Chest, Abdomen and Pelvis CT Protocols Oncology: Hypervascular Mets Chest ADRENAL MASS Protocol Chest CT Low Dose Nodule Evaluation ABDOMEN PELVIS: ROUTINE Chest CT Lung Cancer Screening ABDOMEN PELVIS: TRAUMA Chest CT Routine With Contrast Abdomen Pelvis: FAST ER Protocol: R/O Acute Chest CT Without Routine Appendicitis or Diverticulitis Chest CTA- Pulmonary Embolism Abdomen CTA- Aortic Aneurysm -Pre EVT Chest CTA- Acute Aorta Abdomen CTA- Aortic Aneurysm –Post EVT Chest CTA- Aortic Aneurysm -Pre EVT CT COLONOGRAPHY Chest CTA Aortic Aneurysm- Post EVT CT Enterography Chest CTA- Acute Aorta- Trauma CT UROGRAM Chest CT High Resolution CT UROGRAM LOW DOSE Coronary CTA Screening History Renal Mass Chest, Abdomen and Pelvis Renal CTA Retroperitoneal Hemorrhage Chest Abdomen Pelvis: Acute Trauma Oncology: Hepatoma: (Triphasic Liver CT) Abdomen and Pelvis Oncology: Cholangiocarcinoma CT Cystogram Pancreatic Mass CT Oncology: Lymphoma CT VENOGRAM PELVIS: Pelvic Venous Oncology: Hypovascular Mets Congestion 1 LOWER EXTREMITIES CT VENOGRAM LOWER EXTREMITY 2 3 Chest 4 Chest CT Low Dose Nodule Evaluation Typical Indications: Follow up pulmonary nodule(s). Normal or nearly normal radiograph Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non Lower cervical spine Contrast Y N/A Inspiration through both costophrenic angles Arterial Phase N N/A N/A Venous Phase N N N/A Delayed Phase N N/A N/A Scan Comments: Low dose: reduce mAs appropriate to patients size: consider 100 kVP/mAS modulation per scanner software. Nodules are lesions <3cm. For pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast Routine protocol Scan Comments: Low dose: reduce kVP appropriate to patients size: consider 100 kVP for patients less than 200 lbs/90 kgs. If exam is requested because of an “abnormal CXR” please have outside CXR and report available for review. Note: “pulmonary nodules” are lesions <3cm ; pulmonary masses are >3cm. If scan is for pulmonary mass use Chest CT With Contrast Protocol. 5 Contrast Parameters Parameters Contrast Type None Contrast Volume N/A Saline Flush N/A Injection Rate N/A Oral Contrast N/A Oral Contrast Volume N/A Reconstruction Soft Tissue Bone/ Thin Sag Cor Parameters Lung Data Slice Thickness x 5mm x 5mm x 2mm 3mm 3mm Recon Spacing 5mm 5mm x x x Phase #1 #1 1mm 3mm 3mm #1) Noncontrast #1 #1 #1 Plane Axial Axial Axial Sag Cor Reconstruction Soft Tissue Lung ST ST ST Algorithm Send to PACS PACS Hold PACS PACs 6 Chest CT Lung Cancer Screening (USPTF criteria) 1) Adults aged 55-80, with a >30 pack year history of smoking and who currently smoke or have stopped smoking in past 15 years 2) Screening should be discontinued once the individual has not smoked for 15 years or develops a health problem that significantly limits life expectancy or the ability or willingness to have curative lung surgery. Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non Lower cervical spine Contrast Y N/A Inspiration thru both costophrenic angles Arterial Phase N N/A N/A Venous Phase N N/A N/A Delayed Phase N N/A N/A Scan Comments: Guidelines for techniques include: For BMI < 30 use kVP of 100; mAS < 40; mA 80; goal CTDIvol < 3 mGy For BMI > 30 use kVP of 120; mAS < 60; goal CTDIvol < 5 mGy mAS software modulation with ADIR (Toshiba) or CareDose(Siemens) may alter these parameters. Additional reported risk factors: documented high radon exposure, occupational exposures (silica,cadmium,asbestos,arsenic,beryllium,chromium,diesel fumes,niockel,coal smoke,soot), personal cancer history ( lung cancer, lymphoma, head and neck), COPD or pulmonary fibrosis, family history lung cancer. 7 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special Parameters Tissue Lung Data Slice Thickness x 1 mm 1 mm 0.5 mm x 2 mm 2 mm NA Recon Spacing 0.3 mm x 2 x 2 Phase mm mm #1) Noncontrast Plane Axial Axial Axial Sag Cor Reconstruction Algorithm Soft LUNG LUNG LUNG LUNG N/A Tissue Send to PACS PACS Hold PACS PACs N/A 8 Chest CT Routine With Contrast Typical Indications: Evaluate Infection, known or suspected lung cancer, empyema, evaluate pulmonary mass, hilar enlargement Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non N N/A N/A Contrast Arterial N Use Bolus Inspiration Lower cervical spine Phase Tracking through adrenal glands Venous N N N/A Phase Delayed N N/A N/A Phase Scan Comments: Nodules are lesions <3cm. For incidental nodules may be able to use Noncontrast CT Nodule protocol. For pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast Routine protocol Contrast Parameters Parameters Contrast Type Per institution Contrast Volume 75-80cc Use 100 cc if combined with abdomen CT Injection Rate 4-5cc/sec Oral Contrast N/A