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NAME AND PARAMETERS 

INDICATIONS

TECHNIQUE

1

2

ABD/PELVIS

Routine #1 plus rectal contrast.  Oral contrast on table.

3

CTA

ABDOMINAL AORTA

NO ORAL CONTRAST. Spiral abdomen/pelvis in 8's without contrast. Timing run centered at celiac axis with 20cc IV contrast.  Plot time delay curve to determine delay for CTA.  Inject remaining 130 cc IV contrast and begin scan after appropriate delay.  Scan from 1-2 cm above celiac axis thru pubic symphysis in 3 mm with  -1.5 index.   pitch = 2.0  Coronal & sagittal curved MPR.

4

ABD/PELVIS

tampon/oral/rectal contrast. Bolus 150 cc @ 2.5-3.0 cc/sec. Spiral abdomen in 8's @ 70 sec delay. Spiral pelvis after 5 min delay with 8 mm collim/8 mm recon/pitch = 1.5.  Oral contrast on table.

5

LIVER

Bolus 150 cc @ 3 cc/sec. Spiral liver @ 70 seconds with 8 mm collim @ 8 mm intervals;  Pitch =1.5. Finish abd/pelvis(if ordered) in 8’s. Routine oral contrast.  (fizzy powder for gastric CA if ordered).  Oral contrast on table.

6

LIVER (3-PHASE)

Liver without IV in 8's. Bolus 150 cc @ 3-4 cc/sec. Spiral liver @ 25 sec and 70 sec with 8 mm collim @ 8 mm intervals. Use Pause. Pitch=1.5. Do volumes on non-cons if ordered.  Oral contrast on table.

7

LIVER

Spiral liver without in 10’s to find lesion.  Bolus 100 cc @ 2.5 cc/sec. Serial scanning at 45 sec. delay and then every 15 sec for 3 minutes, then 10 min or as needed.

8

PANCREAS

Give routine oral contrast. Spiral 8’s without to find pancreas.   Bolus 150 cc @ 3cc/sec. Delay 25 sec.  Spiral pancreas 5 mm collim/5 mm interval. Pitch=1.5. Spiral liver 5 mm collim/5 mm interval  @ 70 sec delay.   Program in a pause.  Oral contrast on table.

9

KIDNEY

Routine oral. 5’s without IV. Bolus 100 cc @ 2 cc/sec. Delay 100 seconds and spiral kidneys @ 5mm collim/5 recons/pitch=1.5.  Measure pre/post contrast HU of all cysts (twice). Oral contrast on table.

10

KIDNEY

No oral. No IV. Spiral from T11/T12 to mid symphysis @ 5 mm collim / 5 mm intervals. pitch=1.5. Measure size and HU of stone on bone window.

11

ADRENAL

Oral on table. 8’s without to localize.  Spiral adrenals with 3 mm collimation/3 mm intervals/pitch=1.5. Reconstruct at 1.5 mm intervals. Measure HU of mass. If \< 10 stop, if > 10 HU give 100 cc contrast and rescan at 70 seconds and again in 15 minutes. (Peak HU-Delayed HU) / (Peak HU-Precontrast HU) x 100 = Washout %. Washout% > 60 = Adenoma

12

THORACIC AORTA

For r/o dissection only, do non-contrasted chest in 8's first.   Bolus 100 cc + 50 cc saline @ 3cc/sec.  Delay 30 seconds.   Spiral from lung apex inferiorly using 2 acquisitions. Use 5 mm collim/5 mm recons/pitch=1.5.

13

CHEST/ABD/PELVIS

Spiral chest/abdomen/pelvis with 8 mm collimation @ 8 mm intervals & Pitch = 1.5. oral and IV. Bolus 100 cc @ 2cc/sec. Delay of 30 seconds.   Oral contrast on table.

14

CHEST

No IV. Spiral chest in 8’s. Identify nodule.  Spiral nodule using 2-3 mm collimation (about ½ the nodule size) Measure nodule size and HU’s. Print nodule cuts in mediastinal and lung windows with sharp algorithm

15

CHEST

Bolus 100 cc @ 2cc/sec. Delay 30 sec Spiral chest 5 mm collim/5 mm interval. Pitch=1.5. Go thru adrenal glands. Oral on table.

16

CHEST

Bolus 100 cc @ 2.5 cc. After 90 sec delay  spiral chest with 8 mm collim/8  mm interval/pitch=1.5. Oral on table.

18

CHEST

In patients over 50 consider non-contrast CT with 8 mm thick collimation first, in order to survey whole chest and pick landmarks. Bolus 150 cc straight contrast @ 3 cc/sec in antecubital vein with that arm at the patient's side if average sized patient.  Delay 25 seconds. If patient has IV in the hand or has cardiac dysfunction do timing bolus and increase rate to 3.5 cc/second.  Have radiologist protocol scan area.  Spiral using 3 mm coll/1.5 mm recons with pitch 1.5 - 2.0. Film every other image. Use one acquisition. Cone to lungs and film both windows. Send image to Voxel work station. See leg venography protocol

19

Lower Extremities

Set up scan at the same time the CT for PE is set up

Obtain a scout (pilot) of the abdomen from the knees to the umbilicus. Set the kVp to 120 and the mAs to 250

Begin scanning 3 minutes after the initiation of the contrast bolus for the chest CT. Obtain 10 mm thick slices at 4 cm intervals from just below the knees to 4-5 cm  above the iliac crests, scanning from bottom to top.

Film images at 400 width and 40 level and at 100 width

and 40 level

20

HiRes CHEST

No IV. Spiral chest 10 mm collim/10 mm intervals/pitch=1. HIGH RES (non-spiral) sections 1-1.5 mm thick @ 20 mm intervals. Scan both supine and prone. If patient cannot lie prone, scan supine only at 10 mm intervals.  Also, sections: 1) Arch, 2) 4 cm below arch, and 3) 8 cm below arch in full expiration.

21

HiRes CHEST

No IV. Spiral chest 10 mmcollim/10 mm intervals/pitch=1. HIGH RES (non-spiral) 1-1.5 mm thick @ 10 mm intervals. Supine.