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  • 1

    Chest, Abdomen and Pelvis CT Protocols

    Chest

    Chest CT Low Dose Nodule Evaluation

    Chest CT Lung Cancer Screening

    Chest CT Routine With Contrast

    Chest CT Without Routine

    Chest CTA- Pulmonary Embolism

    Chest CTA- Acute Aorta

    Chest CTA- Aortic Aneurysm -Pre EVT

    Chest CTA Aortic Aneurysm- Post EVT

    Chest CTA- Acute Aorta- Trauma

    Chest CT High Resolution

    Coronary CTA Screening History

    Chest, Abdomen and Pelvis

    Chest Abdomen Pelvis: Acute Trauma

    Abdomen and Pelvis

    CT Cystogram

    Oncology: Lymphoma

    Oncology: Hypovascular Mets

    Oncology: Hypervascular Mets

    ADRENAL MASS Protocol

    ABDOMEN PELVIS: ROUTINE

    ABDOMEN PELVIS: TRAUMA

    Abdomen Pelvis: FAST ER Protocol: R/O Acute

    Appendicitis or Diverticulitis

    Abdomen CTA- Aortic Aneurysm -Pre EVT

    Abdomen CTA- Aortic Aneurysm Post EVT

    CT COLONOGRAPHY

    CT Enterography

    CT UROGRAM

    CT UROGRAM LOW DOSE

    Renal Mass

    Renal CTA

    Retroperitoneal Hemorrhage

    Oncology: Hepatoma: (Triphasic Liver CT)

    Oncology: Cholangiocarcinoma

    Pancreatic Mass CT

    CT VENOGRAM PELVIS: Pelvic Venous

    Congestion

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    LOWER EXTREMITIES

    CT VENOGRAM LOWER EXTREMITY

  • 3

  • 4

    Chest

  • 5

    Chest CT Low Dose Nodule Evaluation Typical Indications: Follow up pulmonary nodule(s). Normal or nearly normal radiograph

    Acquisition Phase

    Phase Included

    Scan Delay

    Respiration Phase

    Anatomical Coverage

    Non Contrast

    Y N/A Inspiration

    Lower cervical spine 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) 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. If scan is for pulmonary mass use Chest CT With Contrast Protocol.

  • 6

    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 Parameters

    Soft Tissue

    Bone/ Lung

    Thin Data

    Sag

    Cor

    Slice Thickness x Recon Spacing

    Phase #1) Noncontrast

    5mm x 5mm

    #1

    5mm x 5mm

    #1

    2mm x

    1mm #1

    3mm x

    3mm #1

    3mm x

    3mm #1

    Plane Axial Axial Axial Sag Cor

    Reconstruction Algorithm

    Soft Tissue

    Lung

    ST

    ST

    ST

    Send to

    PACS

    PACS

    Hold

    PACS

    PACs

  • 7

    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

    Phase Included

    Scan Delay

    Respiration Phase

    Anatomical Coverage

    Non Contrast

    Y N/A Inspiration

    Lower cervical spine 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.

  • 8

    Reconstruction Parameters

    Soft Tissue

    Bone/ Lung

    Thin Data

    Sag

    Cor

    3D/Special

    Slice Thickness x Recon Spacing

    Phase #1) Noncontrast

    1 mm 1 mm 0.5 mm x 0.3 mm

    2 mm x 2 mm

    2 mm x 2 mm

    NA

    Plane Axial Axial Axial Sag Cor

    Reconstruction Algorithm

    Soft

    Tissue

    LUNG

    LUNG

    LUNG

    LUNG

    N/A

    Send to

    PACS

    PACS

    Hold

    PACS

    PACs

    N/A

  • 9

    Chest CT Routine With Contrast Typical Indications: Evaluate Infection, known or suspected lung cancer, empyema, evaluate pulmonary mass, hilar enlargement

    Acquisition Phase

    Phase Included

    Scan Delay

    Respiration Phase

    Anatomical Coverage

    Non Contrast

    N N/A N/A

    Arterial Phase

    N Use Bolus Tracking

    Inspiration Lower cervical spine through adrenal glands

    Venous Phase

    N N N/A

    Delayed Phase

    N N/A N/A

    Scan Comments: Nodules are lesions 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 Parameters

    Soft Tissue

    Bone/ Lung

    Thin Data

    Sag Cor 3D/Special

    Slice Thickness x Recon Spacing

    5mm x 5mm

    5mm x 5mm

    2mm x 1mm

    3mm x 3mm

    3mm x 3mm

    NA

    Plane Axial Axial Axial Sag Cor NA

    Reconstruction Algorithm Soft Tissue Lung ST ST ST NA

    Send to

    PACS

    PACS

    Hold

    PACS

    PACS

    NA

  • 10

    Chest CT Without Routine Typical Indications: Evaluate lung nodule(s)

    Acquisition Phase

    Phase Included

    Scan Delay

    Respiration Phase

    Anatomical Coverage

    Non Contrast

    Y

    N/A

    Inspiration

    Lower cervical spine 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: Nodules are lesions 3cm) or hilar enlargement use Chest CT With Contrast Routine protocol

    Reconstruction Parameters

    Soft Tissue

    Bone/ Lung

    Thin Data

    Sag

    Cor 3D/Special

    Slice Thickness x Recon Spacing

    5mm x 5mm

    5mm x 5mm

    2mm x 1mm

    3mm x 3mm

    3mm x 3mm

    NA

    Plane Axial Axial Axial Sag Cor NA

    Reconstruction Algorithm

    Soft Tissue

    Lung ST ST ST NA

    Send to PACS PACS Hold PACS PACS NA

  • 11

    Chest CTA- Pulmonary Embolism Typical Indications: r/o PE; elevated D-Dimer

    Acquisition Phase

    Phase Included

    Scan Delay

    Respiration Phase

    Anatomical Coverage

    Non Contrast

    N N/A N/A

    Arterial Phase

    Y Use Bolus Tracking

    Inspiration Lung apex thru both 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

    Oral Contrast Volume

    450 cc

    Contrast Comments:

    Internal barium shielding provides some protection from scatter 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.

    http://www.mxcimaging.com/

  • 12

    Reconstruction Parameters

    Soft Tissue

    Bone/ Lung

    Thin Data

    Sag

    Cor

    3D/Special

    Slice Thickness x Recon Spacing

    2mm x 2mm

    5mm x 5mm

    1mm x 0.5mm

    (or as thin as scanner

    config allows)

    3mm x 3mm

    3mm x 3mm

    10 mm thick Coronal MIPS

    Plane Axial Axial Axial Sag Cor Cor

    Reconstruction Algorithm

    Soft Tissue

    Lung

    ST

    ST

    ST ST

    Send to

    PACS PACS Hold PACS PACS PACS

  • 13

    Chest CTA- Acute Aorta Typical Indications: R/O Acute Aortic Dissection/ Aneurysm, follow up endovascular stent, aortic injury

    Acquisition Phase

    Phase Included

    Scan Delay