFT TISSUE NECK – ARMS BY SIDES Scan Scan Direction Respiration Scan CARE Quality kV Detector Configuration Pitch Rotation SFOV Range Delay DOSE Reference Time (cm) Scan Type (Seconds) 4D mAs Slices Per Tube Rotation Table Increment/Speed: (mm/rotation) (Seconds) Superior Orbit to Craniocaudal Don’t 40 Seconds ON 130 110 Detectors: 16 x 1.2 mm Pitch: 0.8 0.6 50 Below Aortic Swallow (Adjust in order to scan Seconds cm Arch. Spiral/Helical Neck at 90 seconds) Slices Per Tube Rotation: 16 Table Increment/Speed: 15.36 mm/rotation Plane Slice Interval Kernal Window DFOV Thickness Width/Level (cm) RECON – AXIAL SOFT TISSUE Axial 2.0 mm 2.0 mm B40s Mediastinum FOV just beyond Medium 400/40 patient’s neck RECON – CORONAL SOFT TISSUE MPR Coronals Angled in Plane to Body Part 2.0 mm 2.0 mm B40s Mediastinum FOV just beyond Coronals Angled in Plane to Body Part Recon Card 3D Coronal MPR Medium 400/40 patient’s neck RECON – SAGITTAL SOFT TISSUE MPR Sagittals Angled in Plane to Body Part 2.0 mm 2.0 mm B40s Mediastinum FOV just beyond Sagittals Angled in Plane to Body Part Recon Card 3D Sagittal MPR Medium 400/40 patient’s neck

SEQUENTIAL AXIALS ANGLED FOR DENTAL WORK Scan Scan Direction Respiration Scan CARE Effective kV Detector Configuration Table Feed Scan Cycle SFOV Range Delay DOSE mAs (mm) Time Time (cm) Scan Type (Seconds) 4D Slices Per Acquisition (Seconds) (Seconds) Top slice in Amalgam with Craniocaudal Quiet 30 Seconds OFF 150 110 Detectors: 16 x 1.2 mm 20.5 mm Full 3.75 50 3 slices Caudally, Angled Respiration To allow 1.5 Seconds cm Cephalic behind dental work. Sequential Gantry Tilt Slices Per Acquisition: 16 Seconds Plane/ Slice Interval Kernal Window DFOV Gantry Tilt Thickness Width/Level (cm) RECON Axials Angled Cephalic 2.4 mm 2.4 mm B40s Mediastinum FOV just beyond behind dental work Medium 450/50 patient’s neck

*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. Torso Allowed CTDIvol Dose Ranges: 1 mGy – 50 mGy. Torso XR29 Dose Notification Value (CTDIvol): 50 mGy. Neck Allowed CTDIvol Dose Ranges: 4 mGy – 60 mGy, 32 cm CTDI Phantom Neck XR29 Dose Notification Value (CTDIvol): 60 mGy.

Approximate Values for TORSO CTDIvol

Patient Weight Weight CTDIvol Size (kg) (lbs) (mGy) Small 50-70 110-155 4-10 Average 70-90 155-200 8-16 Large 90-120 200-265 14-22 Reference: AAPM *The AAPM recommended NEMA XR29 Dose Notification Value for an adult torso is 50 mGy. Dose notification levels less than the AAPM recommended can be set. The maximum CTDIvol should match the dose notification value. Exams with CTDIvol values less than the minimum allowed range should not be performed unless approved by a radiologist. NETWORK: Separate Neck and Chest Exams before sending to PACS 12/2017 Page 2 of 2