Oral Contrast Volume N/A Contrast Comments: Scan delay: usual 25 seconds; Use Bolus Tracking if available Reconstruction Soft Bone/ Thin Sag Cor 3D/Special Parameters Tissue Lung Data Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA Recon Spacing 5mm 5mm 1mm 3mm 3mm Plane Axial Axial Axial Sag Cor NA Reconstruction Algorithm Soft Tissue Lung ST ST ST NA Send to PACS PACS Hold PACS PACS NA 9 Chest CT Without Routine Typical Indications: Evaluate lung nodule(s) Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non Lower cervical spine through both Contrast Y N/A Inspiration costophrenic angles Arterial Phase N N/A N/A Venous Phase N N N/A Delayed N N/A N/A Phase Scan Comments: Nodules are lesions <3cm. For pulmonary masses (>3cm) or hilar enlargement use Chest CT With Contrast Routine protocol Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special Parameters Tissue Lung Slice Thickness x 5mm x 5mm x 2mm x 3mm x 3mm x NA Recon Spacing 5mm 5mm 1mm 3mm 3mm Plane Axial Axial Axial Sag Cor NA Reconstruction Soft Lung ST ST ST NA Algorithm Tissue Send to PACS PACS Hold PACS PACS NA 10 Chest CTA- Pulmonary Embolism Typical Indications: r/o PE; elevated D-Dimer Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non Contrast N N/A N/A Arterial Use Bolus Lung apex thru both Phase Y Inspiration Tracking costophrenic angles Venous Phase N N N/A Delayed Phase N N/A N/A Scan Comments: In Pregnant patients confirm Duplex Venous Exam was NEGATIVE PRIOR to CTA; use low dose protocol; abdominal shielding; informed written consent for radiation during pregnancy; *oral thin barium for “internal shielding” if time permits. No need to breast pump/discard milk recommendations for 24 hours unless patient anxious regarding contrast* Pt info sheet regarding breast feeding available on mxcimaging.com. Contrast Parameters Parameters Contrast Type Per institution Contrast Volume 80cc Injection Rate 4-5cc/sec Oral Contrast 450 cc thin standard barium PO ideally 20-30 minutes pre for pregnant patients only if time allows 450 cc Oral Contrast Volume Internal barium shielding provides some protection from scatter Contrast Comments: radiation to pelvis. Mid and lower abdomen pelvis external lead shielding will minimize direct beam radiation to pelvis. CTA has significantly less Fetal dose than standard VQ imaging but has significantly higher Maternal breast dose. 11 Reconstruction Soft Bone/ Thin Sag Cor 3D/Special Parameters Tissue Lung Data Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x 10 mm thick Recon Spacing 2mm 5mm 0.5mm 3mm 3mm Coronal MIPS (or as thin as scanner config allows) Plane Axial Axial Axial Sag Cor Cor Reconstruction Soft Tissue Lung ST ST ST ST Algorithm Send to PACS PACS Hold PACS PACS PACS 12 Chest CTA- Acute Aorta Typical Indications: R/O Acute Aortic Dissection/ Aneurysm, follow up endovascular stent, aortic injury Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non Top of Aortic Arch to Contrast N** N/A N/A diaphragm Arterial Mid cervical spine thru Phase Y-GATED*** Bolus Tracking Inspiration iliac crests* Venous * If AbdPel CT ordered Phase N N N/A for trauma; pause at diaphragm and continue with 70 sec delay CT of AbdPel Delayed N N/A N/A Phase Scan Comments: ** For Acute Chest Pain with specific history of “r/o dissection” include NonContrast CT to evaluate for acute intramural hematoma. For routine f/u thoracic aneurysm Noncontrast not needed. Dissections often extend into abdomen or neck- coverage includes expanded FOV*. For acute symptoms add GATING*** to optimally see ascending aorta. Contrast Parameters Parameters Per institution Contrast Type Contrast Volume 100cc Injection Rate 4-5cc/sec Oral Contrast N/A N/A Oral Contrast Volume Contrast Comments: 13 Reconstruction Soft Bone/ Thin Data Sag Cor 3D/Special Parameters Tissue Lung Slice Thickness x 2mm x 5mm x 1mm x 3mm x 3mm x #3) 3D radial MPR Recon Spacing 2mm 5mm 0.5mm 3mm 3mm #4) 5mm thick Phase #1 #1 #2 #2 MIPs in SAG and #1) Noncontrast #2 #2 COR #2) Arterial Phase Plane Axial Axial Axial Sag Cor 3) Radial Range 4) SAG/COR Reconstruction Soft Lung ST ST ST ST Algorithm Tissue Send to PACS PACS 1. To 3D PACS PACs PACs : Reformat server 3Ds AFTER 2. PACS transferring raw data to PACS 14 Chest CTA- Aortic Aneurysm -Pre EVT Typical Indications: f/u known or suspected thoracic aneurysm, preop evaluation stent graft Acquisition Phase Scan Respiration Anatomical Phase Included Delay Phase Coverage Non N** N/A N/A Contrast Arterial Use Bolus Mid cervical spine thru Y Inspiration Phase Tracking costophrenic angles Venous Phase N N N/A Delayed Phase N N/A N/A Scan Comments: For routine f/u thoracic aneurysm noncontrast not needed.